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RICKETS
This is a disease of the bones that can affect children
who do not get any exposure to sunlight. Our skin has a pro-Vitamin D that is converted into Vitamin D in the
presence of sunlight. Vitamin D protects the child from getting rickets. However, rickets can also occur
due to calcium deficiency with normal Vitamin D levels in the
body.
SYMPTOMS: In a typical case, an older infant or a
toddler is brought to the doctor with bowing of the legs. The
doctor finds widening of the ends of his long bones, near the
wrists or ankles. The eruption of teeth is delayed. The
forehead appears rather prominent. The anterior fontanelle (the
soft spot on the head) is widely open. The child seems to be
prone to frequent infections. Some children get tetany (fits
due to calcium deficiency). An X-ray of the wrist shows
classical evidence of rickets.
While being aware of the above findings, you must remember that all these features can be
seen normally in individual children. Thus, bowing of the legs in the
absence of the other features of rickets in an infant is normal.
The legs may straighten on their own without any treatment. Teeth may erupt later in some children, who are otherwise
normal. The anterior fontanelle may sometimes normally close towards the end of the second year. The headmay
look
big because of the bigger size of the parents’ heads. So
let your doctor decide whether the child has rickets or not.
TREATMENT: Your doctor will prescribe Vitamin D. In most cases, the improvement is rapid
and the X-rays
return to normal. Do not give your child more Vitamin D than prescribed by
your doctor; he could get Vitamin D
poisoning. You must make sure that the child’s skin is exposed to morning sunlight for 10 minutes everyday, but make sure
that the child does not get sunburn due to prolonged exposure
to the sun.
Rickets is extremely rare in breastfed children. In my 30 plus years of practice, I have seen it
only in 4
breastfed cases. In 3 cases, the child, even though advised, was
not exposed to sunlight for fear of his getting a dark skin.
All improved with Vitamin D and exposure to sun.
11 February, 2013
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