Definition of Rickets in Child:
Rickets is a disorder of growing due to deficiency of vitamin D in which there is failure of mineralization of the epiphyseal growth plate, newly formed bony matrix (osteoid).
Classification or Types of Rickets in Child:
1. Nutritional rickets:
- Lack of vitamin D,
- Other factors: Decreased exposure to the sun due to dark skin pigmentation, urban living conditions and the winter season.
2. Rickets associated with abnormal metabolism of vitamin D:
- Vitamin D dependent rickets,
- Chronic renal disease,
- Chronic anticonvulsant therapy,
- Chronic liver disease.
3. Rickets due to mineral deficiency:
- Familial hypophosphatemic rickets or vitamin D resistant rickets,
- Rickets of prematurity.
4. Related conditions resembling rickets:
- Metaphyseal dysostosis.
Treatment of Rickets in Child:
Clinical Features or Sign and Symptoms of Rickets:
1. Vary with the age of onset of rickets,
2. Skeletal deformity:
- Dwarfism, frontal bossing, craniotabes, philosophers head,
- Genu varum (bow leg): genu valgum (knock knee).
3. Swelling of wrist (deformity of forearm),
4. Rachitic rosary – Swelling of costochondral junction of ribs,
5. Harrison’s sulcus – Depression of lower ribs along the attachment of diaphragm,
6. Delayed closure of anterior fontanelle,
7. Spinal deformity eg. Kyphoscoliosis,
8. Protuberance of abdomen, pelvic deformity,
9. Hypotonia with delay in motor development,
10. Tetany and convulstion.
Investigation of Rickets in Child:
- Calcium: Normal or decreased,
- Phosphate: Decreased,
- Alkaline phosphatase: Increased,
- Parathyroid hormone (PTH): increased,
- 1.25 (OH), D3: Normal or decreased,
- X-ray of knee, ankle, wrist: Cupping, fraying and widening of the distal ends of the long bone with generalized rarefaction.
Management of Rickets in Child:
1. Vitamin D supplementation and intake of calcium (milk)-
- Vitamin D 25-125 µg (1000-5000 IU) daily for 6-8 weeks,
- Stoss therapy with 3 Lac IU as a single dose for rapid healing calciferol 6 tablets at once (one tablets 50000 IU).
2. Then daily allowance of 10 µg (400 IU) daily,
3. Treatment of underlying causes,
4. Biochemical checkup monthly,
5. If tetany develops: injection calcium gluconate,
6. Surgical correction of deformity.
More questions related to this article:
- What do you mean by rickets?
- What are the types of rickets?
- Mention the classification of rickets.
- How will you treat a case of rickets?
- What are the sign and symptoms of rickets?
- What are the clinical features of rickets?
- What are the investigations of rickets?
- Discuss the management process of rickets.
- How to treat a case of rickets?
Maria Khatun Mona is a Founder and Editor of Nursing Exercise Blog. She is a Nursing and Midwifery Expert. Currently she is working as a Registered Nurse at Evercare Hospital, Dhaka, Bangladesh. She has great passion in writing different articles on Nursing and Midwifery. Mail her at “[email protected]”