Rickets in children: causes, signs, and prevention in paediatric care

The role of vitamin D, calcium, and phosphorus in skeletal development

Rickets is a disorder that affects skeletal development and occurs predominantly during the first years of life, a period characterised by rapid bone growth. Although it is now relatively rare in Western countries, owing to improved nutritional status and careful paediatric monitoring, it remains an important clinical and preventive health concern.
Understanding the mechanisms underlying rickets, its early signs, and preventive strategies enables timely intervention and helps protect children’s bone health during a crucial stage of development.

What is rickets in children?

Rickets is a condition characterised by impaired mineralisation of growing bones, mainly due to a deficiency of vitamin D, calcium, and/or phosphorus. These nutrients play an essential role in skeletal formation and strengthening; inadequate levels may make bones more fragile and increase the risk of skeletal deformities.

The age group most commonly affected is generally between 6 and 24 months, when bone growth is particularly rapid. In some cases, vitamin D deficiency during pregnancy may lead to the appearance of early signs during the infant’s first months of life. Limited exposure to sunlight, which is essential for endogenous vitamin D synthesis, is another relevant factor.

Hypophosphataemic rickets: a distinct form

In addition to nutritional forms, hypophosphataemic rickets is a rare genetic condition that is unrelated to dietary vitamin D intake. In this form, the primary abnormality affects phosphorus metabolism, resulting in reduced blood phosphate levels.
This condition may cause bone weakness and joint pain and is diagnosed through specific blood tests and radiological investigations. Its management requires specialist assessment.

Signs and symptoms of rickets in children

The symptoms of rickets may initially be subtle and non-specific. The most common signs include:

• restlessness and irritability
• excessive sweating
• fatigue and muscle weakness
• bone or joint pain
• delayed growth and psychomotor development
• difficulties during teething

In more advanced cases, the following may occur:

• skeletal deformities affecting the skull, lower limbs, or rib cage
• increased susceptibility to infections
• muscle cramps or, rarely, seizures

Because bone deformities are a late sign, early diagnosis is essential. If suspicious symptoms occur, a paediatrician should always be consulted so that the necessary investigations can be initiated.

Preventing rickets: nutrition and sunlight exposure

The prevention of rickets in children is based on two main pillars:

1. Adequate nutrition
   During pregnancy and throughout the child’s first years of life, it is essential to ensure a balanced intake of nutrients involved in bone metabolism, particularly vitamin D, calcium, and phosphorus.
   
2. Adequate exposure to sunlight
   Cutaneous vitamin D synthesis occurs through exposure to sunlight. During the winter months, or under environmental conditions that limit time spent outdoors, this production may be insufficient.

Vitamin D: differences between D2 and D3

The term vitamin D encompasses two main forms:

• vitamin D2 (ergocalciferol), which is derived from plant sources
• vitamin D3 (cholecalciferol), which is derived from animal sources or synthesised in the skin following exposure to sunlight

Scientific evidence indicates that vitamin D3 is more effective than D2 at maintaining adequate serum vitamin D levels.

Dietary sources of Vitamin D

Some foods can contribute to dietary vitamin D intake when introduced gradually and in amounts appropriate for the child’s age:

• oily fish (salmon, mackerel, tuna)
• eggs (yolk)
• butter
• full-fat cheeses
• mushrooms

When diet and sunlight exposure are insufficient, the paediatrician may consider vitamin D supplementation, generally in oral formulations.

When to consult a paediatrician

Monitoring growth and skeletal development is part of routine paediatric care. When risk factors, suspicious symptoms, or conditions that may predispose a child to nutritional deficiencies are present, assessment by a healthcare professional is essential.

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This content is provided for informational purposes only and is not a substitute for advice from a doctor or paediatrician. For personalised guidance concerning a child’s health, consultation with a healthcare professional is always recommended.