It was time for bed. Layla got changed into her pyjamas and picked out her favourite storybook for her mum to read to her. Tonight was Sleeping Beauty’s turn. As she got into bed, her bone pain became worse. She felt exhausted and couldn’t wait to sleep. ‘Once upon a time…’ her mother began whilst stroking Layla on her forehead. She closed her eyes and imagined the story in her mind, dreaming of life as a princess, full of energy and in search of her Prince Charming…
Layla had fallen asleep and was dreaming of her fairy-tale life. Suddenly, a fairy godmother appeared from behind the sparks of a magic wand. ‘Good evening Layla, my dear, I’m you’re fairy godmother and I’ve come to help you feel better. Your mother tells me you’ve been suffering from bone pain and having problems with your growth. Is this correct?’
Layla was surprised and shocked. Could her fairy godmother really help her? ‘Yes,’ Layla replied, ‘I’ve been having problems with my back and my bones are very fragile. When I was a baby, I used to waddle when I walk. My mummy said my bones aren’t growing like all the other children, which is why I have pain and weakness in my muscles’.
‘That’s correct, my dear. When you were a little child, your mummy took you to see the doctor, and they examined you to see if there were any obvious problems. You seemed fine, but your blood tests showed that a low level of vitamin D. Some children also need to have a DEXA bone scan to measure the content of calcium in their bones’, explained the fairy godmother.
‘What does this mean?’ Layla inquisitively asked.
‘Well, my child, your condition is called Rickets, and it affects bone development in children like yourself. The bones become soft and weak and are subsequently more prone to bone deformities. The condition can also happen in adults, but it is called osteomalacia’, clarified the fairy godmother. ‘The most common cause is a lack of vitamin D or calcium in the diet. Vitamin D can also come from skin exposure to the sunlight, and it is essential for children like you to form strong and healthy bones. This is why your mother encourages you to play outside in the sun and to eat cheese, milk and lots of broccoli and cabbage!’
‘But, I don’t like cabbage!! It doesn’t taste very nice’ cried Layla. The fairy godmother smiled and Layla laughed. ‘I like playing outside though’.
‘Both your mother and I know that Layla dear, hence your mother urges you to spend at least 15 minutes playing outside in the sun a few times a week’, continued the fairy godmother. ‘However, in some children, this may not be enough and vitamin D supplements may be needed to reduce the condition becoming worse.’
‘Is that what my tablets are for?’ questioned Layla.
‘Yes! The treatment for the condition includes a diet high in calcium and vitamin D, increasing sunlight exposure and taking vitamin supplements. In some children who have problems absorbing vitamins and minerals, they may need a higher supplement dose or a yearly vitamin D injection. The dose and number of tablets needs to be carefully monitored though, my dear, you can’t take more tablets if you have a lot of pain as it may complicate your condition. The level of calcium in your blood may become too high and you can then suffer from alternative symptoms such as passing a lot of urine, feeling thirsty, nauseous, dizziness and headache,’ advised the fairy godmother.
‘Oh, so I have to take only one tablet like recommended by the doctor otherwise the amount of vitamin D or calcium will not be correct?’ wondered Layla.
‘That’s right dear. Rickets was more common in the past and almost disappeared during the early twentieth century thanks to certain foods such as margarine and cereal being fortified with vitamin D. However, recently, numbers have begun to rise again, although relatively small still; less than 900 cases of rickets were diagnosed in England. It is also more common in children of Asian, African-Caribbean and Middle Eastern origin as their skin is darker and they need more sunlight to get enough vitamin D. Pre-mature babies are also at risk as babies build up their stores of vitamin D in their mothers womb. For this reason, we encourage pregnant and breast-feeding women to also take daily supplements of vitamin D’, reassured the fairy godmother.
‘I’m not alone! Even Sleeping Beauty could have bone problems if she had a low levels of vitamin D…’ exclaimed Layla.
‘Yes,’ laughed the fairy godmother. ‘There are rare genetic forms of rickets and the condition can also develop if other illnesses are present that affect how vitamins and minerals are absorbed by the body. One such condition is called hypophosphatemic rickets but it is very rare.’
Layla felt relieved. She was not alone. She could overcome her bone pain by continuing to play outside and to eat cabbage, even if she didn’t like it as much. Her tablets would also help her. She felt happy, and thanked the fairy godmother, who gave her a kiss on the forehead and disappeared. Layla danced around and continued to dream of her original fairy-tale life…