What Is Rickets? A Plain-Language Guide to Soft, Weak Bones in Children
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 17, 2026
Quick Answer
Rickets is the softening and weakening of bones in children, usually from an extreme and prolonged vitamin D or calcium deficiency. [1] Signs include delayed growth, bone pain, muscle weakness and bowed legs. [1] Exclusively breastfed babies and children with darker skin are among those at higher risk. [1] Most cases respond to vitamin D and calcium supplements. [2]
What the research says
Daily vitamin D drops raise vitamin D levels in breastfed babies, but proof of rickets prevention is still thin. A Cochrane review of 19 studies with 2,837 mother-infant pairs found that 400 IU a day in breastfed infants may raise 25-OH vitamin D levels (mean difference 22.63 nmol/L, 95% CI 17.05 to 28.21; 334 infants) and may reduce vitamin D insufficiency (risk ratio 0.57, 95% CI 0.41 to 0.80; 274 infants), but there was insufficient evidence on rickets itself; the certainty of the evidence was low to very low. (Tan et al., Cochrane Database Syst Rev, 2020) [6]
Rickets has more than one cause around the world. A systematic review found that calcium deficiency remains a major cause of rickets in Africa and Asia, while vitamin D deficiency rickets is perhaps increasing in the Americas, Europe, and parts of the Middle East; the problem sits on a spectrum from isolated vitamin D deficiency to isolated calcium deficiency. (Creo et al., Paediatr Int Child Health, 2017) [7]
Extra vitamin D is not a bone-building shortcut for healthy children. An individual participant data meta-analysis of 11 randomized trials (1,439 participants in the nine trials that shared individual data) found only a small effect of one year of vitamin D on total hip bone density (6.8 mg/cm², 95% CI 0.7 to 12.9) and no effect on other outcomes. The authors concluded that clinically important bone benefits in healthy children are unlikely, and that the findings do not apply to children with symptomatic deficiency such as rickets. (Wu et al., Am J Clin Nutr, 2023) [8]
What Is Rickets, in Plain Language?
Rickets is the softening and weakening of bones in children, often because of an extreme and prolonged vitamin D or calcium deficiency. [1] Rare inherited problems also can cause rickets. [1]
Vitamin D plays a key supporting role: it helps a child's body absorb calcium and phosphorus from food. Not enough vitamin D makes it hard to maintain proper calcium and phosphorus levels in bones, which can cause rickets. [1]
The encouraging news: adding vitamin D or calcium to the diet generally corrects the bone problems associated with rickets. [1] When rickets is due to another underlying medical problem, the child may need additional medicines or other treatment. [1] Some skeletal deformities caused by rickets may require corrective surgery. [1]
Rare inherited disorders related to low levels of phosphorus — the other mineral component in bone — may require other medicines. [1] [5]
What Are the Signs and Symptoms?
Rickets can cause a range of symptoms, including skeletal deformities, though signs may be harder to identify in infants.
What Does Rickets Look Like in Infants?
In infants, symptoms of rickets may be harder to identify because bone and muscle complaints often are not detected until a child starts to walk. [1] Symptoms in infants caused by low blood calcium levels may include tight muscle tone and breathing sounds that are not regular. [1]
Why Does Rickets Cause Skeletal Deformities?
Rickets softens the areas of growing tissue at the ends of a child's bones. These areas are known as growth plates. [1] Because of this softening, rickets can cause skeletal deformities such as:
When Should You See a Doctor?
Talk to your healthcare professional if your child develops bone pain, muscle weakness, or obvious skeletal deformities. [1] If you are concerned your infant isn't getting enough vitamin D — especially if they have risk factors for vitamin D deficiency such as darker skin pigmentation or exclusive breastfeeding — talk to your healthcare professional. [1]
What Causes Rickets?
A child's body needs vitamin D to absorb calcium and phosphorus from food. Rickets can occur if the body doesn't get enough vitamin D or has problems using vitamin D properly. [1] Occasionally, not getting enough calcium — or a lack of both calcium and vitamin D — can cause rickets. [1]
Where Should Children Get Vitamin D?
Children who don't get enough vitamin D from these two sources can develop a deficiency:
Source | How it works — and how children can fall short |
Sunlight | A child's skin produces vitamin D when exposed to sunlight. But children in developed countries tend to spend less time outdoors. They also are more likely to use sunscreen, which blocks the sun's rays that trigger the skin's production of vitamin D. [1] |
Food | Fish oil, egg yolks, and fatty fish such as salmon and mackerel contain vitamin D. Vitamin D also has been added to some foods and beverages, such as milk, cereal, and some fruit juices. [1] |
What About Vitamin D Absorption Problems?
Some children are born with or develop medical problems that affect the way their bodies absorb vitamin D. Examples include celiac disease, inflammatory bowel disease, cystic fibrosis, and kidney problems. [1] [3]
What Raises the Risk?
A number of different factors can increase a child's risk of developing rickets.
Risk factor | Details |
Darker skin pigmentation | |
Mother's vitamin D deficiency during pregnancy | A baby born to a mother with serious vitamin D deficiency can be born with symptoms of rickets or develop them within a few months after birth. [1] |
Northern latitudes | Children who live where there is less sunshine are at higher risk. [1] |
Premature birth | Babies born before their due dates tend to have lower levels of vitamin D because they had less time to receive the vitamin from their mothers in the womb. [1] |
Medicines | Certain anti-seizure medicines and antiretroviral medicines (used to treat HIV infections) appear to interfere with the body's ability to use vitamin D. [1] |
Exclusive breastfeeding |
What Complications Can Occur?
If not treated, rickets can lead to failure to grow, bone deformities, dental defects, and seizures. [1] [3]
Can Rickets Be Prevented?
Yes, and prevention starts with the best source of vitamin D: sunlight. During most seasons, 10 to 15 minutes of exposure to the sun near midday is enough. [1] But if your child has brown or Black skin, if it's winter, or if you live in northern latitudes, you might not be able to get enough vitamin D from sun exposure alone. [1] There's also an important balance: because of skin cancer concerns, infants and young children especially are warned to avoid direct sun or to wear sunscreen and protective clothing. [1]
Foods That Help
To prevent rickets, make sure your child eats foods that contain vitamin D naturally — fatty fish such as salmon and tuna, fish oil, and egg yolks — or that have been fortified with vitamin D, such as infant formula, cereal, bread, milk, and orange juice. [1] One caveat: fortified vitamin D applies to milk, but not foods made from milk, such as some yogurts and cheese. [1] Check labels to determine the vitamin D content of fortified foods.
What About Pregnancy and Infancy?
If you're pregnant, ask your healthcare professional about taking vitamin D supplements. [1]
Guidelines recommend that all infants should receive 400 international units (IU) a day of vitamin D. [1] [4] Because human milk contains only a small amount of vitamin D, infants who are exclusively breastfed should receive supplemental vitamin D daily. [1] [4] Some bottle-fed infants also may need vitamin D supplements if they aren't receiving enough from their formula. [1]
How Is Rickets Diagnosed?
Rickets is diagnosed with a physical exam of the bones, and X-rays plus blood and urine tests can reveal deformities and confirm the diagnosis. They may pay specific attention to four areas:
Body area | What the doctor checks |
Skull | Babies with rickets often have softer skull bones and might have a delay in the closure of the soft spots, called fontanels. [2] |
Legs | Even healthy toddlers are a little bowlegged, but an exaggerated bowing of the legs is common with rickets. [2] |
Chest | Some children develop changes in their rib cages, which can flatten and cause the breastbone to protrude. [2] |
Wrists and ankles | Children with rickets often have larger or thicker wrists and ankles. [2] |
Diagnosing rickets in babies can be challenging. Bone and muscle changes often are not detected until a child starts to walk. [2] The professional likely will pay attention to whether the baby is growing well, has regular breathing sounds, and has typical muscle tone. [2]
For children of all ages, X-rays of the affected bones can reveal bone deformities. [2] Blood and urine tests can confirm a diagnosis of rickets and also monitor the progress of treatment. [2]
How Is Rickets Treated?
Most cases of rickets can be treated with vitamin D and calcium supplements. Follow the directions as to dosage — too much vitamin D can be harmful. [2] [3]
The healthcare team may check progress with X-rays and blood tests. [2]
If your child has a rare inherited disorder that causes low amounts of phosphorus, supplements and medicines may be prescribed. [2]
For some cases of bowleg or spinal deformities, the healthcare professional might suggest special bracing to position the child's body properly as the bones grow. More-serious skeletal deformities might require surgery. [2]
How Should You Prepare for Your Appointment?
You'll likely start by seeing your primary care professional or a pediatrician. Depending on the cause of your child's symptoms, you might be referred to a specialist. [2]
Before the appointment, make a list of your child's symptoms, including any that might not seem related to the reason for the visit, and note when they started. Include key personal information: medicines and supplements your child takes, and whether anyone in your immediate family has had similar symptoms. Also gather information about your child's diet, including the food and drinks they usually consume.
What Questions Will Your Doctor Ask?
Doctor's question | Why it matters |
Is your baby getting vitamin D supplements? | Supplements are the standard defense against deficiency in infants. |
How often does your child play outdoors? | Sunlight on skin produces vitamin D. |
Does your child wear sunscreen? | Sunscreen blocks the sun's rays that trigger vitamin D production. |
At what age did your child start walking? | Delayed walking can signal bone and muscle problems. |
Has your child had much tooth decay? | Dental defects are a possible complication of rickets. |
What is the bottom line on rickets?
Rickets is a condition of soft, weak bones that is both preventable and — in most cases — highly treatable. It begins quietly, with too little vitamin D or calcium over too long a period, and its signs can be easy to miss: delayed growth, bone pain, muscle weakness, bowed legs, thickened wrists and ankles. The diagnosis is straightforward once a professional looks for it — a hands-on bone exam, X-rays, and blood and urine tests. The treatment is usually simple: vitamin D and calcium supplements taken as directed, with X-rays and blood tests to track progress. For the rare inherited form involving low phosphorus, or for more serious deformities, medicines, bracing, or surgery may be needed. The prevention message could hardly be simpler: give infants their daily 400 IU of vitamin D, feed children vitamin D-rich and fortified foods, and allow sensible sun exposure.
Take the Next Step
Concerned your child has bone pain, muscle weakness, bowed legs, or delayed growth? Talk to your pediatrician — especially if your baby is exclusively breastfed or has darker skin. Early treatment with vitamin D and calcium can help your child's bones grow back strong.
Frequently Asked Questions
What is rickets?
Rickets is the softening and weakening of bones in children, most often because of an extreme and prolonged vitamin D or calcium deficiency. Rare inherited problems also can cause it.
What causes rickets?
Vitamin D helps a child's body absorb calcium and phosphorus from food. Not enough vitamin D makes it hard to maintain proper calcium and phosphorus levels in bones, which can cause rickets. It can also occur if a child's body doesn't get enough vitamin D or has problems using it properly, or — occasionally — from insufficient calcium alone. Medical conditions such as celiac disease, inflammatory bowel disease, cystic fibrosis, and kidney problems can also interfere with vitamin D absorption.
What are the symptoms?
Delayed growth, delayed motor skills, pain in the spine, pelvis, and legs, and muscle weakness. Because rickets softens the growth plates (the growing tissue at the ends of a child's bones), it can also cause bowed legs or knock-knees, thickened wrists and ankles, and breastbone projection.
Is rickets hard to spot in babies?
Yes — in infants, symptoms can be harder to identify because bone and muscle complaints often aren't detected until a child starts to walk. In infants with low blood calcium, rickets may show up as tight muscle tone and irregular breathing sounds.
Who is most at risk?
Infants who are exclusively breastfed (breast milk doesn't contain enough vitamin D to prevent rickets), children with darker skin pigmentation, babies born to mothers with serious vitamin D deficiency during pregnancy, children in northern latitudes with less sunshine, premature babies, and children taking certain anti-seizure or antiretroviral medicines.
How is rickets diagnosed?
The doctor gently presses on the child's bones, checking for irregularities in the skull (softer bones, delayed closure of fontanels), legs (exaggerated bowing), chest (rib cage changes), and wrists and ankles (thickening). X-rays of affected bones can reveal deformities, and blood and urine tests confirm the diagnosis and monitor treatment progress.
How is it treated?
Most cases are treated with vitamin D and calcium supplements, taken as directed — too much vitamin D can be harmful. Progress is checked with X-rays and blood tests. Rare inherited disorders causing low phosphorus may need other supplements and medicines, and serious skeletal deformities might require bracing or surgery.
Can rickets be prevented?
Yes. Guidelines recommend that all infants receive 400 IU of vitamin D a day — exclusively breastfed babies should get supplemental vitamin D daily. Children should eat vitamin D-rich foods (fatty fish, fish oil, egg yolks) and vitamin D-fortified foods (infant formula, cereal, bread, milk, orange juice). About 10 to 15 minutes of midday sun exposure in most seasons also helps, balanced against skin cancer concerns for infants and young children.
Can rickets be cured?
Most cases improve with vitamin D and calcium supplements, and bones often get stronger and straighter as a child grows. Some children with severe bone changes may need bracing or surgery.
Can too much vitamin D be harmful?
Yes. Too much vitamin D can be harmful, so give supplements only in the dose your child's provider recommends. Ask before giving extra doses or more than one product with vitamin D.
Related Reading
References
Mayo Clinic Staff. Rickets: Symptoms and causes. Mayo Clinic. Reviewed March 7, 2025. Accessed October 14, 2026. https://www.mayoclinic.org/diseases-conditions/rickets/symptoms-causes/syc-20351943
Mayo Clinic Staff. Rickets: Diagnosis and treatment. Mayo Clinic. Reviewed March 7, 2025. Accessed October 14, 2026. https://www.mayoclinic.org/diseases-conditions/rickets/diagnosis-treatment/drc-20351949
National Institutes of Health, Office of Dietary Supplements. Vitamin D — Health Professional Fact Sheet. NIH Office of Dietary Supplements. Accessed October 14, 2026. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/
Centers for Disease Control and Prevention. Vitamin D and breastfeeding. CDC. Accessed October 14, 2026. https://www.cdc.gov/breastfeeding-special-circumstances/hcp/diet-micronutrients/vitamin-d.html
Genetic and Rare Diseases Information Center. Familial X-linked hypophosphatemic vitamin D refractory rickets. GARD, National Institutes of Health. Accessed October 14, 2026. https://rarediseases.info.nih.gov/diseases/12943/familial-x-linked-hypophosphatemic-vitamin-d-refractory-rickets
Tan ML, Abrams SA, Osborn DA. Vitamin D supplementation for term breastfed infants to prevent vitamin D deficiency and improve bone health. Cochrane Database Syst Rev. 2020;12(12):CD013046. PMID: 33305822. https://doi.org/10.1002/14651858.CD013046.pub2
Creo AL, Thacher TD, Pettifor JM, et al. Nutritional rickets around the world: an update. Paediatr Int Child Health. 2017;37(2):84-98. PMID: 27922335. https://doi.org/10.1080/20469047.2016.1248170
Wu F, El-Hajj Fuleihan G, Cai G, et al. Vitamin D supplementation for improving bone density in vitamin D-deficient children and adolescents: systematic review and individual participant data meta-analysis of randomized controlled trials. Am J Clin Nutr. 2023;118(3):498-506. PMID: 37661104. https://doi.org/10.1016/j.ajcnut.2023.05.028
Disclaimer: This guide is for general information only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions about a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read here.
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