TY - CHAP M1 - Book, Section TI - Rickets A1 - Sun, Di A1 - Appachi, Elumalai A2 - Usatine, Richard P. A2 - Sabella, Camille A2 - Smith, Mindy Ann A2 - Mayeaux, E.J. A2 - Chumley, Heidi S. A2 - Appachi, Elumalai PY - 2015 T2 - The Color Atlas of Pediatrics AB - A 2-year-old boy is brought to the pediatrician by his mother, who reports that the boy appears more irritable lately and does not seem to be growing. After further questioning, the mother mentions that her child has also complained of leg pain and a “waddling” gait. On exam, the boy has widening of the wrists and bowing of his legs and prominence of the costochondral junctions (rachitic rosary; Figures 198-1 and 198-2). The pediatrician asks about the child’s diet, and the mother reveals that the patient is a very picky eater and drinks only fruit juice that is not fortified with vitamin D. The pediatrician is concerned about rickets and orders a serum alkaline phosphatase, which is elevated, and vitamin D level (25-OH Vitamin D), which is low. X-ray of the tibia and femur demonstrated widening of the growth plate and metaphysis (Figure 198-3). The pediatrician prescribes vitamin D and calcium supplementation for the child. After 3 months of supplementation, the boy’s symptoms have resolved and repeat x-ray showed a dense zone of calcification at the metaphysis with improvement in the widened growth plate. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accesspediatrics.mhmedical.com/content.aspx?aid=1114879521 ER -