RICKETS [RICKETS]

It is the characteristic result of vitamin D deficiency in children.


CAUSES:

• It is less common in breastfed infants.
• Less exposure to sunlight.
• Dark skinned infants.
• Dietary deficiency of vitamin D.
• Malabsorption.
• Chronic liver disease.
• Renal osteodystrophy.
• Calcium wasting.
• Hereditary.


SIGN AND SYMPTOMS:

• Head:
– Prominent forehead.
– Delayed closing of anterior fontanels (normally closes by 6 months of age).
– Frequent rocking movement of the head.
– Temporary teeth usually appear late.
– Excessive sweating over the forehead.
• Thorax:
– Beading of ribs (rachitic rosary), at the junction of the ribs and cartilages.
– Prominent sternum (Pigeon`s Breast).
• Spinal column:
– Patient has hump in the back (Kyphosis).
• Extremities:
– Bow legs.
– Knock knees.
– Outwards curving of bones of forearm.
– Dwarfism in severe cases.
– Green stick fractures can occur in severe cases.
• Ligaments and muscles:
– Weakness of legs.
– Delayed walking and standing.
– Over extension of knee joints.
– Pot belly due to weakness of abdominal muscles.
• Digestive system:
– Indigestion due to liver and spleen affection.
• Nervous system:
– Restless at night.
– Rocking of head on the pillow.
– A predisposition to titanic convulsion.
• Respiratory system:
– Adenoid and tonsillar hypertrophy.
– Rhinitis.
– Pharyngitis (inflammation of mucous lining of the pharynx).
– Bronchitis.
– Bronchopneumonia.
• Spasmophilia:
– Triad of tetany.
– Laryngismus strides.
– Convulsion may be expected in low calcium type of rickets.


DIETARY MANAGEMENT:

Avoid:
• Avoid bony injuries, to prevent factures.


CONSUME:

• You should have sun bath for at least 1 – 2 hrs every day.
• Consume foods rich in vitamin D:
– Animal food: egg yolk and fish liver oils are riches source.
– Liver, veal, beef, oyster, salt water fish – mackerel, kipper, herrings, salmon, sardines and tuna.
– Dairy products like – cream, butter, cheese, fortified milk and margarines.
– Plant foods are low in vitamin D – vegetable oils, fruits, nuts and green leafy vegetables.
• Reduce calcium intake (reduce but do not completely avoid calcium as it is needed for maintenance of our body):-
– milk and sea food, nuts, green leafy vegetables, whole grains, peas, lotus stem, pulses, legumes and oil seeds
– Should avoid custard apple and banana as they are high in calcium.
• Breast feeding should be continued.
• You can take vitamin D supplements – cod liver oil, fortified milk.


CONSULT PHYSICIAN:

• Consult physician if you have any of the above sigh and symptoms.
• Associated illness should be treated.
• Vitamin D injections can be injected under the guidance of your physician.