Subject archives guide - Rickets

Our subject archive guides on a range of child health topics are for researchers interested in child health and the history of paediatrics. This guide is on rickets, a condition that affects bone development.
Last modified
12 September 2019

Definition

Rickets is a condition that affects bone development in children. It causes the bones to become soft and malformed, which can lead to bone deformities. Rickets in adults is known as osteomalacia or soft bones.

Rickets involves demineralization or loss of minerals in developing bones in infants and young children before skeletal maturity. In rickets the lack of rigidity caused by demineralization of developing bones results in gross skeletal changes including a classic “bowing of the legs” symptom.1

The most common cause of rickets is a lack of vitamin D and calcium. Vitamin D is essential for a child to form strong and healthy bones.

In rare cases, children can be born with a genetic form of rickets. It can also develop if another condition affects how vitamins and minerals are absorbed by the body.

History of the condition

Evidence of individuals with rickets can be found for as far back as Roman times and in the 1640s, the condition was well documented as a common bone ailment across England. Rickets was also common during Victorian times. The scientifically proven cause of rickets was not identified until the 1920s, and in the 1930s and 1940s, public-health initiatives recommended fortifying food with vitamin D and cod-liver oil as a nutritional supplement for young infants and children. This led to near eradication in Western countries.2

There has been a reported increase in cases of rickets in the UK in recent years. Children from Asian, African Caribbean and Middle Eastern origin are at higher risk because their skin is darker and they need more sunlight to get enough vitamin D. Other risk groups include children who were born prematurely and those on certain medicines that interfere with vitamin D.3

Relevant records held at the RCPCH

  • Questionnaire (1943)
    Reference - RCPCH/004/002/117A completed questionnaire on rickets in children between three and eighteen months to be filled in by the paediatrician in charge, for each child who is X-rayed. The questionnaire covers method of feeding, whether cod liver oil and/or vitamin D was taken, other prophylaxis and clinical evidence of rickets.
  • Survey of rickets during wartime (1943-1944)
    Reference - RCPCH/013/001/005This record provides a list of doctors practicing in the UK and also some correspondence relating to research being carried out on children with rickets.
  • Memorandum on rickets (1945)
    Reference - RCPCH/007/054This memorandum discusses the etiology, the diagnosis and the treatment of rickets. It was prepared by the British Paediatric Association and was published by the Ministry of Health.
  • Report of the Hypercalcaemia Sub-committee (1955)
    Reference - RCPCH/004/006/066Report of a sub-committee set up to consider the incidence of hypercalcaemia in infants and their intake of vitamin D. Includes recommendations to prevent excess intake of vitamin D.
  • Hypercalcaemia in Infants and Vitamin D (1956)
    Reference - RCPCH/004/006/086Report of a sub-committee set up to consider the incidence of hypercalcaemia in infants and their intake of vitamin D. Includes recommendations to prevent excess intake of vitamin D.
  • Report on a Hypercalcaemia and Rickets survey (1961)
    Reference - RCPCH/004/007/077Report by the BPA from a survey conducted throughout 1959.
  • Report from the Subcommittee on Hypercalcaemia, Rickets and Scurvy (1963)
    Reference - RCPCH/004/007/126Includes results of a survey of incidences of these diseases, as well as the research conclusions.
  • Observations on the methodology of the hypercalcaemia, rickets and scurvy surveys undertaken by the BPA (1963)
    Reference - RCPCH/004/007/127Includes observations on methodology and scope for improvement.
  • Report from the Subcommittee on Hypercalcaemia, Rickets and Scurvy (1963)
    Reference - RCPCH/004/008/005Includes results of a survey of incidences of these diseases, as well as the research conclusions.
  • Infantile Hypercalcaemia, Nutritional rickets and infantile scurvy in Great Britain (1964)
    Reference - RCPCH/004/008/006Reference This record discusses and investigates the prevalence of infantile hypercalcemia, nutritional rickets and infantile scurvy and its relationship to vitamin D intake. A discussion and summary of the results are provided. (1964)