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What is Earliest sign of Rickets is and explain in detail?
A. i.e. (Craniotabes) (82- Ghai 7th) (128 - Ghai 6th)RICKETSSCURVY* Craniotabes* is the earliest manifestations (felt like a ping pong ball)* Anterior fontanel is large and its closure is delayed beyond 18 months* Bossing of frontal and parietal bones* Rachitic rosaiy (costochondral junction become prominent dome shaped and semicircular)* Pigeon breast - sternum projects forward* Harrison's groove (Horizontal depression)* Eruption of primary teeth delayed* Moderate degree of scoliosis kyphosis or lordosis* Epiphysis of long bones are widened and broadening of wrists* Long bones of legs get deformed when the child starts bearing weight* Anterior bowing of legs, knock knee and coxa vera*** Pot- belly (Abdomen become protuberant)* Visceroptosis and lumber lordosis* Child is listless, anorexic, fretful and cries onbeing handled* Bones are tender* Hemorrhages occur under the periosteum of long bones* Gum bleeds are common* Petechiae may be seen over the skin* Costochondral junction is prominent and appears sharp and angular* Scorbutic rosary is attributed to separation of epiphysis of ribs and backward displacement of sternum* Wound healing is delayed* Anemia may co- exist* Metaphyseal flaring of the anterior ends of the ribs is characteristically seen in rickets*** **First change to appear is "loss of normal zone ofprovisional calcification" adjacent to metaphysis