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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What are the symptoms of rickets?

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
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Can rickets be treated?

Rickets is a disorder caused by a deficiency of vitamin D, leading to impaired calcium and phosphorus absorption, which then results in abnormal skeletal development. It is a chronic nutritional disease. Generally, the rickets commonly mentioned is due to nutritional vitamin D deficiency, which is treatable. Typically, encouraging children to engage in appropriate physical activities while supplementing with an adequate level of vitamin D can effectively control the disease, and it can even be cured. However, if there are special circumstances, such as significant liver abnormalities, renal function abnormalities, renal failure, or abnormalities in the thyroid or parathyroid glands, including parathyroid tumors, or congenital hereditary diseases, the treatment needs to be based on the cause in order to effectively control the disease and promote normal calcium and phosphorus metabolism in the body. Congenital hereditary diseases generally make treatment more challenging. Therefore, it is crucial for children with rickets to seek timely medical examination at a hospital. If it is a common case of nutritional vitamin D deficiency, parents should supplement vitamin D promptly according to the doctor's advice for treatment.

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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 Yao Li Qin
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Causes of Rickets

Rickets, also known as Vitamin D-deficiency rickets, implies from its name that the cause of the disease is due to insufficient intake of Vitamin D in children, leading to disorders in calcium and phosphorus metabolism and resulting in nutritional disease with skeletal deformities. The incidence of the disease is higher in the north than in the south. Currently, the incidence of mild and moderate rickets is relatively high, while severe cases are less common because people are increasingly paying attention to the supplementation of Vitamin D for children. It is recommended that full-term infants start supplementing with 400 units of Vitamin D daily two weeks after birth, which is the physiological requirement. For premature infants, twins, and extremely low birth weight infants, the daily physiological requirement of supplementation is 800 units per day. After supplementing continuously for three months, it should be adjusted to 400 units per day as per the requirement for full-term infants. With such management, the child will not suffer from rickets. However, if there is no regular supplementation after birth, the lack of Vitamin D can lead to skeletal changes in the child, and once rickets is diagnosed, it requires high doses of supplementation.

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What department should I go to for rickets?

Rickets, called nutritional vitamin D deficiency rickets, is a chronic systemic nutritional disease characterized by bone lesions, caused by a lack of vitamin D in children's bodies leading to disturbed calcium and phosphorus metabolism. Its typical manifestations are inadequate mineralization of the growing long bone shafts and bone tissue. In early-stage rickets, there are no obvious skeletal changes, primarily characterized by low levels of vitamin D and abnormal calcium and phosphorus metabolism, in which case consultation with a pediatric endocrinologist is advised. If evident skeletal deformities like pigeon chest, X-shaped legs, or O-shaped legs have already developed, corrective treatment is necessary, and an orthopedic consultation is required.