Rickets is a disease that has almost died out in Germany and is often referred to as “softening of the bones”. It is a disease that appears in childhood but, if left untreated, can have repercussions well into adulthood.
What is rickets?
The word rickets derives from the Greek term “rhachis” which means “spine”. See AbbreviationFinder for abbreviations related to Rickets.
Before the industrial revolution, rickets was very widespread in Europe, since children in particular worked as cheap labor in factories and mines and hardly saw any sunlight. The air in the cities was stuffy and polluted, sunlight barely reached the people. It was only much later that doctors found the connection between rickets and sunlight.
Rickets is a metabolic disease caused by vitamin D deficiency. Vitamin D is essential for the blood to absorb calcium and phosphate and transport it to the bones.
In the case of vitamin D deficiency, the vitamin can no longer be converted into its effective level in the skin. The growing bones in rickets do not calcify properly, they remain soft and become crooked under stress. Rickets primarily affects the spine, but also the legs.
Causes
As mentioned above, vitamin D metabolism does not work properly in rickets . The cause of this is either protein malnutrition, too little exposure to the sun or incorrect nutrient absorption in the gastrointestinal tract.
There is also a special form of rickets that is not caused by a vitamin D deficiency.
The body needs vitamin D to properly incorporate calcium and phosphate into the bones. Vitamin D also ensures that calcium and phosphate can be absorbed from the intestine and recovered again from the kidneys. In the case of a vitamin D deficiency, this absorption is disrupted. The bones become soft and deform.
The human body produces vitamin D itself in the skin with the help of ultraviolet radiation from sunlight. A small part of the vitamin D requirement is obtained from food. However, intake from food is not sufficient for rickets prophylaxis.
Symptoms, Ailments & Signs
Rickets is a bone disease in children mostly caused by vitamin D deficiency. It is also known as the English disease. The petant of the disease occurring in adulthood is osteomalacia. Calcium deficiency rickets is generally spoken of. Far rarer is the often inherited phosphate deficiency rickets.
The disorder is caused by a loss of phosphate through the kidneys. The first symptoms of the disease appear around the second month of life of the child. Children generally become restless and startle easily. There is also sweating and an itchy rash.
This is caused by increased sweating. After another four weeks, general muscle weakness and the characteristic, soft “frog belly” become noticeable. Children are prone to constipation and muscle cramps. A softening of the cranial bone results in a strongly flattened back of the head, with the typical image of a “square skull”.
The chest and the joints of the extremities widen. Defects are also noticeable in the jawbone. The children teeth late, the enamel shows defects and an open bite can develop. Rickets is accompanied by various bone deformations. A typical sign is bowlegs. These are caused by the curvature of the long bones. Adults with rickets caused by vitamin D deficiency do not show any bone deformities because bone growth has already ended.
course of the disease
The symptoms of rickets appear as early as the second or third month of life. Restlessness, jumpiness and heavy sweating at the back of the head are among the early symptoms. There is also an itchy rash.
Constipation, a sagging abdominal wall, cramps and changes in the skeleton are symptoms that appear in the third to fourth month of life. Skull sutures that are still open only close with a delay, skull bones soften. The typical rachitic rosary can be seen on the ribs. These are swellings at the bone-cartilage border of the ribs that look like strings of pearls.
Tooth eruption is delayed, tooth enamel formation is disturbed and children tend to caries. The thigh bones are typically deformed in rickets, and the children have severe bowlegs.
Complications
Complications are not to be expected in the case of timely and adequate treatment. A therapy based on high-dose vitamin D in combination with calcium usually allows the symptoms to subside very quickly. However, if left untreated, it can lead to a number of complications. Rickets is a disorder that occurs in childhood, but can severely impair the quality of life of those affected in adulthood if it is not treated or not treated adequately.
Children’s growing bones do not calcify properly when they have a vitamin D metabolism disorder, and remain soft and bend when subjected to stress. In severe cases and if therapy is delayed, so-called “greenstick fractures” are to be expected, especially in children. This is an incomplete fracture in which the elastic periosteum surrounding the bone remains intact.
However, the patients usually have to wear a cast for a long time, which is usually very difficult for children in particular. If the bones are badly misaligned as a result of rickets, these can usually only be corrected with surgery. This is not possible in all cases. The patient can then suffer lifelong from deformities that reduce the quality of life and develop other disorders, such as constant shortness of breath with a curvature of the thorax, which accompany him into adulthood.
When should you go to the doctor?
The disease usually occurs in children. The first signs of an irregularity can be seen from the second month of life. Left untreated, it can have long-term consequences that last into adulthood. Parents, relatives and legal guardians should therefore react as quickly as possible and consult a doctor in the event of changes in the child’s state of health. Abnormalities in the complexion, itching or sweating indicate a health impairment. There is a need for action as soon as the symptoms persist for several days or weeks. An increase in irregularities is worrying. In these cases, a doctor’s visit is required as soon as possible.
Medical help is required for disorders of the digestive tract, constipation or a general feeling of illness. Cramps or loss of control over the muscular system are recognized as a hallmark of rickets. If there are any abnormalities in the body structure during the growth process, a doctor should be consulted. If you have a square skull shape, O-shaped legs or a widening of the chest, the observations should be discussed with a doctor. Deformations or curvatures of the skeletal system and peculiarities of the jaw should be examined and clarified. Abnormalities of the teeth, the tooth enamel or delayed tooth growth are signs of a disease. If an open bite occurs, a doctor’s visit should take place so that the cause can be investigated.
Treatment & Therapy
In the past, rickets was treated with cod liver oil because cod liver oil contains vitamin D. Today, sick children receive vitamin D for three weeks and, in the case of calcium deficiency, also high doses of calcium. Vitamin D deficiency rickets should be treated up to the age of 4 weeks with 1000 IU of vitamin D3 and additional calcium supplements (40-80 mg/kg per day) for about 12 weeks. This should be followed by prevention with 500 IU of vitamin D3 up to the end of the first year of life. Babies from 4 weeks to 12 months receive 3000 IU of vitamin D3 and additional calcium supplements (40-80 mg/kg per day) for a period of 12 weeks.
Subsequently, prevention should be treated with 500 IU of vitamin D3 up to the end of the first year of life. Children and adolescents from the age of one year are treated with 5000 IU vitamin D3 and additional doses of calcium (40-80 mg/kg per day) for a period of 12 weeks. After that, it is important to ensure adequate exposure to the sun and a supply of calcium through a balanced diet (e.g. milk). (Source: Guidelines of the Society for Pediatrics and Adolescent Medicine (DGKJ))
Since lack of sunlight is also a cause, sunlight or sun exposure is also part of the therapy. Following drug therapy, a calcium-rich diet must be followed. Regular sunlight is also necessary.
In the case of phosphate deficiency symptoms, phosphate must be substituted with medication. The bone deformities usually heal with this treatment. However, severe thigh deformities caused by rickets often have to be corrected with splints.
Prevention
Rickets is almost extinct in Germany today. In the first year of life, newborns and infants are given a 500 IU vitamin D tablet every day as a prophylactic measure, since mother’s milk and cow’s milk do not contain enough vitamin D.
Infant milk is usually fortified with vitamin D. Actually, 100-200 IU per day is recommended for children of this age, with the higher dosage of the tablet to compensate for fluctuations and occasional forgetfulness of the tablet administration.
In most cases, it is given in combination with fluorine to prevent tooth decay. The tablets are soluble in milk and water and can therefore be administered with infant milk or tea to prevent rickets.
Playing outside or in the sun also ensures a healthy vitamin D balance. However, especially in summer, parents should make sure that their children do not get sunstroke, heat stroke or sunburn.
Aftercare
In most cases, those affected by rickets have no special or direct follow-up measures available, so that they should consult a doctor at an early stage if they become ill. Self-healing is usually not possible either, so that a visit to a doctor is always necessary for the patient. The sooner a doctor is contacted, the better the further course of the disease is usually.
Most of those affected are dependent on a surgical procedure, through which the symptoms can be permanently relieved. Those affected should definitely rest and protect their bodies after such an operation. Definitely refrain from physical exertion and stressful activities.
The further course depends very much on the type and the severity of the malformations, so that a general prediction is usually not possible. The life expectancy of the child may also be significantly restricted or reduced as a result of this disease. Further follow-up measures are not available to those affected by this disease and are usually not necessary. In many cases, rickets reduces the life expectancy of those affected.
You can do that yourself
In rickets, bed rest and warmth are important. At the same time, the patient should supply the body with plenty of sunlight and air. In summer you can sleep with the window open. Hot compresses relieve pain and help speedy recovery. Warm milk with honey also helps with rickets with a sore throat and difficulty swallowing. Other effective natural remedies are heather, willow, thyme and lady’s mantle. These remedies can be drunk as a tea or applied to the skin in the form of a decoction.
In consultation with the family doctor, the patient can start a diet of vegetables, honey and milk products. The most important thing is a diet rich in iron and other minerals and vitamins. Moderate sport and exercises from yoga and Pilates can support physiotherapy and contribute to recovery. Since rickets usually takes a chronic course, aids such as walking aids or a wheelchair must also be organized in the long term. For this purpose, the person concerned should contact their family doctor directly, who can clarify further information with the health insurance company.
Finally, the cause of the rickets must be found and treated. If this succeeds at an early stage, only a few complications occur and the home remedies mentioned are sufficient for a rapid improvement in the state of health. If the symptoms get worse despite all measures, the family doctor must be informed.
