E55.0
DESCRIPTION
Failure to calcify osteoid tissue in a growing child, usually due to deficiency of vitamin D, its active metabolites, calcium, phosphorus or other rare causes. This leads to bone deformity.
Occurs in ex-premature babies during infancy and in children with developmental disability, on anticonvulsants or not exposed to sunlight. In older children it is caused by renal tubulopathy and other rare conditions.
DIAGNOSTIC CRITERIA
Clinical
- Bowing of long bones, widening of metaphyses and cranial bossing.
- Occasionally convulsions or tetany due to hypocalcaemia.
Investigations
- Elevated alkaline phosphatase.
- Serum calcium and/or phosphate abnormalities.
- X-ray of wrists.
GENERAL AND SUPPORTIVE MEASURES
- Prevent vitamin D deficiency.
- Exposure to sunlight, at least 3 hours a week.
Note: Breast milk does not contain adequate vitamin D to prevent deficiency. Ensure adequate sunlight exposure of infant or provide vitamin D until weaning.
- Normal vitamin D-containing diet for lactating mothers.
MEDICINE TREATMENT
Prophylaxis
For premature babies:
- Vitamin D, oral, 800 IU, once daily.
Infants who are exclusively breastfed or not on adequate volume of commercial milk formula:
- Vitamin D, oral, 400 IU, once daily.
Treatment of active rickets
Treat only after confirmation of active rickets on X–ray.
- Vitamin D, oral, 5 000 IU, once daily, in addition to milk in the diet.
- Repeat X–ray after 6–8 weeks.
- If no radiological improvement, further investigation is required.
- If healing occurs, continue for 3 months. Confirm complete healing and adequate diet for the future.
REFERRAL
- Rickets presenting in children older than 2 years.
- No radiological response to treatment after 6–8 weeks.
- Incomplete radiological response.
- Rickets secondary to other disease processes.