Which is the earliest sign of rickets?

RRB Nsg. Superintendent 21 July 2019 (shift 1st)

Child Health Nursing (Pediatrics)

Easy

Appeared in: RRB Nsg. Superintendent 21 July 2019 (shift 1st)

Explanation

Craniotabes is the earliest detectable skeletal sign of rickets.
It is defined as the softening and thinning of the skull bones, which can be felt on palpation, often described as a 'ping-pong ball' sensation.
This sign typically manifests in early infancy, usually between 3 and 6 months of age, before other, more pronounced skeletal deformities develop.

Option A: Harrison's Groove is a later sign of rickets that results from the pull of the diaphragm on softened ribs.
Option C: Bow legs (genu varum) are a weight-bearing deformity and thus only appear after a child starts to stand and walk, typically after one year of age.
Option D: Rickety Rosary, the beading of the costochondral junctions, typically appears after 6 months of age.

Visual 1: Illustration - A diagram showing how to palpate an infant's skull to check for craniotabes, highlighting the 'ping-pong ball' sensation.
Visual 2: Photograph - A clinical image of an infant with a prominent Rickety Rosary to differentiate it from other signs.
Visual 3: Photograph - A clinical image of a child with Harrison's Groove, clearly showing the horizontal depression on the chest wall.
Visual 4: Photograph - A clinical image of a toddler with bow legs (genu varum) to illustrate a weight-bearing deformity.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Chronology of clinical signs in Rickets as background academic context rather than a clinical decision trigger.
Early identification of craniotabes is crucial for nurses as it allows for prompt intervention with vitamin D and calcium supplementation, which can prevent the development of more severe and potentially irreversible skeletal deformities.
Nurses play a key role in educating parents, especially of exclusively breastfed infants, about the importance of vitamin D supplementation as recommended by pediatric guidelines to prevent nutritional rickets.
What if? If an infant presents with seizures and craniotabes, the nurse should suspect hypocalcemic tetany secondary to severe vitamin D deficiency. The priority action would be to ensure airway stability, obtain IV access, and prepare for the administration of intravenous calcium gluconate under a doctor's order.

How to Approach the Question

First, identify the core of the question, which is asking for the 'earliest' sign of rickets. This indicates the need to know the chronological order of the signs' appearance.
Recall the pathophysiology of rickets: it's a disease of growing bones due to deficient mineralization. The earliest changes will occur in the most rapidly growing bones.
Consider the age of onset for each sign. The skull bones grow rapidly in early infancy.
Evaluate the options based on this knowledge: Craniotabes affects the skull and appears in the first few months. Rickety Rosary, Harrison's groove, and bow legs are deformities that develop later, with bow legs being dependent on weight-bearing.
Select the option that corresponds to the earliest age of onset.

Concept Tested & Keywords

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