Rickets Disease:Newborns get nutrition from their mother’s milk but when the child is 6 months old, they need complementary feeding. Children get proper nutrition but then their bones become weak and they suffer from rickets. Know from experts why this happens and what is the real reason behind it.
Rickets is a skeletal disorder that primarily affects infants and young children, leading to soft and weakened bones. The disease is most commonly caused by a deficiency of vitamin D, calcium, or phosphate—nutrients vital for healthy bone formation. Although it is often associated with malnutrition, rickets can still occur in children who appear to receive adequate nutrition. This paradox has puzzled parents and healthcare providers alike, particularly when rickets develops after the period of exclusive breastfeeding.
The Importance of Early Nutrition
From birth until about six months, an infant’s primary source of nutrition is breast milk. Rich in antibodies and nutrients, breast milk is often considered the gold standard for newborn nutrition. It contains all the essential nutrients required for a baby’s growth and development, including proteins, fats, carbohydrates, vitamins, and minerals. However, despite its many benefits, breast milk alone may not provide sufficient amounts of certain nutrients, particularly vitamin D.
Vitamin D is crucial for calcium absorption in the gut and plays a significant role in bone health. While breast milk does contain some vitamin D, the amount may not be adequate to meet the infant’s needs, especially if the mother herself is deficient in this vitamin. This becomes particularly concerning in regions with limited sunlight exposure, as the skin’s synthesis of vitamin D from sunlight is a significant source of this nutrient.
Transitioning to Complementary Feeding
Around the age of six months, infants begin the transition to complementary feeding, where solid foods are introduced alongside breast milk or formula. This stage is critical for providing additional nutrients that are not sufficiently supplied by breast milk alone. Complementary foods should be rich in vitamins and minerals, including vitamin D and calcium, to support the baby’s growing bones.
Despite receiving a diet that appears balanced, some children may still develop rickets. This could be due to several factors:
- Inadequate Vitamin D Intake: Even with complementary feeding, the diet may still lack sufficient vitamin D, especially if foods fortified with vitamin D, such as certain cereals and dairy products, are not included.
- Poor Absorption: Certain medical conditions, such as celiac disease or cystic fibrosis, can impair the absorption of vitamin D and calcium, leading to deficiencies despite an adequate intake.
- Insufficient Sunlight Exposure: As mentioned earlier, sunlight is a natural source of vitamin D. If a child is not exposed to enough sunlight, or if they live in an area with low sunlight levels, their body may not produce enough vitamin D, contributing to rickets.
- Genetic Factors: In rare cases, genetic mutations can affect the metabolism of vitamin D or phosphate, leading to conditions such as vitamin D-resistant rickets or hypophosphatemic rickets.
The Role of Experts: Why Do Children Develop Rickets Despite Adequate Nutrition?
Experts believe that the apparent paradox of children developing rickets despite receiving adequate nutrition is often linked to the nuances of vitamin D metabolism and the challenges of ensuring sufficient nutrient intake during the critical growth period.
1. Vitamin D Deficiency in Breastfeeding Mothers:
A breastfeeding mother’s vitamin D status is directly related to the vitamin D levels in her milk. If the mother has low levels of vitamin D, perhaps due to insufficient sunlight exposure or a diet lacking in vitamin D-rich foods, her breast milk may not provide enough vitamin D to her infant. This is particularly important during the first six months when the infant is exclusively breastfed.
2. Delayed Introduction of Vitamin D-Rich Foods:
The introduction of complementary foods is crucial for providing essential nutrients. However, if the transition to solid foods does not include vitamin D-rich options, such as fortified cereals, dairy products, or oily fish, the child may continue to receive inadequate amounts of this vitamin. Additionally, some cultural or regional diets may lack foods that are naturally rich in vitamin D, further exacerbating the risk of rickets.
3. Suboptimal Sunlight Exposure:
Sunlight exposure is a critical factor in preventing rickets, as ultraviolet B (UVB) rays trigger the production of vitamin D in the skin. However, factors such as high pollution levels, use of sunscreen, indoor lifestyles, and geographical location can limit the amount of sunlight a child receives. In some regions, cultural practices that involve covering the skin for modesty or protection can also contribute to reduced vitamin D synthesis.
4. Malabsorption Syndromes:
Certain medical conditions can affect the absorption of vitamin D and calcium in the intestines. For example, children with celiac disease, which causes damage to the small intestine, may not absorb nutrients effectively, leading to deficiencies. Similarly, conditions like Crohn’s disease or cystic fibrosis can impair fat absorption, which is necessary for the absorption of fat-soluble vitamins like vitamin D.
5. Genetic Factors:
Some forms of rickets are genetic and are not caused by dietary deficiencies. For example, hypophosphatemic rickets is a genetic disorder that affects the kidneys’ ability to reabsorb phosphate, an essential mineral for bone health. Children with this condition may require specialized treatment that includes phosphate supplements and active forms of vitamin D.
6. Premature Birth:
Premature infants are at a higher risk of developing rickets because they are born with lower stores of vitamin D and minerals like calcium and phosphorus. These babies may require additional supplementation to ensure they receive adequate nutrients for bone development.
Preventing Rickets: Strategies for Parents and Caregivers
Given the complexity of factors that contribute to rickets, prevention requires a multi-faceted approach. Here are some expert recommendations for preventing rickets in children:
- Ensure Adequate Vitamin D Intake:
Parents should ensure that their children receive sufficient vitamin D from various sources. This can include:- Breastfeeding Mothers: Mothers should ensure they are getting enough vitamin D, either through diet, supplements, or sunlight exposure, to enrich their breast milk.
- Supplementation: The American Academy of Pediatrics recommends that all breastfed infants receive a daily supplement of 400 IU of vitamin D, starting within the first few days of life. This supplementation should continue until the child is weaned and consuming enough vitamin D-fortified foods.
- Complementary Feeding: Once solid foods are introduced, parents should incorporate vitamin D-rich foods into their child’s diet. These foods include fortified cereals, dairy products, egg yolks, and fatty fish like salmon and mackerel.
- Promote Safe Sun Exposure:
While excessive sun exposure carries risks, moderate exposure is essential for vitamin D synthesis. Experts suggest that allowing children to play outside for short periods, such as 15 to 30 minutes a day, can help maintain healthy vitamin D levels. The amount of time needed varies depending on skin tone, geographic location, and time of year. - Address Medical Conditions:
For children with conditions that affect nutrient absorption, such as celiac disease or cystic fibrosis, specialized medical care is necessary. These children may require higher doses of vitamin D and calcium, as well as regular monitoring of their bone health. - Monitor Bone Development:
Regular check-ups with a pediatrician can help monitor a child’s growth and development. If there are signs of rickets, such as delayed growth, bone pain, or skeletal deformities, early intervention is crucial. Treatment may include high-dose vitamin D supplements, calcium supplements, and in some cases, corrective surgery for bone deformities.
Understanding the Symptoms of Rickets
Parents should be aware of the symptoms of rickets, which can vary in severity. Early signs may include:
- Delayed Growth: Children with rickets often exhibit delayed growth, particularly in their limbs. They may be shorter than their peers or have a disproportionate body.
- Bone Pain: Rickets can cause pain and tenderness in the bones, especially in the legs, pelvis, and spine.
- Skeletal Deformities: As the disease progresses, visible deformities may develop, such as bowed legs, thickened wrists and ankles, and a curved spine.
- Dental Issues: Rickets can affect dental health, leading to delayed tooth eruption, defects in tooth enamel, and an increased risk of cavities.
Treatment and Management of Rickets
The treatment of rickets focuses on addressing the underlying nutritional deficiencies and correcting bone abnormalities. The following are common approaches to managing rickets:
- Vitamin D and Calcium Supplementation:
The primary treatment for rickets involves replenishing vitamin D and calcium levels. High-dose vitamin D supplements are often prescribed, which can be administered orally or through injections. Calcium supplements may also be necessary to support bone mineralization. - Dietary Adjustments:
In addition to supplementation, dietary changes are essential. Parents should ensure that their child’s diet includes vitamin D-rich foods and sufficient calcium. In cases where a child has difficulty absorbing nutrients, a specialized diet or additional supplements may be recommended. - Sunlight Exposure:
Increasing the child’s exposure to sunlight can boost vitamin D production. However, it is important to balance sun exposure with skin protection to prevent the risk of skin damage. - Physical Therapy:
For children with skeletal deformities, physical therapy can help improve mobility and strengthen muscles. In severe cases, orthopedic surgery may be necessary to correct bone deformities. - Monitoring and Follow-Up:
Regular monitoring of the child’s growth, vitamin D, and calcium levels is crucial to ensure the effectiveness of treatment. Follow-up appointments with a pediatrician or a specialist in pediatric bone disorders can help track the child’s progress and make necessary adjustments to the treatment plan.
The Importance of Awareness and Early Intervention
Rickets is a preventable disease, yet it remains a concern in many parts of the world due to factors like inadequate vitamin D intake, insufficient sunlight exposure, and underlying medical conditions. Awareness among parents and caregivers is key to preventing this condition.
