Terms of treatment of rickets. Signs of rickets in infants, treatment, causes, stages of rickets in children

Rickets in children is a disease associated with a lack of vitamin D and a violation of calcium metabolism in the body, most often found in infants. Children born with low birth weight are most susceptible to it. Rickets does not pose a danger to the patient's life, however, if left untreated, deformation of the bone apparatus occurs.

Characteristics of the disease

For normal formation bone tissue calcium, phosphorus and vitamin D are required. These substances enter the child's body with food (breast milk, vegetable oil, vegetables, fish). Part of vitamin D is formed under the influence sun rays.

Children are born with a supply of vitamins and minerals, so up to 2 months the formation of bone tissue occurs normally. In the future, the reserves are exhausted, which is why the need for the child's body in vitamins and minerals increases. If it is not satisfied, calcium and phosphorus begin to be washed out of the bones. This leads to the appearance of the first signs of rickets.

The child has a delay in physical and mental development, muscle weakness, skeletal deformity.

The reasons

The following provoking factors contribute to the development of rickets:

1. Deficiency of nutrients and vitamins in the diet. The risk group includes children who receive unbalanced mixtures instead of breastfeeding.
2. Late introduction of complementary foods. The development of the disease is favored by the predominance cow's milk and cereals in the diet of a child older than 6 months.
3. Rare exposure to sunlight.
4. Violation of digestion and absorption of nutrients in the intestine. Children with organ diseases are susceptible to rickets gastrointestinal tract. In this case, even proper nutrition is not able to meet the needs of the body.
5. Prematurity. Children born prematurely do not have time to accumulate reserves of vitamins and minerals, moreover, they often have an immature digestive system.
6. Large birth weight. Large children need more nutrients.
7. Birth from multiple pregnancy. Deficiency of calcium and vitamin D occurs during prenatal development. In addition, such children are often born prematurely.
8. Congenital pathologies of internal organs.
9. Dark skin color. Dark-skinned babies produce less vitamin D.

Symptoms of rickets

On the early stages rickets in newborns have the following symptoms:

1. Increased sweating. Even with normal temperature air during feeding, drops of sweat appear in the forehead and nose, palms and soles are characterized by high humidity.
2. Behavior change. The child does not sleep well, behaves restlessly, often shudders.
3. Loss of hair in the back of the head.
4. Constipation. With rickets, muscle tone decreases, including those that make up the intestinal walls. The deterioration of peristalsis contributes to the retention of feces.

These signs appear in infants 3-4 months of age. At the start of treatment at this stage dangerous complications does not develop.

With absence therapeutic measures rickets progresses, infants have specific signs:

1. Deformities of the skeletal system. Characteristic manifestations- flat nape, "Olympic forehead" (high, convex), O- or X-shaped curvature of the legs.
2. A pronounced decrease in muscle tone, due to which another characteristic sign arises - “frog belly”.
3. Violation of motor development. The child cannot hold his head, roll over, sit up and crawl at a time when his peers begin to master these skills.
4. Late appearance of the first teeth.
5. Pathologies of internal organs (primarily the digestive system).

In the future, the child's condition improves, but the resulting bone deformities remain for life. These include:

• narrow pelvis;
• large frontal tubercles;
• malocclusion;
• narrow pelvis;
• laterally compressed, convex chest in front;

Diagnostics

For children and adolescents use:

1. Primary inspection. The disease in the later stages has symptoms that make it possible to easily make a preliminary diagnosis.
2. Blood chemistry. Characteristic features rickets are: a decrease in the level of calcium and phosphorus, calcitriol and calcidiol, an increase in the activity of alkaline phosphatase.
3. Biochemical study of urine. Helps to detect increased amounts of phosphorus and calcium excreted by the kidneys.
4. X-ray examination of long bones. The images reflect the pathological changes characteristic of rickets - the expansion of the metaphyses, the disappearance of the boundaries between the epiphyses and metaphyses, the thinning of the upper layer of the bone, the fuzzy visualization of the ossification nuclei, and the decrease in tissue density.
5. Densitometry. Used to assess the general condition of the bones.

Treatment of rickets in a child

Treatment for children under one year old includes:

1. Massage and physical therapy. The complex includes breathing exercises, stroking the upper and lower extremities. Strengthening the muscles is facilitated by turns from the back to the stomach, training crawling and walking reflexes. Exercises on the fitball calm the nervous system.
2. Reception of calcium and vitamin D. With rickets, doctors prescribe Aquadetrim, Videin, Vigantol. Vitamin D3 is more effective water solution better absorbed by the child's body. The course of treatment lasts 30-45 days, then the drugs are taken in maintenance doses. Taking vitamins should be accompanied by regular urinalysis. This will help to avoid an overdose that adversely affects the general condition of the body.
3. Physiotherapeutic procedures (UVI, paraffin baths, therapeutic baths). Improve general state body, promote the absorption of drugs, eliminate unpleasant symptoms diseases.
4. Warm baths. To normalize the state nervous system coniferous baths are used (1 tsp of coniferous extract, which can be purchased at a pharmacy, is taken for 10 liters of water). The duration of bathing is 10-15 minutes. The procedure is recommended to be carried out before going to bed. With a decrease in muscle tone in 10 liters of water, add 2 tbsp. l. salt. To improve the condition of the child, 10 sessions are enough.

Effects

In children with severe vitamin D deficiency, milk and permanent teeth are often destroyed.

Dangerous rickets lag in mental and physical development, curvature of the spine of varying degrees.

In schoolchildren and adolescents, immunodeficiency states, anemia, and myopia are found. Children are prone to colds and infectious diseases. In people middle age osteoporosis develops early.

Prevention

Dr. Komarovsky believes that rickets is easy to prevent. This helps:

1. Reception fish oil. Prevention is carried out from October to April. In areas with insufficient solar activity, do not take breaks in taking the drug. Premature babies are given maximum doses of vitamins.
2. Proper nutrition. An important role in the development of the child is played by the full breast-feeding in the first months of life. After 4 months, it is recommended to introduce the first complementary foods.
3. Regular walks in the fresh air. AT summer time it is not recommended to wrap the child, the face, arms and legs should be exposed to indirect sunlight.

Caring for the health of the unborn child begins during pregnancy. A woman must lead healthy lifestyle life, eat right, walk in the fresh air, take vitamins prescribed by the doctor.

Rickets in children- a disease caused by vitamin D deficiency. Vitamin D is produced by the skin under the action of ultraviolet rays and also found in some foods. Vitamin D actively promotes the absorption of calcium from the intestines and its proper distribution in the body, which is very important for the development of bone tissue, the functioning of the central nervous system, and other organs. Most often rickets occurs in young children, i.e. in the first three years of life.

Signs of rickets in children

The initial period of rickets.

Currently, it is believed that congenital rickets does not happen. What used to be taken as a congenital form of this disease, in fact, are malformations of the skeletal system. First signs of rickets in children occur more often at 2-3 months of age. Parents notice a change in the child's behavior: anxiety, fearfulness, excessive excitability appear - start at a loud cry, a sudden flash of light, etc. Sleep becomes superficial, disturbing. noted excessive sweating especially the face and scalp. Sweat has a sour smell and irritates the skin, causing itching. The child rubs his head against the pillow, baldness of the back of the head appears. Normal for this age, high muscle tone is gradually replaced by hypotension, that is, reduced muscle tone. When feeling the bones of the skull, it is possible to reveal the compliance of the sutures and the edges of the large fontanel. There are thickenings on the ribs ("rosary"). From the side of internal organs there are no changes.

Rickets period.

Most often period of rickets occur at the end of the first six months of life and is characterized by even more significant neuromuscular disorders, up to a delay in psychomotor and physical development: the child reluctantly turns on his stomach and back, does not make an attempt to sit down when he is pulled by the handles, less often hums, there is no babble (pronunciation of syllables).

The processes of osteomalacia, that is, softening of the bones, are especially pronounced in acute cases, are observed in the flat bones of the skull. Over time, flattening of the occiput may develop, often unilateral. Characteristic changes in the configuration for this period chest- its "depression" in the lower third of the sternum ("cobbler's chest") or "bulging" ("chicken breast"). Perhaps O-shaped, and also (much less often) X-shaped curvature of the legs and the formation of a narrowed (“flat-rachitic”) pelvis. Sometimes there is proliferation of non-calcified bone tissue (the growth of which normally stops after calcification), leading to the formation of frontal and parietal tubercles, an increase in head circumference, thickening in the wrist area (“bracelets”), in places where bone tissue passes into cartilaginous tissue on the ribs (“rosary beads”). ").

Characteristic for rickets changes in the bones can be seen on x-rays. However, at present, the diagnosis of rickets is almost always carried out according to the clinical picture, and only bone changes are taken into account. X-ray studies because of them side effects are not used for this purpose.

The recovery period of rickets.

This period is characterized by an improvement in the child's well-being, the elimination of neurological disorders. Static functions improve or normalize - the child begins to sit, stand and walk better (according to age), however, muscle hypotension and skeletal deformity persist for a long time. The level of phosphorus reaches the norm or slightly exceeds it. A slight decrease in calcium in the blood may persist.

Normalization of biochemical parameters indicates the transition of rickets from the active to the inactive phase - the period of residual effects. Now this period is most often absent, since rickets, as a rule, proceeds in a rather mild form leaving no consequences. Previously, especially in wartime, children with rickets had an excessively large head, a deformed chest, twisted legs, and a narrow pelvis for the rest of their lives (in women, this often caused complicated childbirth).

The active phase of rickets is observed only in children under one year old, during the period rapid growth. Now they do not diagnose "late rickets" for children of preschool and school age when there is no longer a rapid growth of the child's body. Pain in the limbs and their deformities at this age (what used to be taken for late rickets) are actually due to other reasons.

Treatment of rickets in children

"Ideology" rickets treatment is to eliminate all the causes that caused it. Treatment should be comprehensive and lengthy. At the same time, currently greater value is given to non-specific (i.e., aimed at general strengthening of the body) treatment.

Nonspecific treatment of rickets in children:

• rational (natural) feeding;
• organization of the daily routine corresponding to the age of the child;
• ensuring a long stay of the child in the fresh air with sufficient insolation (1);
• therapeutic exercises and massage;
• hardening;
• treatment of comorbidities.

Specific treatment for rickets in children:

For the specific treatment of rickets in a child, vitamin D, calcium and phosphorus preparations are prescribed. Vitamin D content is measured in international units (IU). On the packaging of this vitamin, its content in one drop is necessarily indicated. Compared with the recent past, now the therapeutic doses of vitamin D have been reduced many times over. For example, earlier, even with mild forms of rickets, up to 600-800 thousand IU for 15-30 days were prescribed for a course of treatment, while now the average dose is not more than 100-150 thousand in 30-60 days. At the end of the treatment course, long-term prophylactic doses of vitamin D are prescribed, not more than 400 IU per day (usually 100-200 IU). An increase in the prophylactic dose, say, 6 times, can lead to hypervitaminosis. Many doctors generally do not recommend the use of vitamin D in therapeutic doses, given the possible complications associated with its overdose. There are more and more supporters of its individual use after determining the content of active metabolites in the blood. As mentioned above, their level in children with rickets is very often normal. Many authors suggest prescribing children not vitamin D, but a complex of multivitamins, which includes vitamin D in a moderate dose (Polivit Baby, Multi Tabs, Biovital Gel, etc.), since rickets is usually accompanied by polyhypovitaminosis (i.e. deficiency a number of vitamins). This complex necessarily includes vitamin A, which reduces the risk of developing an overdose of vitamin D. If, nevertheless, it is decided to prescribe vitamin D in the treatment of rickets, moderate doses are recommended. As a rule, vitamin D3 (cholecalciferol) is prescribed - videochol, vigantol. Many physicians prefer water-soluble vitamin D because it is better absorbed in the intestines and has a longer duration of action than an oil solution. There are currently more active forms(metabolites) of vitamin D - oksidevit, alfacalcidiol, rocaltrol, calcitriol. However, they are strongly discouraged for the treatment of rickets, as they can quickly lead to hypervitaminosis and hypercalcemia. At present, artificial UVI has been abandoned for young children, given the possible carcinogenic effect of its exposure in the future. It must be remembered that the sensitivity to ultraviolet rays is the higher, the younger the child. Therefore, in summer, direct sunbathing for children under one year old is also contraindicated. Extremely carefully they are assigned to children from one to three years. In the autumn-winter and spring periods, direct sunlight does not cause overheating, the open surface of the body is insignificant, so getting them on the child's face is not only permissible, but also necessary.

The issue of additional administration of calcium and phosphorus preparations has not been fully resolved. It is believed that if the child's diet is well balanced, then the additional administration of calcium, especially simultaneously with vitamin D, can lead to the development of hypercalcemia. Many doctors prescribe phosphorus preparations, especially for premature babies. Magnesium preparations are often added, which contributes to the use of natural reserves of vitamin D, phosphorus and calcium.

Prevention of rickets in children

Currently, mainly non-specific methods of prevention are recommended - both before and after the birth of a child.

Prevention of rickets before the birth of a child:

• complete nutrition of a pregnant woman;
• long walks in the fresh air;
• physical education;
• constantly (three months before pregnancy and throughout pregnancy) - a complex of vitamins with micro- and macroelements for pregnant women ("pregnavit", "mother", "vitrum prenatal", etc.).

A pregnant woman should receive a complete, varied diet with sufficient protein, fat, carbohydrates and vitamins. However, you need to choose the golden mean in everything. For example, an excessive passion for juices will not lead to anything other than a disorder in the digestive system, which will negatively affect the child. At the same time, just to cover the need for vitamin C, a woman should drink 2 liters of juice per day, which, of course, is unrealistic. That is why all women three months before pregnancy, then the entire pregnancy and throughout breastfeeding without interruption should take a special complex of multivitamins with trace elements, which not only prevents the development of rickets in their children, but also significantly reduces the risk of congenital malformations. The latter very often occur with a lack of folic acid in a pregnant woman.

The expectant mother should not only spend as much time as possible in the air, which most of them do, but also be sure to engage in physical education (a set of exercises for pregnant women). In no country in the world, except Russia, do they treat a pregnant woman as a seriously ill person. In our country, unfortunately, caring for a future mother often comes down to advice: "Lie down, rest, do nothing, don't move."

Pregnant women are not prescribed UVR and large doses of vitamin D, which was common a few years ago, since there is evidence that in children whose mothers received UVR during pregnancy, damage to the nervous system develops more often and is more severe. At high doses of vitamin D, the placenta is easily damaged, children develop intrauterine growth retardation, that is, children are born weakened, with various diseases internal organs.

The expectant mother should be under constant supervision in the antenatal clinic from the early stages of pregnancy, since the prevention of various complications largely contributes to the birth of a healthy child, which also prevents the subsequent development of rickets.

Prevention of rickets in children after birth:

• proper feeding (for example, iron deficiency was found in all children with rickets, often in the absence of vitamin D deficiency);
• daily routine corresponding to the age of the child;
• walks in the fresh air and at the same time the rejection of air baths in direct sunlight (walks in the shade of trees);
• hardening;
• massage and gymnastics;
• the constant intake by the nursing mother of multivitamins or special mixtures enriched with micronutrients (i.e. vitamins and trace elements);
• as prescribed by a doctor - multivitamins for infants (Multi-Tabs, Polivit Baby, Biovital Gel, etc.); question about prophylactic reception vitamin D should be decided by the doctor.

AT prevention of rickets in children breastfeeding is definitely number one. Up to 4-6 months, the baby should be fed only breast milk. With proper nutrition of the mother, especially if she continues to continuously take either special multivitamins or mixtures for pregnant and lactating women enriched with micronutrients (“Fabulous nutrition for pregnant women and mothers”, “Enfa Mama”, etc.), breast milk fully covers the child’s need for vitamins and microelements. After 4-6 months, it is necessary to introduce complementary foods (vegetable and fruit purees, cereals, juices, meat, fish). With artificial feeding, adapted, that is, as close as possible in composition to breast milk, mixtures the child also receives a sufficient amount of micronutrients. However, to prevent rickets, proper feeding alone is not enough. They also play an important role correct mode days with long walks, hardening, massage and gymnastics.

Pediatricians say: "Better a little rickets than hypervitaminosis D." And indeed it is. In modern conditions, as already mentioned, rickets proceeds quite easily, with proper treatment, practically leaving no consequences. Hypervitaminosis D (D-vitamin intoxication) is a disease caused by both the direct toxic effect of the drug on cell membranes and its increased content in the blood and urine, which causes the deposition of calcium salts in the walls of blood vessels, primarily the kidneys and heart. In the future, this most often leads to chronic pyelonephritis, chronic kidney failure that is, the child becomes disabled. Hypervitaminosis D is not always caused by an overdose of vitamin D - it can be associated with an individual hypersensitivity to this vitamin, when even moderate doses of it lead to intoxication.

There are acute and chronic D-vitamin intoxication. Acute D-vitamin intoxication develops more often in children of the first six months of life with a massive intake of vitamin for a relatively short period of time (2-3 weeks). With individual hypersensitivity, it manifests itself from the very beginning of the administration of the drug in doses close to physiological. Appetite is sharply reduced, vomiting is often observed, body weight decreases rapidly, dehydration occurs, thirst develops, stools tend to be constipated, but may be unstable and liquid. The child may a short time lose consciousness, sometimes there are convulsions.

Chronic D-vitamin intoxication occurs against the background of long-term (6-8 months or more) taking the drug in moderate doses, but still exceeding the physiological need for it. characterized by less pronounced clinical picture: increased irritability, poor sleep, weakness, joint pain, gradual increase in dystrophy, premature closure of the large fontanelle, and, most importantly, changes in the cardiovascular and urinary systems with the development of chronic damage to the heart muscle and kidney tissue.

Treatment of hypervitaminosis D is carried out in a hospital. It includes the abolition of vitamin D and insolation, the appointment of vitamins A, E, intravenous fluids in combination with diuretics. In severe cases, a short course of prednisolone is prescribed.

Evgenia Kapranova
Associate Professor of the Department of Children's Diseases of the Moscow Medical Academy. THEM. Sechenov, Ph.D.

In this article:

Rickets in babies develops due to a lack of vitamin D in the body. Primarily changes affect the bone and nervous systems. The disease has been known since the 2nd century BC. Ancient portraits depicted children with smoothed occipital bones, superciliary arches in the form of overhanging rollers, twisted arms and legs, and a flattened stomach.

Today, pathology is widespread: more than 20% of children, and in some countries this figure reaches 60%, have an established diagnosis. The risk group includes children living in the northern regions, where there is not enough sunny days per year, and major cities with a developed industry, because there is a high level of air pollution with exhaust gases and other waste.

Classification

There are several systematizations of such a disease as rickets in children, each of which indicates the features of the course, stage and etiology of the disease.

In relation to vitamin D, vitamin-deficient and vitamin-resistant forms are distinguished. The first group includes those patients whose pathology is caused by a lack of this substance, and to eliminate the violations, it is enough to take drugs containing vitamin D in a therapeutic dosage.

The second group includes babies for whom taking standard dosages does not give an effect, and recovery is possible only with the use of a vitamin in an amount several times greater than it.

In the classification of rickets in children, the stages are:

• period of onset of the disease;
• the height of the disease;
• recovery;
• residual stage.

The degree of rickets in children according to the severity of the course:

1. Light- the symptoms are mild, there are minor disorders of the musculoskeletal system and the nervous system.
2. Medium- pronounced disorders of the skeleton and innervation of the limbs, there are deviations in the functioning of the cardiovascular and respiratory system, malfunctions of the gastrointestinal tract.
3. heavy- a high degree of pathological changes in all systems and organs that ensure normal life.

By the nature of the course, rickets happens:

• sharp;
• subacute;
• recurrent.

The reasons

Rickets in newborns and children under 1 year in It occurs due to insufficient synthesis of calciferol in the body. Vitamin D can be absorbed from food and mother's milk, and can also be formed in skin cells when exposed to sunlight or ultraviolet rays. If the intake of the substance is disturbed, a disease develops. Vitamin deficiency disrupts calcium-phosphorus metabolism, which negatively affects the state of the skeletal system.

The causes of rickets include the following:

• low nutritional value of foods that contain a small amount of calciferol;
• lack of ultraviolet rays (living in the north, rare walks);
• pathological processes in the intestine, due to which there is a violation of the absorption of vitamins;
• endogenous causes, including liver and kidney diseases that disrupt the absorption of calciferol;
• feeding a newborn with unadapted mixtures, where the correct ratio of useful elements is not observed;
• chronic use of anticonvulsants.

Rickets is often diagnosed in children born, because the laying and formation of the bone skeleton occurs during fetal development.

Symptoms

Rickets is usually found in young children up to a year, so after a year. The first changes are found at the age of 1-2 months after birth.

First of all, changes affect the nervous system:

• sleep is disturbed, the mode of wakefulness and night rest changes;
• there is irritability, tearfulness;
• the baby does not eat well, refuses or does not eat the prescribed norm, and the feeding process stretches for a long time;
• stool disorders occur, diarrhea appears for no apparent reason or;
• there is increased sweating;
• baldness develops on the back of the head.

The last two symptoms are closely related. During nighttime sleep, the child sweats excessively, which causes a wet spot on the pillow (wet spot syndrome). The baby often turns his head, as sweat leads to discomfort and itching, which causes the hair on the back of the head to be wiped off.

After a couple of weeks, other symptoms join the listed symptoms. A striking sign of rickets in babies is a reduced muscle tone, as well as a "frog" belly - it is as if pressed down by something heavy, which is why it took such a shape. The symptoms of the disease include delayed teething, delayed overgrowth of fontanelles, deformity of the legs and arms, and a change in the shape of the head.

Diagnostics

It is often not difficult to establish the presence of rickets in babies, since the pathology has characteristic external manifestations. At the first stages, neurological disorders appear, after which disturbances occur in bone apparatus. It is at this time that most mothers turn to the pediatrician.

In order to reliably establish the diagnosis and determine the degree of calciferol deficiency, it is necessary to take tests for the content of calcium, phosphorus and vitamin D in the body.

The following indicators are considered the norm of these substances:

1. Calcium - 2.5-2.7 mmol, if the value falls below two, then in this case they speak of the presence of rickets.
2. Phosphorus - the normal value of a trace element in the blood - from 1.3 to 2.6. In severe forms of the disease, this indicator can decrease to 0.6 mmol.

Another reliable way to determine the presence of rickets in a child at 1-3 years old is an x-ray. It shows skeletal deformities and the level of bone mineralization. Consider more precisely developing disorders possible with computed tomography.

Why is rickets dangerous?

If the disease is not treated in a timely manner, then signs of advanced rickets can be observed even in children 5 years of age and older. Pathology disrupts the shape of the skull, spine, limbs, and chest.

Disorders of the skeletal system manifest themselves at an older age:

1. Rachitic rosary - areas of thickening at the ends of the ribs.
2. "Olympic" forehead - the frontal and parietal tubercles increase in size, due to which the head takes on the shape of a cube.
3. Deformed pelvic bones in girls will bring problems during pregnancy and childbirth.
4. The depressed lower third of the sternum interferes with full breathing.
5. Crooked legs in the shape of the Latin letter "X" disturb the gait and create additional stress on the hip joints.

Treatment

Treatment of rickets in the early childhood consists of specific and non-specific methods. The first group includes taking calcium and vitamin D supplements. The dosage of medications is determined individually, depending on the degree of deficiency of substances and the level of demineralization of the bone skeleton according to laboratory tests. Even after the rise in calciferol concentration, vitamin D must be taken in preventive purposes a few more months.

Nonspecific therapy is as follows:

• establishing breastfeeding or selecting a high-quality adapted formula for feeding;
• regular walks in the fresh air;
• gymnastic exercises;
• sunbathing;
• massage;
• hardening procedures;
• treatment of comorbidities.

The most common rickets of the legs in children. Such a violation does not allow the child to fully move, and in advanced conditions does not even allow him to walk. Therefore, it is so important to undergo appropriate treatment at an early stage. It is possible to correct the curvature of the legs with rickets in a child up to 4 years of age, after which attempts may not bring the desired result.

Complications

In the absence of therapeutic correction of the content of calciferol in the body, further aggravation of the disease occurs. At the same time, violations affect the internal organs and cause malfunctions in their functioning.

The following symptoms occur:

• pain in the abdominal cavity;
• increased vomiting and regurgitation after eating;
• pallor of the skin;
• hepatomegaly;
• stool disorders.

Rickets is a common reason that the baby cannot hold his head on his own; much later than his peers, he begins to sit and move around. If rickets appears in a child at 1 or 2 years old, then there is a risk that such a baby may not learn to walk. That is why you should deal with the timely treatment of vitamin deficiency, because the severe consequences of the disease will remain for life. Rickets in a child, appearing after 4 years, leads to flat feet and scoliosis, and sometimes even causes myopia.

Effects

Why is rickets dangerous in a child? Late detection and treatment of the disease has Negative influence on the development of the baby and the state of his health in the future.

The child is threatened:

• violation of the ratio of the jaws;
• frequent tendency to infectious diseases;
• convulsive syndrome due to lack of calcium and magnesium;
• spasm of the larynx;
• osteoporosis.

Prevention

A set of preventive measures aimed at preventing such a childhood disease as rickets consists of activities carried out during pregnancy and after the birth of a child.

Intrauterine prophylaxis:

• complex balanced diet;
• the use of vitamin preparations;
• walks in the fresh air under the sun;
• gymnastics for pregnant women.

After the baby is born,:

• organize proper feeding;
• give vitamin D drops;
• observe the daily routine;
• organize daily sleep or walks on the street;
• massage and exercise.

The most important place in the prevention of rickets is the feeding of the baby with mother's milk until at least six months of age. Rickets refers to those pathologies that are easier to prevent than to subsequently correct violations in the body.

Useful video about what is rickets

- a disease of a fast-growing organism, characterized by a violation of mineral metabolism and bone formation. Rickets is manifested by multiple changes in the musculoskeletal system (softening of the flat bones of the skull, flattening of the occiput, deformity of the chest, curvature of the tubular bones and spine, muscular hypotension, etc.), nervous system, and internal organs. The diagnosis is established on the basis of the detection of laboratory and radiological markers of rickets. Specific therapy for rickets involves the appointment of vitamin D in combination with therapeutic baths, massage, gymnastics, UVI.

General information

Rickets is a polyetiological metabolic disease, which is based on an imbalance between the child's body's need for minerals(phosphorus, calcium, etc.) and their transportation and metabolism. Since rickets mainly affects children aged 2 months to 3 years, in pediatrics it is often called the "disease of the growing organism." In older children and adults, the terms osteomalacia and osteoporosis are used to refer to this condition.

In Russia, the prevalence of rickets (including its mild forms) is 54-66% among term infants and 80% among premature infants. Most children in 3-4 months have 2-3 mild signs of rickets, and therefore some pediatricians suggest considering this condition as paraphysiological, borderline (similar to diathesis - anomalies of the constitution), which is independently eliminated as the body grows older.

Pathogenesis of rickets

The decisive role in the development of rickets belongs to exogenous or endogenous vitamin D deficiency: insufficient formation of cholecalciferol in the skin, insufficient intake of vitamin D from food and impaired metabolism, which leads to a disorder of phosphorus-calcium metabolism in the liver, kidneys, and intestines. In addition, other metabolic disorders contribute to the development of rickets - a disorder of protein and microelement metabolism (magnesium, iron, zinc, copper, cobalt, etc.), activation of lipid peroxidation, multivitamin deficiency (deficiency of vitamins A, B1, B5, B6, C , E), etc.

Main physiological functions vitamin D (more precisely, its active metabolites 25-hydroxycholecalciferol and 1,25-dihydroxycholecalciferol) in the body are: increased absorption of calcium (Ca) and phosphorus (P) salts in the intestine; obstruction of the excretion of Ca and P in the urine by increasing their reabsorption in the tubules of the kidneys; bone mineralization; stimulation of the formation of red blood cells, etc. With hypovitaminosis D and rickets, all of the above processes slow down, which leads to hypophosphatemia and hypocalcemia (low levels of P and Ca in the blood).

Due to hypocalcemia, secondary hyperparathyroidism develops according to the feedback principle. An increase in the production of parathyroid hormone causes the release of Ca from the bones and the maintenance of a sufficiently high level in the blood.

A change in the acid-base balance towards acidosis prevents the deposition of P and Ca compounds in the bones, which is accompanied by a violation of the calcification of growing bones, their softening and a tendency to deformation. Instead of full-fledged bone tissue, osteoid non-calcified tissue is formed in the growth zones, which grows in the form of thickenings, tubercles, etc.

In addition to mineral metabolism, with rickets, other types of metabolism (carbohydrate, protein, fat) are also disturbed, disorders of the function of the nervous system and internal organs develop.

Causes of rickets

The development of rickets is largely associated not with an exogenous deficiency of vitamin D, but with its insufficient endogenous synthesis. It is known that more than 90% of vitamin D is formed in the skin due to insolation (UVR) and only 10% comes from outside with food. Just a 10-minute local irradiation of the face or hands can provide the synthesis of the level of vitamin D necessary for the body. Therefore, rickets is more common in children born in autumn and winter, when solar activity is extremely low. In addition, rickets is most common among children living in regions with a cold climate, insufficient natural insolation, frequent fogs and clouds, unfavorable environmental conditions (smog).

Meanwhile, hypovitaminosis D is the leading, but not the only cause of rickets. Deficiency of calcium salts, phosphates and other osteotropic micro and macro elements, vitamins in young children can be caused by multiple rachitogenic factors. Since the most enhanced supply of Ca and P to the fetus is observed on recent months pregnancy, then premature babies are more likely to develop rickets.

The increased physiological need for minerals in conditions of intensive growth predisposes to the occurrence of rickets. A deficiency of vitamins and minerals in a child's body may be the result of an improper diet of a pregnant or lactating woman, or the baby itself. Violation of the absorption and transport of Ca and P contributes to the immaturity of enzyme systems or pathology of the gastrointestinal tract, liver, kidneys, thyroid and parathyroid glands(gastritis, dysbacteriosis, malabsorption syndrome, intestinal infections, hepatitis, biliary atresia, CRF, etc.).

The risk group for the development of rickets includes children with an unfavorable perinatal history. Adverse factors on the part of the mother are gestosis of pregnant women; hypodynamia during pregnancy; operational, stimulated or rapid childbirth; mother's age is younger than 18 and older than 36; extragenital pathology.

On the part of the child, a large weight (more than 4 kg) at birth, excessive weight gain or malnutrition can play a certain role in the development of rickets; early transfer to artificial or mixed feeding; restriction of the child's motor mode (too tight swaddling, lack of baby massage and gymnastics, the need for prolonged immobilization in case of hip dysplasia), taking certain medications (phenobarbital, glucocorticoids, heparin, etc.). The role of gender and hereditary factors: so, boys, children with swarthy skin, II (A) blood group are more predisposed to the development of rickets; Rickets is less common among children with I (0) blood group.

Rickets classification

Etiological classification involves the allocation of the following forms of rickets and rickets-like diseases:

1. Vitamin D-deficientrickets(calcipenic, phosphoropenic variant)
2. Vitamin D dependent(pseudo-deficient) rickets with a genetic defect in the synthesis of 1,25-dihydroxycholecalciferol in the kidneys (type 1) and with genetic resistance of target organ receptors to 1,25-dihydroxycholecalciferol (type 2).
3. Vitamin D-resistant rickets(congenital hypophosphatemic rickets, Debre de Toni-Fanconi disease, hypophosphatasia, renal tubular acidosis).
4. Secondary rickets with diseases of the gastrointestinal tract, kidneys, metabolism or drug-induced.

The clinical course of rickets can be acute, subacute and recurrent; severity - mild (I), moderate (II) and severe (III). In the development of the disease, periods are distinguished: initial, peak of the disease, convalescence, residual effects.

Symptoms of rickets

The initial period of rickets falls on the 2-3rd month of life, and in premature babies in the middle - the end of the 1st month of life. Early signs rickets are changes in the nervous system: tearfulness, fearfulness, anxiety, hyperexcitability, superficial, disturbing dream, frequent startling in sleep. The child has increased sweating, especially in the scalp and neck. Sticky, sour-smelling sweat irritates the skin, causing persistent diaper rash. Rubbing the head against the pillow leads to the formation of foci of baldness on the back of the head. From the side musculoskeletal system characteristic is the appearance of muscle hypotension (instead of physiological muscle hypertonicity), compliance of the cranial sutures and the edges of the fontanel, thickenings on the ribs (“rachitic beads”). The duration of the initial period of rickets is 1-3 months.

During the height of rickets, which usually falls on the 5-6th month of life, progression of the process of osteomalacia is noted. Consequence acute course rickets can serve as a softening of the cranial bones (craniotabes) and one-sided flattening of the back of the head; deformity of the chest with depression ("cobbler's chest") or bulging of the sternum (keeled chest); the formation of kyphosis ("rachitic hump"), possibly lordosis, scoliosis; O-shaped curvature of tubular bones, flat feet; formation of a flat rachitic narrow pelvis. In addition to bone deformities, rickets is accompanied by an increase in the liver and spleen, severe anemia, muscle hypotension ("frog" belly), looseness of the joints.

In the subacute course of rickets, hypertrophy of the frontal and parietal tubercles occurs, thickening of the interphalangeal joints of the fingers (“strings of pearls”) and wrists (“bracelets”), costal-cartilaginous joints (“rachitic beads”).

Changes in the internal organs in rickets are caused by acidosis, hypophosphatemia, microcirculation disorders and may include shortness of breath, tachycardia, loss of appetite, unstable stools (diarrhea and constipation), pseudoascites.

During the period of convalescence, sleep normalizes, sweating decreases, static functions, laboratory and radiological data improve. The period of residual effects of rickets (2-3 years) is characterized by residual deformation of the skeleton, muscle hypotension.

In many children, rickets is mild and not diagnosed in childhood. Children suffering from rickets often suffer from SARS, pneumonia, bronchitis, urinary tract infections, atopic dermatitis. There is a close relationship between rickets and spasmophilia (children's tetany). In the future, in children who have had rickets, there is often a violation of the timing and sequence of teething, malocclusion, enamel hypoplasia.

Diagnosis of rickets

The diagnosis of rickets is based on clinical signs confirmed by laboratory and radiological data. To clarify the degree of violation of mineral metabolism, a biochemical study of blood and urine is carried out. The most important laboratory signs that allow you to think about rickets are hypocalcemia and hypophosphatemia; increased activity of alkaline phosphatase; decreased levels of citric acid, calcidiol and calcitriol. At research of KOS of a blood acidosis comes to light. Changes in urine tests are characterized by hyperaminoaciduria, hyperphosphaturia, hypocalciuria. Sulkovich's test for rickets is negative.

When radiography of tubular bones, changes characteristic of rickets are revealed: goblet expansion of the metaphyses, blurring of the boundaries between the metaphysis and epiphysis, thinning of the cortical layer of the diaphysis, indistinct visualization of the ossification nuclei, osteoporosis. Therapeutic mud can also be used to assess the state of bone tissue.

Forecast and prevention

The initial stages of rickets respond well to treatment; after adequate therapy, long-term effects do not develop. severe forms rickets can cause pronounced skeletal deformities, slowing down the physical and neuropsychic development of the child. Observation of children who have had rickets is carried out quarterly, for at least 3 years. Rickets is not a contraindication for prophylactic vaccination of children: vaccination is possible as early as 2-3 weeks after the start of specific therapy.

Prevention of rickets is divided into antenatal and postnatal. Prenatal prophylaxis includes the intake of special micronutrient complexes by a pregnant woman, sufficient exposure to fresh air, good nutrition. After childbirth, it is necessary to continue taking vitamins and minerals, breastfeeding, adhere to a clear daily routine, and conduct preventive massage for the child. During daily walks, the child's face should be left open for access to the skin of the sun's rays. Specific prevention of rickets in breastfed newborns is carried out in the autumn-winter-spring period with the help of vitamin D and UV radiation.

The disease with the name "rickets" is heard by many people. However, not everyone knows what exactly it is. From childhood, I remember that thin and weak children were figuratively called "rickets", but no one remembers why.

Of course, nowadays it is enough that the pediatrician who observes the baby has knowledge of the symptoms and treatment of rickets in children. But it is also useful for parents to get acquainted with information about this, because the disease overtakes children at a very early age, starting from the first months of a baby's life.

Rickets is a disease that is caused by a lack of vitamin D in the body, leads to a violation of calcium-phosphorus metabolism, which in turn leads to a change in the process of bone formation and disorders of other vital body functions.

In our country, the diagnosis of "rickets" is often made, but in the vast majority of cases, when physiotherapy and vitamin D (calciferol) are prescribed as treatment, this is enough to eliminate any suspicion of the development of the disease.

Causes of rickets in children

Rickets affects children from 2 months to 3 years. But the main danger is the age of up to a year.

Vitamin D is formed in the human body under the influence of UV rays. This radiation can be obtained while under the open sun. A small part of the radiation also comes in cloudy weather, if a person is outside. This type of radiation does not penetrate through glass.

The causes of rickets are different, but there is a risk group. It:

• severe pregnancy: toxicosis, concomitant diseases, difficult childbirth;
• black children;
• overweight children;
• children with low immunity, often sick;
• children born in winter and autumn. The fact is that babies receive calciferol in the mother's stomach, on last dates pregnancy. And if a pregnant woman has not been in the sun much, then both she and the baby will experience a deficiency of bone formation elements. If the baby in the first months of life is also not taken out in the sun, then the vitamin simply has nowhere to come from;
• premature babies. They do not have time to get an important vitamin from their mother through the placenta.

Once born, babies begin to gain weight and grow rapidly, so they quickly face a shortage of cellular building materials.

The main causes of the development of the disease

1. Rare stay under open sky. The high-tech urban environment makes it difficult to walk in the fresh air, because dust, exhaust gases, wind, dirt, etc. are all around. Therefore, parents of a newborn often hide him on a walk in a stroller so that light does not penetrate there. As a result, it turns out that the baby went for a walk, but did not receive ultraviolet radiation.
2. Bad nutrition. If the baby switches to complementary foods, it is necessary to monitor the diversity of his diet, be sure to include fish, seafood, eggs, milk, and cheese. If the baby is still small, but for some reason the mother cannot breastfeed him, you should responsibly choose the mixture so that it contains everything you need for the diet.
3. Metabolic disease. If a child has a problem with mineral metabolism or, for example, pathology of the kidneys, liver, then vitamin D may simply not be absorbed by the body, no matter how much you walk with your baby on the street.

Signs and symptoms of rickets in a child according to the forms of the disease

There are primary and secondary forms of rickets. They differ in the way the disease originates.

Primary rickets appears as an independent disease, it is the most common form diseases, especially in infants. Secondary rickets will be considered separately.

Secondary rickets

It appears against the background of a disease - a precursor, which leads to a violation of metabolic processes in the body, and, as a result, a lack of vitamin D and a violation of calcium and phosphorus metabolism in the patient's body.

Among the causes of secondary rickets, diseases such as hepatic rickets, lack of phosphates, renal tubular acidosis can be observed, treatment for seizures can be the cause, since seizures accompany the process of massive intake of calcium into the bones. At long-term use anticonvulsants blocking the work of vitamin D, which provokes the production of a protein that transports calcium to the bones.

With hypophosphatization, changes in the structure of the skeleton are pronounced, the patient's legs remain short and crooked.

Hepatic rickets is characterized by the fact that vitamin D is no longer absorbed by the body.

Changes in the body with vitamin D deficiency

Changes in the body are characterized by a pronounced cumulative effect. The disease manifests itself at first with minor symptoms in a latent form, although the body at this time is already in a critical condition.

At the stage when it becomes obvious softening of the bones and the removal of calcium and potassium ions from their composition, the disease has already developed so much that it is almost impossible to stop it without any consequences. This is because the treatment also has a cumulative nature. It is impossible to solve the problem by giving the baby a shock dose of vitamin D. This can lead to serious consequences for the body.

Only 10% of an important vitamin enters the body through food. The rest must be produced in the skin on its own. This means that therapy should include a whole range of activities, the sum of which will allow children's body overcome disease and recover.

Symptoms of rickets in infants

In infants, the first symptoms of rickets may not be recognized by either the parents or the pediatrician. Usually the onset of the disease occurs at the age of 3-4 months.

These are usually behavioral signs rather than clinical symptoms.

The kid begins to misbehave, becomes restless, all regimes of day and night are violated. The child eats little, but at the same time often asks for food, problems with stool, sleeps poorly, often wakes up and falls asleep.

The baby behaves restlessly, including in a dream. Tossing and turning, sweating, the smell of sweat is sour. Because of all this, the hair on the back of the baby's head begins to roll, the back of the head goes bald.

Symptoms of rickets in children from 1 to 2 years

Most often, rickets, which is found in children after a year, is a subacute form and lasts from infancy, just before the severity clinical symptoms was not enough for testing and diagnosis. Symptoms of rickets in children of 2 years old can be attributed to character traits, childhood experiences, and age-related changes.

Therefore, often the main factors in the detection of the disease are changes in bone structure: scoliosis, gait disturbance, curvature of the legs.

The acute course of the disease in children older than a year is rarely observed, since children in this age period almost do not gain weight, and the growth functions of the body are aimed at stretching the skeleton, and not at increasing body weight. Due to this, the body's need for nutrients is not critical.

Main symptoms:

• scoliosis;
• muscle weakness;
• changes in the structure of the chest (depression);
• bulging inflated belly;
• curvature of the limbs;
• nervous deviations.

Accompanying these symptoms are frequent diseases of the respiratory tract, fractures of the limbs, pathologies of the heart, liver, spleen.

Changes in the bone apparatus

1. The appearance on the skull of areas with softened bone cover. Because of this, the shape of the head changes: the frontal bone, temporal lobes protrude, the back of the head, on the contrary, becomes flat, because the child constantly lies on it.
2. Decreased tone of muscles and the whole body. The kid gets tired quickly, moves a little. Does not begin to roll over, sit and crawl with peers.
3. Due to the fact that the bones become soft, the deformation of the chest begins, it seems to be pressed inward, while the stomach increases in size, looks very swollen.
4. There are bony thickenings in the wrist area.
5. Nodules appear on the ribs, which can be seen during external examination. They are called rickets.
6. There is a curvature of the spine, scoliosis.
7. The large bones of the legs begin to bend under the weight of the body, the legs take on the form of two symmetrical arches. The deformity, when the legs form a circle shape, is called varus, the reverse deformity, in the shape of the letter X, is called valgus.
8. Teething may slow down, they may begin to grow in the wrong order, in the future the teeth will be fragile and painful, there may be problems with orthopedic teeth.

With proper treatment, most symptoms, such as crooked leg bones, can be corrected, but spinal problems will remain forever.

Tissues and internal organs

Often, against the background of changes in the skeletal system, there is a decrease in immunity, diseases lymphatic system, enlarged liver and spleen.

There is a decrease in muscle tone, general lethargy of the body. The child lags behind peers in psychomotor development.

The child may develop fear bright light or sounds. At the same time, he is generally nervous and irritable, cannot fully relax and fully actively spend time.

At a late stage of the disease, severe damage to the central nervous system is observed.

In modern conditions, bringing the disorder to such a degree can only occur with the full connivance of the parents, usually the disease is detected and treatment begins at an earlier date. In everyday practice, there is a tendency to reinsurance of medical personnel. This is expressed by the fact that vitamin D preparations are prescribed to babies at the slightest suspicion of the development of rickets. Even if the diagnosis is not correct, prevention does not affect their health in any way.

Rickets classification

Rickets is classified according to a number of parameters. Depending on the degree of damage to the body, mild, moderate and severe stages are distinguished. According to the phases of the course of rickets, there are an initial stage, an acute stage, a stage of recovery and a period of observation of residual effects.

According to the nature of the development, the disease is divided into acute, subacute and chronic. The acute form is typical for children of the first year of life. This is due to the fact that at this age children gain weight up to 2 kg per month. In the first months of life, the baby's body weight increases almost one and a half times every month. Therefore, all life support systems operate in emergency mode. Any failure in the body can lead to a deficiency of vitamins, including a bone formation stimulator.

The subacute form is expressed in slow development, protracted processes, which increases the risk of late detection of the disease, which complicates therapy.

Chronic disease is characterized by relapses. This is possible when therapy is not fully observed, or when preventive measures are not observed, that is, when conditions for the occurrence of rickets are re-created. With secondary rickets, relapses can occur if the disease - the pathogen has not been completely cured.

Algorithm for the development of rickets in children

As the disease progresses, changes in the body begin in the following order:

• nervous and skeletal system: irritability and fearfulness, disturbed sleep and rest, growth and softening of bone tissue, dysplasia.
• disorders of the muscular and cardiovascular systems, pathology of the respiratory system, gastrointestinal tract are added
• severe complications of all the listed symptoms of rickets in children

Treatment of rickets in children consists in complex therapy, which includes:

• taking vitamins
• treatment of concomitant diseases;
• to eliminate muscle hypotonia;
• compliance with the diet of the baby, daily routine;
• physiological procedures.

If a child has been diagnosed with rickets, it is not enough to simply stop the symptoms. Further actions should maximally prevent consequences and relapses.

The therapy takes on the same cumulative character, the rehabilitation period takes months and years, but even after the crisis has passed and there are no visible consequences, all preventive measures should be strictly observed.

Which doctor to contact

If you suspect the development of rickets in your baby, make an appointment with a pediatrician. Doctor general practice will examine the patient and either prescribe treatment himself or refer you to an endocrinologist. This doctor will also examine you. To confirm the diagnosis is assigned biochemical analysis blood. In severe cases, patients are sent for skeletal x-rays to properly assess damage to the body. Further treatment under the supervision of an endocrinologist.

vitamin therapy

Treatment includes taking vitamin D in dosage form according to a strict regimen. The severity of symptoms of rickets in children of early and older age does not affect the dosage, since an overdose is dangerous by intoxication of the body.

Doctors often prescribe water-based calciferol preparations without additives because it is easier to control the dose. One drop contains the daily requirement of the vitamin.

For children under one year old, the drug is diluted in a few drops of water or milk to ensure that the right amount enters the body. Babies of any age are given medicine from a spoon, and not directly from the bottle, to avoid overdose.

Massage

Massage is part of a general strengthening therapy, which is prescribed to eliminate muscle hypotonia. When the muscles return to normal, they tighten the bones and joints, contribute to the normalization of their condition. To align the bones, the mechanisms for maintaining them are developed and trained.

Food

The correct diet of children includes fish, eggs, dairy products, greens. Balanced diet does not create unnecessary stress on the digestive tract. Don't forget about water balance, it is important for children to get enough fluids commensurate with the cost.

Pregnant women and nursing mothers should also carefully monitor their own, which affects the child.

Prevention

Prevention means:

1. Compliance with the daily routine. This will ensure rest and the correct flow of metabolic processes.
2. Outdoor walks are effective preventive measure for the full production of calciferol. According to Dr. Komarovsky, five to ten minutes in the sun is enough, even if the baby only has his face and hands bare, to get a dose of vitamin D for two to three days.

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