Rickets: Clinical Assessment and Management
Rickets is a disorder of defective mineralization of the growing bone matrix, usually resulting from Vitamin D deficiency or abnormalities in calcium/phosphate metabolism.
1. Clinical Features (Classic Signs)
- Cranium: Craniotabes (soft skull bones), frontal bossing, delayed fontanelle closure.
- Thorax: Rachitic rosary (beading of costochondral junctions), Harrison’s sulcus (groove at lower chest).
- Extremities: Widening of wrists (epiphyseal enlargement), bowing of legs (genu varum) or knock-knees (genu valgum).
- Neuromuscular: Hypotonia and delayed motor milestones.
2. Diagnostic Workup
| Test | Classic Findings in Nutritional Rickets |
|---|---|
| Serum Calcium | Low or Normal |
| Serum Phosphate | Low |
| Alk. Phosphatase | High |
| Radiology (X-ray) | Cupping, fraying, and splaying of the metaphysis. |
3. Treatment (Nutritional Rickets)
- Stoss Therapy: Single high dose (600,000 IU) of Vitamin D orally or IM (effective but less preferred due to toxicity risk).
- Daily Regimen: 2,000–5,000 IU of Vitamin D3 daily for 8–12 weeks, followed by maintenance (400–600 IU/day).
- Calcium: Ensure adequate dietary intake.
NEET PG Hint: Remember: Increased Alkaline Phosphatase is the most sensitive early marker of rickets. Also, distinguish from Vitamin D-resistant (hypophosphatemic) rickets—if the child does not respond to standard Vitamin D doses, check serum phosphate. For more high-yield pediatric nutrition and free medical questions, visit mymedschool.org.