Table 1.

Clinical Features Associated With Nutritional Rickets

Osseous signs and symptoms

Swelling wrists and ankles

Delayed fontanelle closure (normally closed by age 2 y)

Delayed tooth eruption (no incisors by age 10 mo, no molars by age 18 mo)

Leg deformity (genu varum, genu valgum, windswept deformity)

Rachitic rosary (enlarged costochondral joints—felt anteriorly, lateral to the nipple line)

Frontal bossing

Craniotabes (softening of skull bones, usually evident on palpation of cranial sutures in first 3 mo)

Bone pain, restlessness, and irritability

Radiographic features

Splaying, fraying, cupping, and coarse trabecular pattern of metaphyses

Widening of the growth plate

Osteopenia

Pelvic deformities including outlet narrowing (risk of obstructed labor and death)

Long-term deformities in keeping with clinical deformities

Minimal trauma fracture

Non-osseous features

Hypocalcemic seizure and tetany

Hypocalcemic dilated cardiomyopathy (heart failure, arrhythmia, cardiac arrest, death)

Failure to thrive and poor linear growth

Delayed gross motor development with muscle weakness

Raised intracranial pressure