The main clinical manifestations of vitamin D deficiency rickets are skeletal changes, muscle relaxation and nonspecific mental and neurological symptoms. Patients with severe rickets can affect the digestive system, respiratory system, circulatory system and immune system, and also affect children's intellectual development. Clinically, it can be divided into initial stage, exciting stage, recovery stage and sequela stage. The initial period, the exciting period and the recovery period are collectively called the active period.

1. Primitive period

Most patients begin to get sick from about 3 months, and the symptoms of mental nerves are the main symptoms in this period. The child has the phenomenon of restless sleep, crying and sweating. After sweating, the scalp itches and rubs the head on the pillow, resulting in baldness on the pillow.

2. Excitement period

In addition to the initial symptoms, children mainly show skeletal changes and bradykinesia. When you press your finger on the occipital bone and parietal bone of a child aged 3 ~ 6 months, you feel the skull invagination and relax and bounce back. This is the so-called table tennis sign. Children over 8 ~ 9 months old often have a square skull with large anterior fontanel and delayed closure. In severe cases, the anterior fontanel has not been closed for 18 months. The connection between ribs and costal cartilage on both sides is bead-like expansion, which is called costal beading. The middle part of the sternum protrudes forward, like a "chicken breast", or sinks into a "funnel chest", and the lower edge of the chest turns outward into a "rib valgus"; Kyphosis and scoliosis; Children's legs that can stand and walk will bend inward or outward, that is, "O" or "X" legs. The child's muscles and ligaments are slack, which makes the abdomen swell because of weakness of abdominal muscles. When lying flat, it is a "frog-shaped abdomen". Because the muscles of the limbs are weak, it is late to learn to sit, stand and walk, and it is easy to fall down because of leg weakness. Teeth are late, teeth are irregular, and dental caries are prone to occur. Cerebral cortex function is abnormal, conditioned reflex is slow to form, children's expression is indifferent, language development is slow, immunity is low, and infection and anemia are easy to occur.

3. Recovery period

After certain treatment, all kinds of clinical manifestations disappeared, muscle tension recovered, blood biochemical changes and X-ray manifestations also returned to normal.

4. Sequela period

More common in children after 3 years old. After treatment or natural recovery, the clinical symptoms disappeared, and only severe rickets left different parts and different degrees of skeletal deformities.

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