Your want your children to have strong bones and grow up healthy. Bones are the storehouse of calcium, thus for a bone to be strong, calcium is a must. You should provide a nourishing diet that is rich in vitamins and minerals. Vitamin D is required for the absorption of calcium and phosphate. Inadequate amount of these vitamins and minerals may lead to deficiency states; one of it is called rickets.
Dietary Considerations
You should know what foods provide vitamin D and the vital minerals, i.e. calcium and phosphorus. If diet is replete with these, then the next concern if the absorption of these in the intestines is adequate. Another interesting fact is that if you do not have ample vitamin D, you will not absorb calcium or phosphorus from the diet.
Calcium and phosphorus are essential minerals present in foods like milk, cheese, curd, and other dairy products, and green vegetables.
Vitamin D is abundant in dairy products, and in fish, fish oils, beef liver, egg yolk, and mushrooms. People who do not consume dairy products, are intolerant to milk or follow a vegetarian diet are prone to being deficient in vitamin D. Additionally, this vitamin is produced in the skin upon exposure to sunlight. People who live in cold climates with little exposure to sun or work indoors are more likely to develop deficiency of vitamin D. Babies who are exclusively breastfed may also develop the deficiency of vitamin D as breast milk is not very rich in vitamin D.
Regulation of calcium and phosphorus
The body regulates the amounts of calcium and phosphorus in the blood and bones. This is done under the influence of a hormone called the parathyroid hormone (PTH). This hormone is released from the parathyroid glands that are located in the neck. When the blood levels of calcium begin to fall, the levels of parathyroid hormone are increased and this in turn causes the calcium to be released from the bones. Hence the bones go porous, loose density, and turn brittle.
Diet and rickets
The commonest cause for rickets remains a dietary deficiency of calcium, phosphorus or vitamin D. Another important cause is the disorders of the intestines that interfere with absorption from intestines. Some of these disorders include conditions like the crohn’s disease in which the intestines are inflamed, and others like celiac disease, or milk allergy. If fats are not adequately absorbed in the intestines, it leads to deficiency of vitamin D as it is a fat soluble vitamin. Rickets can also occur in liver disorders as a diseases liver cannot convert vitamin D into its active form.
Rickets can have a genetic cause. The kidneys may not be able to retain phosphorus or excrete excess calcium due to an inherited disorder. As a result the minerals are mobilized for the bones to maintain balance in the blood and the bones become weak.
Symptoms
Rickets can lead to bone pains, short stature, impaired growth, increased fractures, and several skeletal deformities. The curvatures of the backbone can get unusually prominent. Scoliosis results when sideways curvatures and kyphosis results when the front-back curvatures are affected. The legs may curve and become bow shaped. The breast bone may be pushed forward leading to pigeon chest, and there may develop some bony prominences the ribs, called rachitic rosary. Children with rickets may show dental deformities characterized by delayed formation and easy decay of teeth. Muscle cramps and pains are also common.
Diagnosis
Your doctor will be able to diagnose rickets on the basis of a detailed clinical examination and x-rays. A detailed biochemical blood analysis along with tests for levels of calcium and phosphorus may be done. Blood may be tested for the levels of Parathyroid hormone and active forms of vitamin D. Urine may be subjected to testing for phosphates and other biochemical profiles.
Treatment
Rickets is treated by enriching the diet in sources rich in vitamin D, calcium and phosphorus. The doctor may treat any concurrent disorders of the intestines, liver, or kidney.
Take your kids out in the sun and give them moderate exposure to sunlight. Encourage outdoor activity for sunlight exposure in children. Take them to a park or for a picnic. Allow them to play on grass lawns.
You may use supplements for vitamin D or calcium. Fortified breakfast cereals or other foods can also help to overcome the deficiency. The deficiency corrects over a few months of treatment. You may need injections in some advanced cases. If your child has a skeletal deformity, a brace, muscle strengthening exercises or eventually a surgical correction may be required. Treatment for an underlying kidney disease can correct the bone mineralization defects. Genetic counseling is required when rickets is an inherited condition.
Rickets can be prevented. Make sure your child has a healthy balanced diet with milk, dairy products, beans, pulses and leafy vegetables. Dietary supplements may be required if diet alone is not sufficient to provide the required quantities of vitamin D, calcium or phosphorus. This is especially the case with pregnant women and nursing mothers and in people who choose a vegetarian diet. You may select fortified juices and cereals for your children.
Recommended daily intake of calcium in children is 500 mg in those between 1 to 3 years of age, 800 mg for those aged 4 to 8 years and 1300 mg for those who are 9 to 18 years in age. Children need 400 IU(International units) of vitamin D in a day.
Take-home message
Timely detection and treatment of rickets can prevent many permanent skeletal deformities and promise much healthy bones for your child. A healthy diet and adequate exposure to sunlight are simple ways to prevent bones from becoming brittle and weak. Strong bones built in childhood keeps you strong and moving in old age.
