What are the early symptoms of rickets?

Written by Tong Peng
Pediatrics
Updated on December 15, 2024
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The early symptoms of rickets are mainly due to the inadequate intake of vitamin D in children, leading to disturbances in the body's calcium and phosphorus metabolism. Early signs usually appear around three months of age in infants, characterized by changes in mental state, restless sleep, frequent crying, and excessive sweating. Increased sweating is often accompanied by cradle cap, where circular bald patches appear on the back of the head. In such cases, it is important to include vitamin D-rich foods in the diet and supplement with vitamin D. Continued breastfeeding, engaging in outdoor activities, and exposure to sunlight are recommended to promote the body’s own synthesis of vitamin D. Regular physical examinations are also advised, and if symptoms of rickets occur, an appropriate increase in vitamin D intake may be necessary.

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Early symptoms of rickets

Rickets is a chronic systemic nutritional disease caused by insufficient vitamin D in the body, leading to disturbances in calcium and phosphorus metabolism, characterized by skeletal lesions, typically presenting as incomplete mineralization of the long bones' growth plates and bone tissue. In the early stages of rickets, skeletal development abnormalities are not very obvious. Infants under three months often exhibit signs of increased neural excitability, such as being prone to crying, sweating easily, and potentially frequent head shaking; however, these symptoms are not necessarily specific to rickets. Generally, at this time, there are no obvious abnormalities in skeletal development, and X-rays of the bones are normal. The focus is on vitamin levels, specifically decreased serum 25-hydroxy vitamin D, as well as reduced blood calcium and phosphorus levels. Therefore, early symptoms are not so typical. It is recommended that children regularly visit pediatric clinics for physical examinations to assess their development and, if necessary, undergo trace element and vitamin D level checks.

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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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How should children with rickets supplement calcium?

Rickets is a nutritional disease caused by a deficiency in vitamin D, leading to disturbances in calcium and phosphorus metabolism in the body, which results in abnormal bone development. It is mainly due to a lack of vitamin D, so the primary treatment is supplementing with vitamin D. Dairy is a reliable source of calcium nutrition for infants, and generally, it is not necessary to supplement calcium for the treatment of rickets; attention should be paid to supplementing with vitamin D according to the severity of the condition, and spending more time in the sun. For children who have started eating complementary foods, or older children, it is generally recommended to fully supplement vitamin D levels, spend more time in the sun during summer, and consume high-protein nutrients. Additionally, eating more vegetables and appropriately supplementing with calcium supplements in the winter is advised. The dosage should be based on the child's internal levels of calcium and phosphorus, with calcium supplementation adjusted accordingly.

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How to diagnose rickets?

Rickets is caused by a deficiency of vitamin D, which leads to abnormal calcium and phosphorus metabolism, and thus abnormal bone development. Generally, rickets requires biochemical blood tests and vitamin D level assessments, followed by skeletal X-ray examinations. However, some cases of rickets are caused by other special reasons, such as abnormalities in liver and kidney functions, and there may also be congenital genetic diseases. Therefore, rickets also requires further related examinations, such as liver function tests, kidney function tests, and parathyroid hormone tests, and even some genetic level examinations might be conducted.

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Is rickets easy to treat?

Rickets is primarily a nutritional disease caused by insufficient levels of vitamin D leading to disturbances in calcium and phosphate metabolism, resulting in abnormal bone development. The most common type is nutritional vitamin D-deficiency rickets. This type of disease is self-limiting and thus relatively easy to treat. It requires early detection and proactive intervention. Early measures include encouraging children to engage in outdoor activities and supplementing with appropriate doses of vitamin D, which can effectively treat rickets. However, there are also special causes of vitamin D deficiency such as significant anomalies in liver or kidney function and certain genetic diseases that severely impair vitamin D absorption. When vitamin D treatment is ineffective, it may be due to other special causes. Treatment of rickets under these circumstances can be more challenging, and genetic diseases may respond poorly to treatment.