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Rickets is a child hood disease characterized by softening of bone threatening to cause fracture and deformities of bone. Rickets is found in many developing countries as it is caused by deficiency of vitamin D and up to certain extent due to low calcium diet. Majority of cases occur in children suffering from severe malnutrition usually resulting from famine or starvationand severe diarrhea and vomiting during the early stages of childhood.
The word “ricket”is probably originated from the old English dialect word 'wrickken', to twist. The Greek word “rachitic” was later adopted as a scientific term for rickets due to word’s similarity in sounding. In Some languages it is known as “English disease”.
VitaminD is required for proper absorption of calcium from gut, in abscent of vitamine D, clcium in diet can not be properly absorbed, and it leads to bone and dental deformities-hypocalcimia. A rare X-linked dominant form, exists called Vitamin D resistant rickets
Those at higher risk for developing rickets include:
- Breast-fed infants whose mothers are not exposed to sunlight
- Breast-fed infants who are not exposed to sunlight
- Individuals not consuming fortified milk, such as those who are lactose intolerant
- An infant born from a mother who has low vitamine D level develops the rickets at birth is called as congenital rickets.
Individuals with red hair have been speculated to have a decreased risk for rickets due to their greater production of vitamin D in sunlight.
Signs and symptoms of rickets include
- Bone pain or tenderness
- Dental problems
- Muscle weakness
- Increased tendency for fractures
- Skeletal deformity
Toddlers: Bowed legs (genu varum),Older children: Knock-knees(genu Valgum) or “windswept knees”
- Cranial, spinal and pelvic deformities
- Growth disturbance
- Hypocalcemia(low level of calcium in the blood)
- Tetany (uncontrolled muscle spasms all over the body)
- Craniotabes(soft skull)
- Costochondral Swelling (rickety rosary or rachitis rosary)
- Harrison’s groove
- Double malleoli sign due to metaphyseal hyperplasia
- Widening of wrist raises early suspicion
X- ray- of advance stage shows bow legs(outward curve of long bone of the legs) and a deformed chest..
Changes in the skull can be seen as a distinctive “square headed”. If not treated in time the deformities may persist in to adult life.
Permanent bends or disfiguration of the long bones and a curved back.
- Blood test shows Low levels of calcium, phosphorus and high levels of serum alkaline phosphatase.
- X-ray – of affected bones may show loss of calcium from bones and change in the shape and structure of bones.
- Rarely bone biopsy may perform to confirm the diagnosis of rickets.
Treatment and prevention - (antirachitic)Treatment involves dietary intervention and exposure to sun light.
Increasing dietary intake of calcium (cholecalciferol(D3) Ergocalciferol) HGH, phosphates and vitamin D. Vitamin D is necessary to absorb the calcium.
Recommendation daily dose of vitamin D for infant and children is - 400 IU
Sources of vitamin D
- Fortified milk and milk producgts like butter
- Fortified juice
- Fish liver oil (cod liver oil, halibut-liver oil, and viosterol)and Oily fishes such as tuna,herring and salmon
- Eggs and margarine
Exposure to ultraviolet B light(sunshine when the sun is highest in the sky.
The replacement of vitamin D has been proven to correct rickets using these methods of ultraviolet light therapy and medicine.
Make a puree of 4 tomatoes. Soak some rice for 30 minutes and grind it coarsely. Add this to the pureed tomatoes. Apply this mixture all over the body and leave it on for about 15 minutes. Bathe with warm water; this is a good scrub recipe for oily skin.