Infants who are born prematurely or who have dark skin, and babies who are breast-fed by poorly nourished mothers or who are unexposed to the sun, are all at higher risk for developing rickets.
The most obvious sign of advanced rickets is bone deformity, with the legs bowing or turning inward. Other skeletal problems may include enlarged ankles, knees, or wrists, curvature of the spine, and bending of the ribs. There may be pelvic pain and muscle weakness, slowed development, restlessness and irritability, and very thin skull bones. Older infants may have flattened square skulls whose fontanels (soft spots) on the head may remain open for long periods. Other symptoms include diarrhea, bone fractures, respiratory infections, and poor tooth development.
X rays, blood tests, and observation of deformities are all used to diagnose rickets in infants.
Treatment and Prevention
Vitamin D supplements in therapeutic doses is the treatment of choice. Rickets can be prevented by making sure the infant is getting enough vitamin D, which is not difficult in the United States because virtually all cow’s milk and all standard infant formulas are manufactured with added vitamin D. In addition, supplements are available for premature babies, vegetarians, and others who may not otherwise get enough vitamin D. Doctors often recommend vitamin D supplements to nursing mothers who are also vegetarians and who have dark skin. Foods that are high in vitamin D include liver, some fish, cod liver oil, egg yolks, butter, and vitamin D-fortified milk, margarine, and cereal.