Which of the following is the early sign of Rickets?

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2019

Explanation

Craniotabes is the softening and thinning of the skull bones, which can be felt as a 'ping-pong ball' sensation upon gentle pressure.
It is considered the earliest detectable skeletal sign of vitamin D deficiency rickets, typically appearing in infants.
This sign is due to the inadequate mineralization of the skull's flat bones, making them pliable.
Its presence should prompt immediate investigation for rickets to prevent the progression to more severe deformities.

Option A: Rachitic rosary, which is beading at the costochondral junctions, is a sign of established rickets and appears later than craniotabes.
Option C: Harrison's groove is a horizontal depression on the lower chest caused by the pull of the diaphragm on softened ribs. It is a sign of more advanced and severe rickets.
Option D: Pectus excavatum (funnel chest) is a structural deformity of the chest wall that is often congenital. While severe rickets can cause various chest deformities, pectus excavatum is not a specific or early sign of the condition.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Early clinical signs of Rickets as background academic context rather than a clinical decision trigger.
Early detection of rickets by identifying signs like craniotabes is a critical nursing responsibility in pediatric primary care to prevent irreversible bone deformities and growth failure.
Nurses play a key role in educating parents about vitamin D supplementation (400 IU/day for breastfed infants) and safe sun exposure as primary prevention strategies for rickets.
What if? If an infant presents with seizures instead of skeletal signs, the nurse should consider hypocalcemia secondary to severe vitamin D deficiency as a possible cause, as this is a life-threatening complication of rickets.

How to Approach the Question

First, identify the core concept of the question, which is the 'early sign' of a specific disease, 'Rickets'.
Recall the clinical manifestations of rickets, categorizing them mentally into early and late signs.
Evaluate each option: Craniotabes is known as the earliest skeletal sign.
Consider the other options: Rachitic rosary and Harrison's groove are classic but later signs of chest deformity.
Eliminate Pectus excavatum as it's generally a congenital condition and not a specific sign of rickets.
Conclude that Craniotabes is the correct answer because it appears before the other deformities listed.

Concept Tested & Keywords

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E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 517-519

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 103-105

E6 Text Book Of Pediatric Nursing 3rd Panchali Pal — Part 3 (pp 477-702 of 713) p. 50-52

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