The word ricket is derived from the Anglo-Saxon ‘wrikken’ which means ‘to twist’. It is a deficiency disease of infancy and early childhood in which the bones are softened and deformed. The disease most likely makes its first appearance at the time of teething. It is known as disesase of poverty and darkness and is more prevalent in children of poor class.
The history of rickets as a deficiency disease is much older than our knowledge of preventing it. In the early 19th century cod-liver oil was a well-known folk remedy, and later on as therapeutic agent, for rickets in European countries. Mc Collum, in 1922, isolated Vitamin A and D from cod-liver oil and described vitamin D as an antirachitic vitamin which resists oxidation.
The child becomes restless, fretful and pale, with flabby and toneless muscles, which cause the limbs to assume unnatural postures. Excessive sweating in the head is common. The child’s abdomen protrudes. He may suffer from diarrhoea and anaemia. The bones become soft and bend easily. Under the constant pull of the muscles, the joints lose their shape and are unable to function normally. In young infants there may be a marked softening of the bones of the skull. The chest is also deformed due to softening of ribs and is called pigeon breast. The marked weakness in the bones delays the child’s ability to sit up, crawl and walk. The weight of his body may bend the bones and joints out of shape, causing such deformities as bow-legs, and knock-knees.
Rickets arises as a result of deficiency of vitamin D. This vitamin is also essential for the proper absorption of calcium and phosphorus. It has been proved that poor absorption and metabolism of both these minerals, checks the formation of strong and healthy bones resulting in rickets. Sunlight prevents the disease by irradiating the skin. It contains a provitamin whichis changed into vitamin D by ultra voilet light. Pollution in the cities, prevents the sun rays from falling clearly. In many tropical countreis, where adequate sunshine is available, the practice of covering the child from sunrays leads to this disease.
Another cause of rickets is relaxation of the solid parts, which may arise from being born of weak and sickly parents, or of those who have followed a wrong style of living and lived on a faulty diet such as excessive intake of tea, sugar, coffee, fatty foods and white flour products, or who have had the veneral disease; which was not thoroughly cured.
The rickets are generally curable especially in the initial stages. Proper nursing of the child, however, is very essential and all factors that might promote the disease must carefuly be removed.
Diet is of utmost importance in the prevention and treatment of this disease. As far as possible, the child should be breast-fed for the first year of its existence. He should be given goat’s or cow’s milk, diluted with water according to his age, wherever breast feeding is not possible. Other foods should be introeuced gradually, with emphasis on fruits, steamed vegetables, whole grain cereals and milk.
Adequate intake of vitamin D and calcium is very essential for recovery. The child-patient should be given liberal quantities of vitamin D rich foods such as milk,, cream and butter, eggs , and cod liver oil. Vitamin D can also be given in supplement from 1000 to 4,000 I.U. per day for six to 12 weeks, depending on the severity of the disease. This can be followed by daily supplements of 200 to 400 I.U., which are adequate to prevent the development of the disorder in otherwise normal children.
For severe cases, a supplement of calcium lactate should also be given orally. The diet after weaning may include, with advantage, an egg daily and butter. An adequate intake of iron and ascorbic acid is also necessary.
Besides proper diet and adequate intake of nutrients outlined above, al efforts should be made to improve the hygenic environment of the child. The child should be clothed sparsely and if he was previously confined indoors, he should be allowed outdoor as much as possible to enjoy the sunshine and fresh air.