Early infantile rickets is the least appreciated form of this ancient disease of children. Although it is usually subclinical, the high prevalence recently reported at autopsy (87% < 1 year age) suggests it is far more common than classical presentations and vastly underappreciated. In my experience with living subjects the disease is most often recognized in infants with unexplained fractures undergoing skeletal surveys for suspected child abuse. Classical signs of metaphyseal fraying and splaying are absent, but numerous additional radiographic signs of rickets and hyperparathyroidism are easily recognized. The most common radiographic finding is that of staged rachitic growth plate recovery indicating that extremity fractures occur after initiation of healing. The development of disease is associated with numerous maternal risk factors, particularly vitamin D deficiency and use of antacids. Biochemical testing in the infants is highly variable. Early infantile rickets closely resembles the clinical and radiographic findings of osteopathy of prematurity.
1) To recognize the clinical signs and risk factors of vitamin D deficiency during pregnancy and early infancy
2) Describe the range of radiographic changes of rickets in early infancy and how they differ from classical rickets.