Rickets: 19th Century disease makes a comeback

SunGraphicRickets is traditionally defined as a nutritional deficiency disease — a childhood affliction caused by lack of vitamin D.  In fact, it could also be defined as a sunshine deficiency disease.  It was a common affliction of 19th British children living in poverty, who spent long hours working in factories, from very young ages.  The 19th Century factories are gone, but rickets is making a comeback in Britain for more modern reasons.

Key points about rickets:

  1. It’s a disease of childhood.  Children are growing and need calcium for bone growth.  Vitamin D aids calcium absorption and utilization.  Rickets is caused by insufficient vitamin D during critical growth years, resulting in soft bones.
  2. Soft bones can develop deformities.  One outward sign of advanced rickets is bowed legs in a child.  Spine curvature and thickening of wrists and ankles are other signs.  Bones can also be painful and break easily.
  3. Giving vitamin D to children with rickets can reverse the symptoms.
  4. Human skin manufactures vitamin D when exposed to specific and intense rays of sunshine.  In areas of the Tropics or equator, strong sunshine is always available, but northern areas only get sufficient sun in summer.   Plus in cloudy regions, clouds block the rays.
  5. Sunscreen blocks vitamin D production in skin, regardless of sun exposure.
  6. Dark skin tones also block the sun’s rays and decrease vitamin D production.  This isn’t a problem in equatorial regions, but can be in northern areas with low sunlight.
  7. In the US, vitamin D is added to some foods, including milk, yogurt, some alternative plant-based milks, some cereals and other processed foods.  It’s also present in some fish, and in liver.  Britain does not have vitamin D food fortification.

Cod liver oil was the Brits’ main tool against rickets in the mid-20th Century.  It worked well at the time, but now few children get cod liver oil.  And plenty of kids spend most of their waking hours indoors, away from sunlight.

Should parents be worried?  Rickets, with bowed legs and deformed bones, is a sign of prolonged and severe vitamin D deficiency.  Before the symptoms get that bad, there can be other more subtle problems that aren’t as dramatic.

Vitamin D may be insufficient if your child:

  • drinks little or no fortified milk, or other fortified foods like yogurt
  • was exclusively breast fed, and you didn’t use vitamin D drops
  • has little or no sun exposure
  • has dark toned skin and you live in a cloudy and/or northern region

The best way to assess your child’s vitamin D status is a blood test, ordered by your pediatrician.  If vitamin D is low, the doctor may recommend a supplement or increased consumption of vitamin D-fortified foods.

Find more detailed information about rickets here.

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