Early symptoms of rickets

Written by Quan Xiang Mei
Pediatrics
Updated on February 13, 2025
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Rickets is a bone disease formed due to a deficiency of vitamin D, clinically referred to as rickets. The early clinical symptoms of rickets, which correspond to the early stages of vitamin D deficiency, primarily manifest as autonomic dysfunction, including night terrors, night sweats, and crying. In the early stages of rickets symptoms, parents often believe the cause to be calcium deficiency. Indeed, vitamin D deficiency can also impair calcium absorption, and these are linked reactions. Therefore, parents should pay attention to supplementing vitamin D, especially in areas with insufficient sunlight, ensuring that children receive less than two hours of sunlight exposure per day. During children's growth phases, it is essential to ensure adequate daily intake of vitamin D, with a basic amount of 400 IU being necessary.

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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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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.

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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 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.

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Early clinical manifestations of rickets

Early Symptoms of Rickets: Rickets is a chronic nutritional disease caused by a deficiency in Vitamin D, leading to disordered calcium and phosphorus metabolism and resulting in abnormal skeletal development. It primarily affects infants, especially those under six months old, with the highest occurrence in infants under three months. The general symptoms include heightened neural excitability, such as fussiness, easy irritability, sudden bouts of crying, or being so sensitive that they cry when touched. Other symptoms include excessive sweating and frequent head shaking, though these are not specific indicators of rickets. Diagnosis mainly relies on biochemical markers and Vitamin D levels, like decreased blood calcium and phosphorus levels, elevated parathyroid hormone levels, and reduced 25-hydroxy-D3. X-ray images of bones might appear normal.