Overview

Nutritional rickets, a disease caused by vitamin D, calcium, or phosphate deficiency, is making a troubling comeback among refugee and low-income populations, especially children. Once largely controlled in developed nations, rickets is now re-emerging due to poor diet, limited sun exposure, cultural clothing practices, and food insecurity—highlighting growing global disparities in child nutrition and public health.

What Is Nutritional Rickets?

Rickets is a condition where bones become soft, weak, and deformed due to impaired bone mineralization. It most commonly affects infants and young children during periods of rapid growth.

Causes of Nutritional Rickets

1. Vitamin D Deficiency: Due to inadequate sun exposure, especially in colder climates, overcrowded shelters, or cultural norms that limit skin exposure.
2. Calcium and Phosphorus Deficiency: Common in diets lacking dairy products or fortified foods.
3. Malabsorption Disorders: Conditions like celiac disease or chronic diarrhea that impair nutrient uptake.
4. Exclusive Breastfeeding Without Supplementation: In areas where mothers themselves are vitamin D deficient.

Populations at High Risk

• Refugees and displaced persons living in camps with poor diet and minimal sunlight
• Urban poor in overcrowded housing with limited outdoor access
• Children with dark skin living in high-latitude countries (less vitamin D synthesis)
• Women and children in communities where cultural clothing limits sun exposure

Signs and Symptoms

• Delayed growth or failure to thrive
• Bowed legs or knock knees
• Swollen wrists, ankles, and rib cage (“rachitic rosary”)
• Muscle weakness or pain
• Dental problems or delayed tooth eruption
• Increased risk of fractures

Diagnosis

• Blood tests: Low levels of vitamin D, calcium, or phosphate; elevated alkaline phosphatase
• X-rays: Show bone deformities and poor mineralization
• Dietary and sun exposure history: Critical for assessing root causes

Prevention and Management

• Vitamin D supplementation: Especially in breastfed infants, pregnant women, and high-risk groups
• Nutritional support: Fortified foods and calcium-rich diets for growing children
• Safe sun exposure: Encouraged for 10–30 minutes daily, depending on skin tone and geography
• Public health programs: Targeted screenings in refugee camps, shelters, and underserved communities
• Food policy measures: Mandating vitamin D fortification in staple foods like milk, flour, or oil

Global Health Context

The resurgence of rickets reflects broader nutritional inequality and displacement crises. It serves as a warning sign of deeper systemic failures in refugee care, maternal health, and urban food policy. Rickets is entirely preventable and treatable, yet it continues to affect the world’s most vulnerable.