Skeletal changes are the main manifestation of rickets. In addition, there are also neuropsychiatric symptoms and muscle relaxation. The main manifestations of rickets in the early stage are neuropsychiatric symptoms, such as irritability, excessive sweating, restless sleep, sleep terrors, night crying, and bald pillows in children. The active phase mainly involves skeletal changes: (1) Head. Skull softening is more common in babies under 6 months old. When you press the pillow or top with your fingers, it feels like pressing a ping pong ball. There is also softening of the front skull and suture edges, but it is only diagnostic in infants over 3 months old. Skull deformation is more common in children aged 8 to 9 months. The earliest form of skull deformation is a square skull. In severe cases, a saddle-shaped or cross-shaped skull may be seen. The child's anterior cranial closure was delayed (not complete closure at 1 and a half years old). Teeth eruption is late, teeth erupt only after 10 months, or the order of teeth eruption is reversed, and the dentition lacks enamel and suffers from dental caries.

(2) Chest bone changes. There are rib beading (part of the front chest and hypochondrium bulges like abacus beads); costal margins are everted, and in severe cases, pectus carinatum (the sternum protrudes outward) and pectus excavatum (the lower part of the sternum is sunken).

(3) Limbs. Bracelets and anklets are more common than 6 months old. The child's wrists and ankles have blunt, circular bulges. When children can stand and start walking, the lower limbs will bend due to bone softening and muscle and joint laxity under the influence of body gravity. Bow legs (when the heels are brought together, the knees are bent outward) and "X"-shaped legs (when the knees are brought together, the feet are spread apart and outward). Other skeletal changes include spinal curvature and pelvic flattening. In the active stage of rickets, the muscles of the whole body are relaxed, and the neck is weak. Sitting, standing, and walking are later than normal children. The weak abdominal muscles make the abdomen bulge like a frog's belly. The blood tests of children with rickets show changes in blood calcium, phosphorus, and alkaline phosphatase levels, and the bone X-ray examination also shows specific changes. The diagnosis of rickets can be determined based on the clinical manifestations.