Rickets is a childhood disease caused by metabolic disorders. The disease affects young children (up to 2 years). Although this ailment has been known since ancient times and has been well studied, it is still widespread today.
The disease is not fatal, but it causes numerous disorders in the baby's body, which in some cases can have negative consequences for life. Therefore, the treatment of rickets in a child should be started at the manifestation of its first signs.
This ailment is diagnosed to one degree or another in every fifth small resident of Russia. More often, the disease occurs in children in large northern cities. The likelihood of rickets in children born in the cold season is higher than in those born in spring and summer.
For example, at the beginning of the 20th century, the disease was diagnosed in 50% of children in England, while in sunny Bulgaria this figure was only 20%.
Rickets primarily affects the nervous system and bone apparatus. The disease is based on metabolic disorders caused by a deficiency of vitamin D, which enters the human body with certain foods (dairy products, egg yolk, fish oil, vegetable oil, nuts, etc.).
In addition, vitamin D is produced by the body under the influence of ultraviolet rays. Two forms of this vitamin are important for humans - ergocalciferol and cholecalciferol. It is they who, participating in metabolic processes, allow the baby to form the dense bone mass necessary for him during the period of active growth and development.
Rickets is common disease the human body, which is caused by a discrepancy between the high need of the child's body for calcium and phosphorus and the malfunctioning of the systems that deliver these substances.
Rickets has negative consequences. Children who have been diagnosed with the disease are more likely to get sick than their peers respiratory diseases... This is due to the fact that the disease provokes dysfunction immune system child.
A severe degree of the disease can lead to osteoporosis, poor posture, caries, anemia. Under the influence of a lack of calcium, phosphorus, magnesium, a violation of gastrointestinal motility develops. An early childhood illness can have lifelong consequences.
Causes of the disease
Rapid growth and active development crumbs in the first 3 years of life determine the high need of his body for building material. A baby at this age needs much more calcium and phosphorus than older children, and even more so adults.
An insufficient content of these substances in the blood can occur both due to their limited intake with food, and a violation of the absorption process in the intestine, due to a lack of vitamin D.
As soon as the deficiency of these trace elements in the blood begins, they are washed out of the bones. Therefore, it would be correct to say that the main cause of rickets is a lack of vitamin D, calcium and phosphorus compounds in the body.
In view of the fact that the disease still occurs, every mother should know why rickets appears and how to cure it.
The following factors can provoke the disease:
- prematurity;
- high weight of babies at birth;
- early artificial feeding with unadapted infant formula or cow's milk;
- lack of ultraviolet radiation;
- restriction of the baby's motor activity (tight swaddling);
- abuse of complementary foods rich in carbohydrates (semolina);
- strict vegetarian diet;
- diseases of the gastrointestinal tract or immaturity of enzymes that impair the absorption of calcium and phosphorus in the intestine;
- dark skin of the baby, in this case vitamin D is poorly produced in skin;
- hereditary metabolic disorders;
- congenital malformations of the liver and kidneys;
- receiving some anticonvulsants or glucocorticoids.
Calling main reason rickets is a deficiency of vitamin D in the baby's body, it must be borne in mind that there is no clearly verified certain daily rate, the use of which can definitely guarantee protection against disease.
The dosage of vitamin D varies depending on the child's age, living conditions, nutrition and, importantly, on the color of the skin. The lighter the skin of the crumbs, the more vitamin D it is capable of producing. This is one of the reasons for the prevalence of rickets in African countries.
Vitamin D is best produced under the influence of ultraviolet radiation in red-haired children with fair skin. A 10 minute daily stay in the shade in clear weather is enough for such a child to synthesize the necessary amount of this vitamin in the skin.
Symptoms and diagnosis of rickets in children
The number of babies who have had rickets has dropped significantly over the past half century in developed countries.
This was achieved thanks to factors such as:
- raising the standard of living and, accordingly, enriching the diet of pregnant and lactating women;
- promotion of breastfeeding;
- enrichment of infant formula with vitamin D.
Signs of rickets include:
- softening and thinning of the bones of the child's skull;
- decreased muscle tone;
- an increase in the size of the frontal and parietal cranial tubercles;
- lag in the schedule of the appearance of teeth, the enamel of the teeth is fragile, prone to darkening and destruction;
- rickety beads appear on the ribs - seals;
- deformation chest (depressed "shoemaker's chest" or protruding "chicken" breast);
- the growth rate of the baby is slowing down, the parameters of its development are significantly behind those adopted by the WHO;
- at further development the disease appears fragility of bones, due to which frequent fractures of the legs are possible.
It is common to unreasonably attribute some symptoms to rickets, which in fact are not:
- increased sweating of the child;
- lack of hair on the back of the head;
- violation of appetite;
- increased excitability;
- curvature of limbs,
- "Frog" belly.
Most of these so-called "symptoms" occur in many children much more often without rickets than with it. For example, a child's head sweats for various reasons - overheating, after illness, vaccinations, intense crying, etc. And the hair on the back of the head is wiped off and does not grow for some time in most babies, because they constantly lie on their backs.
It should be understood that the above signs may be symptoms of other diseases. Based on them, it is impossible to independently diagnose rickets in a baby. The disease can only be established by a pediatrician visual inspectionconfirmed by X-ray and laboratory research.
Rickets degrees
| Degree of illness | Manifestations | Changes in the body |
| I (light) | Minor changes in some bones (slight deformity of the skull, curvature of the arms and legs) | Hypotension, but psycho-motor development remains normal, decreased blood calcium |
| II (medium) | Severe bone deformity | Lesions in the nervous system, lag in motor skills, dysfunction of internal organs |
| III (heavy) | Multiple severe bone deformities | Delay in the development of the child, severe anemia, violation of the digestive, nervous, cardiovascular, respiratory systems. |
The main diagnostic method determination of rickets in the laboratory is an analysis of the level of calcium in the plasma. The Sulkovich test for determining the level of calcium in the urine is today considered an outdated method for determining rickets.
Modern diagnostics involves the study of blood for:
- content of calcium, phosphorus, magnesium, alkaline phosphase and creatinine;
- the level of vitamin D metabolites.
In addition to a blood test to establish a diagnosis, an X-ray of the lower leg and forearm is prescribed, which allows you to establish a decrease in bone density and other changes characteristic of rickets.
Rickets treatment
Nowadays, it is well known why the disease occurs, and how to treat rickets in a child.
The main direction of therapy for this ailment is the normalization of the baby's lifestyle and diet, which includes:
- Daily walks lasting at least 4 hours. In the spring and summer period, it is important to provide the baby with the necessary amount of ultraviolet radiation, so for a walk he should be taken out as undressed as possible.
- Long breast-feeding (up to at least 1 year). If breast milk is not available to the baby for any reason, it is necessary to use adapted milk formulas.
- In case of rickets, an earlier introduction of complementary foods is recommended. Since vitamin D is fat-soluble, it is necessary to monitor the balance of fats in the baby's diet. A child under 1 year old can enter butter into the menu.
- Daily coniferous and salt baths, which helps to strengthen the child's immune system and nervous system.
- The use of preparations containing vitamin D. This is the main method, without it all other measures will not be effective enough. Most preferred are aqueous solutions of vitamin D3.
Vitamin D in the treatment of rickets
The most common drug containing water solution vitamin D - Aquadetrim. It does not accumulate in the body, it is well excreted by the kidneys, which minimizes the risk of overdose. Aquadetrim is not only a medicinal, but also a prophylactic agent.
The amount of the drug necessary for the child is selected by the doctor individually, depending on the age, weight and condition of the baby.
But Akvadetrim, like any drug, can cause allergic reactions or individual intolerance to its components. What to do in this case?
Is it possible to cure rickets in a child without this remedy? If the use of Aquadetrim is not possible, then the modern pharmaceutical industry offers oil solutions of vitamin D3 as an alternative.
Treatment of rickets with drugs Vigantol, Videin, Devisol is preferred for children with allergic reactions... Oil solutions are much less likely to provoke allergies, but are not recommended for babies with dysbiosis and some disorders of the intestines.
They are convenient to use for the prevention of rickets, but the therapeutic dosage is difficult to calculate. Any preparation containing vitamin D, regardless of whether it is an oil solution or water, must be taken in strict accordance with the doctor's recommendations.
Parents should remember that an overdose of vitamin D will do as much harm to a baby as a lack of it. . Therefore, you need to entrust the treatment of the disease to a pediatrician, do not self-medicate and do not wait for the disease to pass by itself!
If anyone has a question whether rickets can be treated with drugs other than those containing vitamin D, the answer will be unequivocal. Today, all other drugs are only an adjunct.
Well proven biologically active additive Calcid, which is used to prevent rickets. The preparation contains calcium and vitamin D for better absorption. But the treatment of rickets with Calcid will not be effective at a pronounced stage of the disease, it is better to use it as a prophylactic agent.
The use of calcium preparations is recommended as a necessary supplement if the child is shown a one-time intake of a large dose of vitamin D. In this case, an increased amount of it can lead to a sharp decrease in calcium in the blood, which can provoke convulsions.
Increasingly, during a visit to a doctor, parents may hear such a diagnosis as "rickets" and most simply do not know what this disease is and how it is treated. How to determine rickets in infants, and why is it diagnosed in 3-4-month-old children?
Rickets is a disease that is associated with a violation of the exchange of calcium and phosphorus in the child's body. This happens due to a lack of vitamin D. Calcium is no longer absorbed from the intestines, and there is a shortage of it, which means that the baby's bones begin to bend. At the initial stage of the disease, doctors can diagnose hypoxia in a child, the body's reactivity deteriorates, immunity falls, and this affects overall physical development.
Rickets does not threaten the life of the baby in any way, but its danger is that girls develop a flat rachitic pelvis, and in the future this can affect the course of childbirth. In boys, rickets most often contributes to the curvature of the legs.
Vitamin D benefits
The benefits of vitamin D are as follows:
Only 10% of vitamin D enters the body with food, the remaining 90% are produced by the skin under the influence of ultraviolet radiation. If the baby does not receive this vitamin for a long time, then the process of demineralization develops. bone tissue, which leads to softening of the tubular bones and osteoporosis, and as a result, the bones begin to bend.
Rickets of 1 degree in a child begins at the age of 2-3 months and can last up to 2-3 years, but the most vulnerable period is still considered to be the age of up to a year.
Reasons for the appearance
There are many reasons for the disease, especially when it is accompanied precisely by a lack of vitamin D. All reasons can be divided into several groups:
Disease symptoms
Vitamin D deficiency is capable of change the whole work of the body. For starters, this leads to changes in kidney function, phosphorus absorption is reduced, and phosphate excretion in the urine increases. Symptoms and treatment of rickets in children depend on the stage of the disease.
The very first symptoms of the disease may not be noticed, because they are minor. The baby will sweat, and the smell of sweat becomes sour, it will also be restless, and prickly heat can often be noticed on the skin. In addition, the child begins to rub his head against the pillow, and as a result, baldness of the occiput appears, only at this moment the pediatrician can notice rickets. After a while, the child begins to shudder, even if there is no sharp noise, the muscle tone decreases.
If the disease is not treated for a long time, the bone tissue grows, the occipital protuberances appear, the wrist area thickens, and "rickety rosary" is observed. If the correct treatment is started on time, then the deformity can disappear with age. But if it comes to curvature of the spine, then this will remain with the child for life.
During the height of the disease, which usually occurs at 6-7 months, new symptoms appear:
Severe stage of the disease already leads to complications and affects almost all organs:
Signs of rickets at 3 years old may be the same, but if you start treatment, then by this time there is a noticeable improvement in the general condition. The child begins to be active, turns over, sits well and walks, pain in the legs worries less and less. Unfortunately, such signs as skeletal deformity and muscle weakness will not pass by the age of three, this process is slow, and it takes a lot of time, but after complete recovery, residual effects are practically not observed.
Disease classification
At the moment, there are several forms of rickets: primary and secondary... The primary form is a lack of vitamin D, the secondary form appears with the following pathological processes:
Besides, the following types of rickets are distinguished:
- with a phosphorus deficiency;
- with calcium deficiency;
- without changing the level of these two elements.
By severity:
Rickets treatment
If your baby has been diagnosed with rickets, immediate treatment should be started. Treatment is prescribed depending on the severity, but the main thing is to eliminate the causes of the disease. The most effective is complex treatment... It is worth warning that starting with moderate disease treatment will be long, so you need to be patient. At the moment, specific and non-specific treatment is being practiced.
Specific treatment is the appointment of vitamin D and medications that include phosphorus and calcium. Drugs are prescribed only by a doctor, based on the general condition of the child and the severity of the disease. Typically, the course of medication is 30-45 days. After that, all drugs can be prescribed as a prophylaxis (with a mild stage of the disease), but the dose will already be less.
Non-specific treatment is aimed at improving the child's condition:
Be sure with rickets, you need to massage the legs and back for 20-25 minutes. The massage should be repeated every 5-6 weeks to stimulate the muscles of the buttocks. For flat feet, massage is also done on the surface of the foot to strengthen it. In some cases, the child is prescribed to wear special shoes that will help correct the defect and add confidence when walking.
An excellent remedy for vitamin D deficiency is Aquadetrim. Only one drop of the drug contains 500 ME. Drops are given not only as a treatment, but also in preventive measures.
Prevention methods
The most excellent and effective remedy for the prevention of rickets is child's exposure to the sun... If the child absorbs the rays of the sun, then vitamin D will begin to be produced on his skin. The most beneficial sun is before 11 in the morning. The regime needs to be structured so as to make daily walks before this time. In addition, the drug Akvadetrim is also given for prophylactic purposes, as mentioned above.
In addition, the child needs to be bathed every day, several times a week to do it in pine baths, do not neglect preventive massage courses and do gymnastics with the child.
It is worth noting that prevention should be started at the stage of pregnancy... The following rules must be observed:
To prevent a child from developing a disease such as rickets, prevention is the best protection. Therefore, you should not be lazy to follow all the doctor's recommendations even before the baby is born.
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, the child may also have serious complications ( for example, kidney dysfunction, allergic attacks, liver dysfunction). To avoid such consequences, before giving your child vitamin D, you should carefully read the doctor's prescriptions and, if necessary, consult a specialist directly.
What are the severity of rickets?
There are the following severity of rickets:
- first degree ( easy);
- second degree ( moderate);
- third degree ( heavy).
| The severity of rickets | Clinical manifestations |
| First degree (easy) | The nervous system is affected, and minor changes in the bone structure are observed. The manifestations of the first severity of rickets are:
|
| Second degree (moderate) | It is characterized by more pronounced damage to 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 bones are affected, and all of the above symptoms worsen. 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 severity assigned two to four thousand international units per day for four to six weeks; course dose is 120 - 180 thousand international units;
- with rickets of the second 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 assigned eight to twelve thousand international units per day for six to eight weeks; 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 ensures the delivery of phosphorus and calcium. The onset of classic rickets is accompanied by such predisposing factors as:
|
| Secondary rickets | This type of rickets develops against the background primary disease or an existing pathological process in the body. There are the following factors contributing to the development of secondary rickets:
|
| Vitamin D-dependent rickets | This view rickets is a genetic pathology with an autosomal recessive mode of inheritance. With 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 is observed in children aged three to four months. With a lack of vitamin D, the child's nervous system suffers first. A child with rickets is usually restless, irritable, crying, does not sleep well and shudders in sleep. Also noted excessive sweating, which occurs most often during feeding and sleeping of the child. Due to metabolic disorders, the sweat of the child, like urine, acquires an acidic character and a corresponding sharp sour smell. Due to sweating and friction of the head against the pillow, the child has a baldness in the back of the head. Sour 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 kid stops walking, turning over. There is a delay in the child's psychomotor development. Subsequently, such children begin to stand late, walk and, as a rule, their first teeth are thinned out later.
If you do not attach importance to the first manifestations of rickets in time, then later the development of this disease can lead to more serious disorders of the bone and muscular systems.
Besides clinical symptoms the diagnosis of rickets is confirmed by biochemical laboratory tests. 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:
- urgently see a doctor;
- refrain from self-medication;
- make sure that the child receives the dose of vitamin D strictly prescribed by the doctor;
- regularly take walks 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 for the baby;
- observe the regime of work and rest.
What vitamin deficiency leads to rickets?
Rickets is considered to be a "classic" disease childhood, in which a metabolic disorder occurs in a young body - calcium and phosphorus. Especially dangerous this disease in the first year of a baby's life, when there is an active formation of bone tissue. With its rapid development, this disease usually leads to serious changes in the child's bone structure, affecting also his nervous and muscular systems. 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. It is the only one of the existing vitamins 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.
The following vitamin D-rich foods are distinguished:
- 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 birth, but also for further feeding the child.
A prophylactic dose of vitamin D is also given to the baby immediately after birth. It is taken from October to May, that is, in those months when sunlight not enough. Vitamin D is usually not prescribed from May to October, but it is strongly recommended that you take your child for walks in the fresh air on a regular basis.
Your individual dose of vitamin D will depend on the following factors:
- the age of the child;
- features of genetics;
- type of feeding the child;
- the severity of rickets;
- presence of others pathological processes in organism;
- season ( the weather of the area where the child lives).
In case of any pathology, the daily intake of vitamin D is prescribed by a doctor.
It should be noted that vitamin D overdose can lead to serious consequences. Therefore, in order to avoid this complication, the child is recommended to conduct the Sulkovich test every two to three weeks. This test consists in determining the presence and level of calcium in the analyzed urine.
The 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 urine:
- minus is a negative result in which the child may have a lack of vitamin D;
- one or two pluses are considered normal indicators;
- three or four pluses indicate increased calcium excretion.
What kind of care does a child need for rickets?
Childcare is important aspect treatment of rickets. 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 do the following:
- monitor the child's behavior;
- inspect and palpate fontanelles ( big and small);
- check if the cranial sutures are blocked;
- make a thorough examination of the chest of children of four to six months in order to determine the pathological thickening of the costal-sternal joints;
- 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 over six months;
- determine the child's motor activity, 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, yolk and cottage cheese ( children who are on artificial and mixed feeding, the first complementary foods are introduced one month earlier);
- along with food, enzymes are prescribed ( e.g. pancreatin, pepsin) and hydrochloric acid, which are necessary for a child to improve digestion processes;
- also, in order to reduce the degree of acidosis, vitamins of group B ( B1, B2, B6), vitamin C and citrate mixture ( a product that contains citric acid, sodium citrate and distilled water);
- the nurse monitors urine calcium ( using the Sulkovich test);
- calcium is prescribed in the form of a 5% solution, which is given orally to children ( in the mouth) at the first signs of bone softening;
- physiotherapy exercises and massage are regularly carried out;
- coniferous and saline medicinal baths are prescribed ( the course includes ten to fifteen baths);
- a course ( consisting of 20 - 25 sessionsa) ultraviolet irradiation at home, in the winter time.
- Daily walks with the child in the fresh air. In this case, the total time spent on the street should be at least five hours in the summer time and about two to three hours in the winter time ( depending on temperature). When walking with a child, it is necessary to ensure that his face is open.
- Regular gymnastic exercises. It is recommended to perform flexion and extension movements of the child's arms and legs, as well as adduction and abduction of the baby's limbs.
- Regular hardening of the child. It is necessary to harden the baby gradually. For example, when bathing with warm water, it is recommended to rinse the baby one degree lower at the end. Then, as you get used to it, with subsequent bathing, the degree of water can be reduced lower.
- Correct organization of the daily routine for the child.
- Monitor the regularity and rationality of food. Complementary foods that are introduced should be appropriate for the age of the child. It is also necessary to increase the intake of foods rich in vitamin D ( e.g. liver, fish, egg yolk, butter, cottage cheese).
- Clear implementation of actions as 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 on early stage contributes to the early 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 shuddering, itchy skin, as well as baldness in the back of the head.
- If you suspect rickets, you should urgently consult a pediatrician. Self-medication in this case is categorically contraindicated. The doctor, in turn, can immediately diagnose rickets based on the clinical manifestations of this disease, or prescribe certain diagnostic procedures to identify pathology. After rickets is confirmed, the child will be prescribed appropriate treatment.
- Treatment for rickets includes rational feeding of the baby, organizing an active lifestyle, vitamin therapy, regular walks in the fresh air, as well as eliminating the causes of the disease. In this case, all stages of treatment should be performed strictly according to the doctor's prescription.
The child's food should be complete. It must contain all the necessary nutrients. Especially with rickets, food rich in vitamins and microelements is useful. The best food in this case 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 suits his nutritional needs. In case of the forced transfer of the baby to mixed and artificial feeding, it will be more rational to use adapted milk formulas, the food composition of which is as close as possible to the nutritional composition of breast milk.
Among the adapted milk formulas, examples include such brands as:
- Detolact;
- "Baby";
- "Vitalakt".
Organization of an active lifestyle
This includes massage as well as the use of various gymnastic exercises ( e.g. adduction and abduction of the arms, and flexion exercises of the upper and lower extremities). These procedures have a beneficial effect on metabolic processes in the skin, thereby increasing the performance of vitamin D. Massages are usually done two to three times a day for eight to ten minutes.
Regular walks in the fresh air
You should walk with your child every day for at least two to three hours, especially on sunny days. This procedure promotes the formation of vitamin D in the child, which is synthesized in the skin under the influence of ultraviolet rays.
Vitamin therapy
The main treatment for rickets is therapeutic use vitamin D. When using this tool it is necessary to strictly follow the doctor's recommendations, since an overdose of vitamin D may cause intoxication of the body.
What changes in the head are observed with rickets?
At the onset of the disease, no major changes in the head occur. During this period, the child has increased sweating, especially in the scalp ( in 90% of children). In this regard, during sleep, friction is created between the back of the head and the pillow, and the baby, due to hair loss, forms areas of baldness with a clearly traced venous network. With the subsequent progression of the disease, there is some softening of the edges of the large fontanelle, as well as the 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 area of \u200b\u200bthe large and small fontanelles, as well as in the area of \u200b\u200bthe passage of the cranial sutures. In this regard, a child's large fontanelle closes rather late, by the age of two or three. Also, the baby has an alignment of the parietal and occipital bones.
On the part of the bones of the facial region, the following changes are observed:
- incorrect jaw ratio ( top and bottom);
- violation of the bite;
- narrowing of the vault of the sky;
- narrowing of the nasal passages is possible.
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 outwardly takes a square shape.
The development of these pathological changes from the side of 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 a child's growth. Thanks to calcium, the bone skeleton becomes strong, capable of withstanding 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 the child has hypocalcemia ( a decrease in certain indicators of calcium in blood plasma). With rickets, this condition can occur with active bone mineralization, as well as in premature or low birth weight babies.
It should also be noted that calcium preparations for rickets can be prescribed if the child has various changes in the skeletal system.
Rachytic changes in the skeletal system can occur due to:
- delayed bone formation ( hypogenesis);
- excessive formation of osteoid tissue ( osteoid hyperplasia);
- softening of bones ( osteomalacia).
Among calcium preparations, as an example, Calcium gluconate and Complivit can be distinguished. For full absorption, calcium supplements are usually prescribed in combination with vitamin D.
Among the foods rich in calcium are the following:
- processed cheese;
- cottage cheese;
- sour cream;
- feta cheese;
- beans;
- peas;
- almond;
- pistachios.
Rickets is a polyetiologic metabolic disease in which there is a discrepancy between the body's need to receive calcium and phosphorus salts and the insufficiency of those systems that could provide them with their transportation. In other words, rickets are bone disorders resulting from insufficient mineralization of the osteoid.
The development of this disease can often be observed in children in the first year of their life, including newborns. Children suffering from rickets often get sick in the future. In addition, they have such residual symptoms of the disease as deformation of the lower limbs, skull and chest, as well as abnormal tooth growth and bite.
Boys are more susceptible to the development of rickets, as well as children with darker skin and the second blood group.
The reasons for the development of the disease
Initially, vitamin D deficiency was considered the cause of rickets, but later they began to believe that the disease develops not only for this reason. Today, the main reason leading to the development of this disease is called a deficiency of calcium and phosphorus salts, and hypophosphatemia is more common and more important than.
The deficiency of calcium salts and phosphates in infants is caused by:
- prematurity, since it is in the last months of pregnancy that the most intensive supply of phosphorus and calcium to the fetus occurs;
- improper feeding, leading to insufficient intake of trace elements in the child's body;
- violation of the process of transporting calcium and phosphorus to organs and bones due to pathology or immaturity of enzyme systems;
- poor ecology, as a result of which salts of lead, strontium, chromium accumulate in the body of a newborn;
- hereditary predisposition;
- vitamin D deficiency (endogenous or exogenous);
- endocrine system disorders.
Classification of rickets and its signs
The disease is divided into four periods, each of which tends to have a certain severity of the course and its nature:
Elementary.
This period is characterized by the 1st degree of severity with an acute form of the course. The first signs of rickets, as a rule, appear in infants at 2-3 months of age. They are as follows:
- the child becomes restless, overly excitable, fearful, he shudders at the slightest sudden external stimulus;
- the child's sleep becomes disturbing and, as a result, shallow;
- there is increased sweating, especially on the face and scalp, while sweat causes skin irritation and itching, forcing the child to rub his head against the pillow and wash the hair on the back of the head;
- persistent red dermographism appears;
- muscle hypertonia is replaced by hypotension;
- the seams of the skull become malleable, thickenings are observed on the ribs.
- In the analysis of blood in infants, a sufficient amount of calcium or even its excess is observed, while the concentration of phosphates decreases. Phosphaturia, an increase in the content of amino acids and ammonia are found in the urine.
The height of the disease
The severity is 2nd, the nature of the course is subacute. During this period, the disease enters 4-6 months of a child's life. He is characterized by even greater disorders of the musculoskeletal system and the nervous system:
- flat bones of the skull soften and lead to a flattening of the occiput;
- the chest becomes pliable and easily deformed, pressing in the lower part or, conversely, protruding;
- long tubular bones are bent (more often O-shaped curvature is observed);
- the pelvis becomes narrow and flat;
- a depression appears along the Harrison groove (the line of attachment of the diaphragm);
- hypertrophied parietal and frontal tubercles are formed, wrists, interphalangeal joints of the fingers of the upper extremities and costal-cartilaginous joints thicken.
Reconvalescence.
This period is characterized by the normalization of the patient's well-being and condition. There is an improvement in statistical functions. The content of phosphorus in the blood is close to normal and may even exceed it, but the calcium deficiency persists or increases.
Residual phenomena.
The symptoms of active rickets disappear, which indicates the transition of the disease into an inactive phase. Residual skeletal deformities in combination with muscle hypotonia can persist for a long time.
Diagnostics and treatment
To diagnose rickets, against the background of the clinical picture, it is necessary to conduct biochemical analysis blood, which will determine the concentration of calcium and phosphorus in it, the activity of alkaline phosphatase. Their ratio will determine the period of the disease. In addition, bone x-rays are taken.
As Wikipedia describes, rickets need to be treated comprehensively and for a long time. The first thing that is required from parents is to contact an experienced specialist who will conduct a thorough examination of the child, direct him to undergo the necessary diagnostics, on the basis of which appropriate treatment will be prescribed. First of all, it should be aimed at eliminating the causes that caused the development of the disease.
Therapy should consist of specific and non-specific treatments. Specific treatment involves the use of vitamin D, as well as phosphorus and calcium preparations. Non-specific includes: a rational diet, developed in accordance with the age of the child; long walks in the fresh air; hardening; therapeutic exercises and massage sessions; treatment of concomitant diseases.
For the purpose of prevention, all the described actions must be followed by women themselves even during pregnancy, as well as after it, so that the development of rickets in newborns can be prevented.
A disease called "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, these days it is enough for a pediatrician who observes a baby to have knowledge of the symptoms and treatment of rickets in children. But it is also useful for parents to familiarize themselves 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, leading 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 functions of the body.
In our country, the diagnosis of "rickets" is often made, but in the overwhelming 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 are ill children from 2 months to 3 years. But the main danger is the age of up to one year.
Vitamin D is produced in the human body by UV rays. This radiation can be received while under the open sun. A small part of the radiation is received in cloudy weather, if a person is on the street. 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, who are often sick;
- children born in winter and autumn. The fact is that babies receive calciferol in their mother's belly, in the last stages of pregnancy. And if a pregnant woman has been little in the sun, 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 tolerated 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 quickly gain weight and grow, so they quickly encounter a deficiency of cellular building materials.
The main causes of the development of the disease
- A rare stay in the open air. A high-tech urban environment involves some difficulties with walking in the fresh air, because all around is dust, exhaust gases, wind, dirt, etc. Therefore, the parents of a newborn often hide him for a walk in a stroller so that light does not penetrate there. As a result, it turns out that the kid went for a walk, but did not receive ultraviolet radiation.
- Poor 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, cheese in it. If the baby is still small, but the mother, for some reason, cannot breastfeed him, you should responsibly choose the mixture so that it contains everything you need for the diet.
- Metabolic disease. If a child has a problem with mineral metabolism or, for example, kidney or liver pathology, then vitamin D may simply not be absorbed by the body, no matter how much you walk with the baby on the street.
Signs and symptoms of rickets in a child according to the forms of the disease
Distinguish between primary and secondary forms of rickets. They differ in the mode of origin of the disease.
Primary rickets appears as an independent disease, it is the most common form of the disease, especially in infants. Secondary rickets will be considered separately.
Secondary rickets
It appears against the background of a disease - a precursor, which leads to disruption 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, phosphate deficiency, renal tubular acidosis can be observed, the cause can be treatment for seizures, since seizures accompany the process of massive intake of calcium into the bones. When long-term intake anticonvulsants the work of vitamin D is blocked, 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 ceases to be 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 state.
At the stage when the softening of the bones and the removal of calcium and potassium ions from their composition becomes obvious, 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. You cannot solve the problem by giving the baby a shock dose of vitamin D. This can lead to serious consequences for the body.
Only 10% an important vitamin enters the body through food. The rest should be produced in the skin on its own. This means that therapy should include a whole range of measures, the amount of which will allow the child's body to overcome the 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 to 4 months
These are usually behavioral signs rather than clinical symptoms.
The kid begins to misbehave, becomes restless, all modes of the day and night are violated. The child eats little, but at the same time often asks for food, problems with stool, does not sleep well, often wakes up and falls asleep.
The baby behaves restlessly, including during sleep. Tossing and turning, sweating, and the smell of sweat is sour. Because of all this, the hair on the back of the baby's head begins to roll down, the back of the head becomes bald.
Symptoms of rickets in children from 1 to 2 years old
Most often, rickets, which is found in children after a year, is a subacute form and lasts from infancy, just before the severity of clinical symptoms was not enough for testing and making a diagnosis. The symptoms of rickets in children 2 years old can be attributed to character traits, childhood experiences, age-related changes.
Therefore, often the main factors for detecting the disease are changes in the bone structure: scoliosis, gait disturbance, curvature of the legs.
The acute course of the disease in children over one year old is rarely observed, since children in this age period hardly 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 needs for nutrients are not critical.
The main symptoms are:
- scoliosis;
- muscle weakness;
- changes in the structure of the chest (depression);
- bulging distended belly;
- curvature of the limbs;
- nervous deviations.
Accompany these symptoms frequent illnesses respiratory tract, limb fractures, pathology of the heart, liver, spleen.
Changes in the bone apparatus
- The appearance on the skull of areas with a softened bone cover. Because of this, the shape of the head changes: the frontal bone, the temporal lobes protrude, the back of the head, on the contrary, becomes flat, because the child is constantly lying on it.
- Reduced muscle tone and the whole body. The kid gets tired quickly, moves a little. Does not start to roll over, sit and crawl with peers.
- Due to the fact that the bones become soft, deformation of the chest begins, it seems to be pressed inward, while the abdomen increases in size, looks strongly swollen.
- Bony thickenings are observed in the wrist area.
- Nodules appear on the ribs, which can be seen on external examination. They are called rickety beads.
- There is a curvature of the spine, scoliosis.
- The large bones of the legs begin to bend under the weight of the body, the legs take the form of two symmetrical arcs. The deformity when the legs form a circle is called varus, the reverse deformation, in the shape of the letter X, is called valgus.
- Teething may slow down, they may start to grow in the wrong order, in the future the teeth will be fragile and painful, there may be problems with teeth of an orthopedic nature.
With the right treatment, most symptoms, such as curvature of the leg bones, can be eliminated, 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.
Your toddler may develop a fear of bright lights or sounds. At the same time, he is generally nervous and irritable, cannot fully rest and fully actively spend time.
In the late stage of the disease, severe damage to the central nervous system is observed.
IN modern conditions bringing to such a degree of disorder can occur only with the complete connivance of the parents, usually the disease is detected and treatment begins at an earlier stage. In everyday practice, there is a tendency to reinsure 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 incorrect, prevention does not affect their health in any way.
Classification of rickets
Rickets are classified according to a number of parameters. Depending on the degree of damage to the body, there are mild, moderate and severe stages. According to the phases of rickets, the initial stage, acute stage, the stage of recovery and the period of observation of residual phenomena are distinguished.
By the nature of development, the disease is divided into acute, subacute and chronic. The acute form is typical for children in 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 infant's body weight increases monthly by almost one and a half times. Therefore, all life support systems operate in emergency mode. Any malfunction in the body can lead to a deficiency of vitamins, including a bone formation stimulant.
The subacute form is expressed in slow development, prolonged 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 followed in full, or when preventive measures are not followed, that is, when conditions for the occurrence of rickets are re-created. With secondary rickets, relapses can be observed if the disease - the pathogen could not be 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, overgrowth and softening of bone tissue, impaired growth.
- disorders of the muscular and cardiovascular system, 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;
- adherence to the baby's diet, daily routine;
- physiological procedures.
If a child has been diagnosed with rickets, it is not enough to just stop the symptoms. Further actions should prevent consequences and relapses as much as possible.
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 a baby, make an appointment with a pediatrician. Doctor general practice will examine the patient and either prescribe the treatment himself, or refer you to an endocrinologist. This doctor will also examine you. To confirm the diagnosis, a biochemical blood test is prescribed. In severe cases, patients are sent for skeletal x-rays to properly assess the damage to the body. Further treatment is under the supervision of an endocrinologist.
Vitamin therapy
Treatment includes vitamin D supplementation dosage form according to a strict scheme. The severity of the symptoms of rickets in young and older children does not affect the dosage, since an overdose is dangerous 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 required amount enters the body. Babies of all ages are given the medicine by spoon, not directly from the bottle, to avoid overdose.
Massage
Massage is a part of general strengthening therapy, which is prescribed to eliminate muscle hypotonia. When muscles return to normal, they tighten bones and joints, and help to normalize their condition. In order to align the bones, the mechanisms of their support are developed and trained.
Food
The correct diet for children includes fish, eggs, dairy products, herbs. A balanced diet does not create unnecessary stress on the digestive tract. Do not forget about water balance, it is important for children to get enough fluid in proportion to the cost.
Pregnant women and nursing mothers should be equally careful about their own, which affects the child.
Prevention
Prevention means:
- Compliance with the daily routine. This will provide rest and the correct course of metabolic processes.
- 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 has only bare face and hands, to get a dose of vitamin D for two or three days.
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