Related concepts:
Vitamin D Deficient Rickets, The rachitic rosary

Introduction:
Good health is often a balancing act. Too much sun exposure can cause unwanted sunburn in babies, but too little sun exposure can lead to vitamin D deficient rickets.

Breast milk does not necessarily contain much vitamin D. Neither does cow’s milk, nor most baby foods. Thankfully, mothers and babies can produce their own when their skin is exposed to sunlight. In a warm climate, taking your baby outside for even 15 minutes a week can give you both enough vitamin D – if fair-skinned.

What is it?
Babies who do not get enough or produce enough vitamin D can develop rickets, the failure of developing bones to form properly. In the absence of adequate amounts of vitamin D, the body steals calcium from the bones to keep the blood levels of calcium high enough for life.

Who gets it?               
Breast-fed babies whose mothers do not get adequate time in the sun can develop rickets. This is especially true in colder climates and in darker-skinned individuals. Window panes (and sometimes smog or haze) are able to block the sun’s rays needed to create vitamin D.

Today’s infant formulas are supplemented with plenty of vitamin D.

Low birth weight babies and kids with underlying conditions, such as celiac disease or cystic fibrosis, are more susceptible to rickets. Medications such as steroids and anti-seizure drugs can also increase the risk of rickets.

Several metabolic, liver, and kidney diseases can interrupt the normal functioning of the calcium/vitamin D system and lead to rickets.

What are the symptoms?
In rickets, the bones do not form properly. Often the first noticeable instance of this is the thin, pliable skull. Pressing on it can feel like pressing on a ping-pong ball. The head shape may be abnormal.

Teething may be delayed and the teeth may be poorly formed. Severe cavities are common.

The wrists and ankles may appear swollen. The tips of the rib bones can enlarge creating a string of lumps called the rachitic rosary. Bowed legs, knock-knees, or fractures are common.

Kids with rickets tend to sweat more than average.

Is it contagious?
No

How long does it last?
Rickets lasts until treated.

How is it diagnosed?
Rickets is suspected by the history and the physical examination. The diagnosis is confirmed by lab tests and x-rays.

How is it treated?
For children with nutritional rickets, giving vitamin D will begin reversing the problem. Other underlying problems may require additional treatment.

How can it be prevented?
Babies only need an average of 400 IU of vitamin D per day to prevent vitamin D deficient rickets. Nursing mothers should be sure to get plenty of vitamin D themselves and to try to get their babies outside several times a week (but not enough to cause sunburn). If this is not practical, vitamin D supplements should be given. Today’s formulas already contain enough vitamin D.