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Terre Haute Regional Hospital



Rickets is disease that affects the bones. It causes them to soften and weaken.

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Copyright © Nucleus Medical Media, Inc.


Rickets is caused by a vitamin D, calcium, or phosphorous shortage a child's body. This may occur when:

  • The supply of vitamin D from diet or sun exposure is too low
  • The way the body processes vitamin D is not typical
  • Tissue does not respond to the action of vitamin D
  • There is not enough calcium or phosphorous in the diet or it cannot be absorbed

Less often, rickets can be caused by other disorders that affect vitamin D absorption or calcium metabolism such as:

  • Kidney problems:
    • A hereditary disorder of the kidney called vitamin D-resistant rickets
    • Renal tubular acidosis—a non-hereditary kidney disorder that causes bone calcium to dissolve
    • Chronic kidney failure
    • Long-term kidney dialysis
  • Malabsorption-related diseases of the small intestine
  • Liver or pancreatic diseases
  • Cancer
  • Certain medications
  • Poisoning from:
    • Cadmium
    • Lead
    • Aluminum
    • Outdated tetracycline

Risk Factors

Rickets is more common in children aged 6-24 months. It is also more common in children of African American descent.

Factors that may increase your child's chances of getting rickets include:

  • Lack of sun exposure or having dark skin
  • Babies who are breastfed—breast milk is low in vitamin D
  • Babies who do not drink enough formula that is fortified with vitamin D
  • Children who do not drink enough vitamin D-fortified milk
  • Lactose intolerance with low intake of vitamin D-fortified milk
  • Vegetarian diet
  • Family history of rickets
  • Certain chronic illnesses that result in loss of or poor absorption of calcium or phosphorous
  • Drugs that affect vitamin D, calcium, or phosphorous


Symptoms may include:

  • Muscle weakness
  • Bow legs or knock knees
  • Bone pain and tenderness
  • Skeletal and/or skull deformities
  • Deformity or curvature of the spine—scoliosis
  • Pigeon chest—a chest that protrudes
  • Dental deformities
  • Delayed tooth formation
  • Defects in teeth
  • Loss of appetite or weight loss
  • Difficulty sleeping
  • Delayed walking
  • Seizures


You will be asked about your child's symptoms and medical history. A physical exam will be done.

Your child's bodily fluids and bone may be tested. This can be done with:

  • Blood tests
  • Urine tests
  • Bone biopsy

Pictures may be taken of structures inside your child's body. This can be done with an x-ray.


Treatment attempts to:

  • Relieve or reverse symptoms and improve bone changes
  • Correct the underlying cause

Treating Symptoms

Treatment to relieve or correct symptoms and bone changes:

  • Involves biologically active vitamin D, calcium, and/or phosphate
  • May include:
    • Wearing braces to reduce or prevent bony deformities
    • In severe cases, surgery to correct bony deformities

Treating the Underlying Cause

Treatment of the underlying cause may include:

  • Adding the following to your child's diet:
    • Supplements of vitamin D, calcium, and other minerals
    • Vitamin D-fortified dairy products
    • Foods high in vitamin D, such as fatty fish, egg yolk, and green vegetables
    • Foods high in calcium
  • Adequate, but not excessive, exposure to sunlight
  • Avoiding medication that may be causing poor calcium, phosphorous, or vitamin D absorption
  • Treating underlying illnesses


To help reduce your child's chance of rickets:

  • Drink vitamin D-fortified milk.
  • Consume enough vitamin D, calcium, and other minerals. If you think your child's diet may be lacking, talk with the doctor about other sources of vitamins and minerals.
  • Get sufficient, but not excessive, exposure to sunlight. Fifteen minutes a day is usually enough. Any longer than that requires sun protection with clothing or sunscreens, especially in fair-skinned infants and children. Children with dark skin are at increased risk for rickets and may need more sun exposure and dietary supplements with vitamin D.
  • Breastfed babies and bottle-fed babies who do not get enough vitamin-D fortified formula may need to be given a supplement starting within the first few days of life. Talk to the doctor to make sure your child is meeting the nutritional requirements for vitamin D.

Revision Information

  • Eat Right—Academy of Nutrition and Dietetics

  • Healthy Children—American Academy of Pediatrics

  • Health Canada

  • The Hospital for Sick Children—About Kids Health

  • Rickets. EBSCO DynaMed website. Available at: Updated April 15, 2016. Accessed May 13, 2016.

  • Vitamin D deficiency in children (infancy through adolescence). EBSCO DynaMed website. Available at: Updated February 3, 2015. Accessed May 13, 2016.

  • Rickets. American Academy of Family Physicians Family Doctor website. Available at: Updated April 2014. Accessed May 13, 2016.

  • Balk SJ, Council on Environmental Health; Section on Dermatology. Ultraviolet radiation: a hazard to children and adolescents. Pediatrics. 2011;127(3):e791-e817.

  • Grant WB, Boucher BJ. Requirements for Vitamin D across the life span. Biol Res Nurs. 2011;13(2):120-133.

  • Wagner CL, Greer FR, American Academy of Pediatrics Section on Breastfeeding, American Academy of Pediatrics Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics. 2008;122(5):1142-1152.