Author: Dr. Alla Gordina

Date: 7.2.2002

What will my child need if his/her pre-adoptive medical report has a diagnosis of "rickets"?

Short answer:

1. Good physical and laboratory evaluation to determine the cause of the rickets.
2. In the majority of cases, presuming that all the results of the post-adoption evaluations are normal - your child would need just healthy nutrition, regular multivitamins, sunshine and a lot of love.

Long answer:

1. What is Rickets? Rickets (rik?ets) is believed to be a derivative of the Greek word rhachitis that means spinal complaint. Rickets first were described over 2000 years ago as crooked legs and chest deformities in Roman toddlers, who were neglected and/or inappropriately fed by their mothers.
2. For simplicities' sake we can define rickets as a bone and muscle problem due to vitamin D deficiency. Rickets can be caused by external causes (poor nutrition, lack of sunshine exposure) or by internal causes (diseases and unresponsiveness to vitamin D, loss of minerals and others)

Major symptoms of rickets are:

1. Decreased muscle tone with the normal development of the central and peripheral nervous system,
2. Softness of the middle portion of the long bones, which can cause the bowing of the legs,
3. Craniotabes - softness of the head bones with delayed closure of the fontanels,
4. Abnormal bone formation at the zones of bone growth - "rachitic rosary" - thickening of the sites of attachment of the ribs to the chest bone, widening of the wrists and knees, as well as the "frontal scull bossing" - excessive bone growth at the forehead.
5. Dental caries,which can lead to cavity formation
6. Awkward gait
7. Bone and Muscle pain
8. Increased irritability and sweat production
9. Growth delays.

Rickets itself is not known in causing delays in fine motor and/or mental development. Gross motor delays can be related to muscle weakness, softness of the long bones and to bone and muscle pain.

Rickets in Russia vs. Rickets in the United States. Nutritional rickets (pure vitamin D deficiency) is an extremely common condition in the countries of the former Soviet Union. Such rickets there can be seen not only in orphans, but also in some of the homegrown children from families that can provide good nutrition and access to the outdoors and medications.

In the United States, presently, the most common causes of rickets are extreme prematurity, abnormalities of mineral metabolism, kidney problems and treatment with certain drugs. Such types of rickets do require special medical attention and medications.

Things that can make rickets worse: prematurity, poor nutrition, institutionalization, frequent and prolonged illnesses, prolonged diarrhea, and the winter season.

Things that can make rickets better: In the orphanages, rickets is usually treated with vitamin D supplementation and ultra-violet irradiation. This is the reason why some adopted children can present with clinical signs of rickets and without any abnormality on their blood tests. Massages and other types of physical therapy can be used with good results too.

Taking into consideration that very often rickets, in internationally adopted children, is a self-limited condition, most of the times it does not require any special treatment. In actuality, very frequently, adoption itself is the best medicine for rickets in post-institutionalized children.

Normal nutrition (both the quality and quantity, if you can call "normal" the amount of food newly adopted children usually can eat), over the counter children?s multivitamins, sunshine exposure, addressing other medical problems, and a lot of "vitamins" L (love), M (mama), P (papa), and F (family) will usually do the trick.

HOWEVER - we still have to exclude the possibility of other types of rickets. This has to be done by your child?s doctor.