Surgery to remove an inguinal hernia. Rickets in children: symptoms and treatment Rickets periods of the disease

"is heard by everyone. Parents of newborns and infants perceive it especially reverently, since from their own childhood they remember how they were frightened with rickets if they refused to have a hearty lunch or drink an evening glass of milk. Is rickets as dangerous as it seems, and what to do if a child has been diagnosed with this, we will tell you in this article.

What it is?

Rickets has nothing to do with the amount of food. Many people learned about this only when they became adults. This disease is indeed characteristic of childhood, but it occurs due to other reasons, primarily due to a deficiency of vitamin D in the body. This vitamin is extremely important for the baby during the period of active growth. With a deficiency, bone mineralization is disrupted and problems with the bone skeleton appear.

Rickets is usually observed in infants, in many cases it goes away on its own, without consequences for the child’s body. However, there are also more unfavorable outcomes when a child develops systemic osteomalacia - chronic mineral deficiency of bones, which leads to their deformation, dysfunction of the skeleton, joint diseases and others. serious problems. Children with dark color skin (Negroid race), as well as babies born in winter and autumn due to the small number of sunny days.

Vitamin D is produced when the skin is exposed to direct sunlight; if there is no such exposure or it is insufficient, then a deficiency condition develops.

Rickets was first described by doctors back in the 17th century, and at the beginning of the 20th century, a series of experiments were carried out on dogs, which showed that cod fish oil can be used against rickets. At first, scientists believed that the problem was vitamin A, but then, through trial and error, they discovered the same vitamin D, without which the structure of bones is disrupted. Then in Soviet schools and kindergartens, all children without exception began to be given spoonfuls of nasty and pungent-smelling fish oil. This measure is state level was completely justified - the incidence of rickets in the middle of the last century was quite high and required mass prevention.

Today in Russia, rickets, according to statistics, is much less common - only 2-3% of infants. We are talking about true rickets. The diagnosis of “rickets” is made much more often, and these are diagnostic problems, which we will discuss below. Thus, in our country, according to the Ministry of Health, doctors detect certain signs of rickets in six out of ten babies.

If a child is diagnosed with this, this does not mean that true rickets actually exists. More often we're talking about about overdiagnosis, banal “reinsurance” by doctors, and sometimes about rickets-like diseases, which are also associated with vitamin D deficiency, but which cannot be treated with this vitamin. Such ailments include phosphate diabetes, de Toni-Debreu-Fanconi syndrome, nephrocalcinosis and a number of other pathologies.

In any case, the parents of the baby should calm down and understand one thing - rickets is not as dangerous as most Russians imagine, with proper care and therapy, the prognosis is always favorable; the disease actually does not occur as often as local pediatricians write in their reports.

However, there are really serious cases that you need to know about in more detail so as not to overlook the pathology in your child.

Causes

As already mentioned, rickets develops with a lack of vitamin D, with a disturbance in its metabolism, as well as disturbances in the metabolism of calcium, phosphorus, vitamins A, E, C, and B vitamins associated with this substance. Vitamin D deficiency may develop for the following reasons:

The child does not walk much and rarely gets sunbathing. This is especially true for children who live in northern regions, where there is no sun for six months. It is the lack of sunlight that explains the fact that children who develop rickets in late autumn, winter or at the very beginning of spring get sick longer, more severely and are more likely to experience negative consequences diseases. In the southern regions, a child with rickets is rather a rarity than a common pediatric practice, and in Yakutia, for example, this diagnosis is given to 80% of children in the first year of life.
The child does not receive the right substance with food. If he is fed cow or goat milk in the absence of breastfeeding, the balance of phosphorus and calcium is disrupted, which invariably leads to a deficiency of vitamin D. Artificial infants who receive normal, modern adapted milk formulas usually do not suffer from rickets, because this vitamin is introduced by a variety of manufacturers baby food into such mixtures. A toddler who is breastfed should receive vitamin D from mother's milk. This will not be a problem if the woman herself spends time in the sun or, if such walks are impossible, takes medications with the necessary vitamin.
The child was born premature. If the baby hastened to be born, all its systems and organs have not had time to mature, otherwise they will leak and metabolic processes. In premature babies, especially those born with low birth weight, the risk of developing true rickets is higher than in healthy children born on time.
The baby has problems with metabolism and mineral metabolism. At the same time, they will spend enough time with the child in the sun, give him adapted formulas or preparations with the necessary vitamin, but signs of the disease will still begin to appear. The root of the problem is the malabsorption of vitamin D, lack of calcium, which helps it be absorbed, as well as pathologies of the kidneys, biliary tract and liver. Lack of zinc, magnesium and iron can also further affect the likelihood of developing rachitic changes.

Classification

Modern medicine rickets is divided into three degrees:

Rickets 1st degree (mild). With such rickets, the child has minor disturbances in the nervous system, minor muscle problems (for example, tone), and no more than two symptoms from the skeletal system (for example, relative softening of the cranial bones). Usually this degree accompanies the very initial stage of development of rickets.
Rickets 2 degrees (medium). With this disease, the baby has symptoms from bone skeleton are expressed moderately, nervous system disorders are also recorded (overexcitement, increased activity, anxiety), sometimes problems with work can be observed internal organs.
Rickets 3rd degree (severe). With this degree of the disease, several fragments of the skeletal system are affected, and, in addition, there are pronounced nervous disorders, damage to internal organs, the appearance of the so-called rachitic heart - displacement of this important organ to the right due to dilation of the ventricles and deformation of the chest. Usually this one sign is enough for the child to automatically be diagnosed with rickets of the 3rd degree.

The course of rickets is assessed according to three parameters:

Acute stage. With it, the child only has disorders of bone mineralization and manifestations of disorders of the nervous system. This stage usually develops in the first six months of a child's life.
Subacute stage. It usually accompanies the second six months of the baby’s independent life. At this stage, not only disturbances in bone mineralization (osteomalacia) become apparent, but also the proliferation of osteoid tissue.
Wave-like stage (recurrent). With it, undissolved calcium salts break off in the bones. This can only be seen on an x-ray. Usually we can talk about such a stage when, during acute rickets, such symptoms are found in a child. salt deposits, which indicates that once in active form he has already suffered from rickets, which means there is a relapse of the disease. This stage is extremely rare.

Great importance in forecasting and determining volume medical care For a particular child, the period during which the disease develops also plays a role:

Initial period. It is believed that it starts when the baby is 1 month old and ends when the baby is 3 months old. These are the maximum values. In fact, the initial period of rickets can last two weeks, a month, or a month and a half. At this time, there is a decrease in phosphorus levels in blood tests, although calcium levels may remain quite normal. The period is characterized by signs of the disease of the first degree.
The period of the height of the disease. This period can last from a maximum of six months to nine months; as a rule, at the age of 1 year, the child’s peak transitions to “ new level" There is a noticeable decrease in calcium and phosphorus in the blood, and a deficiency of vitamin D is expressed.
Reparation period. This is a recovery period, it can last quite a long time - up to one and a half years. At this time, doctors will see residual signs of rickets on x-rays. Blood tests will show a clear deficiency of calcium, but this will be more of a favorable sign - calcium goes into the bones and is used for restoration. Phosphorus levels will be normal. During this period, due to the loss of calcium into bone tissue, cramps may occur.
Period residual effects. This period is not limited to a specific time frame; calcium and phosphorus in blood tests are normal. The changes caused by the active stage of rickets may recover on their own, or they may remain.

Symptoms

The very first signs of rickets may go completely unnoticed by parents. As a rule, they can appear as early as a month of the baby’s life, but they usually become obvious closer to three months. The first symptoms are always related to the functioning of the nervous system. This:

frequent causeless crying, moodiness;
shallow and very disturbing sleep;
disturbed sleep frequency - the baby often falls asleep and often wakes up;
excitement of the nervous system manifests itself in different ways, most often by fearfulness (the baby shudders strongly from loud sounds, bright light, sometimes such shudders occur without visible reasons and irritants, for example, during sleep);
The baby’s appetite at the initial stage of rickets is noticeably disturbed, the child sucks sluggishly, reluctantly, quickly gets tired and falls asleep, and after half an hour wakes up from hunger and screams, but if you give breastfeeding or formula again, he will again eat very little and get tired;
the child sweats a lot, especially during sleep, with the head and limbs sweating the most, the smell of sweat is rich, sharp, and sour in tone. Sweating causes itching, especially in the scalp, the baby rubs on the bed, diapers, the scalp is wiped, the back of the head becomes bald;
a baby with rickets has a tendency to constipation, at least with this delicate issue Parents of infants are faced with enviable regularity, even if the child is breastfed.

Bone changes rarely begin at the initial stage, although some doctors argue that the relative softness and pliability of the edges of the fontanel - possible sign early stage rickets. This statement is not scientifically substantiated.

At the height of the disease, which is also called blooming rickets, bone and muscle changes begin, as well as pathological processes in some internal organs.

At this time (usually after the child is 5-6 months old), symptoms are added to the above neurological signs, which should be assessed by a specialist:

the appearance of large or small areas of softening on the bones of the skull, and in severe cases all the bones of the skull are subject to softening;
processes that take place in bone tissue skulls, change the shape of the head - the back of the head becomes flatter, the frontal and temporal bones begin to protrude, due to this the head becomes somewhat “square”;
teething slows down significantly, sometimes teeth are cut in the wrong order, which pathologically changes the bite;
With rickets, the ribs undergo specific changes, which are called “rachitic rosaries.” At the site of the transition of bone tissue into cartilaginous tissue, clearly visible thickening fragments appear. It was they who received the name “rosary”. The easiest places to feel them are on the fifth, sixth and seventh ribs;
the bones of the ribs become softer, due to which the chest quickly undergoes deformation, it looks as if compressed on the sides, in severe cases a change in breathing may be observed;
changes may also affect the spine, in lumbar region which a rachitic hump may appear;

so-called rachitic bracelets appear on the arms and legs - thickening of bone tissue in the area of the wrist and the junction between the lower leg and foot. Externally, such “bracelets” look like circular encircling bone mounds around the hands and (or) feet, respectively;
similarly, the bones of the phalanges of the fingers can be visually enlarged. This symptom is called “rachitic strings of pearls”;
The child’s legs also undergo changes, and perhaps the most serious ones - they bend in the shape of the letter O (this is a varus deformity). Sometimes the curvature of the bones looks more like the letter X (this is a valgus deformity);
the shape of the abdomen changes. It becomes large, giving the impression of constant swelling. This phenomenon is called "frog belly". With rickets, such a visual sign is considered quite common;
joints have increased flexibility and instability.

All these changes certainly affect the functioning of internal organs. Children with rachitic deformed chests are more likely to get pneumonia because their lungs are compressed. With rickets of the third degree, a “rickets heart” can develop, while the position of the heart changes due to its enlargement, usually the organ is displaced to the right. In this case, the pressure is most often reduced, the pulse is more frequent than it should be according to average children's standards, and heart sounds become muffled.

In most children with severe rickets ultrasonography abdominal cavity shows an increase in the size of the liver and spleen. There may be problems with kidney function, as well as with a weakened immune system; the consequence of the latter problems is usually a frequent incidence of viral and bacterial infections, and the episodes of illness themselves are more severe and often become more complicated.

Symptoms of rickets subside gradually and smoothly during the repair period. However, due to the reduced level of calcium in the blood, seizures can sometimes occur.

At the final stage, during residual effects, by this time the child is already, as a rule, 2-3 years old or more, only a few consequences remain - curvature of the bones, a slight increase in the size of the spleen and liver.

But this is not necessary; if rickets is mild, there will be no consequences.

Diagnostics

With the diagnosis of rickets, everything is much more complicated than it might seem at first glance. All of the above symptoms are not considered signs of rickets anywhere in the world, except in Russia and the former Soviet Union. In other words, it is impossible to diagnose a child with rickets only on the basis that he eats poorly, sleeps little, cries a lot, sweats, and has a bald head. For such a verdict, X-ray data and a blood test for calcium and phosphorus levels are required.

However, in practice, in any Russian clinic, both in major cities, and in small villages, pediatricians diagnose rickets only by visual signs. If this happens, you should definitely check with your doctor why it is not prescribed. additional research. If rickets is suspected, it is important that the child's blood is taken and he is sent for an x-ray of the extremities.

It should be remembered that rachitic changes in the skeletal system will appear on an x-ray no earlier than the child is six months old from birth. Usually changes primarily concern long bones. That's why they take pictures of the child's feet. There is no need to examine ribs, skull and other bones using this method.

All pathological processes, if they occur, will be clearly visible in the image of the leg.

Donate blood and do x-rays If the diagnosis is confirmed, it will be necessary several times during the treatment process so that the doctor can see the dynamics and notice possible concomitant pathologies and complications in time. If the above studies and diagnostic methods do not confirm the presence of rickets as such, the symptoms that the doctor mistook for rickets should be considered normal physiological. Thus, the back of the head of babies goes bald in 99% of cases because from 2-3 months they begin to turn their heads while in horizontal position. Thus, the first fragile baby hairs are simply mechanically “wiped off”, and this has nothing to do with rickets.

Sweating is common to all babies due to imperfect thermoregulation. Incorrect microclimate, too dry air, heat in the room where the baby lives, parental mistakes in choosing clothes for the child according to the weather - more probable reasons excessive sweating than rickets.

A protruding forehead and crooked legs, in principle, can also be hereditary individual appearance traits. So does a narrow chest. And capriciousness and increased loudness are a common character trait of a baby or improper care behind him. Precisely because almost every symptom of rickets also has a physiological and completely natural explanation, it is so important to insist on a full diagnosis.

And for the same reason, the similarity of the signs of the disease and the normal variants is so often diagnosed with rickets in children who have no trace of the disease.

Treatment

What treatment will be depends on the stage, period and severity of rickets. Mild rickets, identified by serendipity, in principle, does not require special treatment. It is enough for the child to walk in the sun more often, and if this is not possible, then take medications containing vitamin D. The main thing is not to do this at the same time, that is, do not drink “Aquadetrim” in the summer, since this increases the likelihood of an overdose of this substance, which in itself happens worse and more dangerous than rickets.

If, for more severe degrees of the disease, the doctor prescribes a double dose of the drug with vitamin D, then you need to be wary of such a recommendation and find another specialist who will treat the child competently and responsibly. All medicines containing the right vitamin, should be taken strictly in single age dosages, without exceeding those, regardless of the degree and severity of the disease.

Along with such vitamins, it is advisable to give the child calcium supplements (if the level of this mineral is reduced in the blood).

The most famous and popular means based on vitamin D:

"Aquadetrim";
"Vigantol";
"Alpha-D3-TEVA";
"D3-Devisol Drops";
"Colicalciferol";
edible fish oil.

In order not to confuse the dosage, and also to ensure that the child has enough other vitamins, which is very important in the treatment of rickets, parents can print out a table of vitamin requirements and regularly check it. As you can see, infants need no more than 300-400 IU of vitamin D per day. Violating these dosages is strictly prohibited.

The nutrition of a child with rickets should be radically revised. A doctor will definitely help you correct your diet. The menu should be balanced and contain sufficient quantity iron, calcium. If a child is fed an adapted formula, there is usually no need to add anything to it.

During recovery period and the period for assessing residual effects, the baby’s menu must include fish, eggs, liver, and greens.

For a child with signs of rickets, it is important to spend as much time as possible on fresh air and also take several courses therapeutic massage and therapeutic exercises. In the initial stages, with a mild degree of the disease, a restorative massage is usually prescribed, the purpose of which is to relax the muscles, relieve nervous tension, and improve blood supply to the tissues. With moderate and severe rickets, massage will also play an important role, but it will need to be done very carefully and carefully, since flexion and extension of the child’s limbs in the joints with pronounced bone changes pose a certain danger to the toddler - the likelihood of a fracture, dislocation, or subluxation increases. In addition, children with rickets get tired more and faster during physical activity.

Massage can be done at home using classic techniques - kneading, stroking, rubbing. However, everything should be done smoothly, slowly, carefully. Gymnastics should include bringing and spreading the legs, bending the limbs at the joints. During massage and gymnastics, parents or a massage therapist should avoid patting and striking movements as much as possible, since children with rickets are quite timid and react painfully to unexpected sensations and sounds.

The most preferred gymnastics plan looks like this:

At 1-2 months - lay the baby on the tummy and rock it in the fetal position;
At 3-6 months - lay on the stomach, encourage crawling movements, rollovers with support, arms and legs bend and unbend both synchronously and alternately;
At 6-10 months, they add to the already mastered exercises lifting the body from a lying position, holding the baby by the arms apart, and lifting from a lying position to the knee-elbow position;
From the age of one, you can use massage mats for your feet, practicing daily walking on them, squatting for fallen toys.

In some cases, the child is prescribed artificial irradiation procedures with UV rays. Ultraviolet irradiation procedures are not carried out in conjunction with taking vitamin D supplements in order to avoid an overdose of this vitamin. Some parents can afford to buy a quartz lamp for home to carry out the procedures themselves, some visit the physiotherapy room of the clinic. Each course of “tanning” under the artificial “sun” includes 10-15 sessions.

If UV rays cause severe redness of the skin and signs in a child allergic reaction, the procedures are abandoned and replaced with vitamin D supplements.

Quite often, a doctor prescribes pine and salt baths for a child with rickets. To prepare them, use regular salt or sea salt, as well as dry extract. coniferous trees. Typically, a course of therapeutic baths is prescribed for 10-15 days, the duration of each procedure is from 3 to 10 minutes (depending on age and individual characteristics child).

Additionally, if there is a lack of calcium, calcium supplements are prescribed, if the level of phosphorus is insufficient, ATP is prescribed; the need for such drugs is determined by the results of blood tests.

Consequences

Classic rickets usually has positive and favorable forecasts. The child makes a full recovery. Health complications can occur if, with diagnosed rickets, parents for some reason refused treatment or did not follow medical recommendations.

Only with a timely and adequate response from parents and doctors to the signs of rickets can one count on the fact that the disease will not cause trouble for the child in the future. And complications can be very diverse. This is also the curvature of the bones, it is especially unpleasant if the girl’s legs are like “wheels”, it is not aesthetically pleasing. In addition, curved bones take the body's load differently, they wear out faster, are more susceptible to fractures, and over time they begin to thin out, which can lead to serious injuries to the musculoskeletal system, including disability.

One of the most unpleasant consequences of rickets is narrowing and deformation of the pelvic bones. This consequence is extremely undesirable for girls, because such changes in the pelvic bones make natural childbirth difficult in the long term.

Quite often, rickets transferred to early age, is an indication for cesarean section.

Prevention

A responsible attitude towards the health of the child should begin during pregnancy. The expectant mother should eat enough foods containing calcium and phosphorus, and be in the sun more often so that vitamin D deficiency does not occur. Even if pregnancy occurs in winter, walks are important and necessary, since even the winter sun can sufficiently promote the synthesis essential vitamin in the skin expectant mother.

From the 32nd week of pregnancy, women who have not yet turned 30 years old are usually recommended to take one of the medications containing the required vitamin in a dosage of 400-500 IU per day.

If the expectant mother experiences severe toxicosis or blood tests show anemia (iron deficiency), it is imperative to undergo treatment without delaying it.

The born child must mandatory walk outside as soon as the pediatrician allows walking. Sunlight - best prevention rickets. If for some reason it is not possible to breastfeed a child, he should be given only adapted milk formulas (before six months - fully adapted, after six months - partially adapted). Your pediatrician will help you choose the right food. Adapted mixtures are always marked with the number “1” after the name, partially adapted mixtures with the number “2”.

Feed the baby cow's milk unacceptable, this provokes a fairly rapid development of rickets. Introducing milk too early as complementary foods is also undesirable. Pediatricians advise all children, without exception, to be given vitamin D in the cold season. daily dosage no more than 400-500 IU (no more than 1 drop of the drug "Aquadetrim", for example). However, most formula-fed children who are fed an adapted formula do not need to take additional vitamins; the amount of it in accordance with the child’s needs is included in the formula. Babies who are fed breast milk can be given a vitamin for prevention, since it is quite difficult to measure how much it is contained in mother’s milk, and the composition of mother’s milk is not constant. Prevention

Even earlier. The child sleeps poorly, restlessly, often cries, and flinches even from quiet sounds. He sweats often, sweat irritates his skin, and diaper rash appears. The sweat can be so strong that sweat forms around the baby's head while he sleeps. wet spot. Another characteristic feature- baldness of the back of the head. The child is bothered and irritated by his sweating, so he often turns his head, so his hair is wiped off. The urine of a child suffering from rickets becomes Strong smell, the muscles are flabby, the bones of the skull often soften, the fontanelle heals slowly.

Baby teeth erupt late, in the wrong order, and are often quickly affected by caries. Tooth enamel can also soften and erode.

If treatment is not started at this stage, the disease progresses and the bones become deformed. Thickenings form on the ribs, where bone tissue transitions into cartilaginous tissue; they are also called “rachitic rosaries.” The legs become crooked, X- or O-shaped. The breast can either be depressed (“cobbler’s breast”) or protruded (“chicken breast”). At the same time, the skull becomes disproportionately large, the frontal and parietal tubercles grow, the forehead becomes convex, and the pelvic bones become deformed. In girls, this may later become an obstacle to normal childbirth.

On late stages Abdominal pain, diarrhea, constipation, and regurgitation may occur. These children have pale skin.

Children suffering from rickets are often retarded mentally and physical development. They begin to hold their heads up later, stand up later, and walk later. And if rickets develops in a child older than one year, he may stop walking.

Description

Rickets occurs due to a discrepancy between the growing body's need for calcium and phosphorus salts and the insufficiency of the systems that ensure the transport of these substances and their inclusion in metabolism. Most often, this disease develops in children in the first year of life; after treatment, they often get sick.

This disease was first described in England in the 17th century by Glisson. They didn’t know the cause at that time, but they noticed that rickets develops with a lack of sun. Much later, in the 30s of the 20th century, vitamin D was discovered. Around the same time, it was established that this vitamin is synthesized in the skin under the influence of sunlight. For a long time after that, it was believed that rickets was simply a lack of vitamin D. And only relatively recently it became known that the deficiency of this vitamin is only one of the reasons for its development. It is now known that not only this vitamin is important, but also calcium salts and phosphates. Calcium is involved in the transmission of nerve impulses, participates in bone mineralization, blood clotting, and muscle contraction. Phosphorus is also very important, it is found in bones, tooth enamel, and is involved in metabolism and energy formation.

A deficiency of these substances occurs when:

prematurity (it is known that it is in the last months of pregnancy that calcium salts and phosphates enter the child’s body in large quantities);
insufficient intake of phosphates and calcium salts as a result of improper feeding of the child;
lack of these substances as a result of intensive growth;
disruption of the transport of phosphates and calcium salts in the gastrointestinal tract, kidneys and bones due to the immaturity of enzyme systems or pathology of these organs;
unfavorable ecological situation;
hereditary predisposition;
endocrine diseases(pathologies of the thyroid and parathyroid glands);
vitamin D deficiency.

Rickets is classified according to the severity of the disease. For first degree characteristic only neurological manifestations. This is the mildest degree of the disease, after which there are no residual effects. At second degree skeletal changes, moderate dysfunction of internal organs, and a slight enlargement of the liver and spleen are observed. This is a moderate severity level. At third , the most severe degree of changes in the musculoskeletal and nervous systems are clearly expressed, the functioning of internal organs is seriously impaired.

During the disease, four periods are distinguished: initial, the height of the disease, convalescence (recovery) and the period of residual effects. In the initial period only neurological symptoms can be seen (restlessness, moodiness, irritability, sweating, bad dream) and a small number of symptoms from the skeletal system (thickening on the ribs and softening of the sutures of the skull).

High period most often occurs in the second half of a child’s life. It is characterized by a disorder of the nervous system and more obvious manifestations of a disorder in the formation of the musculoskeletal system. The flat bones of the skull soften, the back of the head becomes flatter, and the legs, arms and chest become deformed.

During the period of convalescence The child’s condition is improving, the tests are almost normal.

Period of residual effects characteristic only of severe rickets. In this case, skeletal deformation and muscle hypotonia may persist for quite a long time after recovery.

The course of rickets can be acute and subacute.

Diagnostics

The diagnosis of rickets is made by a pediatrician. To diagnose this disease, it is very important to determine the level of calcium, phosphorus and alkaline phosphatase in the blood. A urine test is also required.

An x-ray shows how much the child’s bones have changed. These changes can also be seen using computed tomography.

Rickets must be differentiated from rickets-like diseases - phosphate diabetes, renal tubular acidosis and others.

Treatment

Treatment of rickets is complex. First, you need to change the child's lifestyle. You need to walk for at least 2 hours, but straight Sun rays are harmful to a child's first year of life, so it is better to walk in the shade of trees. This is enough to produce vitamin D.

The child needs good nutrition. It is necessary to timely introduce fruit and vegetable purees, cereals, cottage cheese, and meat into the diet. It is better to limit flour; these products make it difficult to absorb calcium in the intestines.

Those suffering from rickets must be prescribed vitamin D. It can be in the form of an oil or aqueous solution. The dosage is determined by the doctor depending on the severity of the disease. But fish oil is rarely used now, since it has unpleasant smell and taste.

Must be prescribed physical therapy, massage and physiotherapy. Gymnastics can be done at home. It includes active and passive exercises. Active exercises are when the child moves on his own. To do this, they use toys so that the child reaches for them.

Passive exercises are done by the mother or a massage therapist. This is flexion and extension of the legs and arms, abduction and abduction of the arms, crossing the arms on the chest.

Massage should only be performed by a specialist. This procedure consists of several techniques, each of which plays its own role in the treatment of rickets. Thus, stroking not only prepares the child for other techniques, but also calms him down and regulates the tone of the nervous system. When rubbed, skin metabolism improves. Kneading improves muscle metabolism and improves their contractility.

Children over 6 months of age are recommended to take medicinal baths - pine and salt. They can be made at home. The water temperature should be 35-36°. If the child is lethargic and inactive, he is recommended to take salt baths. For 10 liters of water you need to take 2 tablespoons of sea salt. You need to take such baths for 3 minutes at first, later you can increase the time the child stays in the water to 5 minutes. Course - 10 procedures, baths should be taken every other day.

If a child has increased nervous excitability, pine baths are recommended. In this case, you need to take 1 briquette of dry pine extract for 10 liters of water. The procedure time is 5 minutes at first, then you can increase it to 10 minutes. A course of 10-15 baths, they need to be done every other day.

Prevention

Prevention of rickets should be carried out even before the birth of the child. A pregnant woman should walk a lot in the fresh air, eat right, and follow a daily routine. If necessary, you need to take vitamins.

The best prevention for a child is breastfeeding and exercise. You also need to take him for walks in the fresh air. There is also specific prevention this disease - taking vitamin D and ultraviolet irradiation.

However, you need to take vitamin D with caution, as an overdose is possible. With it, the child begins to refuse food, sleeps poorly, feels sick and vomits. The body temperature is low-grade, the pulse is slow, breathing is difficult. Constipation alternates with diarrhea. In this case, you need to stop taking the drug for a while. And after the symptoms subside, it is necessary to adjust the dosage of vitamin D.

When a child begins to eat “adult” food, it is necessary to include in his diet foods rich in vitamin D. These are dairy products, fish, especially its liver, and eggs.

Rickets most often occurs in children of early and infancy. This disease is characterized by disturbances in the formation of the skeletal system, insufficient bone mineralization as a result of calcemia (calcium deficiency).

IN pediatric practice Rickets is classified as a “disease of the growing body”, since it affects babies starting from 2 months. up to 3 years. In other cases, terms such as osteoporosis and osteomalacia are used to classify rickets.

Children most susceptible to rickets are those who are artificial feeding, as well as those living in areas with cold climatic conditions where there is a shortage ultraviolet rays, because most of Vitamin D is formed precisely as a result of exposure to ultraviolet radiation.

Types of rickets

Currently, the following forms of rickets can be distinguished:

D Vitamin-resistant rickets (phosphate diabetes). This form of the disease can occur with the absence or inclusion of various bone deformities;
D Vitamin-dependent rickets (pseudo-deficiency);
D Vitamin deficiency (calcipenic, phosphoropenic);
Secondary rickets is observed when there are malfunctions in the gastrointestinal tract, metabolic processes and the use of certain medications.

Rickets occurs in accordance with certain periods:

elementary;
the height of symptoms,
convalescence;
residual manifestations.

According to severity, rickets is divided into 3 degrees:

light (I);
light medium-heavy (II);
heavy (III).

In all cases, the patient’s condition is assessed by a doctor, who determines which vitamin deficiency leads to rickets, and what exactly prevents its entry into the body.

Severe bone deformities (Vitamin D-resistant rickets)

The role of vitamin D

Vitamin D is rightfully considered universal, since it can enter the body in 2 ways: orally (with food) and through the skin (under the influence of ultraviolet radiation).

Taking vitamin D during pregnancy is especially important, since it is during this period that the baby’s body is formed, and in the last trimester the woman prepares for full breastfeeding of the newborn.

Lots of vitamin D in following products:

V butter and margarine;
V fish oil and caviar;
in dairy products (cheese, cottage cheese, sour cream);
V vegetable oil And egg yolk;
in beef, chicken and pork liver.

It must be borne in mind that the occurrence of hypervitaminosis D, which can lead to serious complications, is no less dangerous:

epilepsy attacks;
slower growth;
disorders of the kidneys and heart;
reduction of the body's immune defense;
loss of appetite and general exhaustion of the body;
cardiosclerosis.

In order to prevent the development of hypervitaminosis, it is necessary to strictly adhere to the recommended dosage of the vitamin and perform the Sulkovich test (a urine test to determine calcium levels) once every 2-3 weeks. At positive result Tests and taking the vitamin should be discontinued.

Symptoms of the disease

The occurrence of rickets from vitamin D is accompanied by the following symptoms:

insufficient supply of minerals, accompanied by softening of the sutures of the skull and the boundaries of the fontanelle;
spasmophilia is possible (a ricketogenic condition resulting from disturbances in phosphorus-calcium metabolism), which is accompanied by tachycardia and convulsive syndrome;
noted pathological change fronto-occipital tubercles, distorting the shape of the skull;
Patients with signs of rickets are characterized by a high, steep forehead;
the child may experience delayed teething;
Due to vitamin D deficiency, sweating increases, especially in the head, feet and palms. As a result, the baby often turns his head, which leads to partial baldness of the back of the head;
As a result of bone changes, muscle hypotonia occurs and the spine is bent. The joints weaken, especially in the knees, which become X-shaped;
a horizontal depression of the chest (Harrison's groove) appears at the same level as the diaphragm;
possible deformations of the chest with bulging (keeled breast) or depression (shoemaker's chest), as well as the formation of kyphosis (rachitic hump).

Characteristic symptoms rickets

In addition to bone deformation and decreased muscle tone, the child experiences severe stress loads accompanied by psycho-emotional excitability. As a result of hypovitaminosis, the body's resistance to infectious processes.

Stages of treatment

It is extremely important to discover initial symptoms diseases at an early stage, because timely treatment rickets contributes to the patient’s rapid recovery. At the slightest suspicion, you should consult a doctor who, with the help of laboratory diagnostics and the symptoms of the disease can determine which vitamin deficiency results in rickets. Next, the optimal therapy is selected to eliminate the factors that provoked the disease:

Medication methods

Starting from the fourth week after the baby is born (in premature babies from 2 weeks), it is recommended to give him vitamins against rickets. They must be taken during the cold season, when there is a decrease in solar activity (from October to May). During the rest of the year, it is recommended to compensate for the lack of vitamin D naturally(with long walks in the fresh air).

aqueous solution of Devisol(Finnish analogue of Aquadetrim) - prescribed for children suffering from allergic diseases, but its use is excluded in cases of dysbacteriosis and impaired intestinal absorption, since Devisol causes a worsening of these conditions. The dosage is selected by the pediatrician;
Vigantol, Videin (oil drops)– intended to prevent rickets, osteoporosis, malnutrition, etc.;
Aquadetrim (aqueous solution)– Recommended for use by children and pregnant women. The dosage is selected individually, taking into account all sources of vitamin D replenishment.

As a rule, the use of vitamin D as a prophylaxis for rickets is carried out under the supervision of a doctor, who promptly adjusts the dosage regimen, especially in the first few months of the child’s life.

Rational feeding

Nutrition is of great importance in the prevention of rickets in infants. Breastfeeding is preferable because mother's milk contains all the necessary microelements and a sufficient dosage of vitamin D3 for the child.

In the case when the baby is bottle-fed, it is necessary to choose adapted milk formulas, for example, Vitalact, Malyutka, Detolact, etc. In addition, starting from 2 months, the doctor can prescribe complementary foods with pureed vegetables.

Exercise therapy

Medicinal gymnastic exercises, and different kinds massage, enhance metabolic processes in the body. This, in turn, leads to greater productivity of the vitamin. It is recommended to perform massage at least 2-3 times during the day for 5-10 minutes, and therapeutic exercises(flexion and extension exercises on the limbs, as well as abduction and adduction of the arms) are recommended to be performed 2 times a day for 10–15 minutes.

Performing a massage on a child with signs of rickets is very useful

Walks

It is necessary to spend as much time as possible outdoors with your child, especially in sunny weather, which helps saturate the body with vitamin D. Such walks are an excellent remedy rickets warnings. However, this does not exclude additional intake of vitamin drops.

With timely treatment in newborns, symptoms begin to disappear as the required amount of vitamin enters the body. Children who have had rickets are seen by a pediatrician at least once every 3 months for 3 years. If all medical recommendations are followed, the prognosis for recovery is favorable.

Which develops mainly between the ages of two months and one and a half or two years. As a rule, rickets itself does not pose any particular danger, but it significantly slows down the development process and slightly changes the child’s appearance.

Children develop rickets due to a lack of certain vitamins, which play a special role in the development process. That is why at some point pediatricians may prescribe supplements for your baby. Vitamin D was discovered in the 20th century. And from that moment on, his study progressed very quickly. After several years of experiments, scientists came to the conclusion that it is a lack of vitamin D that provokes the development of rickets. It is customary to distinguish two forms of the vitamin:

Ergocalciferol, which enters the child’s body only with
Cholicalciferol, which enters the body with animal food, and can also be synthesized when the skin is exposed to ultraviolet rays

Vitamin D performs many functions in the body, including:

Regulation of calcium absorption in the intestines, as well as maintaining it at the proper level in the body
Improving the absorption of phosphorus, which subsequently takes an active part in the mineralization of bone tissue
Regulates the production of thyroid hormones
Participates in the growth of chondrocytes, collagen
Stimulates the production of calcium transport protein

That is why it is so important to monitor the level of D in the child’s blood, since its deficiency can lead to poor absorption of calcium, and then a disruption of the structure of the bones, they will become fragile and soft.

Reasons for the development of rickets

In addition to the fact that a lack of vitamin D in the body can lead to the development of rickets, there are several other factors that will affect Negative influence. These include:

Rare walks, due to which the child spends less time in the sun, and vitamin D is not synthesized. This is why children born in winter are advised to take vitamins.
Poor nutrition, namely lack of food that contains vitamin D, calcium, phosphorus, etc.
Artificial feeding, especially incorrect selection, in which there is an insufficient amount of necessary nutrients, vitamins and minerals
Short intervals between births, due to which the mother’s body does not have time to recover and cannot give the baby as many vitamins as he needs
Problems with, namely malabsorption syndrome, problems with the biliary tract

Because of this, the child develops rickets, a disease that, although not considered particularly dangerous, requires immediate treatment.

Symptoms of rickets

You can understand whether a child has enough vitamins or not only by his well-being and behavior. So, most parents immediately notice the main symptoms of rickets. These include:

Irritability and crying, especially in babies. They begin to cry constantly, even if they are full, bathed, etc.
Restless sleep, the child constantly wakes up and falls asleep very difficult, may also startle in his sleep
Increased sweating. This can be noticed in the cold season, when the room is cool, and the diaper on which the baby sleeps (where his head lies) is completely wet
Baldness of the back of the head, which appears due to excessive sweating and itching. The baby constantly turns his head to relieve the itching, and because of this, his thin and fragile hair is wiped off

If these very first symptoms are not paid attention to, then after a few weeks the bones of the skull will begin to soften, causing the head to become irregular shape. In addition, the chest may also change slightly, especially if the baby is still swaddled. If the disease begins to develop during the period when the baby is most active, when he begins to crawl and walk, then due to softened bones and heavy load, the legs begin to bend, they also say “like a wheel.”

If no measures are taken, such curvatures can remain for life.

Prevention

Obstetricians and gynecologists are still telling expectant mothers to take special vitamin complexes, with the help of which they can compensate for the deficiency of those vitamins and minerals that are missing so that the baby in the womb receives everything he needs. If the mother did not take the vitamin, or, despite this, the child began to develop rickets, then it is necessary to begin taking steps to replenish vitamin D.

Quite often, pediatricians prescribe vitamin D3 to babies during their first visit (per month). prophylactic dose As a rule, this is one drop per day, especially if the baby is breastfed. The course ranges from one to three months, depending on what time of year the baby was born. If he was born in the summer, the doctor is unlikely to prescribe vitamins, since being outside will ensure the natural synthesis of vitamin D3.

If the child is bottle-fed, then only a pediatrician can decide to take the vitamin. He must know what formula the baby eats, and, based on this, prescribe it as necessary. If there is a lack of vitamin D, a child may develop rickets, a disease that can change appearance baby. That is why you need to pay close attention to the condition of the child, especially in the first few months after birth. And when the first ones appear, contact your pediatrician.

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Vitamins, calcium for pregnant women: deficiency, sources and what...

Rickets is a polyetiological metabolic disease caused by a discrepancy between the growing body’s need for calcium and phosphorus salts and the insufficiency of the systems responsible for their transport and metabolism. Signs of rickets are bone abnormalities caused by a lack of osteoid mineralization. The disease manifests itself most clearly at an early age, in children under one year of age. Rickets occurs during a period of intense growth of the body.

Causes of rickets

For a long time, it was believed that the manifestation of rickets in children is based on a lack of vitamin D. Undoubtedly, this is a fairly common cause of rickets, but it is far from the only one.

In a broad sense, the disease is caused by a discrepancy between the increased need of a young body for calcium and phosphorus salts and the inability of the body to ensure their inclusion in metabolism.

TO common reasons Rickets in children is attributed to a lack of complete protein, zinc and magnesium, as well as vitamin A and B vitamins. Genetics have almost been able to prove that rickets has a hereditary predisposition.

In children under one year of age, rickets, which occurs due to a lack of calcium salts and phosphates, can be caused by the following reasons

Prematurity, since the most intense supply of phosphorus and calcium to the fetus occurs in the third trimester of pregnancy;
Improper feeding;
Increased need of the body for minerals;
Impaired transport of calcium and phosphorus in the kidneys, gastrointestinal tract, bones due to pathology of these organs or immaturity of enzyme systems;
Poor ecology, causing the accumulation of chromium, lead, strontium salts in the body and a lack of iron and magnesium;
Hereditary predisposition;
Endocrine disorders;
Vitamin D deficiency.

D-deficiency rickets is the most common form of the disease. It develops when there is insufficient intake of vitamin D in the body or as a result of a violation of its metabolism in the body. Actually, the main function of vitamin D is to regulate the absorption of phosphorus and calcium in the intestines and their deposition into bone tissue.

Vitamin D deficiency is often caused by the following factors:

Flaw sunlight, under the influence of which vitamin is produced in the skin;
Vegetarianism or late introduction of animal products into the child’s diet;
Lack of rickets prevention;
Frequent illnesses of the child.

The course of rickets in children

The disease can be divided into four stages:

The initial stage, which, as a rule, appears from the first months of a child’s life. At this stage, autonomic and neurological changes occur, following symptoms rickets: sleep disturbance, tearfulness, anxiety, increased sweating, loss of appetite, baldness of the back of the head.
The height of the disease, when the growth of depleted mineral salts tissue in the bone growth zone, the growth processes of the lower extremities slow down, the fontanel closes late, teeth appear late, etc. The main symptoms of rickets at this stage are: decreased muscle tone, rapid breathing, increased mobility joints, ammonia smell. At this stage of the disease, the child begins to get sick more often, the functioning of other systems and organs is disrupted, and physical and neuropsychic development is delayed.
Convalescence is a gradual smoothing of the signs of rickets. Calcium and phosphorus levels in the blood are normalized, and intensive mineralization of bone tissue occurs.
Residual effects - skeletal deformations remain in adulthood: changes in the chest, lower limbs and bones, poor posture.

In children under one year of age, rickets can be divided into three degrees of severity:

Mild degree, which corresponds to the initial period of the disease;
Moderate degree, when occur moderately pronounced changes internal organs and skeletal system;
Severe degree, when damage occurs to different parts of the skeletal system, severe damage to the nervous system and internal organs, complications appear, and there is a lag in physical and mental development.

Signs of rickets

Diagnosing rickets is not particularly difficult. Usually, characteristic changes of the skeletal system can be detected on radiography already at the initial stage of the disease.

Not mandatory features Rickets is osteomalacia (lack of mineralization of bone tissue) and osteoporosis (structural reorganization of bone tissue).

A symptom of rickets is also a change in the concentration of phosphorus and calcium in the blood serum with a simultaneous increase in the level of alkaline phosphatase.

Consequences of rickets in children

As a rule, the disease does not pose a direct threat to life, but can lead to serious complications, namely:

Decreased immunity and frequent illnesses, including pneumonia;
Persistent skeletal deformation, up to disability;
Delayed physical and neuropsychic development.

To pick up adequate treatment, first you need to determine the form of rickets. If rickets is caused by a lack of vitamin D, then subsequent treatment depends on the severity of the disease, but first of all, intensive vitamin therapy with vitamin D is carried out.

It is very important that the child eats well and spends a lot of time in the fresh air. It is necessary to do therapeutic exercises and massage.

For the treatment of rickets, sun, pine and salt baths, ultraviolet irradiation and other restorative measures are also indicated.

Prevention of rickets

The perinatal period plays an important role in the prevention of rickets, so a pregnant woman needs to maintain a nutritious diet, take long walks in the fresh air, and promptly treat toxicosis and anemia. Pregnant women under 35 years of age are prescribed vitamin D supplements in the third trimester.

In children under one year of age, breastfeeding can help avoid rickets, since lactose contained in human milk, significantly increases calcium absorption.

An infant should spend a lot of time outdoors and be active. He needs massage and hardening procedures.

IN individually Your doctor may prescribe vitamin D supplements and other vitamins and minerals.

It is also important to promptly introduce animal foods (fish, meat, yolk) and other products that contain vitamin D into the child’s diet. It is not recommended to overfeed the child with flour products, as they inhibit the body’s absorption of calcium and bone mineralization.