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 Tong Peng
Pediatrics
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Does rickets cause dry skin and an absence of sweating?

Rickets does not cause dry skin or an absence of sweat. Rickets is a disorder of calcium and phosphorus metabolism caused by a deficiency in vitamin D, and it may also be associated with bone deformities. In infants, it often presents with neurological symptoms such as being easily startled during sleep, increased night sweats, and a variety of symptoms including bald patches on the back of the head. However, an absence of sweating is often a symptom of sweat gland disorders and is not necessarily related to rickets. In some cases, babies sweat less because their sweat glands are underdeveloped, so if a child with rickets has symptoms of dry skin, they are not particularly prominent. If rickets is confirmed, it is crucial to actively supplement vitamin D, spend more time in the sun, and engage in outdoor exercise to facilitate the body's natural synthesis of vitamin D. Severe cases require oral or injected high doses of vitamin D to prevent the condition from worsening and causing bone deformities.

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Written by Tong Peng
Pediatrics
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Will the frontal bossing from rickets get better?

Rickets, if presenting with frontal bossing, can recover depending on the specific condition and age of the child. Rickets is often divided into four stages, with sequelae usually occurring after the age of three. Therefore, if symptoms of rickets are present before the age of three, they can be alleviated through supplementation with vitamin D, calcium, and other trace elements. Symptoms of rickets include craniotabes, Harrison's groove, beading of the ribs, pigeon chest, everted ribs, bowlegs, and knock-knees. Frontal bossing is often a manifestation of craniotabes, which usually occurs during infancy. Supplementing with vitamin D during this period can greatly alleviate the condition. At the same time, it is important to also expose the child to sunlight and engage in outdoor activities to promote the bones' absorption of vitamin D and calcium, preventing the recurrence of symptoms.

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Written by Tong Peng
Pediatrics
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Should I take vitamin D or D3 for rickets?

Rickets should be treated with D3, but strictly speaking, what we commonly refer to as vitamin D is D3, just phrased differently. Vitamin D3 helps promote the absorption of calcium by bones, preventing the occurrence of rickets symptoms. The main clinical manifestations of rickets appear in the deformation of bones, such as square skull, pigeon chest, flaring ribs, X-shaped legs, O-shaped legs, and other changes in bone status. The nervous system can show symptoms such as night sweats, nervous excitability, balding at the back of the head, poor sleep quality, and easiness to cry. For rickets, it is necessary to diagnose early, timely supplement with vitamin D to prevent symptoms from worsening, and also to get more sunlight and engage in outdoor activities, which helps the body synthesize vitamin D and absorb calcium.

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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.

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Written by Li Jiao Yan
Neonatology
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Which department should I go to for rickets?

Rickets is a nutritional disease caused by a deficiency in vitamin D, leading to disturbances in calcium and phosphorus metabolism and resulting in abnormal bone development. During the early and active stages, the X-ray shows no obvious abnormalities in bone development; it is primarily a conceptual metabolic disorder along with low levels of vitamin D. At this time, it is advisable to consult an endocrinology department. If there are sequelae and mild to moderate sequelae, rehabilitation methods are needed for correction, and at this point, a rehabilitation department should be consulted. If there are severe skeletal deformities, surgical correction may be necessary, and at this time, an orthopedic department should be consulted.