Rachitis (English disease) - symptoms, causes, therapies

Rachitis (English disease) - symptoms, causes, therapies

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Rickets and osteomalacia

In rickets, also known as English disease, the mineralization of the child's skeleton is disturbed due to a vitamin D deficiency. If this deficiency occurs in adulthood, it is called osteomalacia. Although both diseases are based on the same cause, their symptoms and consequences differ from one another. This article primarily explains the symptoms, causes, therapies and naturopathy in rickets. Here is a brief summary:

  • Terminology: If the disease occurs in childhood, it is called rickets. In adults, the clinical picture is called osteomalacia.
  • definition: Rachitis is a disease in which a lack of vitamin D availability affects bone structure and bone strength. As a result, demineralization takes place and the bones become soft.
  • Symptoms: Changes in the bones such as the rachitic rosary, bell thorax, scoliosis or bow legs can indicate rickets. General conditions such as restlessness, fearfulness, cramps and sleep disorders are also possible signs.
  • causes: Rickets can be the result of prolonged vitamin D deficiency. This deficiency is rarely a result of poor nutrition. Diseases or inflammation of the intestine, liver or kidneys are often the triggers. Celiac disease (gluten allergy), cystic fibrosis or certain medications can also cause rickets.
  • therapy: Vitamin D supplements, a causal treatment of the underlying disease, orthopedic treatments and regular stays outdoors are used as treatment options.

Symptoms of rickets

The lack of vitamin D usually manifests itself in children in the first two years of life due to rickets. The growth of the skeleton is disturbed. A specific symptom for this is the rachitic rosary. This is a clearly visible swelling of the bone-cartilage border in the chest area, which resembles a rosary. It arises from the lack of vitamin D, whereby the non-calcified overproduction of bone substance becomes visible.

Bell's chest, scoliosis, bow legs

Another symptom is the so-called bell thorax. This is a wide chest in the lower part, which occurs in connection with a lack of abdominal muscles, which is called frog belly in children with rickets. Deformations on the spine (such as scoliosis) and on the lower limbs, in the form of bow legs, also belong to the clinical picture of rickets.

Other symptoms

General symptoms of rickets include:

  • Restlessness,
  • Frightfulness
  • Hyperhidrosis (excessive sweating),
  • Sleep disorders,
  • Cramps,
  • disturbed tooth eruption,
  • itchy rash.

Causes of rickets

Rachitis is the result of the lack of vitamin D availability. In contrast to the past, causes such as a lack of light or insufficient nutrition are rarely responsible for rickets, especially due to the extensive vitamin D prophylaxis in infants in the first year of life. However, if toddlers are kept too far from the sun or there are illnesses in which the absorption of the vitamin from the intestine is disturbed, rickets can also develop.

Diseases that can cause rickets

Examples include ulcerative colitis (inflammatory bowel disease), celiac disease (gluten-induced enteropathy in children) and chronic inflammation of the colon. Kidney and liver diseases can also be responsible for this. Children who need to take certain antiepileptic drugs are also at risk because these drugs can interfere with vitamin D synthesis in the liver.

How does the body get vitamin D?

The so-called calciferols, a group of vitamin D substances, are actually not hormones, but vitamins. The vitamin D does not have to be supplied to the body, but can be produced from preliminary stages itself. These are located in the skin and are derived from cholesterol. A certain amount of sunlight is required to produce the vitamin D hormone, although it can also be absorbed through the digestive tract through the consumption of liver, egg yolk, fish and milk. The quantities that can be absorbed in this way are not sufficient for the need.

Without vitamin D, bone strength suffers

Calcium absorption via the intestine is promoted by vitamin D, regulates the calcium and phosphate balance and ensures that calcium and phosphate are stored in the bones. If this is not the case, demineralization occurs and the bones become soft, as is the case with rickets. The result is bone softening in adults as well, which is not called rickets but osteomalacia.

Vitamin D2 and D3

The main vitamin D compounds are vitamin D2 (ergocalciferol), which occurs in plants, and vitamin D3 (cholecalciferol), which is of animal origin. A healthy body is not dependent on the supply of these substances through food. Daily sunlight on the face and hands provides eighty to ninety percent of the vitamin D for the organism.

Ten minutes of sun a day are enough

Ten minutes of intense sun are enough every day. However, people who rarely or not come outdoors may need an intake of vitamin D.

Vitamin D in foods

The intake of vitamin D through food is far from sufficient. The body cannot produce enough vitamin D without UVB rays. Healthy people should not take vitamin D via dietary supplements because many vitamin D pills pose health risks. Vitamin D is a natural component of the following foods:

  • Fatty fish such as mackerel or eel,
  • Cod liver oil,
  • Egg yolk,
  • Dairy products,
  • Dandelion,
  • Watercress,
  • Nettles.


To diagnose rickets, the blood is first examined. Vitamin D3 is below the norm here and alkaline phosphatase, an enzyme involved in bone metabolism, is increased in rickets. Calcium and phosphate in the blood are pathologically changed. This disease can be diagnosed early on the x-ray by blurred bone structures and widened ends of the forearm bones.

Treatment of rickets

Treatment depends on the cause. Substitution with vitamin D is usually the first priority so that mineralization of the bones can normalize. If the vitamin D deficiency is based on diseases in the intestine, liver or kidney, these are treated as a cause. Regular exposure to the sun is recommended.

Vitamin D prophylaxis

Infants usually receive suitable vitamin D prophylaxis for at least one year from the second week of life, in any case the first two winters of life. In toddlers, the supply of vitamin D is guaranteed by spending two hours a week outdoors, with the face, arms and hands exposed to the sun. Proper nutrition is also important so that the body is adequately cared for. Orthopedic treatments are necessary if rickets have already caused curvature of the bones.

Homeopathy for rickets

In addition to the substitution with vitamin D, healthy nutrition and possible treatment of the underlying disease, classic homeopathy can also support the healing process. Experienced therapists offer the necessary support when choosing the appropriate means. The following means are often used:

  • Calcium carbonicum: A remedy that is given to fair-skinned, mostly overweight children.
  • Calcium phosphoricum: Is given to dark-haired, slim, quickly grown children.
  • phosphorus: Used for slim, tall and very frightened people.
  • Silicea: Is used for children who are tender, sensitive, shy, compliant, indecisive or very sensitive to the cold.

Sun as medicine

For years there has been a massive argument against staying in the sun. Many people are therefore unaware of the benefits of sunlight. Everyone knows that excessive sunbathing is harmful to your health and can lead to skin cancer. However, avoiding the sun completely is also not good for your health. Not only does the soul need the beneficial light from the sun, but above all the body needs the UVB rays so that the vital vitamin D can be produced. The sun is the only free way to prevent rickets and other vitamin D deficiency diseases.

About vitamin D.

The term vitamin is not quite correct in this context, since the body can largely produce this substance itself and is not dependent on food. Vitamin D, although it is always called this, is more like a hormone in the body and actually consists of several compounds. As such, this substance only has an effect when it is converted into its biologically active form. This process takes place in several steps in the skin, liver and kidneys.

Sunlight as an activator

The UVB rays that hit the skin are important for the formation of vitamin D. Previtamin D3 is produced from sunlight by a provitamin formed in the liver from cholesterol. Colecalciferol D3 develops from this in the liver cells. The kidney then produces the biologically active form of calcitriol, which is released into the blood.

Bone strength

The described process mainly stimulates calcium absorption from the large intestine and regulates the calcium metabolism of the bones, which is necessary for bone strength. Research has shown that vitamin D can also be produced in other organs and tissues in the body, but is only involved in various local cell functions there. This relatively new knowledge makes it clear that the vitamin D deficiency can have far more than just an effect on bone metabolism.

Most of the vitamin D is produced by the body

The majority of the necessary vitamin D is produced by the body itself through exposure to the sun, the rest, around ten to twenty percent, has to be obtained from food. In the past, people only knew fatty fish and especially cod liver oil as a vitamin D donor in order to counteract rickets. However, other foods are also quite suitable.

Historical review of rickets

Rachitis was particularly common in the 19th century. The age of industrialization meant that children no longer played on meadows and in the open air, but rather stayed in the streets, in narrow, dark alleys, where barely a sunbeam could penetrate and the air was polluted by exhaust fumes. This smog literally covered the cities. Most children at the time also suffered from malnutrition. The combination of both led to the development of rickets and their widespread spread. (sw, vb)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Susanne Waschke, Barbara Schindewolf-Lensch


  • Merck & Co., Inc .: Hypophosphatemic rickets (accessed: July 17, 2019), msdmanuals.com
  • German Nutrition Society V .: Selected questions and answers on vitamin D (accessed: July 17, 2019), dge.de
  • Walter de Gruyter GmbH: Pschyrembel online: rickets (accessed: 07/17/2019), pschyrembel.de
  • German Society for Pediatric Endocrinology and Diabetes (DGKED): S1 guideline for vitamin D deficiency rickets, as of March 2016, detailed view of guidelines
  • Amboss GmbH: Osteomalacia and rickets (accessed: July 17, 2019), amboss.com
  • National Health Service UK: Overview - Rickets and osteomalacia (accessed: 07/17/2019), nhs.uk
  • Mayo Clinic: Rickets (access: July 17, 2019), mayoclinic.org
  • National Organization for Rare Disorders, Inc .: Rickets, Vitamin D Deficiency (accessed: July 17, 2019), rarediseases.org
  • American Academy of Family Physicians: Rickets (access: July 17, 2019), familydoctor.org

ICD codes for this disease: E55, E64, E83, N25ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.

Video: Rickets in Children - Causes, Symptoms and Treatment (September 2022).


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