Clinical manifestations of rickets

Written by Yao Li Qin
Pediatrics
Updated on February 19, 2025
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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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Rickets is a deficiency of what?

Rickets is caused by a deficiency of what? For rickets, its main gold standard for diagnosis is based on the results of blood biochemistry and skeletal X-ray examinations. Generally, the deficiency in rickets is mainly due to insufficient levels of vitamin D, which then leads to disturbances in calcium and phosphorus metabolism. Typically, this is characterized by low levels of 25-hydroxyvitamin D3 in the body, along with decreased levels of blood calcium and phosphorus, manifesting as deficiencies in calcium, phosphorus, and vitamin D. However, in children, rickets could also be caused by other factors, such as abnormalities in liver or kidney function, or congenital hereditary diseases. Generally, further tests are needed to confirm rickets. If other special causes are ruled out, timely supplementation of vitamin D and appropriate exposure to sunlight, along with calcium supplementation, can effectively cure the disease.

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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 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 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.

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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.