Early manifestations of rickets

Written by Li Jiao Yan
Neonatology
Updated on September 06, 2024
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Rickets is a disease caused by a lack of vitamin D, which leads to a disorder in calcium and phosphorus metabolism, resulting in abnormal bone development. It primarily appears in the early stages in infants within six months old, and particularly within three months after birth. The initial presentation is an increase in nervous excitability, such as fussiness and unease in children, symptoms like excessive internal heat and sweating, especially more sweat on the head. Continuous sweating can lead to significant baldness at the back of the head. Sometimes, children may exhibit constant head shaking, but these are not very specific symptoms. Early detection involves decreased blood calcium and phosphorus levels, increased parathyroid hormone levels, and decreased levels of related markers in blood tests. Early bone X-rays appear normal, so initial symptoms are not so typical. Therefore, it is recommended that infants be taken to a pediatrician for a physical examination as soon as possible, where their developmental status can be assessed and rickets can be diagnosed. If it is early-stage vitamin D deficiency rickets, timely supplementation of vitamin D levels can be an effective cure.

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Written by Tong Peng
Pediatrics
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What are the early symptoms of rickets?

The early symptoms of rickets are mainly due to the inadequate intake of vitamin D in children, leading to disturbances in the body's calcium and phosphorus metabolism. Early signs usually appear around three months of age in infants, characterized by changes in mental state, restless sleep, frequent crying, and excessive sweating. Increased sweating is often accompanied by cradle cap, where circular bald patches appear on the back of the head. In such cases, it is important to include vitamin D-rich foods in the diet and supplement with vitamin D. Continued breastfeeding, engaging in outdoor activities, and exposure to sunlight are recommended to promote the body’s own synthesis of vitamin D. Regular physical examinations are also advised, and if symptoms of rickets occur, an appropriate increase in vitamin D intake may be necessary.

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Written by Li Jiao Yan
Neonatology
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Can rickets be cured?

Can rickets be cured? Rickets, also known as nutritional vitamin D deficiency rickets, is primarily caused by insufficient levels of vitamin D in the body leading to disorders in calcium and phosphorus metabolism. It is a chronic nutritional disease characterized by skeletal lesions. Typically, it manifests as flawed mineralization of long bones and bone tissue at the growth plates. Vitamin D deficiency rickets is a self-limiting disease that can generally be cured if children have sufficient outdoor activities and adequate exposure to sunlight. Adequate sunlight exposure and physiological doses of vitamin D can treat rickets. Therefore, it is usually recommended that children supplement with 400 units of vitamin D starting about two weeks after birth to prevent and treat rickets. However, if the child is in a later stage and shows obvious skeletal deformities, corrective treatment may be necessary. In severe cases of rickets where intracranial lesions occur, it might affect the child's vital signs and, in serious cases, could even lead to the child's death. Therefore, it is advised that children get plenty of sunlight, routinely supplement with vitamin D, and have regular pediatric check-ups to assess their condition.

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Written by Zeng Hai Jiang
Pediatrics
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The difference between rickets and dwarfism.

Rickets is caused by a deficiency of vitamin D in infants and young children, leading to disturbances in calcium and phosphorus metabolism and resulting in skeletal abnormalities as a characteristic of this chronic nutritional disease. Typical symptoms can include changes in the bones, especially in the fastest growing parts of the skeleton, and can affect muscle development and changes in neural excitability. Symptoms such as a "ping pong ball" head, square skull, pigeon chest, funnel chest, and eversion of the rib margins are also observed. Diagnosis is made through examinations such as vitamin D levels and skeletal X-rays. Dwarfism, on the other hand, is a growth disorder caused by a deficiency of growth hormone from the anterior pituitary gland before puberty. Its clinical manifestations are primarily growth disturbances, characterized by a short, proportionate stature. Adults with this condition often retain a child-like appearance, and their bone development is delayed with bone age younger than their chronological age. Intellect corresponds to their age, and sexual development may also be disrupted.

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Written by Li Jiao Yan
Neonatology
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How is rickets treated?

How is rickets treated? Rickets is caused by a lack of vitamin D, leading to disturbances in calcium and phosphorus metabolism. The common nutritional deficiency of vitamin D, primarily due to insufficient intake, results in abnormal bone development. At this time, effectively supplementing vitamin D, engaging in appropriate outdoor activities, and receiving ample sunlight can treat rickets in children. However, there are some special cases, such as significant abnormalities in liver or kidney function, where treatment should be targeted based on the cause of the condition. In addition, some congenital genetic abnormalities causing disturbances in calcium and phosphorus metabolism can make treatment more challenging. Therefore, the treatment of rickets should be based on specific conditions. Generally, if it is simply a case of nutritional deficiency of vitamin D, the treatment outcome is quite favorable and the condition is considered self-limiting. Thus, if a vitamin D deficiency is detected, it is important to supplement promptly to prevent further abnormal bone development.

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Written by Mo Ming Hua
Pediatrics
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If rickets is not treated, what will be the impact?

Rickets, if untreated, mainly involves changes in skeletal deformities and motor function in children. Rickets is primarily caused by a deficiency in vitamin D, which is essential for promoting the absorption of calcium. A deficiency in vitamin D leads to reduced calcium absorption. Lower calcium absorption results in a calcium deficiency in the body, which in turn causes changes in the bones. In the early stages of vitamin D deficiency, the main symptoms are increased neural excitability, which may manifest as startle reactions, irritability, restlessness, and excessive sweating. During the active phase, symptoms of increased nervous system excitability become more pronounced, mainly presenting as skeletal deformities. What aspects do these skeletal deformities affect? One is the softening of the skull, pigeon chest, funnel chest, and changes resembling wristbands and anklets. If the condition worsens further, it can present as X-shaped legs, O-shaped legs, and spinal deformities. Thus, if rickets progresses, it can lead to skeletal deformities and impairments in motor functions, among other issues.