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 |