What is rickets in a child? Signs of rickets in premature babies

The ancient Greeks started talking about such a disease as rickets; in the 17th century there were the first attempts to describe the disease, but the real reason The occurrence of the disease in children became clear only in the first half of the last century. In the 1930s, vitamin D was discovered, and doctors realized that its lack provokes the development of rickets.

Nowadays, signs of rickets in infants are common, but you should not raise the alarm when you hear such a diagnosis from a pediatrician.

The disease has several stages, and at the initial stage, eliminating vitamin D deficiency is not difficult. In addition, some doctors do not consider infantile rickets a disease at all; they characterize it as a special condition of a growing organism.

What is rickets?

The medical definition of rickets is that it is a metabolic failure in the body. A whole chain arises. The body does not receive enough vitamin D, which is needed for the absorption of calcium, in turn, the lack of this mineral leads to a lack of calcium and fluoride, which is extremely important for the child’s body - the skeletal system is deformed and suffers. internal organs, not everything is in order with the nervous system and hormonal levels.

Rickets is a childhood disease, more precisely, during the first twelve months of a baby’s life. But there may be plenty of reasons; not everything comes down to vitamin D deficiency, as you used to think.

Causes

Violation metabolic processes in the child’s body leads to the development of a disease such as rickets. However, you should understand that the reasons may be different, and therefore the treatment will be special in each individual case.

So what causes rickets, you ask. Let's figure it out:

• Prenatal period. Poor nutrition of the mother, consumption of alcohol or drugs, smoking leads to metabolic disorders in the body of the unborn child, failure of the development of internal organs and systems;
• Premature birth. The baby’s body is intensively saturated with minerals and vitamins precisely in the last two months of pregnancy; when born at seven or eight months, the baby did not receive enough nutrients from the mother. A deficiency of one or another mineral or vitamin occurs, and rickets develops in infants;
• If you are during breastfeeding, in pursuit of the ideal form, sit on strict diet, or you use exclusively plant foods Most likely, the baby will develop rickets as a result of a lack of nutrients. Read more about nutrition during breastfeeding in the article: Nutrition for a nursing mother >>>
• Early transition to non-adapted milk formulas;
• Frequent illnesses, admission potent drugs may cause metabolic disorders;
• Rickets can occur for reasons beyond the control of the child's mother. The baby may have kidney disease, stomach disease, skeletal system, defective enzyme functioning. As a result, fusion does not occur or there is an obstruction of calcium and phosphorus, essential minerals for the baby’s growing body;
• There is a so-called predisposition to rickets. At risk are more representatives of the stronger sex, children born in the cold months, those with blood group II and babies with dark skin;
• Diseases of the thyroid and parathyroid glands can also lead to the development of rickets. The process of bone formation is disrupted;
• And only in last place is the lack of vitamin D. They tell you that the required amount of vitamin is not supplied to food, but we are talking about something else. Vitamin D is not absorbed and there is a metabolic disorder.

As you can see, there can be a lot of reasons, but external signs Even you can notice without special medical education.

External signs of rickets

If your baby was born on time and is breastfed (Read the current article: Feeding on demand >>>), then you shouldn’t even look for signs of rickets before two or three months. But it doesn’t hurt to know the enemy by sight.

So, the main external signs of rickets in children under one year old, which should alert you:

1. The child is restless and often cries and shows anxiety;
2. The baby flinches when the light is turned on or when there is a clap;
3. If you press on the baby's skin, red spots appear;
4. There is a receding hairline on the back of the head;
5. The baby sweats profusely, even if temperature regime aged, and the sweat itself has a sour smell;
6. The baby's palms and legs are constantly wet;
7. A clear deformation of the skull is visible;
8. The child has crooked legs.

These are only some of the signs that are visible visually. Of course, you can’t do without consulting a doctor, but knowing the exact diagnosis, you can choose adequate treatment it will be you.

First symptoms

• We may confuse symptoms associated with a disorder of the nervous system, such as crying, nervousness, sleep disturbances (Read the article, why do children sleep poorly?>>>), with manifestations of other diseases. But the symptoms definitely indicate rickets in children. increased sweating, and sour smell feces and sweat;
• If your baby has frayed hair on the back of his head, feel the entire head. During the development of rickets, the fontanel does not heal for a long time, the bone tissue in the area of ​​the back of the head and crown becomes softer. You can also feel softening at the cranial sutures;
• You can determine the symptoms of rickets by doing the usual gymnastics with your baby. If previously, in order to separate the arms or legs, it was necessary to make a small effort, then with the development of the disease, muscle tone becomes very weak;
• You should be concerned if your baby is behind in development compared to his peers. This means that he does not hold his head up by three months, does not roll over on his stomach for a long time, does not try to sit up; Read about the age at which babies begin to sit in the article: When does a child begin to sit?>>>
• Indirect symptoms may include delayed teething, especially if you and your spouse started teething at almost three months of age as children.

Under no circumstances should you leave the manifestations of the disease to chance.

Treatment and prevention of rickets

Do you remember if your baby was prescribed Aquadetrim or other drugs containing vitamin D at the children's clinic? Have you been diagnosed with rickets? No? Then why are you taking the drug if you are not sure that your child has a vitamin D deficiency, and not a metabolic disorder or thyroid disease?

The questions above were not asked by chance, since in modern medical practice Vitamin D preparations are considered a panacea for rickets, although, as an analysis of the reasons shows, only one point out of nine concerned of this vitamin. And even in the case of its deficiency, it is possible to restore the imbalance using other, more gentle methods.

The most basic of them is walking on fresh air under the sun's rays, and there are such even in the cold months of the year. In addition, the prevention of rickets in children gives good results.

Prevention

1. You carry out most of the preventive actions every day, without even realizing that now, at this very moment, you are struggling with rickets. We are talking about everyday walks with a child, the so-called air and sunbathing, hardening, for example, walking barefoot on grass or sand;
2. When you take care of the variety and fortification of your child’s diet, you again work against rickets. Feed your baby cottage cheese or give him steamed fish - again, disease prevention. See also a useful course on how to properly introduce complementary foods to a child >>>
3. You should think about preventing rickets while you are pregnant. There is nothing supernatural here: walks in the fresh air, nutritious nutrition, optimal physical activity.

Treatment

• If in medical card your baby has it written in black and white: “Rachitis”, then you need to think about treatment. But don't rush to swallow pills. You can try to balance the baby’s diet, add foods containing calcium and phosphorus, vitamins C, A, D, and protein. Don't give up breastfeeding. Read the article about vitamins for nursing mothers >>>;
• Even in cool weather, you should take walks in the fresh air, catching every ray of winter sun if possible. Pay attention to the baby’s physical activity, run more, jump if the baby is not walking yet, encourage him to crawl, or do gymnastics on a fitball.

Treatment of rickets in infants can be nonspecific, as described above, and drug-specific, specific.

Which drugs to choose?

Don’t rush to run to the pharmacy for vitamin D, even if your baby has been diagnosed with rickets, this does not mean that you need to drink or swallow vitamin D fish fat. By the way, an excess of vitamin D is much worse than the initial stage of rickets.

Important! You must insist on taking tests. How to determine rickets in a child if no laboratory tests are performed?

Perhaps your child has an iron deficiency, then he needs iron supplements. Alternatively, there is a lack of phosphorus. Again another vector of treatment.

It is better for you to give preference to homeopathic remedies than chemistry. These are somewhat more expensive, but contain useful substances in pure form. On the list homeopathic remedies More than a dozen medications are offered for rickets, and they are safe. The specific names of the medicine will be determined by a homeopathic doctor after a detailed conversation with you (usually the initial appointment will take 2 to 3 hours).

What will happen if left untreated?

Childhood rickets can have three stages of development. All the listed signs and symptoms concerned the first stage. If you take preventive and therapeutic nonspecific or medicinal procedures in time, rickets can be stopped and cured. But, if you let the disease take its course, then a few weeks are enough for the disease to progress to the second stage.

1. The most common consequences of the disease are caries, first of the milk teeth, and later of the permanent teeth. The reason is calcium deficiency;
2. Another consequence of parental negligence is curvature of the joints. lower limbs, and the legs can take the shape of a wheel, or vice versa, bend inward;
3. The disease of all schoolchildren - scoliosis - can also be an echo of infantile rickets;
4. The problem that most pregnant women face is a narrow pelvis, as you might guess, developed this way due to childhood rickets;
5. A general weakening of the body caused by metabolic disorders of useful substances can provoke frequent colds, pneumonia, anemia. Even myopia may well be a consequence of rickets suffered in infancy;

To avoid all these consequences, you need to carry out prevention even before the baby is born, and pay enough attention to nutrition during pregnancy and after. If necessary, replenish mineral reserves with homeopathic remedies and multivitamins, and walk in the fresh air. try to do this on sunny days.

There are diseases that have long been considered “pre-revolutionary” and obsolete, but, as medical practice shows, they are not so rare and may sometimes not depend at all on the standard of living of the family, care baby and nutrition. This includes infants.

Now let's look at this in more detail.

What is rickets?

Internal diseases and genetic abnormalities

The situation is more complicated with children whose internal organs are sick from birth:

• intestines,
• liver,
• kidneys

Malabsorption in the intestine, obstruction of the biliary tract, genetic diseases, preventing the absorption of vitamin D - all this ultimately leads to the appearance of the first signs in infants, which is very difficult to treat.

Other factors

Prematurity and artificial feeding– these are two more important factors that directly affect metabolic processes in the body and the absorption of nutrients from food.

The fact is that premature babies have a significantly higher need for vitamin D than those born at term, so very often food does not cover the vitamin deficiency: it only grows and gets worse if the signs are not noticed in time and the nutrition system is not changed.

Artificial children suffer because the proportion of calcium and phosphorus - the most important building elements for bone tissue - is disturbed in cow's, goat's milk, and artificial formulas.

It is important for mothers whose children do not receive breast milk to know: ideal formulas and animal milk do not exist, therefore the nutrition of an artificial child should be structured so that the deficiency of vitamin D, calcium and phosphorus is constantly covered by complementary foods.

Classification of rickets

The classification of rickets existing in domestic pediatrics is associated with the effectiveness of vitamin D therapy. The following types of disease are distinguished:

• Classic D-deficiency is the most common;
• Secondary;
• Vitamin D dependent;
• Vitamin D-resistant.

In turn, the classic one is subdivided according to changes in the concentration of calcium and phosphorus in the blood, so there are calciumpenic and phosphopenic forms, which indicate a significant deficiency of these important elements. Sometimes the classic one occurs with normal levels of calcium and phosphorus.

They are also prescribed with caution to children receiving adapted milk formulas that already contain vitamin D.

This condition is called rickets and is often very frightening for parents.

Characteristics of rickets in children

Rickets is a curvature of the bones due to a disorder of phosphorus-calcium metabolism caused by a deficiency of vitamin D. In children under the age of 2 years, nutritional, or infantile, rickets of food origin occurs. In older children, the cause of rickets is hypophosphatemia caused by renal failure. The incidence of infantile rickets in the first 2 years of life ranges from 5 to 20%. Rickets is more often observed in children with low weight. During infantile rickets, they distinguish initial stage, the peak stage and the recovery stage.

The initial stage, which appears at the age of 3 months and reaches a maximum at 4-5 months, is characterized by vegetative and neurological manifestations in the form of convulsions, tetany, stridor. In the first half of the year there is a delay in crawling. No bone changes are observed.

The peak stage begins at 6-8 months of age. Characterized by curvature of bones. There is deformation of the bones of the skull, thickening of the frontal and parietal tubercles, thinning of the occipital and parietal bones. There is a delay in calcification of the physis of long bones, which leads to their thickening. The thickness of the epiphyses of the bones of the forearm and phalanges of the fingers is increased. From the second half of the year after mastering sitting, kyphotic deformity of the spine begins. Thickening of the ribs occurs at the osteochondral junction. The chest acquires a convex or concave deformation with protrusion of the lower edge of the costal arch. In the 2nd year of life, with the transition to standing and walking, the curvature of the lower extremities begins to progress. There is a limitation in the growth of bones in length, thickening of the bones and their deformation in the shape of an arc. Curvature of the bones of the lower extremities occurs in the frontal and sagittal planes. In the frontal plane, varus deformity of the femoral and tibia develops more often than valgus.

Varus is accompanied by hypertonicity of the flexor muscles and sprain of the lateral ligament of the knee joint. Valgus is more associated with muscle hypotonia and sprain of the medial collateral ligament of the knee joint. Curvature in the frontal plane is often symmetrical and less often asymmetrical, when varus on one leg is combined with valgus on the other. In the sagittal plane, deformation of the lower leg bones occurs forward and outward. The tibia has a smooth surface, its crest has a sharp edge. The leg bones are painful on deep palpation. There is thickening of the knee joints. Available increased elasticity ligaments, which leads to hypermobility in the joints. When the ligaments of the knee joints are weak, their recurvation develops. Joint space ankle joint beveled with an outward angle. There is a flattening of the pelvis.

The radiograph shows the following changes: varus or hallux valgus femur and tibia in the form of a gentle arch, anterior curvature of the tibia, osteoporosis, which is most pronounced in the ribs, thinning of the cortical layer, curvature of the epiphyses of the femur and tibia, growth of the growth plate to the sides, a wide zone between the metaphysis and the epiphysis, expansion of the metaphyses. On the medial side of the proximal part of the femur, Loeser zones are found in the form of transverse stripes of non-mineralized osteoid, surrounded by a zone of sclerosis, which are qualified as pseudofractures due to osteomalacia. Meet pathological fractures, which lead to angular secondary bone deformations.

The child has a delay in the development of motor skills and a delay in the start of independent walking, which is caused by hypermobility of the joints, low muscle tone and bowed legs. Deformation of the lower extremities and weakness of the gluteal muscles lead to unstable walking with significant deviation of the torso in the frontal plane. Valgus of the legs and thickening of the knee joints lead to their impact during walking. Leg varus causes a narrowing of the stride width. When the lower extremities are deformed, a secondary flat-valgus deformity of the feet occurs with a forced increase in pronation during rolling. The child gets tired quickly and complains of pain in the legs after physical activity.

Recovery stage. Occurs spontaneously in the 3rd year of life. As recovery progresses, statics and dynamics normalize. Deformities of the spine and limb bones are corrected. The pain in the legs stops. Deformation of the legs at the age of 4-5 years in a child with short stature and delayed motor development is considered as prolonged rickets.

Causes of rickets in children

Rickets occurs due to a deficiency of vitamin D in the child’s body, and this is not only a disease of the bones, but general disease, expressed in the softening and expansion of bones closer to their ends, which leads to deformation chest, curvature of the legs and a delay in the start of walking.

Prevention of rickets has long been daily intake vitamin D, as well as supplementing the baby’s diet with foods rich in this vitamin.

It is believed that one of the causes of rickets is insufficient sunlight, but it is known that in many countries where there is plenty of sun, and not everything is in order with nutrition, rickets is still very common.

Pronation (dislocation of an arm or leg)

When playing with a baby who is not yet a year old, parents often grab his hand too tightly, and as a result, dislocation or subluxation of the elbow joint or the head of the radius occurs. The child begins to cry, his hand either hangs powerlessly or freezes in an awkward position: the forearm is bent, the palm is turned down. That's when the diagnosis is made - pronation. And every doctor knows how painful it is for the baby. But any doctor also knows how to correct the situation: one movement (but made by a specialist!) is enough to return the joint to its place and stop the excruciating pain. The child immediately calms down and begins to move his hand exactly as he did before the injury.

Pronation has nothing to do with bone cracks or fractures. In general, this is a painful but not terrible thing, so x-rays are unlikely to be needed. But we must remember: the cartilage in the joints of the bones of a small child is very delicate and fragile, and therefore, when playing with the baby or leading him by the hand when he begins to walk, you should avoid sudden movements, and in no case pull or pull his limbs (pronation can also occur in the leg).

In fact, rickets is not a disease, but a condition, although it can aggravate the course of the disease.

Symptoms and signs of rickets in children

The first symptoms are minor and may not even be noticed by your pediatrician. The child develops increased anxiety, sweating, a sour smell of sweat, and as a result - constant irritation on the skin (prickly heat). The child rubs his head on the pillow, and as a result, baldness of the back of the head appears. The baby begins to flinch at loud noises. Further, muscle strength and tone are impaired; children later master motor skills. Due to a lack of calcium, changes in the skeletal system develop: bones become softer and are easily deformed (flattening of the back of the head, pliability of the edges of the large fontanel, deformation of the chest, curvature of the spine and legs).

In the future, growths of bone tissue may develop, characteristic of long-term untreated hypovitaminosis D: occipital protuberances, “rachitic rosary” (thickenings at the junction of the bony part of the ribs into the cartilaginous part), thickenings in the wrist area (“bracelets”). With age, limb deformities can be eliminated (with proper treatment), but curvature of the spine and other bone changes can remain for life and indicate rickets suffered in childhood. Girls who have suffered from rickets sometimes experience deformation of the pelvic bones, which in the future can create certain difficulties during childbirth. In some children, vitamin D deficiency may slow down the eruption of teeth, which will later suffer from tooth decay. Anemia is a frequent accompaniment of rickets.

A natural question arises: why is almost all infants suffer rickets if the cause of this condition has long been known? Give all of them at the age of 1-1.5 months the required amount of vitamin D, and no rickets!

This approach does not solve the problem and does not reduce the prevalence of rickets. With our lifestyle, the effect of ultraviolet radiation on the skin is minimal and cannot provide the necessary amount of vitamin. Moreover, being in the open sun (“roasting”) is contraindicated not only for infants, but also for adults. Fish products Children under one year old, as a rule, do not receive it, and fish oil, which has again appeared on the market, is much less effective than a vitamin D preparation.

With a severe deficiency of vitamin D, calcium levels can decrease not only in the bones, but also in the blood, which will lead to an attack of seizures. This condition is called spasmophilia and develops more often in the spring.

Vitamin D in conditions of rapid growth of a child in the first months of life is necessary for the growing body in large quantities. How better baby gains weight, the more he lacks vitamin D. The need for vitamin also depends on the individual characteristics of the body, its growth rate, time, date of birth (for children born in the autumn-winter period, it is higher) and dietary habits - untimely administration vegetable puree, cottage cheese, meat (lack of calcium and phosphorus in foods).

Why don't doctors prescribe vitamin D?

For some reason, many doctors stubbornly do not notice the symptoms of developing rickets or, seeing them, do not prescribe vitamin D, citing the following reasons:

• Vitamin D is produced in the human body from provitamin under the influence of ultraviolet rays. Let the child walk in the sun, and there will be no rickets;
• the child is fed with formula milk, which is fortified with vitamin D;
• the child is breastfed, and the mother drinks a vitamin complex that contains vitamin D;
• the use of calcium-rich cottage cheese or a few drops of fish oil (previously this was the only way to treat rickets - some types of fish actively synthesize vitamin D) is enough to get rid of rickets.

If your baby receives porridge more than once a day, his vitamin D deficiency may worsen.

A temporary deficiency of this vitamin appears even in adolescents: during their intensive growth, a condition occurs accompanied by a decrease in calcium in the bones and their increased fragility. On radiographs of the bones, changes similar to those in children with manifestations of rickets are observed.

Naturally, the minimal (one might say microscopic) amount of vitamin D that a child receives from breast milk, formula, and even fish oil is clearly unable to compensate for the deficiency. Moreover, rickets can develop successfully against the background of a so-called prophylactic dose of vitamin D prescribed by a doctor (1-2 drops of an oil or even an aqueous solution per day or every other day).

It turns out to be a paradox: the child receives vitamin D and has a clinical picture of active rickets. What's the matter?

But the point is in the timing of the start of the prevention of rickets, in the doses the child receives for the course of treatment, and in the duration of the course. While the baby is still very small, he has a small supply of the vitamin given to him by his mother. But when he turns one month old, it’s time to give him a prophylactic dose.

There are different regimens for taking vitamin D. There are supporters of constantly taking the vitamin a drop every day or every other day. As practice shows, in this case the effectiveness of vitamin D is low, and rickets is sure to develop to one degree or another.

A preventive course (!) dose of vitamin D for a child who does not yet have signs of rickets is 200,000 - 400,000 IU. The number of drops and the duration of their administration depend on the concentration of the vitamin in the drug you purchased, as well as what kind of vitamin it is - D 2 or D 3.

When prescribing vitamin D, it must be remembered that it is dosed not in drops or milliliters, but in thousands of international units (IU).

Vitamin D 2 (ergocal diferol) dissolves in oil and alcohol and accumulates in the liver, so it can be prescribed after 1-1.5 months of life in intermittent courses (8000-12,000 IU per day for 20-25 days).

In a number European countries a prophylactic dose of vitamin D 2 is given quarterly in several doses or even in one dose (200,000 IU). In our country, such a scheme for the prevention of rickets has not been adopted.

2-3 months after completion of the preventive course of vitamin D (the child does not receive vitamin D at this time), his condition is assessed to decide whether to continue the prevention or treatment of rickets. If the baby does not have signs of rickets, he is repeated a preventive course of vitamin D, and this is done again in the 2nd half of life.

Currently, all children after reaching one month old You should start giving 4 drops (2000 IU) of an aqueous solution of vitamin D3 (colecalciferol) once a day continuously until they are one year old. But monitoring over time is necessary (this dose is not enough for all children).

Considering the fact that an oil solution of vitamin D2 is less absorbed, and an alcohol solution is not currently available, scientists have developed water solution vitamin D3 (colecalciferol), which is eliminated from the body much faster and requires constant intake. Vitamin D3 is produced under the commercial name "Aquadetrim". One drop of this drug contains 500 IU of this vitamin.

If a child has certain signs of rickets, he needs a treatment course of vitamin D. The total dose for the entire treatment course depends on the severity of rickets and can range from 400,000 to 1,000,000 IU. Naturally, the pediatrician should determine how much vitamin D should be given per course. The general rule is the following: the course of treatment should not be very long - the child should receive the entire required dose in 2-4 weeks. Moreover, the more severe the rickets, the sooner the child should receive the course dose (accordingly, the higher the daily dose). Why? As practice has shown, vitamin D accumulates in the body and begins to act most actively only after the child has received the entire course of vitamin D.

After 2-3 months, the child must be examined to assess the effectiveness of antirachitic treatment. At good result(disappearance or significant reduction in the signs of current rickets), after some time (at the age of 8-9 months) the child is re-prescribed a prophylactic course of vitamin D (especially if this age falls in the autumn-winter period). If the effect is insufficient, a therapeutic course of vitamin D is re-prescribed. Children with some individual characteristics(premature; receiving anticonvulsant therapy; with pathology gastrointestinal tract) may require higher doses of vitamin D and repeated courses of treatment. The decision on this, of course, must be made by the doctor.

We remind you that if the need for prophylactic administration of vitamin D is ignored and rickets develops, the child may subsequently develop deformities of the legs, chest, curvature of the spine and other postural disorders, and caries can easily develop. If you notice the first signs of vitamin D deficiency, bring it to your doctor's attention immediately.

I would especially like to warn you about the inappropriate use complex drug- an aqueous solution of vitamins D and A imported. It contains extremely little active ingredient (up to 10 bottles are needed for a course of treatment).

In the old days, rickets was called the “English disease.” Perhaps this happened because it was on the shores of Foggy Albion, where there was a severe lack of sunlight, that it manifested itself especially often in children and English pediatric doctors paid attention to this disease? However, today there is nothing “foreign” about this disease; domestic children are no less susceptible to rickets.

It should be said that rickets can manifest itself in a child in varying degrees. A mild form of rickets is almost close to normal, while a severe form entails severe developmental delays and weakening of the body for many years. A mild form of rickets is not even considered a disease; it is easily corrected with vitamin D, sufficient exposure to the sun and proper nutrition, and severe forms are treated in special rehabilitation centers.

Rickets or hypovitaminosis D - enough frequent violation in children under three years of age. In children under one year of age, rickets is most pronounced. Children born in the autumn-winter period, as well as “artificial” children, are especially susceptible to it. Premature babies and twin babies are also very vulnerable to this disease.

City children are susceptible to rickets to a much greater extent than village children.

Almost anyone modern child(according to some data, more than 60% of domestic children suffer from rickets) there are some signs of rickets. Manifestations of rickets are varied - the child sweats frequently and profusely (especially during eating and sleeping), the back of his head becomes bald, and his appetite decreases. The urine and sweat of a child with rickets may acquire an ammonia odor.

It is more difficult to cure rickets in a child in whom it is caused by digestive disorders (vitamin D is not absorbed). This usually happens with intestinal dysbiosis, when absorption of many vitamins does not occur. After the dysbacteriosis is cured, rickets quickly disappears.

Severe cases of rickets are very rare these days. Typically, severe rickets accompanies a general painful state of the body (digestion, neurology). In severe cases of rickets, bone deformation occurs and the fontanel may not heal for a long time (up to 3 years). Children with rickets sleep poorly, become whiny and nervous. Physical and mental development child. A child with a severe form of rickets begins to sit after one year, and walks only by two years. In the future, rickets may come back to haunt you with scoliosis, caries, and even stunting. Already in the elementary grades, children who suffered from a severe form of rickets may develop myopia.

Children with severe rickets are usually registered at a dispensary and treated in special centers, taking ultraviolet and salt baths, and therapeutic massage.

But that's enough light form rickets can lead to curvature of the bones (hence the so common occurrence in adults with crooked legs, protruding ribs, “chicken” breasts, and protruding shoulder blades).

Treatment of rickets in children

To treat rickets, general drug therapy and orthopedic measures. Assign Spa treatment, insolation, massage and baths. Vitamin D and calcium supplements are used as medicines. Rest and load limitation are prescribed. In the advanced stage, if there is a risk of bone fracture, immobilization is used with splints and orthoses. At the age of 1.5-2 years, for varus, splints are used on the thigh and lower leg with a retraining pad in the area of ​​the knee joint. Redressing is used up to 3 years of age. If there is a risk of fracture, a Thomas apparatus is prescribed to unload the hip and tibia. Full load is limited until 5 years of age. Gradual loading of the legs is allowed when bone calcification appears against the background of general and drug treatment.

For rickets, massage the muscles of the legs and back. A massage session takes 20-25 minutes. The course of treatment consists of 20 sessions. The massage is repeated after 4-5 weeks. If the gluteal muscles are weak, a stimulating massage of the buttocks and thighs is done by rubbing and kneading them. In case of varus curvature of the knee joint, manual correction of the joint is performed by pressing on external condyle femur. Provide a relaxing massage inner surface legs in the form of stretching, stroking, shaking and toning muscle massage outer surface thighs and legs. In case of valgus curvature of the knee joint, manual correction of the joint is performed by compression on the internal condyle of the femur, relaxing massage outer surface legs and firming massage on the inner thigh and lower leg. For planovalgus feet, a relaxing massage is given on the outer surface of the foot and a strengthening massage on its inner surface. Varus curvature can be corrected more easily than valgus, which is difficult to correct after 3 years. The prognosis of treatment depends on the time of its start. Treatment results for it early start turn out to be relatively better.

The operation is performed both before the end of growth and after ossification of the skeleton. The operation on a growing child is performed with the aim of affecting the bone growth zone and correcting the axis of the limb, which facilitates growth conditions in all joints and segments of the leg and reduces the possibility of secondary deformities. Unilateral epiphysiodesis with fixation with staples or a plate is used. Surgery after growth is complete is performed in case of significant deformation of the femur and tibia. The most common procedure is supracondylar osteotomy of the femur.

In case of infantile rickets, the child is shown preventive shoes, which give him confidence in walking and help improve motor activity. Most often these are sandals for home wear with an instep support, which prevents the development of planovalgus feet. During internal rotation of the leg, the shoe insole is made with the pronator fasciculus. The child wears shoes until recovery.

Prevention of rickets in children

The best way to prevent rickets is to keep your baby in the sun (under the influence of ultraviolet rays, vitamin D is produced in the skin). In this case, the child must directly absorb Sun rays(expose at least your face and bare arms to the sun, but be sure to cover your head with a hat or scarf). The most beneficial sunshine occurs from early morning until 11 o'clock (and on hot days - until 10 o'clock). After 11 am and before 5 pm it is better not to walk in the open sun - it is too radioactive. But in the cold season, the baby’s exposure to the sun is limited (from approximately October to March, the number of sunny days is very small), so the prevention of rickets is carried out using an oil solution of vitamin D (ergocalciferol).

The mother, after consulting with the doctor, should begin preventing rickets even before the baby is born (especially if it is expected to appear between mid-autumn and the end of winter). Mom needs to walk in the sun (in the morning, but not “roast” in the sun). Diet expectant mother should be rich in proteins and vitamins. You should take special vitamin complexes for pregnant women, which include vitamin D3.

Breastfeeding also takes important place in the prevention of rickets. It is breast milk that contains calcium, vitamin D and phosphorus in the proportions necessary for the baby, this ensures their complete absorption.

Artificially-bred children are prescribed to take vitamin D at 1 drop per week (besides, vitamin D is contained in infant formula), and if the child drinks mother’s milk, then the mother should take vitamins (1 drop of vitamin D every three days). After the introduction of complementary foods in a volume of more than one third of all food, the infant is given vitamin D 2 drops per week.

Before giving the baby vitamin D, drop it with a pipette into the a large number of(spoon) breast milk or formula. Then the diluted vitamin is given to the child to drink.

A healthy diet is also very important for the prevention of rickets. If at the age of up to six months this is done using mother’s milk or an adapted formula, then after six months the child is given foods rich in vitamin D: egg yolk, butter, fish (especially fish oil!). However, fish oil should only be given to a child on the recommendation of a doctor. Most useful varieties fish with rickets are cod, hake, pike perch. Vegetables and fruits and various juices are good for the child. Since rickets destroys bones and prevents them from strengthening, calcium is useful. Cottage cheese - invaluable resource calcium, accessible to the child already after 4-5 months. We can also recommend special dairy products(cottage cheese, yoghurts), enriched with calcium, for older children. Eggshells are a source of easily digestible calcium. Eggshells are prepared in the same way as for the treatment of diathesis (see the chapter on diathesis). Juices from apricots, apples, plums, and blackberries contain large amounts of calcium. For better absorption of calcium, it is advisable to mix cereal and flour dishes with fruits or vegetables and wash them down with juice.

Rickets is a childhood disease caused by metabolic disorders. Children are susceptible to the disease early age(up to 2 years). Although this disease has been known since ancient times and is well studied, it is still widespread today.

The disease is not fatal, but causes numerous disorders in the baby’s body, which in some cases may have Negative consequences for life. Therefore, treatment of rickets in a child should be started when its first signs appear.

This disease is diagnosed to one degree or another in every fifth person. little resident 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 basis of the disease is a metabolic disorder caused by a deficiency of vitamin D, which enters the human body with certain products nutrition (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, by participating in metabolic processes, that allow the baby to form the dense bone mass he needs during the period of active growth and development.

Rickets is a general disease of the human body, which is caused by a discrepancy between the high need of the child’s body for calcium and phosphorus and the improper functioning of the systems that deliver these substances.

Rickets has negative consequences. Children who have been diagnosed with the disease are more likely than other peers to suffer from respiratory diseases. This is due to the fact that the disease provokes dysfunction immune system child.

Severe disease can lead to osteoporosis, poor posture, caries, and anemia. Under the influence of a lack of calcium, phosphorus, and magnesium, gastrointestinal motility disorders develop. Disease suffered in early childhood, can leave consequences for life.

Causes of the disease

The rapid growth and active development of the baby 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.

Insufficient levels of these substances in the blood can occur due to both limited intake from food and impaired absorption in the intestine due to a lack of vitamin D.

As soon as a deficiency of these microelements 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.

Due to the fact that the disease still occurs, every mother should know why rickets appears and how to cure it.

The disease can be provoked by the following factors:

• prematurity;
• high birth weight of babies;
• 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;
• gastrointestinal diseases or immaturity of enzymes that impair the absorption of calcium and phosphorus in the intestines;
• dark skin of the baby, in this case vitamin D is poorly produced in the skin;
• hereditary metabolic disorders;
• congenital abnormalities of the liver and kidneys;
• taking some anticonvulsants or glucocorticoids.

When calling the main cause of rickets a deficiency of vitamin D in the baby’s body, it is necessary to take into account that there is no clearly defined daily requirement, the use of which can clearly guarantee protection against the disease.

The dosage of vitamin D varies depending on the child’s age, living conditions, nutrition and, importantly, skin color. The lighter the baby's skin, the more vitamin D it can produce. 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. For such a child, a 10-minute daily stay in the shade in clear weather is enough for the required amount of this vitamin to be synthesized in the skin.

Symptoms and diagnosis of rickets in children

The number of children suffering from rickets has decreased significantly over the past half century in developed countries.

This was achieved thanks to factors such as:

• improving the standard of living and, accordingly, enriching the diet of pregnant and lactating women;
• breastfeeding promotion;
• 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 tubercles of the skull;
• delay in the appearance of teeth, the enamel of the teeth is fragile and prone to darkening and destruction;
• rachitic rosary beads appear on the ribs - compactions;
• deformation of the chest (depressed “shoemaker’s chest” or protruding “chicken” chest);
• the baby’s growth rate slows down, his development parameters lag significantly behind those accepted by WHO;
• at further development diseases, bone fragility appears, due to which it is possible frequent fractures legs

It is common to unfoundedly attribute certain symptoms to rickets that are not actually such:

• increased child sweating;
• lack of hair on the back of the head;
• loss 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 various reasons- overheating, after illness, vaccination, 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 back.

It is necessary to understand that the above signs may be symptoms of other diseases. Based on them, it is impossible to independently diagnose rickets in a baby. Only a pediatrician can establish the disease through a visual examination confirmed by x-ray and laboratory tests.

Degrees of rickets

Main diagnostic method Determination of rickets in laboratory conditions is an analysis of calcium levels in plasma. The Sulkowicz test for determining the level of calcium in urine is currently considered in an outdated way definitions of rickets.

Modern diagnostics involves studying blood for:

• calcium, phosphorus, magnesium, alkaline phosphate and creatinine content;
• levels 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 us to determine a decrease in bone density and other changes characteristic of rickets.

Treatment of rickets

It is now well known why the disease occurs and how to treat rickets in a child.

The main direction of treatment for this disease is the normalization of the baby’s lifestyle and diet, which includes:

• Daily walks lasting at least 4 hours. In the spring-summer period, it is important to provide the baby with the necessary amount of ultraviolet radiation, so he should be taken for a walk as undressed as possible.
• Long-term breastfeeding (at least up to 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, earlier introduction of complementary foods is recommended. Since vitamin D is fat-soluble, it is necessary to monitor the balance of fats in your baby's diet. For a child under 1 year old, butter can be added to the menu.
• Taking pine and salt baths daily, which helps strengthen the child’s immune system and nervous system.
• The use of medications containing vitamin D. This is the main method; without it, all other measures will not be effective enough. The most preferred are aqueous solutions of vitamin D3.

Vitamin D in the treatment of rickets

The most common drug containing an aqueous solution of vitamin D is Aquadetrim. It does not accumulate in the body and is well excreted by the kidneys, which minimizes the risk of overdose. Aquadetrim is not only a medicine, but also a prophylactic agent.

Amount required for child medicine is selected by the doctor individually depending on the age, weight and condition of the baby.

But Akvadetrim, like any medicinal product, it may 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 as an alternative, the modern pharmaceutical industry offers oil solutions of vitamin D3.

Treatment of rickets with Vigantol, Videin, Devisol is preferable for children with allergic reactions. Oil solutions are much less likely to provoke allergies, but are not recommended for children with dysbacteriosis and certain intestinal disorders.

They are convenient to use for the prevention of rickets, but the therapeutic dosage is quite difficult to calculate. Any drug containing vitamin D, regardless of whether it is an oil solution or a water solution, must be taken in strict accordance with the doctor’s recommendations.

Parents should remember that an overdose of vitamin D will cause no less harm to the baby than its deficiency. . 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 go away on its own!

If anyone has a question whether rickets is treated with drugs other than those containing vitamin D, the answer will be clear. Today, all other drugs are only an aid.

The dietary supplement Calcid, which is used as a prophylaxis for rickets, has proven itself well. The drug contains calcium and vitamin D for better absorption. But treatment of rickets with Calcide will not be effective at an advanced stage of the disease; it is better to use it as a prophylactic agent.

The use of calcium supplements is recommended as a necessary supplement if a child is prescribed a one-time dose large dose vitamin D. In this case, its increased amount can lead to sharp decline calcium in the blood, which can cause seizures.

Calcide effectively replenishes calcium losses. Using it like any other drug and biologically active additive, requires mandatory consultation with a pediatrician who constantly monitors the baby.

In the treatment of rickets important factor is its timeliness and professional approach. The list of recommended medications and their exact dosages can only be calculated by a pediatrician. Only a doctor will determine how to treat rickets if there is already curvature of the legs or deformation of the chest, since the dosage of drugs depends on the stage of the disease.

Prevention of rickets in children

Prevention of rickets is correctly carried out during a woman’s pregnancy.

Prevention of the disease during this period consists of:

• maintaining a daily routine;
• daily walks in the fresh air;
• rational balanced diet;
• prescribed according to vitamin D indications for later pregnancy.

Prevention of rickets during the period of intrauterine development of a child does not exclude its need after birth and consists of the following:

• feeding with breast milk, and if this is not possible, with adapted milk formulas;
• compliance motor mode(prohibition of tight swaddling, massage, gymnastics);
• daily walks;
• adherence to daily routine;
• hardening procedures;
• taking vitamin D in prophylactic doses.

Rickets is a disorder of metabolic processes in the body, which results in pathological changes in various organs and systems of the baby. Following simple preventive measures can protect your baby from this difficult disease.

When it was not possible to prevent the disease, contacting a pediatrician at the first suspicion will help reduce the consequences of the disease to a minimum.

Useful video about rickets

In this article:

Rickets in children develops due to a lack of vitamin D in the body. The changes primarily affect the skeletal and nervous systems. The disease has been known since the 2nd century BC. Ancient portraits depicted children who had smoothed out occipital bones, brow ridges in the form of overhanging ridges, curved arms and legs, as well as a flattened stomach.

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

Classification

There are several systematizations of such a disease as rickets in children, each of which indicates the characteristics 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 deficiency of this substance, and to eliminate the disorders, it is enough to take medications containing vitamin D in a therapeutic dosage.

The second group includes children for whom taking standard dosages has no effect, and recovery is possible only by consuming the vitamin in an amount several times higher.

The classification of rickets in children by stages includes:

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

Degrees of rickets in children according to severity:

1. Lightweight– symptoms are mild, noted minor violations from the musculoskeletal system and nervous system.
2. Average – pronounced violations skeleton and innervation of the limbs, deviations in the functioning of the cardiovascular and respiratory systems, and disruptions in the gastrointestinal tract are observed.
3. Heavy– high degree pathological changes in all systems and organs that ensure normal life.

According to the nature of its course, rickets can be:

• sharp;
• subacute;
• recurrent.

Causes

Rickets in newborns and children under 1 year of age V occurs due to insufficient synthesis of calciferol in the body. Vitamin D can be absorbed from food and breast milk, and can also be formed in skin cells under the influence of sunlight or ultraviolet rays. If the supply of the substance is disrupted, the disease develops. Vitamin deficiency disrupts calcium-phosphorus metabolism, which negatively affects the condition of the skeletal system.

The causes of rickets include the following:

• low the nutritional value food products that contain small amounts of calciferol;
• lack of ultraviolet rays (living in the north, rare walks);
• pathological processes in the intestines, due to which the absorption of vitamins is impaired;
• endogenous causes, including liver and kidney diseases that interfere with the absorption of calciferol;
• feeding a newborn with unadapted formulas where the correct ratio of beneficial elements is not observed;
• constant use of anticonvulsant medications.

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

Symptoms

Rickets usually occurs in both young children under one year and after one year. The first changes are detected at the age of 1-2 months after birth.

First of all, changes affect the nervous system:

• sleep is disturbed, wakefulness and night rest patterns change;
• irritability and tearfulness occur;
• the baby does not eat well, refuses or does not eat the prescribed amount, and the feeding process extends for a long time;
• stool disturbances occur, diarrhea or diarrhea appears for no apparent reason;
• increased sweating is noted;
• Baldness develops on the back of the head.

Two last symptom are closely interconnected. During night sleep, the child sweats excessively, causing a wet patch to form on the pillow (wet spot syndrome). The baby often turns his head, as sweat causes discomfort And skin itching, due to which the hair on the back of the head is wiped out.

After a couple of weeks, others will join the listed symptoms. A clear sign Rickets in children is characterized by decreased muscle tone, as well as a “frog” stomach - it seems to be pressed down by something heavy, which is why it has taken this shape. Symptoms of the disease include delayed teething, delayed overgrowth of fontanelles, deformation of the legs and arms, and changes in the shape of the head.

Diagnostics

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

In order to reliably establish a 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 for these substances:

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

Another reliable way to determine the presence of rickets in a child aged 1-3 years is an x-ray. It shows skeletal deformations and the level of bone mineralization. Developing disorders can be more accurately examined using computed tomography.

Why is rickets dangerous?

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

Disorders of the skeletal system appear at older ages:

1. Rachitic rosary - areas of thickening at the ends of the ribs.
2. “Olympic” forehead - the frontal and parietal tubercles increase in size, which is why the head takes on the shape of a cube.
3. Deformed pelvic bones in girls will cause 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” disrupt gait and create additional stress on the hip joints.

Treatment

Treatment of rickets in 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 data laboratory tests. Even after calciferol concentrations rise, vitamin D must be taken for preventive purposes for several 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 concomitant diseases.

Rickets of the legs is most common in children. This disorder does not allow the child to move fully, and in advanced conditions does not even allow him to walk. This is why it is so important to undergo appropriate treatment in the early stages. It is possible to correct the curvature of the legs due to 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 calciferol content in the body, the disease further worsens. In this case, violations affect internal organs and cause disruptions in their functioning.

The following symptoms occur:

• abdominal pain;
• frequent vomiting and regurgitation after eating;
• pale skin;
• hepatomegaly;
• stool disorders.

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

Consequences

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

The child is threatened:

• violation of the jaw relationship;
• 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 a childhood disease such as rickets consists of activities carried out during pregnancy and after the birth of a child.

Intrauterine prophylaxis:

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

After the baby is born, you should:

• organize proper feeding;
• give vitamin D drops;
• maintain a daily routine;
• organize daily sleep or walks outside;
• massage and exercise.

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

Useful video about what rickets is