Rickets is a condition that makes children's growing bones soft and weak. It is usually caused by a lack of vitamin D or calcium. Find out about the causes, symptoms, treatment and ways to help prevent it.
🕒 6 min read
What is rickets?
Rickets affects the way children's bones develop. Bones can become soft and weak, leading to changes in their shape, including bowed legs. A similar soft-bone condition in adults is called osteomalacia.
What causes rickets?
Rickets is usually caused by vitamin D deficiency, calcium deficiency, or a combination of both. Rare inherited conditions can also cause rickets. The cause matters because treatment needs to address the underlying problem.1
Vitamin D deficiency
Vitamin D helps the body regulate calcium and phosphate, which are needed for healthy bones, teeth and muscles. Not getting enough can affect a child's developing skeleton.
The skin makes vitamin D when exposed to sunlight. In the UK, the sun is not strong enough for us to make enough between October and early March. Food sources include oily fish such as sardines, salmon and mackerel, egg yolks and fortified foods.2
Calcium deficiency
Calcium is also needed to build bones. A diet that provides too little calcium can contribute to nutritional rickets, even when vitamin D intake is adequate. Children who avoid dairy need suitable alternative calcium sources.
Inherited or other medical causes
Some children are born with a genetic form of rickets. If a medical condition is responsible, a specialist will assess the cause and recommend appropriate treatment.
Super Strength Vitamin D3
For healthy bones, teeth, muscles and immunity
- 25mcg (1,000IU) vitamin D3 per tablet
- Supports normal bones, teeth and muscle function
- Contributes to normal immune system function
For adults. Follow the product label. This 25mcg formula is higher than the routine 10mcg prevention advice and is not a children's rickets treatment.
What are the symptoms of rickets?
Children with rickets may have leg pain, muscle weakness or changes in the shape of their bones. Signs can include:
- Bowed legs or other changes in leg alignment.
- Painful or swollen wrists.
- Growing more slowly than expected.
- Reluctance to walk, or becoming tired when walking.
- Teeth coming through later than usual.
These signs can have other causes, so they do not confirm rickets on their own. See a GP if you think your child may have rickets.1
In severe cases, low blood calcium can lead to fits or breathing difficulties. These need immediate emergency assessment; do not wait for a routine appointment.
Symptoms of osteomalacia in adults
Adults with osteomalacia can have aching bones and muscle weakness that make it difficult to climb stairs or get up from a chair. It can also change the way they walk. Speak to a GP about persistent symptoms.
Who is at risk of rickets?
Children need vitamin D and calcium for their developing skeletons. Risk can increase when their diet or supplement routine does not provide enough, or when they have little opportunity to make vitamin D from sunlight.
People who are housebound, spend little time outdoors or usually cover most of their skin may be more likely to have low vitamin D levels. People with darker skin may also make less vitamin D from sunlight. These factors do not mean that someone will necessarily develop rickets.2
How is rickets diagnosed?
A GP will assess the symptoms and may check vitamin D and calcium levels with blood tests. Further investigations, including X-rays, may be needed to assess the bones or find the cause. Diagnosis involves more than a vitamin D result alone.1
How is rickets treated?
Treatment depends on the cause. Nutritional rickets is usually treated with vitamin D and calcium, alongside dietary changes. A clinician decides the dose, duration and follow-up; treatment doses can differ from routine prevention supplements.
Inherited forms or other underlying conditions may need specialist treatment. Some bone changes need further assessment and, occasionally, surgery. Do not try to treat suspected rickets by choosing a high-strength supplement yourself.1
How can rickets be prevented?
Nutritional rickets can usually be prevented by getting enough vitamin D and calcium. This does not prevent every inherited form. A balanced diet and an age-appropriate supplement routine are the main starting points.
Vitamin D supplements by age
The following NHS guidance is for prevention, rather than treatment of diagnosed rickets.23
| Age or group | Guidance |
|---|---|
| Breastfed babies under 1 year | 8.5–10mcg vitamin D daily from birth, throughout the year, even if the breastfeeding parent takes vitamin D. |
| Formula-fed babies | Extra vitamin supplements are not usually needed if they drink more than 500ml of formula daily. Ask a health visitor about lower intakes. |
| Children aged 1–4 | 10mcg vitamin D daily throughout the year. |
| Adults and children over 4 | Consider 10mcg daily during autumn and winter. People at increased risk of vitamin D deficiency may need it throughout the year. |
10mcg is equivalent to 400IU. Use products suitable for the child's age, follow the label and check for vitamin D already present in other supplements. A pharmacist or health visitor can help you choose.3
Food and safe time outdoors
Include calcium-rich foods such as milk, yoghurt and cheese, or suitable calcium-fortified alternatives. Check labels when choosing dairy alternatives. Oily fish, eggs and fortified foods can contribute vitamin D.
Summer sunlight also helps the body make vitamin D. Protect skin from burning and avoid relying on a fixed number of minutes in the sun, because skin type, weather and other factors vary. Young children should still have their recommended vitamin drops even when they spend time outdoors.3
You can also browse our vitamin D range. For a child, check age suitability and ask a pharmacist or health visitor about the appropriate supplement.
Rickets FAQs
Which vitamin deficiency causes rickets?
Vitamin D deficiency is a common cause. Too little calcium can also contribute, and rare genetic forms have different causes. A GP can assess which applies.
Can adults get rickets?
Rickets affects growing bones in children. Adults can develop a related condition called osteomalacia, which may cause bone pain and muscle weakness.
Can rickets be cured?
Nutritional rickets can often be treated successfully with clinician-directed vitamin D and calcium. Recovery and any further treatment depend on the cause and extent of bone changes.
Is rickets hereditary?
Most nutritional rickets is linked to vitamin D or calcium deficiency rather than inheritance. Rare inherited forms do exist and need specialist assessment.
What are the first signs of rickets?
There is no single first sign for every child. Bone pain, bowed legs, poor growth, muscle weakness or delayed teeth can raise concern, but a GP needs to assess the symptoms.
Does sunlight prevent rickets?
Sunlight helps the skin make vitamin D, but it does not replace a child’s recommended supplements or an adequate calcium intake. Protect the skin from burning.
How much vitamin D does a child need to help prevent rickets?
For routine prevention, breastfed babies under 1 need 8.5–10mcg daily; children aged 1–4 need 10mcg daily. Formula intake affects whether babies need supplements. Treatment of diagnosed rickets follows a clinician’s instructions.
