The ancient Greeks started talking about such a disease as rickets, in the 17th century there were the first attempts to describe the disease, but true reason the emergence of the disease in children became clear only in the first half of the last century. In the 1930s, vitamin D was discovered, and doctors realized that its lack provokes the development of rickets.
Now the signs of rickets in infants are common, but you should not raise the alarm when you hear such a diagnosis from a pediatrician.
The disease has several stages, and at the initial stage it is not difficult to eliminate vitamin D deficiency. In addition, some doctors do not consider infantile rickets a disease at all, they characterize it as special condition growing organism.
What is rickets?
The medical definition of rickets is that it is a metabolic failure in the body. There is a whole chain. The body does not receive enough vitamin D, which is needed for the absorption of calcium, in turn, the lack of this mineral leads to a lack of calcium and fluorine, which is extremely important for the child's body - the skeletal system is deformed, internal organs suffer, not everything is in order with the nervous system and hormonal background.
Rickets is a childhood disease, more precisely, the first twelve months of a baby's life. But there can be plenty of reasons, not everything comes down to vitamin D deficiency, as you used to think.
Causes
Violation of metabolic processes in the body of a child leads to the development of a disease such as rickets. However, you should understand that the causes may be different, and therefore the treatment will be special in each individual case.
So what causes rickets, you ask. Let's figure it out:
- intrauterine period. Improper nutrition of the mother, the use of alcohol or drugs, smoking leads to a metabolic disorder in the body of an unborn child, a failure in the development of internal organs and systems;
- premature birth. The baby's body is intensively saturated with minerals and vitamins precisely in the last two months of pregnancy, having been born at seven or eight months, the baby did not receive useful substances from his mother. There is a deficiency of one or another mineral, vitamin, rickets develops in infants;
- If you, while breastfeeding, in pursuit of an ideal shape, go on a strict diet, or eat exclusively plant foods, most likely the baby will develop rickets, as a result of a lack of nutrients. Read more about nutrition during breastfeeding in the article: Nutrition for a nursing mother >>>
- Early transition to non-adapted milk formulas;
- Frequent illnesses, taking potent drugs can provoke metabolic disorders;
- Rickets can occur for reasons beyond the control of the child's mother. The baby may have diseases of the kidneys, stomach, skeletal system, defective work of enzymes. As a result, there is no fusion or there is an obstruction of calcium and phosphorus, essential minerals for the growing body of the baby;
- There is a so-called predisposition to rickets. In the risk group there are more representatives of the stronger sex, children born in the cold months, owners of the II blood group and babies with swarthy skin;
- Diseases of the thyroid and parathyroid glands can also lead to the development of rickets. There is a violation of the process of bone formation;
- And only in last place is the lack of vitamin D. You are told that the right amount of vitamin is not getting the right amount of vitamin in food, but this is more likely a different matter. Vitamin D is not absorbed, there is a metabolic disorder.
As you can see, there can be many reasons, but external signs even you, without a special medical education, can notice.
External signs of rickets
If your baby was born at the appointed time, is breastfed (Read the current article: Feeding on demand >>>), then you should not even look for signs of rickets before two or three months. But knowing the enemy in person will not be superfluous.
So, the main external signs of rickets in children under one year old, which should alert you:
- The child is restless and often cries, shows anxiety;
- The baby shudders when the light is turned on or clap;
- If you press on the skin of the baby, red spots appear;
- Bald patch on the back of the head;
- The baby sweats profusely, even if the temperature is maintained, and the sweat itself has a sour smell;
- The palms and legs of the baby are constantly wet;
- A clear deformation of the skull is visible;
- The child has crooked legs.
These are just some of the signs that are visible visually. Of course, you cannot do without consulting a doctor, but knowing the exact diagnosis, it will be you who will choose the appropriate treatment.
First symptoms
- Symptoms associated with the disorder nervous system, such as crying, nervousness, sleep disturbance (Read the article, why do children sleep poorly?>>>), we can confuse with manifestations of other diseases. But the symptoms of excessive sweating, as well as the sour smell of feces and sweat, definitely indicate rickets in children;
- If your baby has frayed hair at the back of his head, feel the whole head. During the development of rickets, the fontanel does not drag on for a long time, the bone tissue in the area of \u200b\u200bthe back of the head and crown becomes softer. You can also feel softening at the cranial sutures;
- You can determine the symptoms of rickets by doing the usual gymnastics with your baby. If earlier, in order to spread the arms or legs, it was necessary to make a small effort, then with the development of the disease, muscle tone becomes very weak;
- You should be concerned if the baby is behind in development from peers. It means that he does not hold his head by three months, does not roll over on his stomach for a long time, does not try to sit down; Read about the age at which babies begin to sit in the article: When does a child begin to sit?>>>
- Indirect symptoms may be late teething, especially if you and your spouse had teeth erupted in childhood almost at the age of three months.
In no case should you leave the manifestations of the disease to chance.
Treatment and prevention of rickets
Do you remember if your baby was prescribed Aquadetrim or other preparations containing vitamin D in the children's clinic? Have you been diagnosed with rickets? Not? Then why are you taking the drug if you are not sure that your child has a vitamin D deficiency, and not a metabolic disorder or a thyroid disease?
The questions above were not asked by chance, since in modern medical practice it is drugs with vitamin D that are considered a panacea for rickets, although, as an analysis of the causes shows, only one item out of nine concerned this vitamin. And even in the case of its deficiency, it is possible to restore the imbalance by other, more gentle methods.
The most elementary of them is walking in the fresh air under the sun, and there are such even in the cold months of the year. Moreover, nice results gives the prevention of rickets in a child.
Prevention
- You carry out most of the preventive actions every day, without even realizing that now, at this very minute, you are fighting rickets. We are talking about everyday walks with a child, the so-called air and sun baths, hardening, for example, walking barefoot on grass or sand;
- When you take care of the variety and fortification of your child's diet, you are again working against rickets. Feed your baby cottage cheese or give steamed fish - again the prevention of the disease. See also a useful course on how to introduce complementary foods to a child >>>
- You should think about the prevention of rickets while still pregnant. There is nothing supernatural here: walks in the fresh air, a full fortified diet, optimal physical activity.
Treatment
- If in medical card your baby is written in black and white: "Rickets", then you need to think about treatment. But do not rush to swallow pills. You can try to balance the baby's nutrition, add foods containing calcium and phosphorus, vitamins C, A, D, protein. Don't give up on breastfeeding. Read the article about vitamins for nursing mothers >>>;
- Even in cool weather you should take walks in the fresh air, if possible, catch every ray of the winter sun. pay attention physical activity baby, run more, jump, if the baby does not walk yet, provoke him to crawl or do gymnastics on a fitball.
Treatment of rickets in infants can be non-specific, described above, and drug-specific.
What drugs to choose?
Do not rush to the pharmacy for vitamin D, even if your baby has been diagnosed with rickets, this does not mean that you need to drink vitamin D or swallow fish oil. By the way, an excess of vitamin D is much worse than the initial stage of rickets.
Important! You must insist on taking tests. How to determine rickets in a child if no laboratory tests are carried out?
Your child may be iron deficient and will need iron supplements. Alternatively, a lack of phosphorus. Again another vector of treatment.
You'd better give preference to homeopathic remedies than chemistry. These are somewhat more expensive, but contain useful substances in their pure form. Listed homeopathic remedies more than a dozen drugs are offered for rickets, and they are safe. The specific names of the medicines will be determined by the homeopathic doctor after a detailed conversation with you (usually initial appointment takes 2 to 3 hours).
What will happen if not treated?
Children's rickets can have three stages of development. All of the listed signs and symptoms related to the first stage. If you do preventive and therapeutic non-specific or medicinal procedures in time, then rickets can be stopped and cured. But, if you let the course of the disease take its course, then a few weeks are enough for the disease to progress to the second stage.
- The most common consequences of a previous illness are caries, first of milk, and later permanent teeth. The reason is calcium deficiency;
- Another consequence of parental negligence is the curvature of the joints. lower extremities, and the legs can take the form of a wheel, and vice versa, bend inward;
- The disease of all schoolchildren - scoliosis - can also be an echo of infantile rickets;
- The problem most pregnant women face is narrow pelvis, as you may already guess, developed this way due to childhood rickets;
- The general weakening of the body, caused by a violation of the metabolism of useful substances, can provoke frequent colds, pneumonia, anemia. Even myopia may well be the result of rickets suffered in infancy;
To avoid all these consequences, it is necessary to carry out prevention even before the birth of the baby, to pay enough attention to nutrition during pregnancy and after. If necessary, replenish the mineral reserve with the help of homeopathic remedies and multivitamins, and walk in the fresh air. try to do it on sunny days.
Infantile rickets is widespread in children of the first years of life. This disease has been known for centuries. For the first time in the scientific literature, rickets is mentioned in the writings of Soranus of Ephesus (98-138 AD), who noted deformities of the lower extremities and spine in children with this disease.
A complete clinical and pathoanatomical description of rickets was made by the English orthopedist Francis Glisson. His book "De rachitide" was published in 1650. According to Glisson, the main risk factors for the development of rickets in children are aggravated heredity and poor nutrition of the mother. The author attached great importance to the nervous or unstable constitution of one or both parents, drinking heavily, leading an idle lifestyle, lack of physical labor, adherence to the debilitating arts and sciences, which are music, poetry, daily visits to comedies, as well as diligent reading of novels.
In a pathoanatomical study of patients suffering from rickets, Glisson drew attention to the following symptoms: disproportion of individual parts of the body (the head is of normal size, and the face is with fat deposits); the muscles of the whole body are thin, emaciated; all skin thin and drooping like a glove; thickenings are noticeable near the joints, especially at the wrist and ankle; articulations and joints are less strong and hard and more flexible than usual; the chest protrudes forward, very narrow, especially under the arms, as if squeezed from the sides, pointed in front, like the keel of a ship or the breast of a chicken; the ends of the ribs have the same thickenings as the wrists and ankles; the abdomen protrudes somewhat forward compared to other parts of the body.
In 1847, the book “Pediatrics” was published, in which the Russian pediatrician S. F. Khotovitsky described, in addition to symptoms from the skeletal system, changes in the gastrointestinal tract, autonomic disorders (sweating) and muscle hypotension in patients with rickets. In 1891, N. F. Filatov emphasized that rickets is a general disease of the body, manifested mainly by a peculiar change in the bones. He was fully supported by A. A. Kisel, who also believed that "rickets is a disease not only of the skeletal system, but of the whole organism as a whole." Currently, the definition of rickets is generally accepted, according to which rickets is a disease caused by a temporary discrepancy between the needs of a growing organism for calcium and phosphorus and the insufficiency of systems that ensure their delivery to the child's body. In addition to violations of phosphorus-calcium metabolism, rickets is characterized by changes in the processes of lipid peroxidation, protein metabolism, trace elements (copper, iron, etc.).
Rickets is a medical and social problem, as it has serious consequences, causing a high incidence of children at an older age. Immunity disorders detected in rickets (decrease in the synthesis of interleukins I, II, phagocytosis, interferon production) and muscle hypotension predispose to frequent respiratory diseases. Rickets transferred at an early age can have an adverse effect on the further growth and development of children.
The most significant links in the pathogenesis of rickets are: a violation of the formation of cholecalciferol in the skin, the formation of active metabolites of vitamin D in the liver, kidneys, as well as insufficient intake of vitamin D from food.
The most active form of vitamin D is 1,25-dihydroxycholecalciferol and 1,25-dihydroxyvitamin D3 (calcitriol).
The incidence of rickets is higher in the autumn and winter seasons, especially in children living in regions with insufficient insolation, cloudiness, frequent fogs or in areas of ecological trouble (smoky atmospheric air).
Most often, rickets develops in children born either from young mothers (under 17 years old) or from women over 35 years old. Of great importance for the formation of disorders of phosphorus-calcium metabolism in a child is an unbalanced diet of a pregnant woman in terms of the main food nutrients (deficiency of protein, calcium, phosphorus, vitamins D, B 1, B 2, B 6). Rickets often develops in babies whose mothers during pregnancy were not exposed to the sun enough, did not move much, had extragenital diseases.
Rickets is more common in children born with signs of morphofunctional immaturity, twins, premature or, conversely, with a large birth weight. Children who are on early artificial feeding with non-adapted milk mixtures (kefir, cow's milk, etc.) and who receive carbohydrate food (semolina porridge) as complementary foods become ill with rickets much more often. Insufficient motor mode is important for the development of rickets.
Rickets is also predisposed to: skin diseases in which the synthesis of cholecalciferol is impaired; syndrome of impaired digestion and absorption, the consequence of which is a violation of the absorption of calcium, phosphorus, vitamin D in the intestine; diseases of the liver and kidneys, in which the formation of active metabolites of vitamin D is disrupted.
Violation of phosphorus-calcium metabolism can be observed with recurrent acute respiratory viral, intestinal infections, reception medicines(glucocorticoids, anticonvulsants etc.).
Identification and correction of risk factors for the development of rickets contribute to its prevention. Prevention of rickets is divided into antenatal and postnatal, nonspecific and specific. Despite the fact that in last years most of the children in Russia receive adapted mixtures with artificial feeding, enriched with a preventive dose of vitamin D, babies with mild and moderate forms of rickets are not getting smaller. That is why it is necessary to pay attention again not only to the specific prevention of rickets, but also to non-specific measures taken both with pregnant women and with children.
Antenatal prevention of rickets involves a number of the following measures.
Compliance with the daily routine pregnant woman, sleep of sufficient duration day and night. Walks in the open air for at least 2-4 hours daily, in any weather. Rational nutrition of a pregnant woman(daily consumption of at least 180 g of meat, 100 g of fish (3 times a week), 100-150 g of cottage cheese, 30-50 g of cheese, 300 g of bread, 500 g of vegetables, 0.5 l of milk or fermented milk products). Instead of milk, you can use special milk drinks intended for women during pregnancy and lactation (“Dumil Mom Plus”, etc.), which can prevent violations of phosphorus-calcium metabolism in a woman during pregnancy, fetus and infant during breastfeeding. These milk drinks for moms contain high quality whey proteins with high nutritional value, carbohydrates (lactose) that stimulate growth normal microflora intestines, as well as the absorption of calcium and magnesium in the intestine. Recommended for pregnant women taking multivitamin preparations throughout the lactation period. You can use a special multivitamin preparation, which also contains trace elements and is based on recent achievements physiology, elevit pronatal. It fully meets the needs of pregnant and lactating women in vitamins and trace elements. In women with normal level hemoglobin (12.5 g/dl) at the beginning of pregnancy, it prevents iron deficiency anemia. Reduces the frequency of congenital malformations, in particular defects of the spine and limbs. Reduces nausea, vomiting and dizziness in the first trimester of pregnancy. It is well tolerated: the frequency of gastrointestinal disorders and skin reactions with its use does not differ significantly from that with placebo. V clinical research in pregnant women, the drug did not cause weight gain. Elevit pronatal is a multivitamin preparation, the protective properties of which have been proven in placebo-controlled double-blind studies. Regular intake of multivitamin preparations can compensate for the lack of vitamins in food, prevent the violation of phosphorus-calcium metabolism in the body of a pregnant woman, and thereby reliably provide the developing fetus with calcium, phosphorus, and vitamin D.
Pregnant women at risk (nephropathy, diabetes mellitus, hypertension, rheumatism, etc.), if they do not receive special multivitamin and mineral complexes, it is necessary to prescribe additionally starting from the 28th-32nd week of pregnancy vitamin D at a dose of 500-1000 IU for 8 weeks. Antenatal prevention of rickets includes application of calcium. Calcium is the most "common" macronutrient in the human body. In the body of an adult, it contains about 1000 g, of which 99% is part of the bone tissue.
The main functions of calcium in the body: mineralization of bone tissue and the formation of the bone skeleton; participation in the creation of the electrical potential of the cell; regulation of the activity of autonomous cells, biologically active substances; participation in the integration of body functions; ensuring normal neuromuscular excitability and muscle contractility; participation in maintaining the normal functioning of the hemostasis system; an activation cofactor for many enzymes and enzyme complexes.
Clinical manifestations of calcium deficiency: osteoporosis, headaches, collaptoid conditions, prolongation of the duration of the electrical systole of the heart, a decrease in myocardial contractility, an increase in neuromuscular excitability, up to the development of muscle spasms, laryngospasm, and even convulsive syndrome with loss of consciousness, increased bleeding.
The level of calcium intake in the body depends not only on its content in the food consumed. Of particular importance in the metabolism of calcium belongs to the active metabolites of vitamin D, which are necessary for better absorption of the macronutrient, and their low level leads to secondary calcium deficiency.
For the prevention of hypocalcemia in pregnant women and children, multivitamin complexes containing calcium can be used.
Instead of vitamin D preparations, ultraviolet irradiation, which promotes the endogenous synthesis of cholecalciferol, can be used in the winter and spring periods of the year, especially in the northern regions. However, it is necessary to start irradiation with 1/4 of the biodose, gradually increasing it to 2-2.5 biodoses. The minimum distance is 1 m. The course is 20-30 sessions, daily or every other day.
Postnatal prevention of rickets
It is extremely important to organize proper nutrition of the child. For a child of the first 2 years of life, breastfeeding is best, provided that the nursing woman is properly nourished.
In the report of prof. A. A. Kiselya, at the IX Congress of Doctors in St. Petersburg in 1904, based on the analysis of 669 cases of rickets in children who are breastfed, the following conclusions were made: breastfeeding prevents the development of rickets, rickets also occurs with breastfeeding , but it flows more easily and does not take such severe forms, as with artificial feeding, rickets of bone changes occur in children as early as the first weeks of life, shortly after the birth of a child.
A. A. Kisel's advice on preventing the incidence of rickets: the child most of all needs sunlight and air, the room is a prison for the child, the child should be kept outdoors all day.
The daily diet of a nursing woman should be varied and include the required amount of protein, including animal origin; fat containing polyunsaturated fatty acids; carbohydrates that provide the body with energy, as well as vitamins and minerals. It is advisable to continue taking multivitamin preparations started during pregnancy or special milk drinks (up to 3 glasses a day).
In the case of artificial feeding, it is necessary to select an adapted milk formula that is as close as possible to human milk, containing 100% lactose, which enhances the absorption of calcium, cholecalciferol and is distinguished by a balanced ratio of calcium and phosphorus equal to 2. In milk mixtures, the ratio between calcium and phosphorus is equal to 1 ,2:2. However, in breast milk it is 2.0, so for children with rickets it is better to prescribe artificial formulas with a ratio between calcium and phosphorus close to 2.
It is necessary to systematically, regularly, for a long time to carry out physiotherapy exercises, massage, with a gradual and uniform increase in load.
It is extremely important for the daily exposure of the child to the fresh air. V summer time the doctor may allow walks in the fresh air from the first days of life. In winter, you can walk when the child reaches the age of 3-4 weeks and the temperature is not lower than -5°C.
Postnatal specific prevention of rickets is carried out with vitamin D, the minimum prophylactic dose of which is 400-500 IU per day for healthy term infants (WHO, 1971; Guidelines Ministry of Health of the USSR, 1990). This dose is prescribed starting from 4-5 weeks of age in the autumn-winter-spring periods, taking into account the living conditions of the child and risk factors for the development of the disease. It should be remembered that in summer period, with insufficient insolation (cloudy, rainy summer), especially in the northern regions of Russia, when feeding with unadapted milk formulas, it is advisable to prescribe a prophylactic dose of vitamin D. Specific prevention of rickets for full-term children is carried out in the autumn-winter-spring periods in the first and second year of life. Children at risk for rickets are recommended daily administration of vitamin D at a dose of 1000 IU during the first 2 years of life during the autumn-winter-spring period.
According to the recommendations of the Ministry of Health of the USSR (1990), premature babies with I degree of prematurity are prescribed vitamin D from the 10th-14th day of life, 400-1000 IU daily for 2 years, excluding summer. With prematurity II degree, vitamin D is prescribed at a dose of 1000 IU daily throughout the year, excluding summer.
Children with small fontanelles have only relative contraindications to the appointment of vitamin D. Specific prevention of rickets is carried out for them starting from 3-4 months of life under the control of the size of the large fontanel and head circumference. The absorption of vitamin D requires the use of B vitamins.
For the prevention of rickets, you can use special vitamin complexes, such as biovital gel, specially designed for young children.
The drug is contraindicated in hypercalciuria and hypercalcemia. Assigned to young children 1/2 teaspoon 1-2 times a day.
The expediency of using the biovital gel complex for the prevention of rickets is determined by the optimal ratio of vitamins B1, B2, B6, the content of lecitip and antioxidants. Lecithin promotes the absorption of fat-soluble vitamins A and D. In addition, lecithin is necessary for the normal psychophysical development of children.
N. A. Korovina, doctor medical sciences, Professor
I. N. Zakharova, Doctor of Medical Sciences, Professor
RMAPO, Moscow
Table 1. Composition of Biovital gel for children
| Compound | Content |
| Vitamin A (retinol palmitate) | 5000 IU |
| Vitamin B 1 (thiamine hydrochloride) | 0.33 mg |
| Vitamin B 2 (riboflavin) | 0.33 mg |
| Vitamin B 6 (pyridoxine hydrochloride) | 1.5 mg |
| Vitamin B 12 (cyanocobalamin) | 1 mcg |
| Vitamin C ( vitamin C) | 100 mg |
| Calcium pantothenate | 1 mg |
| Nicotinamide | 5 mg |
| Vitamin D3 (cholecalciferol) | 600 IU |
| Vitamin E (alpha-tocopherol acetate) | 1.65 mg |
| calcium phosphinate | 2.5 mg |
| Soluble Magnesium Hydrogen Citrate | 6 mg |
| sodium molybdate | 0.25 mg |
| Lecithin | 200 mg |
* - in 10g - 2 teaspoons.
Rickets is the most common disease in infants and young children. Rickets is also called "growing pains" because it mainly affects children during one of the fastest growing age periods– from 2 months to 3 years.
Rickets in itself is not a dangerous disease, but it contributes to the frequent occurrence of bronchopulmonary diseases, especially pneumonia, of cardio-vascular system and digestive tract.
When and why does rickets develop?
In the third month of a child's life, rickets often begins, characterized by temporary metabolic disorders (primarily phosphorus-calcium metabolism). Cause of rickets vitamin D deficiency in the body, which contributes to the proper absorption of calcium and phosphorus in the intestines, which is very important for the development of bone tissue, the functioning of the central nervous system, and other organs.
According to ICD-10, rickets belongs to the section of diseases endocrine system and metabolism (ICD-10 code - E55.0. Active rickets), but not to the beriberi section.
Rickets develops when a child does not take enough vitamin D with food or when the natural formation of this vitamin in the body is disturbed (insufficient ultraviolet solar radiation). Therefore, it is especially common among northern peoples who live in conditions of lack of sunlight.
Children born in autumn and winter (from October to February) suffer from rickets more often and more severely than children born in the spring and summer. The disease is most severe in premature babies and in children who are bottle-fed.
Children are at risk for developing rickets.:
- premature and born with a small body weight;
- born from women with an unfavorable course of pregnancy (pyelonephritis, urolithiasis disease, genital diseases);
- born during repeated births with a small interval between them;
- receiving non-adapted milk formulas, without the addition of vitamin D;
- with late introduction of complementary foods, with malnutrition of the mother;
- receiving mainly vegetarian complementary foods (cereals, vegetables) without a sufficient amount of animal protein (yolk chicken egg, meat, fish, cottage cheese), oils;
- with chronic pathology of the liver, biliary tract and kidneys;
- often suffering from acute respiratory diseases;
- with insufficient motor activity due to damage to the nervous system or lack of massage and gymnastics.
1 degree rickets
1st degree - the most mild form, small changes in the nervous and muscular systems. With timely prevention and treatment of residual effects does not give.
The initial manifestations of rickets are characterized by: irritability, anxiety, tearfulness, excessive sweating with a sour smell of sweat (more often at night), sweating of the palms and feet, baldness of the back of the head, shuddering in a dream.
Signs of osteomalacia (insufficient bone mineralization): “compliance” of the edges of the large fontanel and skull sutures (craniotabes).
Laboratory confirmation of grade 1 rickets is a slight hypophosphatemia, that is, a decrease in the level of phosphates (salts of phosphoric acid), for this a blood test for inorganic phosphorus and an increase in alkaline phosphatase activity are taken. At the same time, blood calcium is normal.
1 degree of rickets is observed in 70-80% of children aged 2.5 to 3.5 months. If at this initial period of the disease, in the presence of the above symptoms, rickets is not diagnosed and prevention is not started, then rickets passes into the next stage.
Noticing the first signs of rickets, immediately contact your local pediatrician. He will select the optimal dose of vitamin D.
2 degree rickets
2 degree rickets (moderate) - accompanied by moderate, but distinct bone deformities, as well as damage to the muscular and nervous systems.
In the second degree of rickets, the child has the following manifestations: skull deformity (enlargement of the frontal tubercles, the head acquires a “square” shape), softening and thinning of the flat bones of the skull in the region of the large and small fontanelles. The anterior part of the chest, together with the sternum, bulges forward somewhat, a "chicken" chest appears.
Changes in the second degree of rickets are also observed in the muscular, nervous and hematopoietic systems. Due to muscular hypotension (flabbiness of the muscles of the abdominal wall), a protrusion of the abdomen, the so-called "frog belly", is observed. In addition, rickets creates favorable conditions for the formation of an umbilical hernia.
The functions of the internal organs are moderately impaired; palpation and ultrasound show a slight increase in the size of the liver and spleen (hepatosplenomegaly). A complete blood count shows anemia (low hemoglobin).
In the study of blood biochemistry, hypophosphatemia (a decrease in the level of phosphorus) is more often determined, the degree of which depends on the severity of the disease and a significant increase in the activity of alkaline phosphatase. In this case, calcium may be normal or slightly reduced.
Rickets of moderate severity is observed in 40-45% of children in the second half of life.
3 degree rickets
3 degree rickets (severe) - pronounced changes in the central nervous, bone and muscle systems, internal organs. Due to deformities of the chest, the child is constantly in a state of hypoventilation, that is, there is an insufficient supply of oxygen to all tissues and organs. There are mixed shortness of breath, hard breathing with an extended exhalation. Dispersed dry and moist rales are possible. The phalanges of the fingers thicken ( "strings of pearls").
Children later than others raise their heads, sit down, get up and walk.
Violated the time and order of teething, with poor quality enamel, which can lead to caries. An incorrect bite may form, which is formed in a child due to violations of the growth of the jaws.
Rickets of the 3rd degree is characterized by a gross curvature of the spine (rachitic kyphosis), with the formation of a hump. A similar curve can begin to form after the first six months of a child's life. This feature of the disease has been noted for a long time and is reflected in the name - "rickets" comes from the Greek word "spine".
Deformation of the bones of the lower extremities (the child's legs take an O-shaped or X-shaped shape). A large fontanel closes only at the age of 1.5-2 years and later.
With severe rickets, there are disorders of the liver, gastrointestinal tract, protein, fat metabolism, there is a lack of B vitamins, as well as vitamins A, C, E, copper, zinc, magnesium.
Signs of rickets in children
The first signs of initial rickets appear most often at 2-3 months of a child's life.
Functional changes in the nervous system: anxiety, irritability, frequent crying, unmotivated whims, irritability. Sleep is disturbed - children do not fall asleep well and often wake up.
With a loud sound or a sudden flash of light, the baby flinches.
With light pressure, red spots remain on the skin of the child for a long time - traces from the hands of the mother or the doctor.
Excessive sweating, especially at night, and when crying and feeding. The baby has constantly wet hands and feet. Even at a moderate room temperature and not too warm clothes the child's body is usually wet. Sweat has an unpleasant pungent and sour smell. Persistent prickly heat and diaper rash irritate the skin, causing itching. The kid rubs his head against the pillow, because of which the hairs on the back of the head are wiped off, fall out, the so-called rachitic "bald spot" appears.
Rachitic "bald spot".
Constipation may occur, even with good appetite. The initial period of rickets lasts from one and a half weeks to one month. Further, 2-3 weeks after the appearance of the first signs, if no action is taken, untreated rickets passes into the next period of the disease - the peak period, which doctors call blooming rickets. Children with rickets in the full stage begin to lag behind in development: later they begin to sit, crawl, walk, get sick more often and more severely, especially with pneumonia.
In children with rickets, tooth growth often slows down. Milk teeth erupt much later or in the wrong order.
The "skeletal" signs of rickets usually join a little later, they are accompanied by muscle tone disorders - hypotension (low muscle tone varying degrees of severity).
The child may subsequently show lesions of the skull and chest: the frontal and parietal tubercles increase, the head acquires a “square” shape, the skull becomes disproportionately large.
In severe rickets, the ribs become soft, twisted, rib cage deformed, there is a protrusion of the sternum (the so-called "chicken breast"). The bones of the lower extremities are bent - the legs look like the letter O or X, the bones of the pelvis are almost always deformed. These changes appear closer to the year when the child begins to walk. At the same time, the abdomen is swollen and protruding.
Rickets. Bones of the lower limbs.
With rickets, the skull is affected in the first 3 months of life, chest deformity occurs, as a rule, at 3-6 months, and deformity of the lower extremities occurs at the age when the child begins to stand and walk.
If left untreated, rickety changes can progress in the 2nd and even 3rd year of life, skeletal deformities remain for life.
In blood biochemistry, there is a reduced amount of phosphorus, an increase in phosphatase activity.
Treatment of rickets
Treatment of rickets begins at 4 weeks of age and consists in an integrated approach to the disease.
Distinguish between nonspecific and specific treatment, including UVR, the introduction of vitamin D preparations, rational nutrition, sufficient exposure to fresh air, massage and gymnastics.
Specific treatment for rickets carried out with vitamin D3 preparations, for example, using an aqueous solution of cholecalciferol - Aquadetrim or Complivit® Aqua D3. The preparations are rapidly absorbed from the gastrointestinal tract, are easily dosed: water-soluble vitamin D is available as a liquid in vials, 1 drop contains 500 IU of the drug.
For the treatment of rickets, it is mandatory to take aqueous solutions of vitamin D3 (cholecalciferol).
According to the instructions, the drugs are prescribed daily at a dose of 2000-5000 IU / day, which corresponds to 4-10 drops, for 4-6 weeks, depending on the severity of rickets (1, 2 or 3 degrees of rickets). Treatment should be continued until clear therapeutic effect, followed by a transition to a prophylactic dose of 500–1,000 IU per day.
At the same time, biochemical parameters (calcium, phosphorus, alkaline phosphatase activity in the blood) should be monitored.
To control the toxic effect of vitamin D, it is recommended to conduct a Sulkovich test (urine analysis for calcium content) once every 3-4 weeks. Elevated calcium in the urine indicates an overdose of vitamin D (hypervitaminosis D).
A therapeutic dose of vitamin D should only be given to children who have laboratory confirmed hypovitaminosis D (calcidiol (25-OH vitamin D) level less than 30 ng/mL).
prophylactic dose of vitamin D 1-2 drops per day. The drug is given to the child in a spoonful of liquid. A prophylactic dose of vitamin D can be given without laboratory examination to determine the level of calcidiol.
Children aged 1 to 6 months, regardless of the type of feeding (breastfeeding, mixed or artificial), regardless of the season of the year, for the prevention of vitamin D deficiency, cholecalciferol preparations are recommended at a dose of 1000 IU / day, that is, 2 drops ( ).
Oil solutions of vitamin D (for example, Vigantol) are currently practically not used in pediatrics, as they are more toxic than aqueous solutions and are less absorbed.
Nutrition for rickets
It is important to organize the proper nutrition of the child - breastfeeding is best provided that the nursing woman is properly fed: protein (meat, fish, eggs, moderate fiber, fat and phosphates (contained in sausage, pastries, cakes, fast food and sweet soft drinks) ).
Breastfeeding prevents the development of the disease, rickets also occurs during breastfeeding, but it is easier and does not take such severe forms.
For children with signs of rickets, complementary foods and complementary foods are administered like all children, starting from the age of six months, provided that the mother has a balanced diet. If the mother’s diet is not proper, the child’s frequent regurgitation, the presence of anemia, the pediatrician may recommend the introduction of complementary foods in more early dates starting from 4-5 months.
It is recommended to use as the first feeding vegetables, at first monocomponent, and then from several types of vegetables with a higher content of calcium and phosphorus: carrots, white cabbage, turnips, pumpkin, zucchini.
It is necessary to timely introduce cottage cheese and egg yolk into the child’s diet, which is rich in fat-soluble vitamins (10 g of egg yolk contains from 20 to 50 IU of vitamin D), B vitamins, calcium and trace elements.
To improve the processes of digestion of food in moderate and severe forms of rickets, within 2-3 weeks from the start of treatment, the doctor may prescribe enzyme preparations, such as Creon.
When choosing cereals as the first food, preference is given to buckwheat, oatmeal, and later mixed cereals of industrial production, which are enriched with a vitamin and mineral complex, including vitamin D.
When artificial feeding, it is necessary to use only adapted milk formulas, their carbohydrate component is represented mainly by lactose, which enhances the absorption of calcium and cholecalciferol. To ensure the proper development of bone tissue and the prevention of rickets, the ratio of calcium and phosphorus in infant formula is in the range of 1.5:1–2.0:1, which is optimal for their absorption.
Air and sun baths for rickets
A longer than usual stay with the child in the fresh air (2–3 hours) is shown, and the room where the child is located must be regularly ventilated.
The child needs sunlight and fresh air. Under the influence of ultraviolet rays, the skin produces its own vitamin D. At the same time, it is not necessary that the child be in direct sunlight, it is enough that he be as open as possible (short-sleeved shirt, panama, short pants).
In summer, the child should spend as much time as possible in the shade of the trees, trying to get the sun's rays directly on the face and limbs of the baby. Even on frosty days, it is necessary to ensure that direct sunlight falls on the face of the baby, at the same time, his body is covered in accordance with the ambient temperature.
The production of endogenous vitamin D occurs in human skin mainly under the influence of ultraviolet rays. This spectrum of sunlight does not penetrate fabric or glass, so "walking on a glazed balcony" will not do any good. In addition, in cities, a significant part of the ultraviolet spectrum solar radiation absorbed by dust and exhaust particles.
In the autumn-winter period, for preventive purposes, the pediatrician may recommend taking a course ultraviolet irradiation- UFO (quartzization). After the end of the course of ultraviolet irradiation, it is not recommended to take vitamin D for 3-4 weeks.
The active movements of the baby should be stimulated. Clothing should be loose so as not to hinder the movement of the child.
Massage and gymnastics for rickets
In addition to daily walks in the fresh air, taking air baths is of great importance non-specific prophylaxis rickets, which involves the use therapeutic gymnastics and massage, which should be carried out systematically, regularly, with a gradual and even increase in load.
Do not swaddle your baby tightly, give him the opportunity to freely move his arms and legs. With muscle activity, the blood supply to the bones increases, which means that the bones will get stronger faster and will not succumb to rickets. However, you can not massage with rickets during the period of exacerbation.
Therapeutic exercises and massage stop the development of bone deformities. Given the increased excitability of the child, massage should give preference to strokes that calm the nervous system.
Below is an approximate set of activities with a child of 2-3 months having signs of rickets of the initial stage. It is enough to repeat each exercise 3-4 times. The total duration of massage and gymnastics at the initial stage is no more than 10-12 minutes.
It is desirable to carry out a complex of gymnastics and massage at the same time, 30-60 minutes before meals or 1-1.5 hours after it.
Stroking is one of the main massage techniques, in which the massaged hand only glides over the skin without shifting it into folds.
Smoothing hand massage.
1. Massage movements occur along the entire length of the child's arm from the hand to the shoulder. To do this, raise the child's left arm and stroke the inner and outer surfaces of the arm, moving from the hand to the shoulder. When massaging the child's left hand, hold his hand with your left hand and massage with smooth movements with your right.
Smoothing foot massage.
2. Lightly holding the child’s right leg by the foot with the right hand, stroke the palm of the other hand in the direction from the foot to the thigh along the back-outer side of the leg. Massage of the left leg is performed in the same way, but with the right hand. During the massage, do not touch the kneecap and do not touch the front surface of the lower leg.
Foot massage.
3. With one hand hold the child's leg, with the fingers of the other hand, "draw" a figure eight in a circular motion. Stroke the foot from the base of the toes to the heel along the outer edge of the foot. On the left leg, such movements resemble the letter "C".
4. For the prevention of bone deformation, the child is laid out on the stomach several times a day. In this position, muscles are strengthened, deformities of the chest are corrected.
Smoothing back massage.
5. The child lies on his stomach, stroke the back of the child with the palm of your hand from the buttocks to the head and back. Then repeat stroking with the back of your hand. You can alternate hands, or you can stroke with only one hand, while holding the child's legs with the other.
Stroking massage of the abdomen on the oblique muscles.
6. The procedure must begin with circular stroking, which is performed clockwise. In this case, you should try not to put pressure on the area of \u200b\u200bthe right hypochondrium (liver).
To massage the oblique muscles of the abdomen, place both palms on the baby's lower back, then with a wrapping motion, point your hands towards each other, up and forward so that at the end of the movement your fingers connect over the navel.
Reflex crawl.
7. Lay the child on his stomach, bending his legs, spread his knees to the sides. Place four fingers of both hands under the baby's feet. In response to this, the child will begin to vigorously push off, straightening his legs. When performing this exercise, be careful that the child does not slip from the place where the massage is being done.
Massage and gymnastics for rickets at 3-6 months
A child at 3-6 months old, with rickets, in addition to stroking, rubbing and kneading are used, which tone the muscles.
To the above complex at this age, the spreading of the arms to the sides and crossing them on the chest are added.
Breeding and crossing hands.
The child lies on his back, put your thumbs in his palms, hold the baby's hand with the rest of your fingers. Spread your arms to the sides, and then lead them towards each other to the cross on the chest. When crossing from above, the right and left handles of the crumbs should be alternately on top. Turn from back to stomach
Lay the child on its side, hold one leg with your hand, push the other leg and pelvis slightly forward. This twisting will force the baby to lift the upper body (thoracic region) and roll over from the barrel to the stomach.
Baths for rickets
For rickets, baths with sea salt (500 g per large bath), coniferous extract (1-2 tablespoons of liquid coniferous extract per large bath), or their alternation are useful. The course of therapeutic baths is 10-15 days, daily or every other day for 5 minutes, gradually increasing the procedure time to 10 minutes. The water temperature is 36.5-37 degrees. It is important to keep the heart area in such a bath above water.
Coniferous and salt baths not only treat rickets, but improve blood circulation, strengthen the child's immunity, and are a general healing and calming procedure.
Clinical examination for rickets
Children who have had mild rickets, that is, 1st degree, are observed by a pediatrician for up to 2 years, and those who have had rickets of 2nd degree (moderate) and 3rd degree (severe) are observed for three years. All children are subject to examination by a pediatrician in a timely manner in accordance with the age of the child. In the first year of life - every month, in the second year of life - once a quarter, in the third year of life - once every six months.
General blood test and general analysis urine - once a month during the height of rickets. According to the indications, the pediatrician may prescribe a biochemical blood test (determination of the content of calcium, phosphorus and alkaline phosphatase), X-ray of the bones.
The Sulkovich test is taken once every two weeks, when therapeutic doses of vitamin D are prescribed.
According to indications, you can get advice from an orthopedist, dentist, orthopedist, surgeon.
Rickets is not a contraindication for prophylactic vaccinations. After the end of vitamin D treatment, the child can be vaccinated.
Prevention of rickets in a child before birth
Nonspecific prevention of rickets should begin long before the birth of a child - during pregnancy. Such prevention of rickets is called antenatal.
First of all, a pregnant woman should observe a daily routine with sufficient time for rest day and night. She should walk in the fresh air for at least 2-3 hours daily. A woman should not overwork, engage in heavy physical work, but at the same time move enough.
Factors contributing to the development of rickets in children are also unbalanced nutrition of a pregnant woman, including calcium and phosphorus deficiency in food. An increased risk of calcium deficiency in pregnant women and, as a result, in the fetus occurs if a woman does not consume dairy products, meat, fish, eggs for any reason. The best food source of calcium are dairy products (cheeses, milk, kefir, cottage cheese).
In the third trimester, calcification of the fetal skeleton begins, which significantly increases the body's need for calcium. Therefore, in order to prevent rickets in a child, starting from the 28th week of pregnancy and until the moment of delivery, regardless of the season, a woman needs to take vitamin D, especially women at risk: those with gestosis, diabetes mellitus, hypertension, nephropathy, etc.
For the purpose of antenatal prevention of vitamin D deficiency, all women are prescribed 2000 IU throughout pregnancy, regardless of gestational age. ( National Program "Vitamin D Deficiency in Children and Adolescents" Russian Federation: modern approaches to correction").
Nevertheless, all instructions for vitamin D preparations (Aquadetrim, Complivit® Aqua D3) contain restrictions on the use of colecalciferol during pregnancy - no more than 600 IU per day.
Multivitamin preparations for pregnant women contain vitamin D in different dosages: from 400 IU in Elevit® Pronatal, Vitrum® Prenatal to 200 IU in Complivit® Trimestrum 3rd trimester, Multi-tabs Perinatal.
Vitamin D in the human body
Vitamin D enters the human body in two ways:
- Under the influence sun rays through the skin (which is why it is called the "sunshine vitamin");
- with food (a small amount) through the gastrointestinal tract.
Vitamin D in the human body
In both cases, vitamin D enters the body in an inactive form. Vitamin D is activated in the liver and kidneys (1,25 (OH) 2D). The active transition of the synthesized vitamin D from the skin into the bloodstream occurs only during intense physical activity.
In the human body, the most important compounds are vitamin D3 (cholecalciferol) and vitamin D2 (ergocalciferol).
Vitamin D3 is the main form of vitamin D, it is ingested through food (found in cod liver, fish oil, butter, egg yolk, milk, cottage cheese), and can also be synthesized in the skin under the influence of sunlight.
In products plant origin(vegetable oils, wheat germ) contains its analogue - ergocalciferol (vitamin D2).
In the liver, vitamin D3 is converted to calcidiol, also known as 25(OH)D3, and ergocalciferol (vitamin D2) is converted to 25(OH)D2 in the liver. To determine a person's vitamin D status, serum levels of these two vitamin D metabolites are measured. Some calcidiol is converted in the kidneys to calcitriol, the biologically active form of vitamin D.
Calcitriol circulates in the blood as a hormone that regulates the concentration of calcium and phosphate in the blood and is responsible for healthy bone growth. Calcitriol also affects neuromuscular and immune function.
For the treatment of rickets, therapeutic doses of vitamin D are prescribed, however, it should be noted that due to an excess of this drug, a child can also have serious complications ( e.g. kidney dysfunction, allergic attacks, liver problems). To avoid such consequences, before giving a child vitamin D, you should carefully read the doctor's instructions and, if necessary, directly consult with a specialist.
What are the degrees of severity of rickets?
Exists the following degrees severity of rickets:
- first degree ( light);
- second degree ( moderate);
- third degree ( heavy).
| The severity of rickets | Clinical manifestations |
| First degree (light) | The nervous system is affected, and minor changes in the bone structure are also observed. The manifestations of the first degree of severity of rickets are:
|
| Second degree (moderate) | It is characterized by a more pronounced lesion of the bone, muscle and nervous systems. With the second degree of severity of rickets in a child, the following manifestations are observed:
|
| Third degree (heavy) | Long tubular bones are affected, and an aggravation of all of the above symptoms is also observed. With the third degree of rickets, the following pathological changes are formed:
|
Depending on the severity of rickets, therapeutic doses of vitamin D2 are prescribed in the following order:
- with rickets of the first degree of severity assigned two to four thousand international units per day for four to six weeks; the course dose is 120 - 180 thousand international units;
- with rickets of the second degree of severity assigned four to six thousand international units per day for four to six weeks; the course dose is 180 - 270 thousand international units;
- with rickets of the third degree of severity eight to twelve thousand international units are assigned per day for six to eight weeks; the course dose is 400 - 700 thousand international units.
What are the types of rickets?
There are the following types of rickets:
- vitamin D-deficient ( classical) rickets;
- secondary rickets;
- vitamin D-dependent rickets;
- vitamin D-resistant rickets.
| Types of rickets | Description |
| Vitamin
D-deficient (classical)rickets | This type of rickets most often occurs in the first years of a child's life. The period of development of children from two months to two years is considered the most dynamic, while the growing body's need for phosphorus and calcium increases. Vitamin D-deficient rickets occurs when the child's body does not receive the necessary resources due to insufficient intake of vitamin D from food or due to a violation of the system that provides the delivery of phosphorus and calcium. The occurrence of classic rickets is accompanied by such predisposing factors as:
|
| Secondary rickets | This type of rickets develops against the background of a primary disease or a pathological process in the body. There are the following factors contributing to the development of secondary rickets:
|
| Vitamin D dependent rickets | This type of rickets is a genetic pathology with an autosomal recessive type of inheritance. In this disease, both parents are carriers of the defective gene. There are two types of vitamin D dependent rickets:
|
| Vitamin D-resistant rickets | The development of this type of rickets is facilitated by such background diseases as:
|
What are the first signs of rickets?
Most often, the development of rickets occurs in children aged three to four months. With a lack of vitamin D, first of all, the nervous system of the child suffers. A child with rickets, as a rule, is restless, irritable, tearful, does not sleep well and shudders in his sleep. There is also increased sweating, which occurs most often during feeding and sleep of the child. Due to a violation of metabolic processes, the child's sweat, like urine, acquires an acidic character and a corresponding sharp sour smell. Due to sweating and friction of the head on the pillow, the child has baldness at the back of the head. "Acid" urine, in turn, irritates the baby's skin, causing diaper rash. Also, in the initial stage of rickets, the child loses his skills acquired by three to four months. The baby stops walking, rolls over. There is a delay in the psychomotor development of the child. Subsequently, such children begin to stand, walk late and, as a rule, their first teeth thin out later.
If time does not attach importance to the first manifestations of rickets, then later the development of this disease can lead to more serious disorders of the skeletal and muscular systems.
Apart from clinical symptoms The diagnosis of rickets is confirmed by biochemical laboratory research. These tests determine the amount of phosphorus and calcium in the child's blood. With rickets, the above indicators ( phosphorus and calcium) are reduced.
When the first signs of rickets appear, it is strongly recommended:
- immediately consult a doctor;
- refrain from self-medication;
- make sure that the child receives the dose of vitamin D strictly prescribed by the doctor;
- regularly walk with the child in the fresh air;
- monitor the child's nutrition, it should be regular and rational ( increase intake of foods rich in vitamin D);
- regularly do massage and gymnastics to the baby;
- comply with the regime of work and rest.
Which vitamin deficiency leads to rickets?
Rickets is considered to be a "classic" disease of childhood, in which a metabolic disorder occurs in a young body - calcium and phosphorus. This disease is especially dangerous in the first year of a baby's life, when there is an active formation of bone tissue. Rapidly developing, this disease usually leads to serious changes in the bone structure of the child, affecting also his nervous and muscular system. These pathological changes occur due to a lack of vitamin D, which, in turn, is a regulator of metabolism in the human body.
Vitamin D is considered universal. This is the only existing vitamin that can enter the human body in two ways - through the skin under the influence of ultraviolet rays, and also through the mouth, entering the body with food containing this vitamin.
Allocate following products foods rich in vitamin D:
- fish fat;
- fish caviar;
- butter, margarine;
- vegetable oil;
- sour cream, cottage cheese, cheese;
- egg yolk;
- liver ( beef, pork, chicken).
That is why vitamin D is prescribed in the last trimester of pregnancy, since during this period of time a woman prepares her body not only for the birth, but also for the further feeding of the child.
A prophylactic dose of vitamin D is also given to the child immediately after birth. It is taken from October to May, that is, in those months when there is not enough sunlight. From May to October, vitamin D is usually not prescribed, but regular walks with the child in the fresh air are strongly recommended.
Prescribing an individual dose of vitamin D will depend on the following factors:
- the age of the child;
- features of genetics;
- type of feeding the child;
- severity of rickets;
- the presence of other pathological processes in the body;
- season ( the weather of the area where the child lives).
For any pathology daily allowance vitamin D is prescribed by a doctor.
It should be noted that an overdose of vitamin D can lead to serious consequences. Therefore, in order to avoid this complication, the child is recommended to conduct a Sulkovich test every two to three weeks. This test consists in determining the presence and level of calcium in the test urine.
Urine for this sample is collected in the morning, before meals.
The results of the study are determined depending on the degree of turbidity of the urine:
- minus is a negative result, in which the child may have a lack of vitamin D;
- one or two pluses count normal indicators;
- three or four plus points indicate increased calcium excretion.
What care is needed for a child with rickets?
Childcare is important aspect rickets treatment. At the same time, high-quality child care should be carried out both in the hospital and at home. When caring for a child with rickets, medical personnel should perform the following actions:
- monitor the behavior of the child;
- perform inspection and palpation of fontanelles ( big and small);
- to check the fusion of cranial sutures;
- make a thorough examination of the chest of children four to six months old in order to determine the pathological thickening of the costal-sternal joints;
- to monitor the thickening of the epiphyses of the bones of the lower leg and forearm, as well as the curvature of the bones in children older than six months;
- determine the motor activity of the child, as well as the state of muscle tone;
- make adjustments to the child's nutrition;
- teach the rules of care for the parents of the baby.
- therapeutic doses of vitamin D are prescribed;
- a child in the third - fourth month of life, who is breastfed, is introduced into the diet with juices, fruit decoctions, vegetable purees, egg yolk and cottage cheese ( children who are on artificial and mixed feeding, the first complementary foods are introduced one month earlier);
- Enzymes are given with food e.g. pancreatin, pepsin) and hydrochloric acid, which are necessary for the child to improve the processes of digestion;
- also, in order to reduce the degree of acidosis, vitamins of group B are prescribed along with nutrition ( B1, B2, B6), vitamin C and citrate blend ( product containing citric acid, sodium citrate and distilled water);
- nurse monitors the calcium content in the urine ( using the Sulkovich test);
- calcium is prescribed in the form of a five percent solution, which is given to children orally ( in the mouth) at the first signs of bone softening;
- physiotherapy exercises and massage are regularly carried out;
- coniferous and saline are assigned therapeutic baths (the course includes ten to fifteen baths);
- a course ( consisting of 20 - 25 sessions) ultraviolet irradiation at home, in the winter.
- Daily walks with the child in the fresh air. At the same time, the total time spent on the street should be at least five hours in the summer period and about two to three hours in the winter period ( temperature dependent). When walking with a child, it is necessary to ensure that his face is open.
- Regular exercise. It is recommended to make flexion and extensor movements of the child's arms and legs, as well as to perform adduction and abduction of the baby's limbs.
- Regular hardening of the child. It is necessary to harden the baby gradually. For example, while bathing with warm water, at the end it is recommended to rinse the child with water one degree lower. Then, as you get used to it, during subsequent bathing, the degree of water can be reduced below.
- Proper organization of the daily routine for the child.
- Monitor the regularity and rationality of nutrition. Complementary foods that are introduced should be appropriate for the age of the child. You also need to increase your intake of foods rich in vitamin D ( e.g. liver, fish, egg yolk, butter, cottage cheese).
- Accurate implementation of actions prescribed by the doctor.
Can rickets be cured?
You can completely cure rickets, but for this you will need to do the following:
- It is very important to timely detect the first symptoms of this disease, since the treatment of rickets at an early stage contributes to the speedy recovery of the child. The first manifestations of rickets are usually excessive sweating, mainly observed at night and after feeding the baby, anxiety and irritability, tearfulness, sleep disturbance, manifested by frequent tremors, pruritus, as well as baldness of the back of the head.
- If you suspect rickets, you should immediately consult a pediatrician. Self-treatment in this case is strictly contraindicated. The doctor, in turn, can immediately diagnose rickets based on clinical manifestations of this disease or prescribe certain diagnostic procedures to detect pathology. After confirmation of rickets, the child will be prescribed appropriate treatment.
- Treatment of rickets includes the rational feeding of the baby, the organization of an active lifestyle, vitamin therapy, regular walks in the fresh air, as well as the elimination of the causes that caused the disease. At the same time, all stages of treatment should be carried out strictly according to the doctor's prescription.
The child's food must be complete. It should contain all the necessary nutrients. Especially with rickets, food rich in vitamins and trace elements is useful. most the best food in this case it is the mother's breast milk, which is rich in vitamins, amino acids, enzymes and immune bodies. The composition of breast milk is optimal for the child, as it best meets his nutritional needs. In the case of a forced transfer of the baby to mixed and artificial feeding, it will be more rational to use adapted milk formulas, the nutritional composition of which is as close as possible to the nutritional composition of breast milk.
Examples of adapted milk formulas include brands such as:
- "Detolact";
- "Baby";
- "Vitalakt".
Organization of a mobile lifestyle
This includes massage, as well as the use of various gymnastic exercises ( for example, adduction and abduction of the arms, as well as flexion exercises of the upper and lower extremities). These procedures favorably affect the metabolic processes in the skin, thereby increasing the productivity of vitamin D. Massage is usually done two to three times a day for eight to ten minutes.
Regular outdoor walks
Walking with a child should be at least two to three hours a day, especially on sunny days. This procedure contributes to the formation of vitamin D in a child, which is synthesized in the skin under the influence of ultraviolet rays.
vitamin therapy
The main method of treating rickets is the therapeutic use of vitamin D. When using this remedy, it is necessary to strictly follow the doctor's recommendations, since an overdose of vitamin D may lead to intoxication of the body.
What head changes are observed in rickets?
At the onset of the disease, no major changes in the head occur. The child during this period has increased sweating, especially in the area of the scalp ( in 90% of children). In this regard, during sleep, friction of the back of the head against the pillow is created, and the baby develops areas of baldness with a clearly visible venous network due to hair loss. With the subsequent progression of the disease, there is some softening of the edges of the large fontanel, as well as bones at the site of the passage of the sagittal ( located between the parietal bones) and occipital sutures.
The height of the disease is characterized by thinning and softening of the bones of the skull ( craniotabes). These pathological changes in the bones are especially pronounced in the region of the large and small fontanelles, as well as in the area where the sutures of the skull pass. In this regard, a large fontanel in a child closes quite late, by two to three years. Also, the baby shows alignment of the parietal and occipital bones.
From the side of the bones of the facial section, the following changes are observed:
- jaw misalignment ( top and bottom);
- malocclusion;
- narrowing of the arch of the sky;
- possible narrowing of the nasal passages.
It should also be noted that with the progression of the disease, an increase in the frontal and parietal tubercles occurs, due to which the head increases in size and externally takes on a square shape.
The development of these pathological changes in the head largely depends on:
- the age of the child;
- the severity of the disease;
- individual characteristics of the baby's body.
Is it necessary to take calcium for rickets?
Calcium plays an indispensable role in the growth of a child. Thanks to calcium, the bone skeleton becomes strong, able to withstand heavy loads. In addition, the participation of calcium is indispensable in the processes of blood coagulation, as well as in the functioning of the nervous system. The need for calcium supplementation occurs when a child has hypocalcemia ( decrease in certain levels of calcium in the blood plasma). With rickets, this condition can occur with active bone mineralization, as well as in premature or low birth weight children.
It should also be noted that calcium preparations for rickets can be prescribed if the child has various changes in the skeletal system.
Rachitic changes in the skeletal system can occur due to:
- slow bone formation hypogenesis);
- excessive formation of osteoid tissue ( osteoid hyperplasia);
- bone softening ( osteomalacia).
Examples of calcium preparations include Calcium gluconate and Complivit. For complete absorption, calcium preparations are usually prescribed in combination with vitamin D.
Calcium-rich foods include:
- processed cheese;
- cottage cheese;
- sour cream;
- cheese;
- beans;
- peas;
- almond;
- pistachios.
In order for the baby to grow up healthy, physically strong, he must spend a lot of time in the fresh air, eat fully. The healing effect of sunlight stimulates the formation of vitamin D in the skin, which is necessary for bone development. Rickets is more common in children born in winter, when the weather is cloudy, as well as those living in the northern regions. It is necessary to deal with the prevention of rickets in children. It is important not only to carry out hardening, massage, but also to ensure that the child's body replenishes the lack of vitamin D, calcium and phosphorus.
Content:
Description of the disease
Rickets is a pathology of bone tissue development associated with a lack of vitamin D in the body. This substance promotes the absorption of calcium and maintaining the balance of calcium and phosphorus, which are part of the bones. Rickets mainly affects children under the age of 2 years, but it also occurs in adults. This disease does not pose a danger to life, but its consequences can be very severe. There is a deformation of the skeleton (skull, ribs, limbs, spine), disruption of the internal organs, lag in mental and physical development. Girls have an incorrect formation of the pelvic bones (the so-called flat-rachitic pelvis appears). Subsequently, this greatly complicates the course of childbirth, makes it impossible to have a child in a natural way.
Forms of the disease
There are the following forms of rickets:
- Acute. The disease occurs in infants during the first months of life (especially in premature infants) who did not receive additional vitamin D in the form of special preparations. Sometimes in this form rickets occurs in obese children who are fed mainly with food high in carbohydrates (cereals, pasta, sweets). The manifestations of rickets in this case (bone pain, weak muscle tone, deformation of the bones of the skeleton, the occurrence of fractures) are pronounced and progress rapidly.
- Subacute. Osteoid hyperplasia occurs - the formation of frontal and parietal tubercles, thickening of the wrists, abnormal development of the ribs, joints of the fingers and toes. This course is observed in babies older than 6 months, if prevention or treatment at the onset of the first symptoms was insufficient.
- Recurrent (wavy) form. There are signs of rickets against the background of already existing manifestations of a previously transferred disease.
Severity
Pathology proceeds with varying degrees of severity.
1 degree (light). The beginning of changes, the appearance of the first symptoms.
Grade 2 (moderate). There are moderate changes in the skeletal system and internal organs.
3 degree (severe). There is damage to the bones, internal organs, nervous system, the wrong formation of the skull.
There are several types of diseases like rickets that can develop in older children. These include, for example, "phosphate-diabetes" - a lack of phosphorus in the bones. With this disease, a person has low growth, curvature of the bones, despite the fact that his physique is strong.
There is also pseudo-deficiency rickets, which occurs due to the inability of the body to absorb vitamin D.
Video: Causes of rickets
Causes of rickets
The causes of rickets in a baby are:
- lack of vitamin D in the body of his mother during pregnancy;
- insufficient intake of nutrients in the body after birth;
- violation of the absorption of vitamin D by the digestive system of the child.
Avitaminosis during pregnancy
The lack of vitamin D in the body of a pregnant woman is formed due to malnutrition, insufficient intake of foods containing this vitamin, as well as calcium and phosphorus. They form the basis of bone tissue and are necessary for the proper formation of the skeleton and muscles of the unborn baby. Severe pregnancy, exposure to a harmful environmental environment, smoking - these factors contribute to the occurrence of beriberi, lack of vitamin D.
If the pregnancy proceeded normally, the woman's nutrition was complete, then the newborn has a supply of these useful substances in the body up to 1-2 months. Subsequently, its intake with mother's milk or in the form of additives to milk mixtures is required. If the birth was premature, then the beneficial substances do not have time to accumulate, the deficiency occurs from the moment of birth.
After birth
Factors that provoke the occurrence of rickets in infants are:
- Vitamin D deficiency in breast milk due to maternal malnutrition.
- Feeding a child with mixtures with a low content of components necessary for the formation of bone and muscle tissue.
- Too tight swaddling, restricting baby's movements.
- The use of anticonvulsants.
- Feeding the baby with cow's milk, which is poorly absorbed by his digestive system.
- Late introduction of complementary foods. After 6 months, it is necessary to gradually include vegetable, fruit, meat puree in the diet, since mother's milk alone is no longer enough to replenish the supply of vitamins and minerals. The predominance of cereals (semolina, for example) in complementary foods contributes to the formation of their deficiency. Their use contributes to the excretion of vitamin D from the intestines along with feces.
- In older children, the cause of rickets may be a lack of animal products in the diet, the predominance plant food from which the absorption of vitamin D is worse.
- Insufficient stay of the baby under the rays of the sun. Vitamin D is formed in the skin under the influence of ultraviolet radiation.
Premature babies are at risk for rickets.
Other reasons
If the weight of the child at birth was large, then his body's need for useful substances higher than in children with normal weight, so a balanced diet is of particular importance for him. The risk of rickets is increased in twins and twins. Lack of vitamin D, calcium and phosphorus occurs even during fetal development, moreover, as a rule, such children are born prematurely.
Contribute to the occurrence of rickets congenital underdevelopment of organs digestive system, in which the absorption of useful food components worsens. Calcium absorption is impaired in the presence of thyroid disease. In dark-skinned babies, rickets is more common than in fair-skinned ones, since the production of vitamin D is under ultraviolet rays they are weaker.
Children living in large cities with polluted air that poorly transmit ultraviolet rays are more susceptible to rickets.
Note: Rickets is more common in boys than girls, and the symptoms tend to be more severe. In some families, there is a hereditary predisposition to rickets.
Symptoms and signs of rickets
In babies, an uncomplicated disease goes through 4 periods of development: initial, peak period, reparation and recovery.
At the beginning of the disease, such manifestations as baldness of the back of the head, poor sleep, increased irritability, and softness of the bones around the fontanel are observed. This period lasts from 2 weeks to 2 months.
During the height of the disease, there is a curvature of the bones, muscle weakness, poor teething, impaired psychomotor development. The period lasts 3-6 months.
Reparation occurs as a result of properly performed treatment. Pathological changes in bones stop, muscles get stronger, signs of nervous system disorder disappear, after which recovery occurs.
The first signs by which a mother may notice the development of rickets in a 1-2 month old baby is a decrease in his appetite (the feeding process becomes short). The kid does not sleep well, shudders at the slightest sound, sweats a lot in his sleep. The back of his head is balding. Digestion is disturbed (diarrhea is replaced by constipation).
It is necessary to draw the attention of the pediatrician to the appearance of such signs.
Symptoms of rickets in children appear over the next few months if the pathology begins to progress. In doing so, the following happens:
- muscle tone weakens, the baby becomes lethargic and inactive, cannot hold his head, does not sit well, falls sideways, cannot roll over onto his stomach;
- the child's teething is delayed, the fontanel overgrows late, it is difficult for him to rise to his feet, he starts walking late;
- bloating occurs;
- the deformation of the skull gradually progresses: the back of the head becomes flat, the head is elongated, frontal tubercles appear;
- the legs become crooked, the pelvis does not develop, the chest is formed incorrectly;
- the work of internal organs worsens, signs of difficulty breathing, heart rhythm disturbances appear, the liver enlarges;
- there is a lag in mental development, mental disorders occur.
During the height of the disease in a child, trembling of the hands and chin becomes noticeable.
Diagnosis of rickets
Signs of rickets, as a rule, do not cause doubts in the doctor. However, to confirm the diagnosis, determine the period of development of the disease and the degree of calcium deficiency in the body, a urine test is performed, the so-called “Sulkovich test”. Urine is collected in the morning before the first feeding. If necessary, an analysis of urine excreted during the day is carried out for the content of calcium and phosphorus.
By biochemical analysis, the concentration of calcium, phosphorus and vitamin D in the blood is determined, the content of the enzyme necessary for the absorption of phosphorus (“alkaline phosphatase”) is established in it.
The degree of bone deformation and disturbance of the state of internal organs is established using ultrasound and x-rays.
Treatment
To eliminate and alleviate the manifestations of rickets, specific and non-specific therapy is carried out. They must be started immediately after diagnosis.
Specific Therapy
Treatment with vitamin D preparations is carried out in a dose corresponding to the period of development of the disease and the nature of the symptoms. A Sulkovich test is performed once every 7-10 days to monitor the course of treatment and adjust the dosage. If a noticeable effect appears, then after 1-1.5 months the dose is reduced.
To prevent relapses, the drug is taken in a reduced dose until the age of 2, and then until the age of 3 years - only in the winter.
There are preparations of vitamin D dissolved in water, and preparations in the form of oil solutions. Water-soluble vitamin D is absorbed by the body better and stays longer in the liver, showing its activity. Oil preparations (devisol, videin) are more often prescribed in cases where the baby has a tendency to constipation.
The main drug in the treatment of rickets in children is aquadetrim. The dose is selected individually for each child in order to avoid the occurrence of side effects.
A course of ultraviolet irradiation is carried out with a gradual increase in dose. This stimulates the formation of the body's own vitamin D and improves its absorption.
Video: The first signs of rickets
Nonspecific therapy
It is carried out to improve the absorption of calcium in the child's body by restoring the acid-base balance. For this purpose, a citrate mixture ( water solution sodium citrate) and dimephosphone. Potassium orotate is given to improve metabolism.
With a low content of calcium in the blood, calcium gluconate and its other preparations are prescribed. To strengthen the body, therapy with vitamins C and group B is carried out. In the presence of anemia, iron preparations (maltofer, tardiferon) are prescribed.
Medicinal baths are used. Special massage and therapeutic exercises are carried out.
It is recommended to increase the duration of walks in the fresh air, as well as make adjustments to the child's diet, include egg yolks, cottage cheese and other foods with a high content of calcium and phosphorus in the diet. When treating infants, it is recommended to reduce the consumption of cereals, introduce complementary foods, accustoming the baby to vegetable and meat purees.
Auxiliary treatment with folk remedies
When the first signs of rickets develop in a baby, it is useful to bathe him in salt water or with the addition of coniferous decoction. Coniferous baths are used to calm the child's nervous system. To prepare it, coniferous extract is poured into warm water (1 teaspoon per 1 liter of water). The child is placed in the bath for 10-15 minutes.
Bathing in salt water is carried out if the child is lethargic. Cooking or sea salt at the rate of 2 tbsp. l. for 10 liters of water. After the bath, it is necessary to wash off the salt by pouring the baby with clean water.
To compensate for calcium deficiency, you can prepare a composition of finely crushed eggshells, ¼ cup lemon juice and 1 cup water. Give medicine after meals.
Prevention of rickets in children
Care must be taken to prevent the development of rickets in a child even before his birth. During pregnancy, women should take vitamins (for example, gendevit) to make up for the deficiency of useful elements, which inevitably arises due to the increased need associated with the growth of the fetus. It is important to take vitamin D tablets in the last 2 months before giving birth, especially if the woman lives in areas where summers are short or the baby is due in the fall/winter period. The drug is taken strictly in the doses prescribed by the doctor, since an excess of vitamin D is just as harmful to the unborn child as its deficiency.
A pregnant woman should eat well, spend a lot of time outdoors under the influence of ultraviolet radiation emitted by the sun, avoid infectious diseases and colds, and regularly take the necessary tests.
After the birth of a child, it is necessary to strive to maintain the possibility of feeding him with full breast milk for at least 5-8 months. From 6 months, it is necessary to start feeding, gradually introducing fortified foods rich in calcium, phosphorus (egg yolks, liver, meat, butter) into the diet.
If necessary, the pediatrician prescribes preventive therapy for children at risk fish oil or vitamin D supplements.
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