Dear Shay

Dear Shay,
      My I recently took my two year old child to the park for a birthday party, I have not noticed until now that she is much smaller than the other children her age. She also seemed to tire out much faster than the other kids on the playground. I had to take her home before the cake and ice cream because she was so exhausted.
      I have noticed since she could stand that her knees never fully came together suggesting that she was bow legged, but I dismissed the notion that anything was wrong because my father too is bow legged. In the recent months however her wrist has been swollen because her baby bracelet won't fit anymore and she has been complaining about back pain. I figured this was just part of her growing until the incident at the park. I think something might be wrong, but I am not for sure. Is this just part of her  growing or should I be concerned?

Sincerely,
Overly Concerned Parent

Dear Overly Concerned Parent,

     Through my experience with bone disease it sounds to me like your child might have a disease called rickets.  Rickets is the softening and weakening of bones due to a vitamin D deficiency. Some common symptoms of this disease include delayed growth,  pain in the spine,  and muscle weakness. This would explain why your child appeared so much smaller than the other children. Also it explains the tiredness she was feeling along with why her back hurts. Since the disease softens the growth plates, rickets can also cause bowed legs and swollen ankles or wrists, this could be the reason for those also. The deficiency of vitamin D causing this could be from lack of sunlight or not getting enough in her diet. Foods with lots of vitamin D include fatty fish, egg yolks, milk, cereal and some fruit juices like orange juice. Certain diseases also make it difficult to absorb vitamin D like Celiacs Disease, Cystic Fibrosis, and Inflammatory bowel disease. There are also different risk factors for developing this disease and one of them is the child being between 6 and 24 months of age, because of rapid bone growth during this period. Pre-mature births and anti-seizure medication could also put a child at risk. Sounds to me like you should get your child to a doctor to discuss the disease more and come up with a plan of action for treating it!

Sincerely,
Shay