Why rickets with so much sunshine (II)
A child with rickets can present in so many ways. These include generalised weakness, thinning and softening of the skull bones known in medical parlance as craniotabes.
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Classically, the bone feels like “table tennis or ping pong ball” and is usually see in infants. Older children with rickets present with thickening of the skull bones, delayed closure of the soft part of the infant head called anterior fontanelle.
There is spreading of the ends of the long bones, forming knobs at the ends because of weak bone formation. Weight bearing on these bones in the lower limbs lead to bowlegs and knock-knees.
In the chest, knobby deformity at the ribs leads to rounded edges that that tends to be in line when viewed from up to down called a rachitic rosary. The sternum can also be pulled into a pigeon- breast deformity.
In more severe instances, softening of the bones of the back can lead to posture deformity with curving of the bones of the back. Other symptoms of rickets include pain or tenderness in the bones of the limbs and spine, stunted growth or short stature, teeth deformities including delayed tooth formation and holes in the teeth.
In investigating a child with rickets, an assay of the minerals involved in bone formation and strengthening such as calcium and phosphates are done. Also, an enzyme that is involved in mobilisation of calcium from the bones called alkaline phosphatase as well as the vitamin D levels in the blood is done and analysed.
Serum parathyroid, kidney function test are also done to ascertain the possible cause of the rickets. An x-ray of the hands and feet can show thinning and fraying of the bones, widened joint space, destroyed bone ends.
Treatment for rickets focuses on replacing the deficient minerals in the body. Most of the symptoms are eliminated with replacement of the minerals. Foods rich in vitamin D and calcium are encouraged. In severe cases, vitamin D and calcium preparation is given to boost calcium absorption and good bone formation.
If skeletal deformities are present, the child will need to see an orthopaedic surgeon. Serial x-rays to monitor the angles of deformities are done to ascertain whether self-correction is likely or not.
Braces to help position the bones correctly as the child grows is another treatment option for those with limb deformities that don’t seem to correct itself. In some cases, corrective surgery is done.
In preventing rickets, consumption of diets rich in calcium, phosphorous and vitamin D are recommended. Sun exposure is valuable and sunscreen is not recommended for those with dark skins. Regular monitoring and replacement of calcium and phosphates in a child with kidney problems can prevent development of rickets.
With early recognition and treatment modalities put in place, complications of rickets can be avoided. Treatment may need to be continued for a longer period and repeat blood tests to ascertain improvement of bone mineralisation.
There may be the need to adjust the dosage of vitamin D and calcium based on the results of these investigations.