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Children can develop rickets if they don't get enough vitamin D, which is important for forming strong, healthy bones.

Rickets is a bone disease that starts in childhood. (When it occurs in adults it's called osteomalacia.) The disease causes bones to soften and break easily.

While rickets may be hereditary, in most cases the disease is caused by getting too little vitamin D, which in turn affects how the body absorbs calcium and phosphorus. The body needs all three of these elements to grow healthy, strong bones.

Fortunately, the disease can be prevented with dietary supplements and healthy lifestyle habits.

Who is at risk?

Children are most at risk for rickets from age 6 months to 24 months, according to the American Academy of Family Physicians (AAFP). Their bones grow quickly during that time.

Children also have an increased risk for rickets if they:

• Are exclusively or partially breastfed for a long time and don't take a vitamin D supplement. Breast milk doesn't contain enough vitamin D to prevent rickets.
• Get too little sunlight. Our bodies make vitamin D in our skin when it is exposed to sunlight. Lack of sun means too little vitamin D.
• Are dark-skinned. People with darker skin require more sun exposure to make vitamin D.
• Have health problems or a restricted diet. Vegetarians and children who are lactose-intolerant may not get all of the vitamins and minerals their bones need to grow.
• Don't take in enough bone-building nutrients. Children, teens and adults can get vitamin D by consuming vitamin D-rich foods (fish, fish oil and eggs) or vitamin D-fortified foods (cereals, milk and orange juice). They also need calcium, found in milk, cheese and salad greens.

Telltale signs of disease

According to the AAFP and the American Academy of Orthopaedic Surgeons (AAOS), signs and symptoms of rickets may include:

• Muscle weakness.
• Seizures.
• Stunted growth.
• Pain in the bones of the spine, pelvis and legs.
• Stooped posture.
• Bowed legs.
• Widening of wrist or ankle bones.
• Tooth problems, such as cavities and problems with tooth structure.
• Chest and rib deformities. Some children develop bumps (nodules) at the end of their ribs. Chest deformities can develop due to rib deformities and in turn may lead to lung infections.

Diagnosing and treating rickets

To diagnose rickets, doctors do a thorough exam. They look for bone deformities and growth problems. They may take x-rays to see bones and perform blood tests to measure vitamin D, calcium, phosphorus and hormone levels.

Treating rickets may involve:

• Vitamin D supplements.
• Calcium supplements.
• Braces to correct skeletal problems.
• Surgery to correct bone deformities.

What's the prognosis?

Rickets is serious, but correcting the nutritional deficit starts the healing process. Bowed legs or other deformities may get better over time without surgery, according to the AAOS. Recovery can take months, however.

Some deformities require surgery; others may be permanent.

Prevention is best. The American Academy of Pediatrics (AAP) recommends supplements of 400 international units (IU) of vitamin D a day for babies who are exclusively breastfed. Supplements should start soon after birth.

Baby formula is fortified with vitamin D, but infants and babies who drink less than 27 ounces (3.375 cups) of it a day may need supplements too, according to the AAP.

Talk to your doctor about whether your baby or older child needs a supplement and how much is recommended. Taking too much of some nutrients—including vitamin D—can be dangerous, according to the Office of Dietary Supplements.

Reviewed 4/5/2024