Rickets is softening and weakening of the bones in children, usually caused by a long-term lack of vitamin D, calcium or both. It is seen in Afghanistan, especially in young children who get little sunlight, whose mothers are themselves low in vitamin D, or who eat few calcium-rich foods. It causes bowed legs, late walking and poor growth. It can be prevented and, when found early, treated.
Symptoms
Bowed legs or knock knees
Thick wrists and ankles
Late sitting, crawling or walking
Poor growth and short height
Bone pain or tenderness, and weak muscles
A soft skull, late closing of the soft spot on the head, or late teeth
A row of bumps along the ribs, or a chest that sticks out
Causes
Not enough vitamin D — from little time in sunlight, skin that is always covered, or long winters indoors
A mother low in vitamin D during pregnancy and breastfeeding
Not enough calcium in the diet (little milk, yoghurt or cheese after weaning)
Premature birth
Rarely, kidney, liver or gut diseases that stop vitamin D or calcium being used
Prevention
Let babies and children spend some time outdoors in daylight most days, with face, arms and legs uncovered when safe
Vitamin D drops for babies, especially breastfed babies, as advised by a health worker
Good nutrition and vitamin D for mothers in pregnancy and while breastfeeding
From 6 months, give calcium-rich foods: yoghurt, milk, cheese, eggs and green vegetables
Regular growth checks at the health centre
Treatment
Blood tests and sometimes an X-ray to confirm the diagnosis
Vitamin D and calcium treatment for several weeks or months — the dose is set by a doctor
A calcium-rich diet and regular time in daylight
Follow-up checks of growth and blood levels
Most bone changes improve with treatment; severe leg bowing sometimes needs a bone specialist
Do not give high-dose vitamin D injections or drops without a doctor — too much can be harmful
Common questions
Will the bowed legs straighten?
In most young children the legs slowly straighten over months to a few years once rickets is treated. If they stay very bowed after treatment, a bone specialist should check them.
How much sunlight does my child need?
Short periods outdoors on most days — for example 15 to 30 minutes with face, hands and arms uncovered in the morning or late afternoon — help the skin make vitamin D. Avoid sunburn and the strongest midday summer sun.
