7 Common Rickets Symptoms You Should Know About

Rickets is a skeletal disorder that primarily affects children during periods of rapid growth. This condition occurs when bones fail to mineralize properly, leading to soft and weakened bones that can become deformed. While rickets was once considered a disease of the past, it still affects children worldwide, particularly in regions with limited sunlight exposure or nutritional deficiencies. Understanding the symptoms of rickets is crucial for early detection and appropriate medical intervention. In this comprehensive guide, we’ll explore the most common signs and symptoms that parents and caregivers should be aware of.

1. Skeletal Deformities and Bone Pain

One of the most recognizable symptoms of rickets is the development of skeletal deformities. As bones soften due to inadequate mineralization, they become susceptible to bending and warping under the body’s weight and during normal physical activities.

Common skeletal manifestations include:

• Bowed legs (genu varum): The legs curve outward at the knees, creating a distinctive bow-legged appearance
• Knock knees (genu valgum): The knees angle inward while the ankles remain apart
• Thickened wrists and ankles: The ends of long bones become enlarged and swollen
• Breastbone projection: The sternum may protrude forward, creating a pigeon-chest appearance
• Spinal curvature: Abnormal curves in the spine may develop, including scoliosis or kyphosis

Children with rickets may also experience bone tenderness and pain, particularly in the legs, pelvis, and spine. This discomfort can worsen with physical activity and may cause children to become reluctant to walk or play actively.

2. Delayed Growth and Development

Rickets significantly impacts a child’s growth trajectory, often resulting in noticeable developmental delays. Children with this condition typically fall below expected height percentiles for their age group, and their overall physical development may lag behind their peers.

The growth retardation associated with rickets manifests in several ways. Children may remain shorter than average for their age, with disproportionate body segments. The softening of bones prevents normal skeletal elongation, while the metabolic disturbances underlying rickets can affect overall tissue growth and development.

Beyond height, developmental milestones may be delayed. Affected children might take longer to achieve motor skills such as sitting independently, crawling, and walking. The combination of weak bones and decreased muscle strength contributes to these developmental setbacks, creating a cycle that can impact multiple aspects of physical maturation.

3. Muscle Weakness and Low Tone

Muscular symptoms represent a significant but sometimes overlooked aspect of rickets. Children with this condition frequently exhibit generalized muscle weakness and decreased muscle tone, medically referred to as hypotonia.

This muscle weakness is not merely a secondary effect of bone problems but stems from the same metabolic deficiencies that cause skeletal issues. The muscles may feel soft and flabby to the touch, and children often demonstrate reduced strength during physical activities. They may struggle with tasks that require muscular effort, such as climbing stairs, running, or even maintaining posture while sitting.

The hypotonia can be particularly evident in the abdominal muscles, contributing to a protruding belly appearance. Additionally, affected children may tire easily during physical activities and prefer sedentary behaviors. This muscle weakness can create a vicious cycle, as reduced physical activity further compromises muscle development and bone strength.

4. Dental Problems and Delayed Tooth Eruption

The effects of rickets extend to dental health, causing a range of oral manifestations that can have long-lasting consequences. Since teeth are calcified structures similar to bones, they are similarly affected by the mineralization defects characteristic of rickets.

Dental symptoms commonly include:

• Delayed tooth eruption: Both primary and permanent teeth may emerge later than expected developmental timelines
• Defective tooth enamel: Teeth may have weak, poorly formed enamel that is more susceptible to decay
• Increased cavity formation: The compromised tooth structure makes children more prone to dental caries
• Abnormal tooth structure: Teeth may be malformed, with irregular shapes or sizes
• Dental abscesses: Higher risk of tooth infections due to structural weaknesses

These dental problems can persist even after the rickets is addressed, potentially requiring ongoing dental care throughout childhood and beyond. Early recognition of these dental symptoms can prompt investigation for underlying rickets.

5. Cranial Abnormalities

The skull is particularly vulnerable to the effects of rickets, especially in infants and young children whose cranial bones are still developing and fusing. The softening of skull bones leads to several distinctive cranial manifestations.

Craniotabes, a condition where areas of the skull feel abnormally soft when pressed, is often one of the earliest signs of rickets in infants. Parents or healthcare providers may notice that portions of the skull, particularly at the back and sides, indent with gentle pressure and then slowly return to their normal position.

The anterior fontanelle (soft spot) may remain open longer than expected, sometimes persisting well beyond the typical closure age of 18-24 months. The skull may also develop an abnormal shape, including frontal bossing where the forehead appears unusually prominent and squared off, or a flattened back of the head.

In some cases, the skull bones may thicken along the suture lines, creating ridges that can be felt when examining the baby’s head. These cranial changes can affect facial appearance and, in severe cases, may even impact brain development if left untreated.

6. Rachitic Rosary

The rachitic rosary is a classic and highly characteristic sign of rickets that refers to the beaded appearance of the rib cage. This distinctive symptom occurs when the costochondral junctions—the points where the ribs meet the cartilage that connects to the breastbone—become enlarged and prominent.

When viewed or palpated, these enlarged junctions create bumps along both sides of the chest that resemble beads on a rosary, hence the name. The rachitic rosary can often be both seen and felt through the chest wall, appearing as a series of rounded protrusions running parallel to the sternum on each side.

This symptom develops because the softened bone tissue accumulates at the growth plates of the ribs, unable to properly mineralize and form normal bone structure. The rachitic rosary is particularly useful for diagnosis because it represents a relatively specific sign of rickets, though it must be distinguished from normal anatomical variations in some children.

The prominence of the rachitic rosary can vary depending on the severity and duration of rickets. In mild cases, it may only be detectable through careful palpation, while in more severe cases, it can be quite visually apparent.

7. Irritability and Behavioral Changes

Children with rickets often exhibit behavioral and emotional symptoms that can significantly affect their quality of life and may be among the first changes noticed by parents or caregivers. These symptoms are sometimes overlooked or attributed to other causes, delaying the diagnosis of rickets.

Increased irritability is commonly reported in children with rickets. They may seem unusually fussy, difficult to console, or prone to crying episodes. This irritability likely stems from multiple factors, including bone and muscle pain, general discomfort from skeletal deformities, and the metabolic disturbances underlying the condition.

Sleep disturbances frequently accompany rickets, with children experiencing difficulty falling asleep, frequent night wakings, or restless sleep patterns. The discomfort from bone pain and muscle weakness can make it challenging for children to find comfortable sleeping positions.

Some children with rickets also demonstrate increased lethargy and reduced interest in activities they previously enjoyed. They may appear listless, tire easily, and prefer to remain sedentary rather than engage in active play. This change in activity level can be subtle but represents a significant departure from normal childhood behavior patterns.

Cognitive development may also be affected in some cases, with children showing decreased attention spans or delayed achievement of cognitive milestones, though these effects are generally reversible with appropriate intervention.

Main Causes of Rickets

Understanding the underlying causes of rickets is essential for both prevention and recognition of risk factors. While rickets can result from various etiologies, all ultimately lead to inadequate bone mineralization.

Vitamin D Deficiency: This is the most common cause of rickets worldwide. Vitamin D is crucial for calcium absorption in the intestines and proper bone mineralization. Deficiency can occur due to:

• Inadequate sunlight exposure, particularly in children with darker skin pigmentation, those living in northern latitudes, or children who spend little time outdoors
• Insufficient dietary intake of vitamin D, especially in exclusively breastfed infants whose mothers are vitamin D deficient
• Use of sunscreen that blocks vitamin D synthesis in the skin
• Cultural practices involving extensive body covering that limits sun exposure

Calcium Deficiency: While less common than vitamin D deficiency in developed countries, inadequate dietary calcium can cause rickets. This is more prevalent in regions where dietary calcium sources are limited or in children with restricted diets.

Phosphate Deficiency: Some forms of rickets result from phosphate deficiency, which can be dietary or due to inherited disorders affecting phosphate metabolism in the kidneys.

Genetic Disorders: Several hereditary conditions can cause rickets by affecting vitamin D metabolism or phosphate regulation, including:

• Vitamin D-dependent rickets (types 1 and 2)
• X-linked hypophosphatemic rickets
• Hereditary hypophosphatemic rickets with hypercalciuria

Malabsorption Disorders: Conditions that impair nutrient absorption can lead to rickets, including:

• Celiac disease
• Inflammatory bowel disease
• Cystic fibrosis
• Chronic liver disease
• Kidney disease

Prematurity: Premature infants have increased nutritional requirements and may not have accumulated sufficient mineral stores before birth, placing them at higher risk for developing rickets.

Prevention Strategies

Preventing rickets is highly achievable through proper nutritional practices and lifestyle modifications. Since the condition is largely preventable, awareness of protective measures is crucial for parents and healthcare providers.

Ensure Adequate Vitamin D Intake:

• Breastfed infants should receive vitamin D supplementation starting in the first few days of life, as breast milk alone typically does not provide sufficient vitamin D
• Formula-fed infants who consume less than adequate amounts may also require supplementation
• Older children and adolescents should receive vitamin D through a combination of diet, sensible sun exposure, and supplementation if needed
• Consult with healthcare providers about appropriate vitamin D supplementation doses for your child

Promote Safe Sun Exposure:

• Encourage moderate sun exposure during appropriate times of day when UV radiation is less intense
• Balance sun protection against skin cancer risk with the need for vitamin D synthesis
• Even brief periods of sun exposure on small areas of skin can contribute to vitamin D production
• Children with darker skin may require longer sun exposure to produce adequate vitamin D

Provide Calcium-Rich Foods:

• Include dairy products such as milk, yogurt, and cheese in the diet
• Offer calcium-fortified alternatives for children with lactose intolerance or dairy allergies
• Incorporate leafy green vegetables, fish with edible bones, and calcium-fortified foods
• Ensure adequate calcium intake during periods of rapid growth

Include Vitamin D-Rich Foods:

• Fatty fish such as salmon, mackerel, and sardines
• Egg yolks
• Fortified foods including milk, orange juice, and cereals
• Cod liver oil or other fish oil supplements when appropriate

Regular Health Monitoring:

• Attend scheduled well-child visits where healthcare providers can monitor growth and development
• Discuss risk factors for rickets with your child’s healthcare provider
• High-risk children may benefit from screening tests to assess vitamin D levels and bone health
• Address any feeding difficulties or dietary restrictions that might impact nutritional status

Special Considerations for High-Risk Groups:

• Premature infants require close monitoring and often need higher doses of vitamin D and calcium supplementation
• Children with chronic medical conditions affecting nutrient absorption should receive specialized care and monitoring
• Families following restrictive diets should work with nutritionists to ensure adequate nutrient intake
• Children with limited outdoor access or those living in extreme latitudes may require year-round supplementation

Frequently Asked Questions

At what age does rickets typically develop?

Rickets most commonly develops in infants and children between 6 months and 3 years of age, during periods of rapid growth. However, it can occur at any age during childhood and even in adolescence, particularly during growth spurts. Infants are especially vulnerable after depleting the vitamin D and calcium stores acquired before birth.

Can rickets be reversed once symptoms appear?

Yes, rickets is generally reversible with appropriate intervention, especially when caught early. The skeletal system can remineralize and strengthen with proper nutritional support. However, some severe skeletal deformities that develop during critical growth periods may persist even after treatment, potentially requiring orthopedic intervention. Early detection and treatment offer the best outcomes.

Is rickets contagious?

No, rickets is not contagious. It is a metabolic bone disorder caused by nutritional deficiencies or genetic factors, not by infectious agents. Children with rickets pose no transmission risk to others. However, siblings may be at increased risk if they share similar dietary patterns, sun exposure habits, or genetic factors.

How is rickets different from osteomalacia?

Rickets and osteomalacia represent the same underlying process of defective bone mineralization, but they affect different age groups. Rickets occurs in children whose bones are still growing and affects both the bone matrix and the growth plates. Osteomalacia occurs in adults after the growth plates have closed, affecting only the bone matrix. The symptoms and treatment approaches differ accordingly.

Can vitamin D from sunlight alone prevent rickets?

While sunlight exposure can stimulate sufficient vitamin D production to prevent rickets in many cases, several factors affect this process including geographic location, season, time of day, skin pigmentation, and the amount of skin exposed. In many regions, particularly during winter months or at high latitudes, sunlight alone may not provide adequate vitamin D. Therefore, dietary sources and supplementation are often necessary, especially for high-risk populations.

What tests are used to diagnose rickets?

Healthcare providers use a combination of approaches to diagnose rickets. Blood tests measure levels of vitamin D, calcium, phosphate, and alkaline phosphatase, as well as parathyroid hormone. X-rays can reveal characteristic bone changes including widening of growth plates, fraying of bone ends, and skeletal deformities. Physical examination identifies clinical signs such as bowed legs, rachitic rosary, and cranial abnormalities. The combination of clinical, laboratory, and radiographic findings confirms the diagnosis.

Are breastfed babies at higher risk for rickets?

Exclusively breastfed infants can be at increased risk for rickets because breast milk contains relatively low amounts of vitamin D, even when mothers have adequate vitamin D status. This is why health organizations recommend vitamin D supplementation for breastfed infants starting shortly after birth. Formula-fed infants receive vitamin D through fortified formula, though those consuming insufficient amounts may also require supplementation. The benefits of breastfeeding far outweigh this risk when appropriate supplementation is provided.

Can rickets cause permanent damage?

The potential for permanent effects depends on the severity and duration of rickets and the timing of intervention. Mild cases caught and treated early typically resolve completely without lasting effects. However, severe or prolonged rickets can result in permanent skeletal deformities, short stature, and dental problems. Very rarely, untreated rickets may lead to complications such as seizures from severe calcium deficiency or respiratory problems from chest deformities. This underscores the importance of early recognition and treatment.

Do children need to take supplements indefinitely after having rickets?

The duration of supplementation depends on the underlying cause of rickets. For nutritional rickets caused by vitamin D or calcium deficiency, supplementation is typically needed until bone mineralization normalizes and adequate dietary intake is established. Some children may need ongoing supplementation, particularly if they have limited sun exposure or dietary restrictions. Children with genetic forms of rickets may require lifelong treatment. Healthcare providers should determine the appropriate duration and monitoring schedule based on individual circumstances.

References:

• Mayo Clinic – Rickets
• NHS – Rickets and Osteomalacia
• Johns Hopkins Medicine – Rickets
• Boston Children’s Hospital – Rickets
• MedlinePlus – Rickets
• CDC – Vitamin D Status: United States