How is rickets diagnosed?

Written by Li Jiao Yan
Neonatology
Updated on October 27, 2024
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Rickets is a chronic nutritional disease caused by a deficiency in vitamin D, which leads to a disruption in calcium and phosphorus metabolism, resulting in abnormal bone development. Typically, the initial symptoms of rickets are most commonly seen 2-3 months after birth. At this stage, affected children often show neurological symptoms such as excessive sweating unrelated to the season, irritability, particularly in infants under three months old who can become easily agitated, and exhibit straining as if constipated, but these are not specific symptoms of rickets. Early diagnosis generally requires specific tests such as blood biochemistry to check the levels of 125 dihydroxy vitamin D3, as well as calcium and phosphorus levels in the blood, and to see if there is any change in serum alkaline phosphatase. The active phase is mainly characterized by skeletal changes, such as early signs of enlarged fontanelles or delayed closure, late teething, and sometimes a softening of the skull resembling a ping-pong ball, gradually leading to a square skull. Subsequently, changes like pigeon chest or noticeable deformities in the lower limbs such as X-shaped legs, O-shaped legs, or K-shaped legs may appear. Sometimes, there may also be curvature of the spine, with occasional scoliosis. These obvious skeletal changes make the condition more recognizable, though the initial presentations are not very typical, necessitating related biochemical blood tests.

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Written by Li Jiao Yan
Neonatology
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What department should I go to for rickets?

Rickets, fully known as nutritional vitamin D deficiency rickets, is a chronic nutritional disease characterized by skeletal lesions in children caused by insufficient vitamin D leading to disturbances in calcium and phosphorus metabolism. In the early stages of rickets, the main issues are disturbances in calcium and phosphorus metabolism and low levels of vitamin D. At this time, one can consult the endocrinology department to check the child's trace elements. If sequelae have already formed, such as obvious pigeon chest or developmental deformities of the lower limbs bones, then it would be appropriate to consult an orthopedic department for corrective treatment.

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Written by Li Jiao Yan
Neonatology
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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 Yao Li Qin
Pediatrics
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Clinical manifestations of rickets

Rickets, also known as vitamin D deficiency rickets, occurs because children do not supplement vitamin D in a timely manner after birth, leading to a deficiency of vitamin D in the body and resulting in a nutritional metabolic disease primarily involving skeletal changes. In the early stages, children mainly show symptoms related to mental and emotional state, such as irritability, crying, excessive sweating, shaking their heads back and forth, and rubbing their heads. Subsequently, symptoms like bald patches on the back of the head and softening of the skull bones may appear. As children grow, they may develop conditions such as a square-shaped skull, beaded ribs, pigeon chest, funnel chest, and bracelet-like deformities around the wrists and ankles. In severe cases, children may later develop X-shaped legs and O-shaped legs. If rickets is suspected, it is crucial to promptly conduct a blood test to measure the vitamin D level. If the level is below normal, it is essential to actively treat the diagnosed rickets.

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Written by Li Jiao Yan
Neonatology
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How to treat rickets X-type legs?

If rickets presents with an X-shaped deformity, it generally indicates either an active phase of the disease or the residual phase. During this time, it is advisable to minimize the child's standing and walking at home. For lower limb deformities, muscle massages can be performed. For X-shaped legs, massage the inner muscle groups, followed by internal rotation exercises after massaging the double sliding joints. Typically, early treatment involves corrective rehabilitation techniques, and it is possible to visit a pediatric rehabilitation department for relevant manual treatments. If there is a significant skeletal deformity, surgical intervention may be necessary for correction.

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Written by Huang Kun Mei
Pediatrics
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Symptoms of rickets in infants and young children

The symptoms of rickets in infants and young children mainly include excessive sweating, night terrors, thinning hair at the back of the head, rib cage flaring, pigeon chest, bow legs, and knock knees, among others. If a child exhibits the above symptoms, it is necessary to promptly test for trace elements and check bone density to see if the child has symptoms of calcium deficiency. If so, it is crucial to supplement the child with vitamin D and calcium. In terms of diet, it is necessary to enhance the child's nutrition and increase outdoor activities. Ensure that the child engages in outdoor activities for more than two hours each day, particularly between 12 PM and 2 PM. Avoid exposing the child to sunlight during this time to prevent sunburn, especially to the child's eyes.