Rickets in children
Impaired mineralisation of growing bone in children. The main cause is vitamin D deficiency combined with insufficient dietary calcium. Presents with lower-limb deformity, craniotabes, and epiphyseal widening.
ICD-10 E55.02 drugs
Also known as: Nutritional rickets, Vitamin D-deficient rickets
Drugs used for this condition
- ACholecalciferolFirst line · Vitamins. Regulator of calcium-phosphorus metabolismCornerstone treatment and prevention of rickets in children. Prophylactic dose for term newborns is 400 IU daily from the first days of life, 800–1,000 IU daily for preterm infants. Therapeutic dose for established rickets is 2,000–5,000 IU daily for 30–45 days followed by prophylactic dosing. Efficacy is supported by decades of paediatric practice and is reflected in the AAP and Russian Paediatric Society guidelines.
- BCod liver oilAdd-on therapy · Cod liver oil: EPA and DHA combined with retinol (vitamin A) and cholecalciferol (vitamin D3); registered as a medicine in SpainCod liver oil received historical registration as a rickets-prophylaxis product in children in the early twentieth century when vitamin D deficiency and lack of sun exposure were widespread. AEMPS in Spain still registers Aceite de Higado de Bacalao as a medicine for prevention of vitamin A and D deficiency in children with insufficient dietary intake. Modern paediatrics (AAP 2008/2010, AEP, Endocrine Society 2024, Spanish SEEN 2024) recommends pure cholecalciferol (vitamin D3) 400 IU/day from the first days of life on breastfeeding for rickets prevention; these preparations carry no retinol load. Cod liver oil remains a workable option but is not first line. In schoolchildren and adolescents D3 drops or tablets are also preferred. If cod liver oil was prescribed for rickets prevention, check the vitamin D dose against the 400–600 IU/day requirement; excess retinol is undesirable.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit