The main manifestations of rickets in the early stage

Written by Yao Li Qin
Pediatrics
Updated on February 22, 2025
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Rickets generally refers to vitamin D deficiency rickets, mainly due to insufficient vitamin D in children, leading to calcium and phosphorus metabolism disorders. It is a chronic nutritional disease characterized by skeletal lesions. The main manifestations are changes in the fastest growing parts of the skeleton, which can also affect muscle development and changes in neural excitability. The initial symptoms of rickets are common in infants, especially those under three months old. The main symptom is increased neural excitability; the child is particularly prone to being agitated, irritable, crying, sweating, and shaking their head due to scalp stimulation, but these are not specific symptoms of rickets. Therefore, blood tests are still necessary in the early stages, showing decreased levels of 25-hydroxyvitamin D3, blood calcium, and blood phosphate, increased PTH, normal or slightly elevated alkaline phosphatase activity, and normal or slightly blurry calcification zones in skeletal X-rays. These are the early manifestations of rickets.

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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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Early manifestations of rickets

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 Li Jiao Yan
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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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Can rickets be cured?

Rickets is a chronic nutritional disease caused by vitamin D deficiency that leads to disturbed calcium and phosphorus metabolism in the body, causing abnormal skeletal development. If a square skull is observed, it indicates that the child's disease has entered an active phase. Generally, in the early stages, there is an enlargement of the fontanelle or a delay in the closure of the fontanelle. By seven to eight months, a square skull can appear, primarily characterized by outward bulging centered on the frontal and parietal bones. At this time, it is generally necessary to administer a sufficient dose of vitamin D and encourage appropriate outdoor activities. Depending on the child's condition, it might be appropriate to supplement with calcium as well. Gradually, this should be curable; however, if there are other special causes for the abnormal vitamin D levels, such as severe liver or kidney disease or some new genetic diseases causing square skull, the treatment might be more challenging.

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How is rickets diagnosed?

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.