Rickets

Rickets is the consequence of poor bone mineralisation. It is the childhood equivalent of osteomalacia

• commonest cause of rickets is simple nutrient deficiency of vitamin D (from sunlight, diet or both), ie. deficiency in the absence of any other cause such as malabsorption, or disorders of the liver, kidneys or metabolism

Clinical features summary:

• classically present with bony abnormalities such as leg-bowing and knock-knees
  • may also be bony deformities of the chest, pelvis and skull, fractures in severe cases, delayed dentition, poor growth, and, rarely, bone pain
• may present with symptoms of hypocalcaemia, such as neuromuscular irritability (e.g. convulsions, tetany), cardiomyopathy or cardiac arrest may be the presenting feature, especially in very young infants

Vitamin D deficiency in children

• overall prevalence of vitamin D deficiency in children in the UK is not known
• appears particularly prevalent among non-European ethnic minorities
  • evidence from observational studies suggest that, in these minority groups, vitamin D deficiency occurs:
    • in around 50% of pregnant women and their neonates, up to 40% of toddlers, up to 45% of schoolchildren and over 70% of adolescents

Reference:

1. Chanchlani R et al. An Overview of Rickets in Children. Kidney Int Rep. 2020 Apr 11;5(7):980-990