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Two-year-old Dhairya lived in a flat. Both parents worked, he spent the whole day at home with a nanny and almost never went outside. He started walking late, his legs looked bowed outward at the knees, his wrists were thick, his head sweated at night, his teeth came late and he was irritable. Grandmother said, “A baby’s legs are always bent, they will straighten as he grows.” The pediatrician examined him and ordered a wrist X-ray and blood tests: vitamin D very low, alkaline phosphatase high, nutritional rickets. With the doctor’s vitamin D and calcium treatment, 20 minutes of play in the morning sun every day, milk, curd, ragi and sesame, and Ayurvedic oil massage, Dhairya was running within six months and his legs began to straighten.
Rickets is a bone development condition in growing children in which calcium and phosphorus are not deposited properly in bone (mineralization), so the bones, especially the growing ends (growth plates), become soft, weak and bent. The most common cause is vitamin D deficiency, made worse when combined with low calcium intake. It is seen mostly in children aged 6 months to 3 years, and during the rapid growth of adolescence. In adults the same condition is called osteomalacia. In Ayurveda it is understood together with asthi dhatu kshaya, bala shosha and phakka roga described in the Kashyapa Samhita, in which the child is unable to walk, the legs are weak and the body is emaciated; at the root lie agnimandya, weakness of the dhatu nourishment chain from rasa to asthi, and vata (asthi is the seat of vata).
Key Takeaways
- Rickets: soft, bent bones in children from vitamin D or calcium deficiency.
- Common even in sunny India: indoor living, screens, covered bodies.
- Early treatment usually gives complete recovery; vitamin D only in the doctor’s dose.
- Ayurveda: agni deepana, asthi dhatu nourishment, traditional calcium sources like praval and mukta shukti, abhyanga and sunlight-play, along with the doctor’s vitamin D treatment, strengthen bones quickly and prevent the deficiency from returning.
Symptoms
Bone related
- Bowed legs, knees outward (bow legs) or inward (knock knees), in walking children
- Thick wrists and ankles
- Bead-like bumps on the ribs (“rachitic rosary”)
- Late closure of the soft spot on the head (fontanelle), soft skull, prominent forehead
- Change in chest shape
- Curved spine
- Bone pain, fractures with minor injury
- Short stature
Others
- Delayed sitting, standing and walking
- Late teeth, tooth decay, weak enamel
- Weak muscles, loose protruding belly
- Irritability, heavy sweating of the head at night
- Frequent chest infections
- In severe calcium deficiency, muscle cramps, seizures (fits), an emergency
“Bowed legs”: when are they normal?
In young children, slightly outward bowed legs (bow legs) up to 2 years, and slightly inward knees (knock knees) at 3–5 years, are part of natural development and straighten by 7–8 years. When to worry: if the bowing is marked, on one side only, increasing instead of decreasing with age, or comes with short stature, thick wrists or other signs of rickets, an evaluation is needed.
Causes
Modern view
- Lack of sunlight, the skin makes vitamin D from sunlight (UVB); flats, indoor living, screens, city pollution, fully covered body, sunscreen
- Darker skin, needs more sunlight to make vitamin D
- Exclusive breastfeeding without supplemental vitamin D, breast milk is low in vitamin D; especially if the mother is also deficient
- Maternal vitamin D or calcium deficiency in pregnancy
- Low calcium, little milk, curd, ragi or sesame; calcium deficiency rickets also occurs in India
- Premature birth, low birth weight
- Malnutrition
- Absorption problems, celiac disease, chronic diarrhea, liver disease
- Kidney disease
- Some medicines, certain medicines for seizures (fits)
- Genetic rickets, types that do not improve with vitamin D (phosphate deficiency and others), need specialist treatment
Ayurvedic view
- Agnimandya, food is not converted into rasa.
- Weak dhatu nourishment chain, rasa → rakta → mamsa → meda → asthi; if the earlier dhatus are weak, nourishment does not reach asthi.
- Vata prakopa, asthi is the main seat of vata; when vata increases, asthi depletes (in Ayurveda asthi and vata have an inverse relationship).
- Stanya dushti or alpata, the mother’s milk is scanty or lacking in nourishment.
- Garbhini apathya, inadequate maternal nutrition in pregnancy.
- Lack of atapa (sunlight) sevana, Ayurveda too regards appropriate exposure to sunlight as useful for health.
Ayurvedic Understanding
According to Ayurveda, asthi is the fifth dhatu and gives the body dharana (support). It is nourished from meda dhatu, its upadhatu is danta (teeth) and its mala is kesha-nakha (hair and nails). So the features of rickets, weak bones, late and weak teeth, weak hair and nails, match the Ayurvedic description of asthi kshaya beautifully. Charaka and Sushruta describe “asthi shoola, danta-nakha bhanga, kesha patana, rukshata” (bone pain, breaking of teeth and nails, hair fall, dryness) in asthi kshaya.
Kashyapa described three types of phakka roga: ksheeraja (from vitiated or scanty breast milk), garbhaja (from reduced milk when the mother becomes pregnant again) and vyadhija (after illnesses), in which the child cannot walk even after one year, the legs are weak and the body is emaciated. Its treatment describes measures such as ghrita, abhyanga, nourishing food and the trichakra ratha (a three-wheeled device to teach walking, like a walker).
Samprapti: scanty or vitiated breast milk and food, lack of sunlight, agnimandya → weak dhatu nourishment chain → asthi dhatu kshaya + vata vriddhi → softness and bending of bones, delayed teething and walking.
Samprapti vighatana: identify the cause (vitamin D, calcium or other) → medical supplementation → agni deepana → dhatu nourishing food (ksheera, ghrita, tila) → abhyanga (vata shamana, asthi nourishment) → atapa sevana (sunlight) → active play.
Classical References
- Kashyapa Samhita, Chikitsa Sthana, Phakka Chikitsa (chapter level).
- Charaka Samhita, Sutra Sthana, Chapter 17, Kiyantahshiraseeya: signs of dhatu kshaya (including asthi kshaya).
- Sushruta Samhita, Sutra Sthana, Chapter 15, kshaya and vriddhi of dosha, dhatu and mala.
- Charaka Samhita, Chikitsa Sthana, Chapter 15, Grahani: order of dhatu nourishment.
- Ashtanga Hridaya, Sutra Sthana, Chapter 11, Doshadi Vijnaniya: relationship of asthi and vata.
Tests
- Physical examination by the doctor, height and weight
- Blood: 25-OH vitamin D, calcium, phosphorus, alkaline phosphatase (ALP), PTH
- Wrist or knee X-ray, typical changes of rickets; improvement after treatment is also visible
- If needed, kidney and liver function, celiac tests
- If there is no improvement despite treatment, a specialist for genetic types
Treatment
- Vitamin D, the doctor decides the exact dose and duration according to age and severity (daily or weekly; sometimes one large dose), followed by a maintenance dose.
- Calcium, through diet and, if needed, supplements.
- Follow-up, blood tests and X-ray at 1–3 months; bones usually improve within a few months and the bowing reduces gradually (over 1–2 years).
- Marked or non-improving bowing, orthopedic advice (surgery rarely).
- Underlying cause, kidney, absorption or genetic, needs special treatment.
Warning: too much vitamin D can be toxic: vomiting, constipation, thirst, kidney damage. Never give large doses (shots, sachets) without the doctor’s advice and dose; “more” is not “better”.
Prevention
- Mother in pregnancy, calcium, vitamin D (on the doctor’s advice), sunlight, nourishing food
- Newborn and infant, many pediatricians advise a small daily dose of vitamin D drops in the first year for exclusively breastfed babies, ask your doctor
- Sunlight, between 10 AM and 3 PM (more UVB) for 15–30 minutes, with arms, legs and back uncovered; shorter time for small children, protect eyes and head, avoid sunburn; a little longer for darker skin; sunlight through window glass does not give UVB
- Calcium-rich food, daily
- Active play, weight-bearing for bones, running, jumping, climbing
- Less screen time
- Timely treatment of malnutrition and chronic diarrhea
Diet: For Bones
Calcium sources: milk, curd, buttermilk, paneer; ragi (finger millet), the best vegetarian calcium; sesame (especially black), sesame-jaggery; fenugreek, drumstick leaves, bathua, amaranth (rajgira); chickpeas, rajma, soybean; almonds (powder); figs; tofu.
Vitamin D sources (little in food): egg yolk, fish (in non-vegetarian families), sun-dried mushrooms, fortified milk or oil. For vegetarian children, sunlight and supplements when needed are the main sources.
Others: protein (dal, legumes), vitamin C (amla), magnesium (seeds, whole grains), ghee in moderation (vitamin D is absorbed with fat).
Reduce: cold drinks (phosphoric acid), excess salt, junk food, excess tea and coffee (in older children).
Useful Ayurvedic Medicines / Therapies (in the vaidya’s child dose; not a substitute for vitamin D treatment)
The right medicine, dose, anupana and timing are decided by the vaidya according to the person’s prakriti, age, other illnesses and current medicines.
- Abhyanga, daily massage with bala taila, lakshadi taila or sesame oil, for vata shamana and nourishment of muscles and bones; a short time in the sun after the massage (a traditional Indian practice, oil massage followed by sunlight).
- Praval pishti, mukta shukti, shankha bhasma, traditional as calcium sources; only in the vaidya’s child dose, from pure, certified sources.
- Lakshadi guggulu / asthishrinkhala, asthi sandhana; in older children, on the vaidya’s advice.
- Ashwagandha, shatavari, balya, dhatu nourishment.
- Chyawanprash / amalaki, rasayana (after 3 years).
For agni deepana, formulations such as bala chaturbhadra. For the breastfeeding mother, shatavari, sesame and ghee for stanya nourishment. To be clear: in established rickets the doctor’s vitamin D and calcium treatment is essential; Ayurveda is supportive, for abhyanga, diet, agni and general strength.
Gradual Ayurvedic approach: In established rickets the doctor’s vitamin D and calcium treatment is needed; Ayurvedic treatment starts alongside it, without stopping anything. Bala chaturbhadra for agni deepana, praval pishti or mukta shukti in child doses, lakshadi guggulu and ashwagandha in older children, daily abhyanga with bala or sesame oil followed by play in the sun, ragi, sesame, milk and ghee. When bones and reports improve, the doctor moves vitamin D to a maintenance dose or stops it, and then the routine of abhyanga, sunlight and diet prevents the deficiency from returning (apunarbhava). In genetic rickets, specialist treatment is needed and continues.
Daily Routine
- Morning oil massage, then 15–30 minutes of play in the sun (according to age and skin)
- 1 hour of active outdoor play daily
- Calcium-rich breakfast, ragi, milk, sesame
- Age-appropriate sleep, for bone growth
- Limited screen time
- Vitamin D medicine at the time and in the dose the doctor says
- Regular follow-up
Simple Calcium-Rich Recipes
- Ragi porridge or sheera, with jaggery and ghee (after 8 months)
- Sesame-jaggery laddoo or chikki, for older children (for small children, sesame powder in khichdi or sheera)
- Paneer bhurji, paneer paratha
- Methi-palak thepla, with curd
- Drumstick leaf dal
- Ragi-bajra dhokla
- Almond-fig milk, with soaked almond powder
For Grandparents and Nannies
Indian tradition has a lovely practice of massaging the baby with oil in the morning and laying them in the sun. Continue it, but safely: early morning or mild sunlight, eyes and head covered, never leave the child alone, not in strong heat. Families living in flats can take the child to the terrace or a garden.
Season Wise
Winter, less sunlight and more time indoors due to cold, so play in the morning and midday sun is especially important; sesame-jaggery, ghee, milk, abhyanga. Monsoon, cloudy, make use of sunlight whenever available; talk to the doctor about supplements. Summer, plenty of sunlight but heat at noon, a short time around 10–11 AM or 3–4 PM; enough water.
By Prakriti
- Vata prakriti: thin, thin bones, cracking joints; abhyanga, ghee, milk, sesame and regularity are especially important.
- Pitta prakriti: turns red easily in the sun; short, early sunlight; cooling, nourishing food.
- Kapha prakriti: plump, plays less; increase active play.
For Parents
“A baby’s legs are always bent” is true up to a certain age, but not every time. Watch growth, walking age, teeth and leg shape; if in doubt, show the child to a pediatrician, a simple blood test gives the diagnosis. Working parents should give nannies or grandparents clear instructions to let the child play in the sun every day. If you live in a flat, use the terrace, a balcony (open, without glass) or a garden.
Common Myths
- “India has plenty of sun, there is no vitamin D deficiency”, wrong; it is very common.
- “Sit the child by the window, they will get sunlight”, glass blocks UVB.
- “Bowed legs will straighten on their own as the child grows”, normal bowing yes; rickets bowing not without treatment.
- “Give a big dose of vitamin D, the more the better”, dangerous; toxic effects.
- “Milk alone is enough”, it gives calcium, but sunlight or supplements are needed for vitamin D.
Precautions
- Seizures (fits), muscle cramps, low calcium; emergency.
- Vitamin D only in the doctor’s dose; with an overdose, vomiting, thirst, constipation, see the doctor at once.
- No improvement within 3 months despite treatment, see a specialist (genetic or kidney cause).
- Bhasma formulations only from a qualified vaidya, in child doses.
- Do not keep small children in strong noon sun for long, burns, heat.
Do’s and Don’ts
Do: daily sunlight and play, calcium-rich food (ragi, sesame, milk), oil massage, the doctor’s vitamin D treatment, follow-up, maternal nutrition in pregnancy.
Don’t: stay indoors all day, excess screens, cold drinks and junk, large vitamin D doses on your own, ignore bowed legs.
Case Studies
Case 1: A child living in a flat
2 years; late walking, bowed legs, thick wrists, night sweats; vitamin D very low, ALP high, rickets on X-ray, the doctor started vitamin D and calcium. In Ayurvedic terms agnimandya with asthi dhatu kshaya and vata vriddhi; the vaidya gave bala chaturbhadra and praval pishti in child doses, morning bala taila massage followed by 20 minutes of play on the terrace, ragi, milk and sesame, and a clear routine for the nanny. Within three months reports were normal and the doctor moved to a maintenance dose; within six months he was running and his legs began to straighten, and the routine kept the deficiency from returning. (Results may vary from person to person.)
Case 2: Bone pain in a teenage girl
13 years; pain in the legs and lower back, tiredness, difficulty climbing stairs; the whole day at school, tuition and home, did not like milk; vitamin D low, the doctor gave treatment. The vaidya gave mukta shukti, ashwagandha and shatavari, lakshadi guggulu, daily abhyanga, 20 minutes of walking in the morning sun, ragi, sesame, curd and paneer. Within a month the pain was much less, at three months it was gone and reports normal; the doctor stopped the supplement, and sunlight and diet kept her well. (Results may vary from person to person.)
Case 3: Rickets that did not improve
3 years; bowing increasing despite vitamin D treatment, short stature. The pediatrician did further tests: a genetic type with phosphate deficiency; specialist treatment needed and ongoing. Alongside, with the specialist informed, the vaidya gave agni deepana, bala taila abhyanga and nourishing food. Appetite, energy and muscle strength improved, and with the specialist’s treatment growth was good. This case shows why further tests are needed when the usual treatment does not bring improvement. (Results may vary from person to person.)
When to See a Doctor (Red Flags)
- Seizures, muscle cramps
- Very late walking (not walking even after 18 months)
- Increasing or one-sided bowing
- Thick wrists, beads on the ribs
- Fractures with minor injury
- Very short stature
- Persistent bone pain
About Dr. Nikul Patel
Dr. Nikul Patel (BAMS) is an Ayurvedic physician at Lifecare Ayurveda and has been practising since 1999, that is, for 27 years. In childhood rickets and asthi dhatu kshaya, he gives supportive guidance through abhyanga, atapa sevana, calcium-rich diet and bone-nourishing herbs in child doses, in coordination with the pediatrician’s vitamin D treatment.
Frequently Asked Questions
What causes rickets?
Mainly a deficiency of vitamin D and calcium, which makes the bones soft and bent.
How much sunlight does a child need?
Usually 15–30 minutes between 10 AM and 3 PM with arms and legs uncovered; according to age and skin.
Can rickets be cured?
Yes, nutritional rickets usually improves completely with early treatment.
Calcium for vegetarian children?
Ragi, sesame, milk, curd, paneer, green vegetables, chickpeas, almonds.
Does Ayurveda help in rickets?
It supports through abhyanga, diet, agni deepana and asthi nourishment; along with vitamin D treatment.
People Also Ask
When are bowed legs normal?
Slightly outward up to 2 years and slightly inward at 3–5 years is natural; if marked or increasing, get it checked.
Does sunlight through a glass window work?
No, glass blocks the UVB rays that make vitamin D.
What is phakka roga?
Described in the Kashyapa Samhita, a condition where a child is unable to walk and is emaciated due to lack of nourishment.
Can vitamin D overdose happen?
Yes, too much can be toxic, only the doctor’s dose.
Why is ragi useful?
Ragi is an excellent source of calcium in a vegetarian diet.
Conclusion
Rickets is a preventable condition that usually improves completely. Along with the doctor’s vitamin D treatment, Ayurveda is a strong path: agni deepana, asthi dhatu nourishment, praval and mukta shukti in child doses, ksheera, ghrita and tila, abhyanga and atapa sevana strengthen bones quickly, make the child sturdy and prevent the deficiency from returning. Every child’s results may differ.
Dr. Nikul Patel (B.A.M.S.)
307, 3rd Floor, Shalin Complex, Above Farki Lassi, Krishnabaug Char Rasta, Maninagar, Ahmedabad – 380008
Timings: 10:00 AM to 1:00 PM and 3:00 PM to 6:30 PM | Saturday–Sunday: Closed
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