Early manifestations of rickets

Written by Li Jiao Yan
Neonatology
Updated on September 06, 2024
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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
Neonatology
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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.

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Written by Yan Xin Liang
Pediatrics
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What is the fundamental difference between rickets and tetany?

Rickets is a type of vitamin D deficiency disease, primarily caused by insufficient vitamin D in infants, children, or adolescents, leading to disorders in calcium and phosphorus metabolism. It is a chronic nutritional disease characterized by skeletal lesions, mainly manifesting as changes in the fastest growing parts of the skeleton, such as square skull, pigeon chest, funnel chest, bow legs, and knock knees, among other symptoms. On the other hand, tetany is primarily due to hypocalcemia and its manifestations differ; it does not exhibit the skeletal changes seen in rickets but primarily presents as spasms or cramps in the hands and feet. Thus, this constitutes their fundamental difference.

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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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Rickets is caused by a deficiency of what element?

Rickets is a systemic chronic nutritional disease caused by vitamin D deficiency leading to disturbances in calcium and phosphorus metabolism, which results in abnormal bone development. The main cause is a lack of vitamin D, generally related to feeding methods, the addition of cod liver oil, living environment, outdoor activity time, repeated respiratory infections, calcium deficiency during pregnancy, and the season of birth. It is generally recommended to routinely supplement vitamin D and cod liver oil after birth, have regular follow-ups, engage in appropriate outdoor activities, and during pregnancy, it is important to supplement with adequate calcium and vitamin D. Additionally, attention should be paid to children who have repeated respiratory and gastrointestinal diseases, as these can also affect the absorption of vitamin D and calcium and phosphorus. Thus, it is vital to actively prevent other diseases that may affect the absorption of vitamin D and to treat illnesses proactively when they occur.

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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.