Rickets
Contents
Background
- Preventable condition in infants and children that is attributed to Vitamin D deficiency and Hypocalcemia
- Extreme deficiency leading to decrease bone mineralization in children, with or without hypocalcemia
- Risk factors for Vitamin D deficiency in infants include:
- Exclusive breastfed infants without vitamin D supplementation
- Dark skin pigmentation
- Maternal Vitamin D deficiency
- In utero, 25-hydroxyvitamin D passes through the placenta to the infant
Clinical Features
- Peak incidence between 3 and 18 months of age
- Enlarged and soft skull (Craniotabes)
- Enlarged joints of long bones
- Enlarged joints of the rib cage (aka "rickety rosary"
- Double malleoli sign due to metaphyseal hyperplasia
- Widening of wrist due to metaphyseal cartilage hyperplasia
- Curvature of the spine and femurs
- Bowed legs in toddlers (Genu varum)
- Knock-knees in older children (Genu valgum)
- Generalized muscle weakness
- Bony pain or tenderness
- Dental problems
- Growth disturbance
- Hypocalcemia
- Tetany
Differential Diagnosis
Evaluation
Management
- Prevention key:
- For healthy infants, children, and adolescents recommend a vitamin D intake of at least 400 IU/day