Rickets: A Comprehensive Guide
Medically reviewed by Andre Stone | MD, University of Pittsburgh School of Medicine on July 31st, 2026.
Published on April 8th, 2026. Updated on August 24th, 2026.
Key Takeaways
Rickets is a bone disease that primarily affects growing children due to vitamin D, calcium, or phosphate deficiency
The condition causes soft, weak bones that can bend and deform, leading to skeletal abnormalities
Vitamin D deficiency is the most common cause, often linked to limited sun exposure or poor nutrition
Early diagnosis and treatment can prevent permanent bone deformities and growth problems
Many cases of nutritional rickets are preventable through adequate vitamin D and calcium intake. Inherited rickets and rickets related to medical conditions may not be preventable this way.
Overview
Rickets is a skeletal disorder that weakens and softens bones in children during periods of rapid growth. This condition occurs when the body doesn't get enough vitamin D, calcium, or phosphate - nutrients essential for healthy bone development. Without these nutrients, bones become soft and malleable, leading to deformities and growth problems.
The disease primarily affects children between 6 months and 3 years old, though it can occur throughout childhood. In developing countries, rickets remains a significant health concern affecting millions of children. Even in developed nations, cases have been increasing due to lifestyle changes that limit sun exposure and dietary factors.
Rickets can have lasting effects on a child's skeletal system if left untreated. However, with proper diagnosis and treatment, most children can recover completely and develop normal, healthy bones.
Symptoms & Signs
Rickets symptoms develop gradually as bones become increasingly soft and weak. The signs often become more noticeable as children begin walking and putting weight on their bones.
Primary Symptoms
Bone pain and tenderness - Children may experience aching in their bones, particularly in the spine, pelvis, and legs
Dental problems - Delayed tooth formation, cavities, and defects in tooth structure are common early signs
Skeletal deformities - Bowed legs, knocked knees, and curved spine develop as soft bones bend under body weight
Growth delays - Children with rickets often have shorter stature and delayed physical development compared to peers
Muscle weakness - Weak muscles can cause delayed sitting, crawling, and walking milestones
Frequent fractures - Bones break more easily due to their weakened structure
Enlarged wrists and ankles - Swelling at bone joints becomes noticeable as the condition progresses
When to Seek Care
Contact a healthcare provider if you notice bone deformities, delayed growth, or frequent bone pain in your child. Early intervention prevents permanent skeletal problems. Watch for signs like difficulty walking, unusual bone shapes, or delayed tooth eruption.
When to Seek Immediate Care
Seek emergency medical attention if your child experiences severe bone pain, inability to bear weight, or signs of fracture after minor trauma.
Causes & Risk Factors
Age
Risk Factors
Children at increased risk include infants and toddlers (6 months to 3 years) during rapid bone-growth periods; children with a family history of rickets or inherited disorders affecting vitamin D metabolism; children with limited sun exposure; and children with certain kidney, liver, celiac, or malabsorption disorders.
Genetics
Family history of rickets or inherited disorders affecting vitamin D metabolism
Lifestyle
Limited sun exposure, indoor lifestyle, or living in northern climates with less sunlight
Other Conditions
Kidney disease, liver disorders, celiac disease, or malabsorption syndromes
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Diagnosis
Medical History & Physical Examination
During the evaluation, your doctor will ask detailed questions about your child's diet, sun exposure, family history, and symptoms. They'll examine your child's bones, looking for signs of deformity, tenderness, or unusual growth patterns. The physical exam includes checking for bowed legs, enlarged wrists or ankles, and dental abnormalities.
The doctor will also assess your child's growth and development, comparing height and weight to standard growth charts. They'll evaluate muscle strength and may observe how your child walks or moves to identify any functional limitations related to bone weakness.
Diagnostic Testing
Blood tests - Measure vitamin D, calcium, phosphate, and parathyroid hormone levels to identify specific deficiencies
X-rays - Show bone deformities, delayed bone formation, and characteristic changes in bone structure typical of rickets
Additional imaging or other tests - May be used in selected cases when the diagnosis or severity remains unclear
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Treatment Options
Treatment for rickets focuses on correcting nutrient deficiencies and preventing further bone deformities. Most children respond well to appropriate supplementation and dietary changes.
Conservative Treatments
Vitamin D supplementation - A healthcare professional may prescribe vitamin D in a dose chosen for the child's age, test results, and cause of rickets
Calcium supplements - Additional calcium ensures adequate mineral availability for bone formation and strengthening
Dietary modifications - Increasing foods rich in vitamin D, calcium, and phosphate supports natural bone healing
Sun exposure - Gradual, safe sun exposure helps the body produce vitamin D naturally while avoiding sunburn
Physical therapy - Exercises and stretches help strengthen muscles and improve mobility as bones heal
Advanced Treatments
Orthopedic care - A specialist may recommend monitoring, bracing in selected cases, or other treatment for persistent or severe deformities
Surgical correction - In severe cases with significant deformities, surgery may be needed to straighten bones and improve function
Families interested in complementary approaches should discuss them with the child's healthcare team and should not use them in place of proven treatment.
Living with the Condition
Daily Management Strategies
Create a routine that includes vitamin D and calcium supplements as prescribed by your doctor. Keep a daily log to track supplement intake and ensure consistency. Plan outdoor activities when weather permits to encourage natural vitamin D production. Choose foods fortified with vitamin D and calcium, such as fortified milk, cereals, and fish. Work with your healthcare team to monitor progress through regular check-ups and blood tests.
Exercise & Movement
Encourage age-appropriate physical activities that promote bone strength without putting excessive stress on weakened bones. Swimming is excellent for building muscle strength while supporting body weight. Walking and gentle playground activities help maintain mobility and normal development. Avoid high-impact sports or activities with fall risk until bones have strengthened sufficiently.
Prevention
Ensure adequate vitamin D intake through supplements, fortified foods, or safe sun exposure during early childhood
Maintain calcium-rich diet including dairy products, leafy greens, and fortified alternatives for children with dietary restrictions
Regular pediatric check-ups allow early detection and prevention of nutritional deficiencies before rickets develops
Sunlight can contribute to vitamin D production, but the amount needed varies with skin tone, location, season, clothing, and other factors. Follow local sun-safety and vitamin D guidance rather than relying on a fixed daily exposure time.
Breastfed infants usually need vitamin D supplementation unless a healthcare professional recommends a different plan, such as appropriately supervised high-dose supplementation for the breastfeeding parent.
Screen high-risk children including those with limited sun exposure, dietary restrictions, or family history of rickets
Maintaining appropriate nutrition and healthy lifestyle habits can help prevent nutritional rickets and support overall childhood development.
Frequently Asked Questions
Nutritional rickets often heals well when identified early and treated appropriately. Inherited or medically caused forms may require long-term treatment, and some deformities can persist. Treatment depends on the cause and may include vitamin D and calcium. Phosphate or other medicines are used only for certain forms under specialist supervision. However, some skeletal deformities may be permanent if treatment is delayed.
Many children begin showing improvement within weeks, although laboratory recovery and bone healing vary with the cause, severity, treatment, and child's age. The healthcare team will monitor progress and adjust treatment as needed.
No, rickets is not contagious and cannot spread from one child to another. Rickets can result from nutritional deficiencies, inherited disorders, or medical conditions that disrupt vitamin D or phosphate balance. The condition develops due to dietary, environmental, or medical factors affecting individual children.
Adults can develop a similar condition called osteomalacia, which involves bone softening due to vitamin D deficiency. True rickets specifically affects growing children's bones. Adults with vitamin D deficiency may experience bone pain and an increased risk of fractures.
Yes, there are several types of rickets. The most common is nutritional rickets from vitamin D deficiency. Other types include hereditary rickets caused by genetic disorders affecting vitamin D metabolism, and rickets secondary to kidney or liver disease that interferes with nutrient processing.
Still have questions?
Consult with a healthcare professional for personalized advice.