What are the symptoms of rickets?

Written by Li Jiao Yan
Neonatology
Updated on December 08, 2024
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The condition generally referred to as rickets is most commonly nutritional vitamin D deficiency rickets, a type of nutritional disease that is prevalent among infants and young children, particularly very young babies. It primarily manifests as changes in the bones where growth is most rapid and can also affect muscle development and changes in nervous excitability. Initially, especially within the first three months, symptoms in very young infants typically include increased nervous excitability, such as crying easily, excessive head sweating, and as a result of the sweating, frequent head shaking, irritability, restlessness, and noticeable crying and restlessness at night. These symptoms at this stage are not necessarily indicative of typical rickets.

As the condition progresses, changes in the skeleton gradually become apparent. In infants under six months with rickets, the changes are mainly in the skull, typically feeling like pressing on a ping-pong ball. After six months of age, the head shape becomes squared or box-like, and the head circumference is larger than normal. Later, the characteristic beading changes of rickets appear, with beaded protrusions above the ribs, followed by the formation of blunt, circular raised areas at the wrists and ankles, referred to as wrist and ankle bracelets. Around the age of one, infants may develop a deformity resembling pigeon chest. As the child begins to stand and walk, the weight bearing on the lower limbs may lead to deformities, such as bowlegs or knock-knees, and sometimes even K-shaped deformities of the legs, and some might develop spinal deformities.

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Written by Li Jiao Yan
Neonatology
1min 58sec home-news-image

Rickets symptoms

Rickets, also known as nutritional vitamin D deficiency rickets, is a chronic nutritional disease in children caused by inadequate vitamin D in their bodies, leading to disorders in calcium and phosphorus metabolism and characterized by changes in the growth plates. Its manifestation varies with different ages. In infants under six months, especially those under three months, symptoms often include increased nervous excitability, such as being easily irritable, restless, sweating, and shaking their heads due to scalp irritation. As the condition progresses in children under six months, the primary changes are seen in the skull; the edges of the anterior fontanelle are softer, and the skull is thinner. After six months, the softening of the skull disappears, but there can be ping-pong ball-like changes around the skull, leading to a box-shaped head from seven to eight months. Gradually, beading changes form, most notably around the 7th to 10th ribs. Around the age of one, children can develop a pigeon chest deformity, and in severe cases of rickets, a horizontal depression forms at the lower edge of the thoracic cage, known as the costal groove or Harrison's groove. Due to bone softening and muscle and joint laxity, when the child begins to stand and walk, the legs may become bow-legged or X-shaped, and in severe cases, can develop into 'K'-shaped leg deformities. Once the child starts to sit and stand, general ligament laxity can cause spinal deformities. Severe hypophosphatemia leads to muscle carbohydrate metabolism disorder, resulting in overall muscle laxity, decreased muscle tone, and subsequently reduced muscle strength.

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Written by Li Jiao Yan
Neonatology
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Can rickets be treated by injection?

Rickets is primarily caused by a deficiency of vitamin D, leading to a disturbance in calcium and phosphorus metabolism in the body, which results in abnormal bone development. It is a systemic nutritional and chronic disease. The main treatment is to supplement a sufficient dosage of vitamin D, generally administered orally. The choice of vitamin D formulation, dosage, duration of treatment, whether it is administered once or multiple times, and whether supplementation is oral or intramuscular, should be determined based on the specific situation of the child. Relevant tests are generally required, and the doctor will develop a treatment plan based on the child's condition. The route of administration should also be decided based on the condition of the disease.

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Written by Yan Xin Liang
Pediatrics
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What is the fundamental difference between rickets and tetany?

Rickets is a type of vitamin D deficiency disease, primarily caused by insufficient vitamin D in infants, children, or adolescents, leading to disorders in calcium and phosphorus metabolism. It is a chronic nutritional disease characterized by skeletal lesions, mainly manifesting as changes in the fastest growing parts of the skeleton, such as square skull, pigeon chest, funnel chest, bow legs, and knock knees, among other symptoms. On the other hand, tetany is primarily due to hypocalcemia and its manifestations differ; it does not exhibit the skeletal changes seen in rickets but primarily presents as spasms or cramps in the hands and feet. Thus, this constitutes their fundamental difference.

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Written by Li Jiao Yan
Neonatology
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Can rickets be cured?

The rickets we commonly talk about is nutritional Vitamin D deficiency rickets, which is due to a deficiency of Vitamin D in the body leading to a disorder of calcium and phosphorus metabolism. This results in a systemic nutritional disease characterized by skeletal lesions. If rickets is caused by insufficient intake, it can be self-healing and is a self-limiting disease. Once infants and young children spend enough time outdoors and receive physiological doses of Vitamin D treatment, rickets can be treated. However, treatment becomes significantly challenging in cases of congenital developmental abnormalities causing skeletal lesions, or any genetic diseases that lead to Vitamin D absorption disorders. Such cases often result in severe complications, including prominent kidney dysfunction leading to further disturbances in calcium and phosphorus metabolism, as well as liver function abnormalities causing Vitamin D synthesis disorders. Therefore, it is important to understand the specific causes of Vitamin D deficiency in children, and if the deficiency is due to common reasons that can be promptly controlled, then supplementation with Vitamin D and trace elements like calcium can effectively treat the condition.

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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.