Approach To A Child With Rickets

MCPS Family Medicine  ( Sample Questions)

A mother brings in her 16 month old son who has not started walking yet. His weight is 9 kg and on examination he has wide wrist joints, with open anterior fontanel.

1. What is the most likely diagnosis?
2. What further points would you explore in history?
3. Briefly outline your management plan?

Question Solved:


1. What is the most likely diagnosis?

Answer:   Rickets ( soft and weakened bones due to prolonged deficiency of Vitamin D in children)

2. What further points would you explore in history?

Answer: It is important to ask the mother regarding:

• Child's current nutritional history
• Is the Child on breast feeding ( if Yes then look for mother's nutritional status and any signs of vitamin D deficiency) 
• When was weaning started
• What was the food given for weaning
• Where do they reside and does the child get any exposure to sunlight
• Any history of repeated episodes of diarrhea in the child (which may suggest malabsorption)..
• Other developmental milestones ( language and social) 
• Family history of rickets and if other siblings had similar problem.
• Any history of seizures ( which may indicate hypocalcemia) 

3. Briefly outline your management plan?

Answer;

After a detailed clinical history and physical examination order following investigations:

• Serum Calcium ( decreased in rickets)
• Alkaline phosphatase  (raised in rickets) 
• X ray of the wrist and Knee joints ( reduced bone opacity and after treatment a distinct growth line would be seen) 
• Serum phosphorus ( decreased) 
• Plasma 1,25 hydroxy Vitamin D levels

Treatment: 

1. Give a single Intramuscular injection of Vitamin D (600,000 IU)
2. Maintenance daily intake of  oral Vitamin D supplements (400 units) should be given.

3. Also give oral calcium supplements ( 40 mg/kg/day) 

4. Advice the mother regarding Vitamin D and calcium rich foods. ( Milk, cheese, fish, egg yolk)

5. Expose the child to sunlight daily. 

6. Follow up in 1 month.