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Nutritional rickets: beyond the chief complaint
Laurie Hickey1, Catherine Cross, Michele Burns Ewald
1Department of Medicine, Children's Hospital Boston, Boston, MA 02115, USA.
Insights
Emergency physicians can diagnose conditions like nutritional rickets beyond the main complaint. Early detection on pediatric radiographs, especially in winter-born infants with specific risk factors, is key.
Area of Science:
- Pediatrics
- Radiology
- Nutritional Science
Background:
- Emergency departments are crucial for identifying conditions beyond initial patient complaints.
- Pediatric radiography offers opportunities for incidental diagnoses.
Observation:
- Nutritional rickets may be detected on plain films ordered for other pediatric conditions.
- Risk factors for infant nutritional rickets include exclusive breastfeeding and late winter/early spring presentation.
Findings:
- Pigmented skin on physical examination can be a sign of nutritional rickets.
- Radiographic signs of rickets can be identified on standard pediatric X-rays.
Implications:
- Enhances the role of emergency physicians in early diagnosis of nutritional deficiencies.
- Highlights the importance of careful radiographic review in pediatric emergency care.
- Suggests proactive screening in high-risk infants presenting during specific seasons.
Abstract:
In the emergency department, opportunities exist for the emergency physician to make a diagnosis beyond the chief complaint. For example, an astute reader of pediatric radiographs may detect signs of rickets on plain films that are obtained for other reasons. Risk factors that should suggest nutritional rickets in an infant include a history of exclusive breast-feeding, time of presentation in late winter or early spring, and a physical examination that reveals pigmented skin.
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