Table 1.

Main characteristics of nutritional rickets.

Early Signs
Delayed fontanel closure (normally closed by age 2 years)
Craniotabes (softening of skull bones, best detected by palpation of cranial sutures in first 3 months)
Bone pain
Restlessness and irritability
Swelling of wrists and ankles
Frontal bossing
Rachitic rosary (enlarged costochondral joints)
Late signs
Delayed tooth eruption (no incisors by age 10 months, no molars by age 18 months)
Leg deformity (genu varum, genu valgum)
Osseous/Radiographic features
Splaying, fraying, cupping, and coarse trabecular pattern of metaphyses
Widening of the growth plates
Osteopenia
Pelvic deformities including outlet narrowing (risk of obstructed labour and death)
Long-term or permanent deformities of childhood abnormalities of bone
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