What causes rickets in children. Rickets in infants: photos, symptoms, treatment and prevention of the most common disease in infants

Since there are practically no sick children, parents have to deal with various pathologies. One of the dangerous conditions for babies is rickets, and what it is, moms and dads do not fully understand. Often, the disease is associated with an emaciated child, whose tummy is bulging, and the arms and legs are thinned and weakened. Indeed, such signs indicate the development of rickets, but the clinical picture of the pathology may be more extensive.

The concept of rickets in children

Rickets is not a disease of a specific organ or system. Doctors consider it as a complex of metabolic disorders caused by a deficiency of nutrients. Signs of deviations appear in the background lack of vitamin d- the main participant in phosphorus-calcium metabolism. The correct formation of the musculoskeletal system of children depends on its quantity.

Why do babies up to a year have metabolic failures? There are several reasons for the anomaly:

1. Irrational nutrition of a woman carrying a child. Food depleted in calcium and vitamin D is useless for the pregnant woman and the fetus.
2. premature birth. The baby receives a significant dose of calcium in the last weeks of intrauterine development. Early birth does not allow him to receive the right substance in full.
3. Birth in the cold season or in the northern regions. The lack of natural ultraviolet radiation causes rickets in infants. Small inhabitants of warm countries suffer from pathology less often.
4. Improper feeding. Early transfer to mixtures, excessive or insufficient food intake cause a distortion of metabolism and deplete the body of vitamins.
5. Bad ecology. The residence of infants in megacities and areas with high concentrations of pollution, as well as a long stay in harsh climate zones, is fraught with a deficiency of the “sunshine vitamin”.
6. Congenital metabolic disorder. The incorrect course of the processes responsible for the absorption of vitamins and minerals provokes the development of certain diseases and affects the balance of nutrients.

How is vitamin deficiency expressed?

During the neonatal period, signs of rickets are usually absent. Parents can notice its first manifestation at 3-4 months of a baby's life, when the process of bone formation is activated in the body. "English disease" in children under the age of one year proceeds in several stages.

At the 1st stage, parents notice changes in the behavior of the crumbs. He is worried and irritated for no reason, or vice versa, becomes lethargic and indifferent. The baby sweats profusely and suffers from itching. In an attempt to get rid of discomfort, he can twist his head and rub it against the pillow, which leads to abrasion of the hair on the back of his head.

But these symptoms are not yet direct evidence of the development of the disease. Often they are associated with children being exposed to dry, hot conditions that cause sweating and restlessness. Baldness appears due to the fact that an overly active child turns his head with pleasure. However, parents should not relax. The baby must be shown to the pediatrician and tested.

With a careless attitude to the health of the child, the signs of beriberi worsen closer to 8 months. Rickets takes the form of moderate severity and shows characteristic symptoms:

• the fontanel does not contract or expand;
• head disproportionately enlarged and sweaty;
• the forehead and tummy become convex;
• the baby cannot sit and crawl due to muscle weakness;
• rapid growth of the lower ribs and thickening of the bones at the wrists (this condition doctors call "rosary").

In stage II, treatment of children should be started as soon as possible. But if the parents continue to ignore the symptoms of rickets, up to 1 year the disease takes a protracted turn and develops into the III degree. Now the signs of beriberi will be observed even more clearly and additional anomalies will join them:

1. chest deformities;
2. curvature of the legs (O-shaped or X-shaped);
3. disproportionality of the head and torso;
4. mental retardation and weakness of motor skills.

In premature babies, all of the listed symptoms appear on the basis of unfavorable intrauterine development. Their body weight is already small, but due to poor conditions in the mother's womb and poor bone mineralization, weight loss cannot be corrected from birth until the end of the first year of life.

The danger of rickets for children's health

Lately taken under control the state of rickets or its improper treatment is dangerous for babies with pathological changes. So, soft bone tissue distorts significant parts of the skeleton - the spine, skull, hips, shins and ribs. In adulthood, the consequences of rickets are fully felt by girls who have difficulties during childbirth. They are explained by the deformation of the pelvic bones and the concomitant underdevelopment of the reproductive organs.

Untimely treatment of rickets is fraught for female patients with infertility or difficult childbirth, if conception does occur. The physical development of children, whether girls or boys, lags behind noticeably. Mental abilities suffer slightly, but in the later stages of rickets does not allow kids to attend educational organizations.

Correction of rickets

The pediatrician prescribes treatment based on the results of the examination. To help diagnose the deviation:

• urinalysis according to Sulkovsky, which reveals the degree of calcium loss;
• a biochemical blood test that determines the content of phosphorus and calcium.

If the tests confirmed the external symptoms of rickets, parents should not panic - adequate therapy can completely improve the health of the baby. For figure correction, treatment is carried out with optimal doses of vitamin D, more specifically, ergocalciferol (D2). It is given to children in the form of oily and aqueous solutions (Vigantol, Akvadetrim). The second type of medicine is considered more effective, since the substance is absorbed worse in oil. Difficult processing causes malfunctions in the digestive tract.

Cholecalciferol (D3) with sufficient exposure to the sun is produced by the body on its own. Prevention in the form of air baths allows you to receive it. The substance improves the absorption of phosphorus and calcium and contributes to the normal construction of the skeleton. Its deficiency is replenished with food of animal origin, plant products D3 do not contain.

Calcium preparations are quickly absorbed by the digestive system, even those children who suffer from allergies or have gastrointestinal problems. The exact dosage of medicines allows the child to receive about 500 IU of the substance with each drop.

For patients under the age of one year, therapy begins with 4 drops with a gradual increase to 10 for one day. High dosages for a rickety baby are needed when the symptoms show pronounced bone changes.

The average course of therapy is designed for 30-45 days, after which prophylaxis begins (1-2 drops of medication per day).

Reception of drops is reinforced by the use of phosphorus and citric acid preparations - it is needed for better absorption of calcium by the intestines. Symptoms of vitamin deficiency are eliminated by irradiation with a UV lamp and natural sunbathing. While therapy is being carried out, hardening procedures, walks, physical therapy exercises, massages and salt baths will be useful.

The diagnosis of rickets, made by a doctor to a child of 3-4 months, takes parents by surprise. Despite the fact that the name of the disease is well known to many, few can accurately determine its symptoms. A detailed study of the disease, finding out the causes leading to an unpleasant diagnosis, and effective methods of treating the disease will help dispel the doubts and anxiety of parents.

The diagnosis is made exclusively by a specialist on the basis of the clinical picture and research

What is rickets?

Doctors mean by rickets a violation in the development of the child's bone tissues. Failures in the metabolic process of phosphorus and calcium lead to a lack of vitamin D, the child's intestines poorly absorb calcium ions, which affects the bones of the baby. Their gradual demineralization and curvature take place, acquiring large volumes with the neglected treatment of the disease. Changes can last a lifetime if they are not stopped at the earliest possible date.

Progressive changes cause osteomalacia (softening of the bones) and osteoporosis (rarefaction of tubular bones). All these negative processes lead to a noticeable curvature of the bones.

Often rickets in infants is diagnosed at a very young age, at 2-3 months. Rickets is detected in children even at 2 years old, but children under 1 year old are most vulnerable to a painful illness. Much in the fight against rickets depends on the parents, so it is important for them to know both its causes and the symptoms of the disease.

Causes of disease in infants

How much vitamin D a child needs depends on many factors - there is no single norm. When calculating the indicator of an element, doctors take into account the specifics of children's nutrition, their place of residence, climatic conditions, the characteristics of the child's body, race, and weight. People living in the north of the country get less sun than people in the south. Obviously, the production of vitamin D is different for them. Consider the common factors contributing to the development of rickets.

If a child grows up in northern latitudes, he may have a lack of vitamin D.

What are the main reasons?

The risk of rickets formation exists at any stage of a baby's development. The causes of the development of the disease can be:

• Artificial feeding, when the baby is given mixtures with insufficient amounts of calcium, vitamin D and phosphorus. Breastfed babies suffer less from rickets because they get all these elements in sufficient quantities from their mother's milk. Today, many types of baby food are produced with a rich content of the three most important elements, but the imperfect digestive system of the crumbs can poorly absorb them.
• premature birth. A premature baby suffers from enzyme deficiencies and metabolic failures, which leads to unstable absorption of vitamin D even when the baby gets enough of it.
• Colds. With a cold, vitamin D requirements increase, and it is absorbed more slowly. In addition, babies are less taken outside, which affects the level of insolation (the child receives sunlight).
• genetic predisposition. Poor absorption of vitamin D can be hereditary. Hypothetically, experts note that rickets is found more often in children with blood group II. A tendency has also been established that boys are ill more often than girls.

Who is at risk?

Especially for parents, we have compiled a list of signs by which children may be at risk for a predisposition to rickets. Let's refer to them:

• Overweight infants for whom it is difficult to calculate the correct dose of vitamin D.

• Children who receive little ultraviolet radiation. Most of the vitamin enters our body through sunlight. A child born in winter or autumn does not get enough of it. Little ultraviolet goes to the body and when walking on the balcony: the glass prevents the full penetration of ultraviolet. Only when it comes into direct contact with the skin does the correct absorption of vitamin D occur.
• Dysbacteriosis. Violations of the microflora lead to malfunctions in the gastrointestinal tract, the production of enzymes worsens, the metabolism is destabilized, vitamin D is poorly absorbed, and its shortage is formed. The consequence of such violations is the weakening of the protective properties of the child's body. Frequent illness reduces the number of walks.
• Race and skin color. The mechanism of absorption of vitamin D in white-skinned and fair-haired people is faster than in owners of swarthy and black skin. Melanin, which is responsible for the dark color of the skin, prevents the cells from producing the vitamin properly.
• Physical inactivity. Dr. Komarovsky claims that inactivity, due to lifestyle, lack of physical activity, or disorders in the nervous system, also causes rickets.

Symptoms of the disease by stage

It is not easy to detect signs of rickets in children, especially at an early age (more in the article:). The newborn tightens the legs and arms, which looks natural to him, so it is impossible to identify the beginning of the curvature. The first symptoms can be determined only by 4 months, during the period of active formation of bone tissue. The body reacts sharply to the lack of building material necessary for the bones and clearly signals dangerous manifestations. The development of the disease follows an increasing trajectory, passing through several stages. Let's consider each of them more specifically.

1 stage

The onset of rickets development occurs at the age of 2 months and proceeds within 2-4 weeks. Doctors define this period as the initial stage of rickets, which is characterized by temporary disruptions in the central nervous system (irritation, convulsions) and in muscle tone. The initial stage does not give irreversible consequences and is successfully treated. It is determined by the following symptoms:

• the behavior of the child changes, he is often irritated for no reason or, on the contrary, becomes lethargic, apathetic;
• the body of the baby reacts with increased and frequent sweating;
• skin itching begins, the baby rubs the back of the head against the pillow, a bald spot forms from friction.

The described symptoms do not have a direct connection with rickets, profuse sweating may be the result of too dry air, and the appearance of bald spots may be due to the excessive activity of the baby. However, they should not be left unattended, it is necessary to show the crumbs to the pediatrician in order to protect them from illness. Research using analyzes will help to correctly identify the culprits of such changes and avoid their progression.

2 stage

A moderately severe disease is manifested by a decrease in hemoglobin levels, disturbances in muscle tone, and a slight increase in internal organs. The disease provokes the destruction of bone tissue and is expressed in other noticeable changes:

• the fontanel does not overgrow, and in some cases even begins to increase (we recommend reading:);
• the tummy is rounded and protrudes, the functioning of the intestine is disrupted;
• disproportionately in relation to the body, the head increases, the forehead becomes convex;

• in the area of ​​\u200b\u200bthe wrists and on the lower ribs thickenings (“rachitic beads”);
• the baby does not sit or crawl due to weakness of the ligaments and muscles.

Agree, such changes are hard not to notice, so all the blame for the difficult condition of the child falls on the parents.

With severe symptoms, a visit to the doctor can no longer be postponed, the child needs urgent and serious help. The average severity of the disease requires a long course of treatment. If the parents did not notice the development of rickets in time, the disease can go into III, the most severe stage of the disease.

3 stage

The most serious form of the disease, marked by severe disorders of bone and muscle tissues, serious malfunctions of the central nervous system and other organs. The progression of the disease leads to the curvature of the entire skeleton of the child. It is accompanied by the following unpleasant manifestations:

• the child lags behind in mental and motor development;
• the legs are bent, acquiring the shape of the letter "X" or "O";
• noticeable disproportion of the torso and head;
• the chest is pressed in or becomes convex, the stomach is strongly rounded (see also:).

In fairness, we note that a severe form of the disease is very rarely established. What kind of negligence should parents have in order to bring the condition of the baby to a terrible one. It is obvious that such a situation can develop in dysfunctional families where little attention is paid to the child. However, visits by a pediatrician to such a family can prevent an exacerbation of the disease.

Experts point to the periodicity of the course of rickets, which means that the disease has periods of exacerbation or the complete disappearance of its signs. However, such a frequency does not guarantee getting rid of the recurrence of the disease. The disease can manifest itself in cold weather. To allow such negligence in relation to the health of the crumbs is criminal, it must be immediately shown to the doctors and treated.

What to do if rickets is diagnosed after a year?

The neglected form of rickets inevitably leads to severe disorders throughout the child's body. If in a baby these disorders are not so noticeable, then for a one-year-old baby they become a real disaster. The child is severely retarded in development, he cannot crawl and walk, flat feet are formed, the hip bones are deformed, the legs are bent. Having affected the baby at an early age, rickets leads him to myopia, malocclusion, scoliosis.

Close supervision of specialists is also required for a 3-year-old baby with rickets. If parents do not persevere in the fight against a dangerous disease, if they provide their crumbs with proper nutrition and exercise, then the disease will recede without leaving serious consequences.

Chances of success and dangerous consequences

When rickets is diagnosed at the very beginning of its development, the chances of a full cure are very high if treated in a timely manner. The high development of medicine allows you to quickly identify the disease and take effective measures to eliminate it. Looking at the eloquent photos, it becomes clear that a severe form of the disease or the time lost by parents for treatment lead to irreversible changes in infants:

• the baby is not growing well, his height remains low compared to his peers;
• tubular bones are significantly bent;
• kyphosis (poor posture) is formed;
• the oral cavity is affected, the teeth become uneven, a bad bite is formed, tooth enamel is destroyed, caries appears;
• skeletal muscles remain underdeveloped;
• narrowing of the pelvic bones in girls, which leads to problems during childbirth.

How is rickets diagnosed?

Diagnosis of the disease begins with the establishment of a complete history based on the results of an interview with parents. A visual examination of a small patient is carried out. The doctor examines the legs, arms, spine and head of the baby. The picture of clinical symptoms becomes clear. Special additional studies help to recognize the severity of the disease:

• a blood test is taken to determine the degree of anemia;
• blood biochemistry to detect the level of calcium, magnesium, phosphorus, creatinine and alkaline phosphatase activity;
• x-ray of the lower leg, wrist, forearm;
• ultrasound procedure;
• the level of vitamin D metabolites is checked.

Treatment of rickets

In an effort to cure rickets in infants, doctors resort to a long-proven method - taking vitamin D solutions (more in the article:). Why was this dosage form chosen? Vitamin in a soluble form is quickly absorbed by the child's body, it is well excreted by the kidneys. The following solutions are prescribed:

• "Aquadetrim" - the medicine contains vitamin D3 (cholecalciferol) (we recommend reading:). Normalizes the exchange of phosphorus and calcium. Produced in the form of drops. The dosage is individual and depends on the body weight of the child, the stage of the disease, the nutritional habits, the baby's lifestyle and other factors. Duration of admission - up to 1.5 months, 6-10 drops. For the prevention of the disease, the remedy is given 2-4 drops.
• "Davis Drops" (drops) - the drug is designed for small patients who do not suffer from dysbacteriosis and other gastrointestinal disorders. Dosage - 5 drops. It is used in the prevention of illness in newborns. Analogues of the product are produced: "Videin" and "Vigantol" (we recommend reading:).
• "Ergocolciferol" - the main element of the drug vitamin D2. Serves as a preventive measure.
• Multivitamin complex - for infants and children up to 2 years. Helps restore metabolism, contains a sufficient dose of vitamin D.
• Calcium gluconate - the drug serves as an additional agent and is taken simultaneously with vitamin D intake for 2 weeks. Often recommended for premature babies.

What to do to prevent the disease?

Prevention of rickets in children should begin from the first months of pregnancy. This means that the expectant mother takes responsibility for the birth of a healthy baby. Prevention of rickets in infants by pediatricians is divided into two phases: antenatal and postnatal. In the antenatal (before delivery) phase, a pregnant woman should:

• daily walk in the fresh air;
• receive moderate sunlight;
• drink special vitamin complexes;
• choose foods with a lot of vitamin D for food (oatmeal, egg yolk, any fermented milk products, fish dishes, potatoes, butter and vegetable oil, parsley).

Procedures under the lamp and taking vitamin in solutions are not prescribed for pregnant women due to possible intrauterine disorders in the fetus. After the birth of the baby, preventive measures are supplemented:

• desired breastfeeding;
• long stay on the street;
• hardening of the child;
• physical exercises (gymnastics);
• sunbathing (without direct sunlight);
• taking vitamin D in prophylactic doses.

For infants, the prophylactic dose of vitamin D does not exceed 1-2 drops, one-year-old babies are given 400 IU, from a year to 2-3 years - 500-600 IU. In the spring, the dosage of the drug is significantly reduced or not taken at all.

Useful clarifications

If from birth the baby receives the necessary vitamin from mother's milk, then after six months, when the moment of complementary feeding comes, it is necessary to monitor his diet. Make sure that fish and meat dishes are present in the child's diet. Gradually accustom the baby to butter and vegetable oil, diversify the dairy menu with cottage cheese, kefir, yogurts.

When taking walks with the baby on sunny days, make sure that the rays illuminate the baby evenly, but not constantly. Try not to wrap the baby too much, leaving him freedom of movement in the stroller.

Protect against colds if you are taking vitamin D prophylactically so as not to reduce the level of its absorption by the body. When introducing complementary foods, pay attention to allergic reactions, especially to egg yolk and some types of meat.

Modern mothers, fortunately, try to closely monitor the health of their children, and medicine does not stand still. Today you rarely see severe rickets, as a rule, the disease is quickly recognized and successfully treated. Our review, in fact, is also a preventive measure that allows inexperienced mothers to learn more about a dangerous disease and prevent it in time.

Parents who want to know what are the symptoms of rickets in infants should carefully monitor the condition and behavior of their baby. If he is naughty, eats poorly, and sweats a lot during feeding and at night, there is reason to sound the alarm.

Rickets is a disease in which the body's metabolism is disturbed due to a lack of vitamin D, while the nervous and skeletal systems of the child suffer greatly. The disease most often occurs in infants.

Pay attention to the main signs of rickets in children, on the basis of which pathology is diagnosed. The disease is characterized by abnormal development of the skeletal system due to lack of calcium. The bones of the baby soften, become pliable, they cannot support the weight of the body in the correct position, from which the skeleton is bent.

Vitamin D enters the body through food. In human skin there is an enzyme with the help of which calciferol is formed under the influence of ultraviolet rays. Thanks to vitamin D, metabolic processes are regulated with the participation of phosphorus and calcium. It promotes the absorption of these substances, their absorption by the body and their deposition in bone tissue. Its presence affects the growth of bones.

Reasons for the development of rickets:

• lack of vitamin D;
• lack of ultraviolet (sun) rays.

If the baby eats properly and receives all the substances his body needs, rickets does not occur in him. The disease appears with improper feeding.

If breast milk does not contain all the useful components, it is poor in minerals and vitamins, the child does not receive the elements that are important for its growth and development.

A mother's poor diet affects the health of her baby. In this case, and will help.

It is possible that breastfeeding contains all the necessary vitamins, but the child is simply too lazy to suck out the hindmilk. He is lazy, besides, he is quickly saturated with the front, that is, with the one that is easier to get. Rickets is very often observed in children who are artificially fed and fed with unadapted mixtures.

Babies who are rarely outdoors are susceptible to the disease. Ultraviolet does not penetrate window glass. If the kids walk only occasionally, they develop rickets.

Most often, the disease appears in late autumn, in winter or early spring.. There is little sun during this period, its ultraviolet rays almost do not fall on the skin of the child, because babies are fully dressed in cold weather.

How does childhood illness manifest itself?

The first signs of rickets in infants can be seen as early as 3 months of age. The child's behavior changes. He becomes moody and lethargic, cries for any reason, especially at night.

The baby weakens the muscles, including the intestines, because of this, he is tormented by constant constipation.

During feeding, droplets of sweat appear on the baby's face, and the head becomes wet. When the child sleeps, he sweats more, which makes the bed damp.

The baby is worried about itching, he constantly rubs his head on the bed to relieve discomfort. Because of this, the hair on the back of his head falls out. These are the first symptoms of rickets in infants 3 months of age.

How to determine rickets in a child? Parents need to carefully look at the condition of the baby. The disease affects his behavior. The child becomes restless, sleeps poorly, eats little.

The skeletal system suffers: the bones of the skull soften, the head is deformed, a bald and flat nape appears, the pelvic bones and chest develop incorrectly. The spine bends, a hump may appear on the back in more severe cases. When the baby begins to walk, his legs are bent in the shape of X or O. The child's belly swells.

Symptoms of rickets in the baby

1. Can't hold his head.
2. It is difficult to roll over from back to stomach and vice versa.
3. It's hard to sit on your own.
4. The fontanel on the head tightens late.
5. Teeth erupt later than in healthy peers.

Symptoms of rickets in children appear gradually. At first, babies are just naughty and sweat a lot. If treatment is not started, their skull begins to soften, bones develop incorrectly. The child has a slowdown in development, growth. Suffer internal organs (heart, liver, kidneys), respiratory system.

What is the rate of development of height and body weight in children under one year old - read.

stages

There are several stages in the development of the disease. The absence or presence of any sign of rickets does not exclude or confirm the disease. The doctor can identify the disease after a thorough examination of the sick baby.

There are such stages of rickets:

1. Easy. There are disturbances in the functioning of the nervous system (nervousness, increased sweating), bone tissue suffers (the edges of the large fontanelle become pliable).
2. Average. There are changes in the skeletal system (parietal tubercles, chest deformity, large abdomen, muscle hypotension).
3. Heavy. serious changes in the central nervous system (lack of appetite, speech and motor disorders, lethargy), bone tissue is deformed(softening of the bones of the skull, retraction of the bridge of the nose, deformation of the chest, pelvic bones, limbs), disturbances appear in the muscular system, the size of the liver and spleen increase, anemia appears, teething slows down.

Signs of rickets in children at 2 years old are supplemented with new details. Rachitic rosaries appear on the anterior segments of the ribs. The chest looks compressed on the sides. When the child walks, he has a curvature of the legs in the form of an arc or in the form of the letter X.

Health implications and early diagnosis methods

If parents ignore the disease and the advice of doctors, then rickets can cause curvature of the spine and lower extremities, the appearance of flat feet. The pelvic bones do not develop properly, which can subsequently affect the course of childbirth. This problem is more typical for girls.

Rickets can lead to osteoporosis. This is a disease in which bone tissue is affected. The bones become loose, which is why they often break even with light loads. In a child with rickets, immunity decreases, resistance to other diseases decreases. Serious disturbances occur in the work of the heart, respiratory organs and gastrointestinal tract.

The diagnosis is made on the basis of signs of rickets, characteristic of children under 1 year old. A biochemical blood test is required to determine the concentration of calcium and phosphorus. With the help of plasma studies, the activity of alkaline phosphatase is studied.

An x-ray of the bones is taken. Thanks to this method, you can see a picture of bone changes. An X-ray examination and a biochemical blood test provide all the information about the pathology that a child has.

Treatment of rickets in children

How to treat rickets in a child - you should do this as soon as possible. If the first symptoms are detected, you should immediately seek help from the local pediatrician.

The mild stage of the disease is cured by dosed daily use of synthetic vitamin D3. The child is prescribed a vitamin preparation on an aqueous (AQUADETRIM) or oil (VIGANTOL) basis. The baby's body absorbs vitamin D better in water. The drug for the treatment of rickets in infants is given with meals and dissolved in milk. During the treatment period, the doctor recommends adhering to a special diet that is rich in trace elements and vitamins.

Treatment of rickets in children up to a year and older is carried out using the following medications:

*The price of the drug depends on the manufacturer and country of issue

Treatment of rickets with AQUADETRIM is carried out under careful monitoring of the clinical condition and with the study of biochemical parameters (calcium, phosphorus, alkaline phosphatase) of blood and urine. You should start with 2000 IU for 3-5 days, then increase the dose to individual treatment (most often 3000 IU). A dose of 5000 ME is prescribed only for severe bone changes X.

As needed, after a week break, you can repeat the course of treatment.
Treatment is carried out until a clear therapeutic effect is obtained, followed by a transition to a prophylactic dose of 500-1500 IU / day. If signs of hypervitaminosis D appear, it is necessary to cancel the drug, limit the intake of calcium, prescribe vitamins A, C and B.

VIGANTOL is a drug that regulates the metabolism of calcium and phosphorus and compensates for vitamin D3 deficiency. Enhances calcium absorption in the intestines and phosphate reabsorption in the kidneys. Promotes bone mineralization and is necessary for the normal functioning of the parathyroid glands.

In children, especially young children, the use of an oily solution of vitamin D3 may cause diarrhea due to a significant fat load.

Treatment with TRIDEVIT should be discontinued if symptoms of hypervitaminosis appear.: fatigue, nausea, diarrhea, polyuria. Simultaneous use of vitamin D3 DROPS with drugs containing a large amount of calcium or thiazide diuretics increases the risk of hypercalcemia.

It should be borne in mind that PLIVIT contains methyl parahydroxybenzoate (E 218). This component may cause allergic reactions (possibly delayed). The baby is prescribed sunbathing, irradiation with artificial ultraviolet rays. The doctor can prescribe fish oil, vitamin complexes (MULTITABS). To increase muscle tone - do massage, do gymnastic exercises.

In addition to vitamin D3, the baby is prescribed calcium supplements I. If the baby is not gaining weight well, he is given GLUCONATE or CALCIUM LACTATE. In complex treatment, vitamins C and B1 are used.

Prevention

So that the child does not suffer from rickets, the expectant mother, even during pregnancy, must take care of her own and his health. It is necessary to be on the street every day, including organizing, taking vitamins, and eating well.

The mother's diet should consist of fermented milk products, fruits and vegetables, cereals, lean meat, fish (which varieties are possible and which are prohibited with HB for more details from the article on).

Be sure to drink freshly squeezed juices during pregnancy. However, in some cases, for example, the use of compotes from, you need to make sure that there is no allergic reaction in a breastfed baby.

To protect the baby from rickets, you must:

• breastfeed him for as long as possible;
• in time ;
• go out with the child every day;
• bathe daily in water with the addition, if necessary, of a decoction of medicinal herbs (chamomile, nettle, celandine, calendula, walnut leaves, needles);
• do massages.

Mother's milk should be rich in vitamins and microelements necessary for the child. To this end, a nursing woman should eat enough dairy products, cottage cheese, eggs, fresh fruits and vegetables. You can read more about this.

To prevent the disease, the pediatrician may prescribe synthetic vitamin D3 in water or oil.. It is necessary to take the drug in accordance with the dose indicated in the instructions and the prescription of the local doctor. The doctor's instructions for admission must be followed. It is forbidden to give a drug to a child without consulting a pediatrician.

A vitamin remedy is usually given with meals in the first half of the day. The need of the child's body for vitamin D3 is 500 IU per day. Prevention of rickets in children is carried out for 2-3 months.

An overdose should not be allowed. If too much vitamin D enters the child's body, then calcium salts accumulate, which leads to intoxication. The baby suffers heart, liver, kidneys, stomach. If the dose of the vitamin is exceeded, the child may lose appetite, vomiting, diarrhea or constipation. In severe cases, difficulty breathing, convulsions, slowing of the pulse are noted. To alleviate the condition, the baby should stop giving the vitamin preparation.

findings

Rickets is a serious disease, but rare and subject to treatment. In no case can you delay the moment of contacting a specialist, because the sooner the disease is diagnosed and therapy begins, the sooner the baby will recover. The authoritative opinion of Dr. Komarovsky, see the video:

Rickets refers to the background pathological conditions of babies. It develops in the first two years of life. Another name for this pathology is "English disease", due to its frequent occurrence in the past in the industrial areas of England. The leading cause of the disease "rickets" is considered to be a lack of vitamin D, which is directly involved in the normal phosphorus-calcium metabolism of a person.

The importance of studying this disease is very high, since rickets can take a severe course, leaving behind serious consequences. It is important for all young parents to know how rickets begins in infants (symptoms and laboratory criteria). After all, it is they who are most often the first to notice problems in the health of their baby. How to treat rickets after the child has been diagnosed?

What is the disease "rickets"?

Rickets is a disease that is very common among infants and children of the second year of life. The development of the disease is due to the fact that a growing organism does not have the same needs for minerals such as calcium and phosphorus, and the systems that ensure their transportation to the body do not work perfectly. The main symptoms of the disease "rickets" are changes in the bone tissue.

Many mistakenly believe that rickets is a disease that is typical only for children from socially disadvantaged families. In fact, children from any social strata suffer from this disease, because, first of all, the disease "rickets" is a problem of an intensively growing organism.

What is the development of pathological processes connected with? With rickets disease, vitamin D is limited in food, the child does not have enough of it. In addition, its synthesis in the skin of the baby is reduced. A significant role in the development of the pathological process is also played by such factors as a violation of the metabolic processes of phosphorus and calcium in the liver and kidneys.

Causes of rickets in infants and older children

In the development of rickets in infants and older children, predisposing factors play a role, which are due to both the state of health and lifestyle of the mother, and the characteristics of the baby.

What maternal factors are most important in the development of rickets in children under one year old and older?

• The young age of the mother (up to 18 years), as well as the age of the mother over 35 years.
• Severe pregnancy (especially gestosis).
• Various diseases of internal organs (disorders of the endocrine system, problems of the digestive tract, etc.).
• Nutrition during pregnancy with foods depleted in vitamins and trace elements.
• A sedentary lifestyle and insufficiency of ultraviolet radiation for the body during the bearing of a baby.
• Births that proceeded with complications.
• Unsatisfactory socio-economic conditions, low material status.

What factors on the part of the child contribute to the development of rickets?

• The birth of a child before the due date, its immaturity.
• The birth of a baby in the second half of the year.
• High birth weight (above 4 kg)
• Intensive weight gain and growth in the first year of life, especially in the first 3 months.
• Feeding a baby with non-adapted milk mixtures and cow's milk.
• Rare walks.
• The immobility of the baby, due not only to the characteristics of the child himself, but also to the mistakes of the parents (lack of massage and gymnastics, tight swaddling).
• Perinatal damage to the nervous system.
• Diseases of the skin and internal organs (liver, kidneys, intestines, etc.).
• Frequent morbidity of the baby with respiratory and intestinal infections.
• Taking certain medications (for example, phenobarbital, diacarb, etc.).
• Hyperpigmentation of the skin and other rarer causes.

What pathological processes occur in rickets due to a lack of vitamin D?

With the disease "rickets" vitamin D in the body is present in insufficient quantities. This leads to the fact that the absorption of calcium in the intestine decreases, followed by phosphorus. The excretion of phosphates, amino acids and citric acid by the kidneys is enhanced.

Why is this happening? Due to the lack of vitamin D in the bloodstream, the activity of the parathyroid glands increases, that is, their hormone (parathormone) is released in an increased amount. Parathyroid hormone is responsible for maintaining a normal concentration of calcium in human blood. After all, calcium is a very important blood electrolyte, the content of which must be kept at a certain level. Calcium is needed for nerve excitation, normal heart function, it is involved in blood clotting.

In order to keep calcium in the blood at the required level, its mobilization into the blood from the bones begins. This explains the fact that with the disease "rickets" in children, symptoms of softening of the bone tissue appear.

The absorption of phosphorus is secondarily reduced, as phosphorus binds to calcium. That is, with a lack of calcium, phosphorus cannot be absorbed in the right amount. In addition, the excretion of phosphates from the body is enhanced, which is due to the activation of the parathyroid glands. To compensate for the lack of phosphorus in the bloodstream, it also begins to be washed out of the bone tissue. Thus, the process of calcification of bone tissue in a child is disturbed.

Rickets in infants and older children in its course has several periods or stages.

• Initial period. It lasts from 2 weeks to 2-3 months.
• Height period. Its duration is several months, depending on when the treatment was started.
• The period of recovery (reconvalescence). It lasts several months.
• Residual period. After suffering from the disease "rickets" in children, some symptoms may remain for life. They mainly relate to changes in the musculoskeletal system.

Signs of rickets in children

The initial symptoms of rickets in infants become noticeable at the age of one to two months. By the age of 3-6 months, in the absence of therapy, the signs of rickets in children become apparent, that is, the clinical picture becomes detailed.

The initial symptoms of rickets in infants are as follows:

• The kid becomes shy, irritable, reacts negatively to bright light or loud sound (shudders).
• Mothers begin to notice that the baby’s sleep has been disturbed (sleeps restlessly, often wakes up).
• Sweating appears, appetite decreases, tissue turgor and muscle tone decrease, constipation begins to bother.
• One of the first symptoms of rickets in children is nape baldness, although this also occurs in healthy babies.
• On the part of the bone tissues, some suppleness of the edges of the large fontanel can be noted, that is, they become flexible and soft.
• If an X-ray examination of the bones is carried out at an early stage of the disease, no abnormalities will be found.
• In the study of a biochemical blood test, a physiological content of calcium and a reduced or normal amount of phosphorus are noted. The content of alkaline phosphatase increases.
• When examining urine, phosphates are found in the analysis.
• Sulkovich's specific test for the diagnosis of rickets becomes positive (+).

Symptoms of rickets in children during the height of the disease

The disease "rickets" in the peak period is manifested by the following symptoms:

• Symptoms of bone softening become more pronounced (cranial sutures become pliable, the back of the head flattens, the occipital bone may become softened).
• Since the bones become malleable, they change their shape under the influence of physical exertion and a certain position of the body. Therefore, there are such symptoms of rickets in children as a violation of posture and curvature of the spine, a change in the shape of the chest (bell-shaped chest, depression of the sternum inward, etc.), curvature of the pelvic bones (flat pelvis), X-shaped and O-shaped curvature of the legs. Changes in the limbs become noticeable when the baby begins to stand and walk for a long time, as the load on the legs increases.
• There are signs of bone growth: in the place where the 7th-10th ribs join the sternum, there is a thickening (“rosary”), a thickening in the area of ​​the epiphyses of tubular bones (“bracelets”), epiphyseal thickenings on the phalanges of the fingers (“strings of pearls”), change in the shape of the skull.
• Milk teeth erupt slowly and asymmetrically. There are such symptoms of rickets as underdevelopment of the bones of the skull, which results in the formation of a high "Olympic forehead", a saddle nose.
• Become more pronounced sweating, decreased muscle tone. The result of reduced muscle tone is constipation, a flattened "frog" belly, increased mobility in the joints.
• Emotionally, the baby becomes unstable, often irritated, he lags behind in neuropsychic development, and often suffers from respiratory infections.
• In the biochemical analysis of blood, a reduced content of calcium and phosphorus is determined, the content of alkaline phosphatase increases even more.
• When examining a complete blood count, anemia attracts attention.
• In the analysis of urine, phosphorus remains normal or increases.
• An X-ray examination of the bones will already indicate signs of rickets (lack of bone mineralization): osteoporosis, an increase in the width of the middle part of the tubular bones, blurred areas of calcification.

With the disease "rickets" the symptoms gradually fade away during the recovery period. The child's well-being improves, he becomes cheerful, more inquisitive, and progresses better in neuropsychic development. The baby has constipation, muscle tone improves, sweating goes away, sleep normalizes.

In the blood test, the ratio and amount of calcium and phosphorus are normalized. An x-ray examination shows thickening of the bone tissue in the growth zones.

What signs of rickets suffered up to a year in children can remain for life?

The final stage of the disease is the period of residual effects, starting at about the age of 2-3 years. Are there any symptoms of rickets that remain with a person for life? It would be more correct to call them residuals.

The fact that a person suffered from the disease "rickets" in childhood can be indicated by the following signs: bone deformities, flat feet, impaired posture up to scoliosis, changes in the shape of the pelvis. These children are more susceptible to dental caries. There may be a lag in growth, visual impairment (myopia).

Rickets in children up to a year and older can occur in varying degrees. There are three degrees of severity of rickets: from mild to severe. The severity of rickets is determined by the presence of certain signs and how bright they are.

In the course of the disease, "rickets" in infants and children of the second year of life can be acute, subacute, or have a recurrent course.

Signs of rickets in children up to a year in the acute course of the process increase very quickly. This course is characterized by symptoms of softening of the bone tissue. The process usually starts in the first half of the year.

Subacute rickets in children under one year old is characterized by a slow development of the clinical picture. The symptoms of bone tissue proliferation predominate. This course of the disease is more common in babies of the second half of life. From subacute rickets can go into acute. This may be affected by the occurrence of an acute illness in a child.

Signs of recurrent rickets in children under one year old and older are not constant. Periods of improvement are replaced by deterioration. This is influenced by the conditions of care for the child, the type of feeding, the presence of concomitant diseases, the adequacy of treatment. The main signs of recurrent rickets in children up to a year and older are as follows: against the background of already existing symptoms of bone tissue growth, signs of its softening begin to appear again.

Mild rickets

A mild degree of rickets is manifested by severe neurological symptoms (tearfulness, irritability, poor sleep). Among the bone changes, attention is drawn to the softening of the edges of the large fontanel.

With a moderate degree of rickets, bone changes appear, but there are no more than two or three groups of bones.

Severe degree of rickets

Rickets in children under one year of age and older has severe clinical symptoms: softening of the bones of the base of the skull, saddle nose bridge, pronounced bone deformities, significant muscle hypotension, delayed neuropsychic development, involvement of internal organs in the pathological process, severe anemia, etc.

Treatment of rickets in children

Treatment of rickets in children should be started as early as possible. Then it will be more effective, and the disease is more likely to proceed without complications. How to properly treat rickets so that the child recovers sooner?

If signs of rickets are found in children up to a year and older, it is necessary to contact the local pediatrician as soon as possible. He will examine the child, conduct the necessary diagnostic studies, refer the child for a consultation to narrow specialists. The sooner the treatment of rickets in children is started, the better the outcome of the disease will be.

In no case should you engage in self-diagnosis and treatment. There are rickets-like diseases that are not associated with vitamin D deficiency. An erroneous treatment of the wrong disease can lead to complications. Therefore, it is very important to responsibly treat the issues of diagnosis and only after it proceed directly to the treatment of the disease.

Regime in the treatment of rickets

Features of the regimen for infants and older children in the treatment of rickets:

• Regular walks on the street (from 4 hours a day). It is advisable to walk at least twice a day, try not to miss sunny days, you can sleep on the street (in a stroller, in a sled).
• The child needs enough sleep, a lot of movement. Parents should interest him in books, educational toys, music, limiting his time to the TV or computer as much as possible, which is often found even at such a young age.
• Proper and balanced nutrition of the child. When breastfeeding, it is important for the mother to eat well.
• Salt-coniferous baths are very useful. They are prescribed in courses, from 15 to 20 procedures for 10 minutes. Such baths are carried out every two or three days. In order to prepare such a bath, you need to take 50-100 g of sea salt per 10 liters of water and 10 ml of coniferous concentrate per the same volume of water.
• In the recovery period, ultraviolet irradiation of the skin is indicated. A course of 15-20 procedures is carried out.

Massage and therapeutic exercises used in the treatment of rickets in children are very important and useful. Thanks to them, blood circulation, tissue trophism improves, muscle tone normalizes. The child quickly improves new motor skills, with the help of which he can master a new space and develop. In addition, massage contributes to the faster development of speech.

Features of nutrition of children with rickets up to a year and older

In the treatment of rickets, feeding a child under the age of one year and older plays an important role. It is worth striving to continue breastfeeding for at least a year. If it is impossible to breastfeed a child, preference should be given to adapted mixtures.

Complementary foods for children suffering from rickets should be introduced in a timely manner, after discussing this with your doctor. It is worth remembering that many foods that are rich in vitamin D, calcium and phosphorus turn out to be allergens for some children. Therefore, it is worth introducing new products gradually.

Equally important is good nutrition for the mother. Dairy products (milk, cottage cheese, cheese, butter, etc.), greens and leafy vegetables, potatoes, berries, fruits, meat dishes, cereal cereals, eggs, fish dishes must be present in her diet.

The largest amount of calcium is noted in cheeses, dairy products, milk, cottage cheese, parsley, green onions, and beans.

Vitamin D in the treatment of rickets in children

Since there is a lack of vitamin D in the disease "rickets", it is his subsidy that is the main link in the fight against this pathology. How to treat rickets with vitamin D?

The most commonly used vitamin D3 (international name Cholecalciferol). It is given to babies in therapeutic doses of 2000 to 5000 IU, depending on the severity of the disease. The selected dosage of the drug is given for one to one and a half months, then the dose is gradually reduced until it reaches the prophylactic dose. At this dose, the drug is given until the child reaches the age of two years, and in the winter months or autumn-winter months in the third year of life.

Treatment should begin with a starting dose of 2000 IU, it is given for several days, then gradually increased to 3000-5000 IU. A dose of vitamin D3 in 5000 IU is given to a child with pronounced changes in the bone tissue.

Babies who are at risk are given another course of treatment for rickets 3 months after the end of the first course of treatment. This treatment lasts 3-4 weeks. In this case, the dosage of the drug is given from 2000 to 5000 IU. This is done to prevent recurrence of the disease.

It is important to pay attention to how much IU is contained in 1 drop of the drug. So, in 1 drop of an oil solution of the drug Vigantol contains 670 IU of cholecalciferol. And 1 drop of an aqueous solution of vitamin D3 (Aquadetrim) contains 500 IU of the substance.

There are also drugs for the treatment of rickets containing vitamin D2 (ergocalciferol). They are available in the form of oil and alcohol solutions. However, preference is given to preparations containing vitamin D3, since this form of the vitamin is more active.

In addition to vitamin D, calcium, phosphorus, vitamins of group B, A, C, potassium, magnesium, citrate mixture are used in the treatment of rickets in children.

Prevention of rickets is carried out in two stages: before the birth of a child and after his birth.

Prenatal prevention of rickets:

• Taking measures to prevent the birth of a premature baby.
• Timely detection and competent management of women with extragenital diseases and pathologies of pregnancy.
• Complete nutrition of the expectant mother during pregnancy.
• The correct daily regimen for a pregnant woman (long walks, sufficient sleep, moderate physical activity, etc.).
• The use of multivitamin complexes by the expectant mother, according to indications, which also include trace elements.
• In women living in the far north, ultraviolet skin irradiation is recommended to stimulate the production of their own vitamin D.

Postpartum nonspecific prevention of rickets:

• Breastfeeding in the first year of life and beyond. In the absence of such, feeding with adapted milk mixtures.
• The introduction of complementary foods at the right time.
• Compliance with the regime of the day (long walks, especially in sunny weather, good sleep).
• Providing the child with conditions for normal physical activity (do not swaddle tight, lay on the stomach, encourage crawling, etc.).
• Timely completion of courses of medical massages and physiotherapy exercises for the child according to indications. In the absence of indications, maternal massage and gymnastics should be carried out.

Specific prevention of rickets in infants and older children (up to 3 years of age) is that children are given vitamin D daily by mouth. There is an aqueous and oil solution of vitamin D. For most children, a dose of vitamin D 500 IU (1 drop of the drug) is considered prophylactic.

Vitamin D is given to full-term babies from 3 weeks of age. Prematurely born children are prescribed vitamin D from two weeks after birth. There are risk groups for children to develop rickets, for example, children living in northern latitudes, or children with certain diseases. In them, the prophylactic dose can increase to 2 drops, less often up to 3 or 4 drops.

In the latitudes of our country, where a significant part of the time is sunny weather from May to September, the prevention of rickets with drugs is not massively carried out. The issue is decided individually, based on the characteristics of each child. In the North, this prevention is carried out even in summer.

In terms of duration, drug prevention of rickets lasts up to two years of life. In the third year of life, it is indicated for children who have had rickets, for other children - only in winter or autumn-winter.

If the child has a high risk of rickets, then preventive measures are supplemented by the appointment of B and C vitamins.

Children born prematurely are at risk for rickets in the first year of life. Moreover, this risk increases as the gestational age at which the children were born decreases. According to some reports, 80% of premature babies have signs of rickets of one degree or another. Those babies who were born weighing less than 1500 g are very likely to have rickets.

This is due to the high growth rates of premature infants, their large needs for calcium and phosphorus. In addition, many children born prematurely have various health problems that exacerbate the course of rickets. The medications taken by the child also affect the process. Some drugs contribute to the excretion of unnecessary calcium and phosphorus.

Studies have been conducted that indicate that it is in the third trimester of pregnancy that the fetus intensively stores calcium and phosphorus, and the mineralization of the skeleton occurs. Accordingly, the birth of a baby prematurely disrupts this natural process.

Signs of rickets in premature babies

Rickets in premature babies is called osteopenia. The disease is characterized by an acute course from the first weeks or months of a baby's life.

With the development of the disease "rickets" in premature infants, the symptoms of the disease are as follows:

• Neurological symptoms (tearfulness, irritability, sleep problems, etc.).
• Symptoms of softening and pathological growth of bone tissue are similar to those in full-term.
• The occurrence of spontaneous fractures and cracks in tubular bones (ribs, hips, shoulder, etc.)
• Hypoplasia of tooth enamel, late teething.
• Muscular hypotension.
• Formation of persistent bone deformities (change in the shape of the skull, curvature of the limbs, flattening of the pelvic bones).

Signs of osteopenia in a premature baby are not always recognized in a timely manner. This is partly due to the fact that premature babies usually have other comorbidities that have more pronounced clinical signs. In other words, against the background of the course of severe illnesses in premature babies, the symptoms of rickets may be less noticeable. However, we must not forget that rickets is very insidious, so you should be very careful about this problem in babies born prematurely.

How to treat rickets in premature babies?

How to treat rickets in children born prematurely? The regimen, nutrition, massage and gymnastics are similar to those of children born on time. Naturally, the individual characteristics of each baby, its concomitant diseases, and gestational age are taken into account.

It is very important to continue breastfeeding as much as possible. If it is necessary to supplement or feed with artificial mixtures, it is worth choosing a formula specially designed for premature babies. Breast milk fortifiers are used as indicated.

A special role belongs to therapeutic massage and gymnastics, since for the correct formation of the bone, a load on the bones and muscle apparatus is needed, which is so lacking in premature babies.

The appointment of drugs begins at two weeks of age. Not only drugs containing vitamin D are used, but also drugs containing calcium and phosphorus salts. Dosage and drug are determined by the attending physician. Many factors influence this.

It is worth carefully studying the side effects of all drugs that are used for nursing and treating premature babies. Many of them affect the phosphorus-calcium metabolism in the baby's body and contribute to the development of osteopenia.

The first year of a baby's life is one of the most important. At this time, the foundation of the health of the crumbs is laid, the baby is growing and changing rapidly. Parents often ask questions about the health and development of the child, worry about whether the crumbs have diseases, whether rickets is missed.

Every mother knows that for the prevention of rickets, you need to give medicine and walk with the baby. But rarely does anyone know how to suspect and distinguish rickets from other diseases, what are the signs of rickets in newborns and infants.

Pediatrician, neonatologist

Rickets is a disease associated with a lack of vitamin D in the body, a violation of the metabolism of trace elements, calcium, phosphorus. A distinctive feature of the disease is the defeat of the predominantly skeletal system of the child.

Most often, rickets occurs in children under the age of three. This is due to the rapid growth of fidgets, increased need for vitamins and trace elements.

Already from 4 weeks, the manifestation of the disease is possible, but more often the disease occurs in the first 2-4 months of the baby's life. Sometimes signs of rickets in children appear after 1 year of life. In such cases, the child may be severely retarded in development, later mastering the skills of walking.

A lack of vitamin D leads to a decrease in the concentration of calcium in the bones. The structure of the bones changes, they become deformed, become soft, thin. Lesions in rickets are not limited to bone tissue, the functioning of the nervous system and internal organs is disrupted.

Although many questions arise about rickets, most of the fears of parents are unfounded, rickets is not common. Statistics say about 1 case of rickets per 200 thousand of the child population. But in the case of the development of the disease, severe bone changes are irreversible. Therefore, it is important to see the signs of rickets in infants, to properly care for the child in order to prevent the disease.

Causes and factors for the development of rickets in children

• Lack of solar radiation. Most of the vitamin D is formed when baby's skin is exposed to sunlight. A child receives only 10% of the daily requirement of a vitamin from food. The importance and significance of walking is underestimated by many parents. Even on cloudy days, sunlight is sufficient to produce vitamin D.
• Improper nutrition of the child. Feeding with non-adapted milk formulas, cow,. Modern adapted mixtures contain enough vitamin D. But a low-quality mixture that is not enriched with vitamins can lead to the development of the disease. The same situation is with whole milk, which is contraindicated for infants. Late introduction of complementary foods, the predominance of vegetarian dishes in the baby's diet. The low content of animal protein in food crumbs will not lead to rickets instantly. But it will serve as a predisposing factor and, with insufficient production of vitamin D in the skin, will aggravate the condition.
• Birth before term. The accumulation of calcium and phosphorus reserves in the child occurs at the end of pregnancy. The mother's body does not have time to give enough nutrients until 30 weeks of pregnancy. On the other hand, premature babies are characterized by rapid growth rates compared to full-term toddlers. The need for trace elements in these children is more pronounced.
• Irrational nutrition of a pregnant woman. The low content of protein, microelements, vitamins in the food of a pregnant woman leads to a decrease in the supply of elements in a newborn.
• Malabsorption syndrome. Even if there are enough nutrients, the baby's body must properly absorb them. In malabsorption syndrome, the intestines do not work properly, the absorption of substances is impaired.
• Metabolic diseases. There are family, hereditary metabolic diseases. In such situations, the disease can be traced in family members, passed from parents to children.
• Chronic diseases of the liver and kidneys, infectious processes. In the case of a chronic process, the formation of vitamin D is reduced.
• Lack of physical activity. It occurs in children who have suffered damage to the nervous system. This, in combination with other factors, can provoke the development of rickets in a child.
• Polyhypovitaminosis is a lack of many vitamins and minerals.

In addition to vitamin D, vitamins of groups B, E, A, C, microelements also participate in the structure of bone tissue. Therefore, with the development of rickets, it is worth suspecting a lack of other nutrients.

Signs of rickets

Symptoms of rickets in infants differ depending on the period of the disease, the severity of the process. If the diagnosis of rickets in the later stages does not cause difficulties, then at the beginning of the disease, the manifestations of the disease can be erased, imperceptible.

To determine rickets in a child, you need to understand the periods of the disease, the manifestations of the disease in each individual of them.

The onset of the disease

In the first period, the disease is manifested by changes in the autonomic nervous system. The baby becomes restless, sweating, although this has not been observed before. Startle, sleep disturbance and other manifestations of nervous system excitation are possible. The back of the baby's head is going bald due to the friction of the sweaty head on the pillow.

The doctor draws attention to the long-term red dermographism. By the end of the first period, after 2-4 weeks, the bones of the skull begin to change. Attention is drawn to the softening and pliability of the bones along the sutures of the skull. The muscle tone of the child also changes, often there is hypotension, a decrease in muscle tone.

Sometimes the initial signs of rickets go unnoticed, this can lead to the transition of the disease into a peak period.

The peak period of rickets

During this period, vegetative disorders continue and become stronger. The general condition of the child worsens, the baby becomes lethargic, inactive. The muscle tone of the child is significantly reduced, looseness in the joints appears, it can be difficult for the baby to make the usual movements.

During the peak, the symptoms of the skeletal system are clearly expressed.

1. Softening of the flat bones of the skull. Softening occurs not only along the sutures of the skull, the process extends to the parietal, occipital bones. When pressing on the affected areas, compliance is felt, the bones resemble parchment, a plate.
2. Change in the shape of the skull. As the bones of the skull soften, deformity and asymmetry of the head occur. Bone tissue continues to form, but does not have time to calcify. The head grows incorrectly, becomes angular. The frontal and parietal tubercles protrude more distinctly, the skull takes on a square shape.
3. The baby's nose seems saddle-shaped, with a sunken bridge of the nose, and the forehead strongly protrudes, for which it received the name "Olympic". The baby's eyes open wide, bulging, exophthalmos occurs.
4. The enamel of the child's teeth is affected, caries occurs, the bite is disturbed. The rate of teething slows down sharply, and a large fontanel closes only after 2 years.
5. Chest deformity. As a result of softening of the bones of the chest, its shape changes. The chest with rickets looks squeezed from the sides. Perhaps even protrusion of the sternum forward, there is a so-called "chicken" or "keeled" chest. The spine is deformed, a “rachitic hump” appears, and physiological curves intensify.
6. Bone tissue continues to form incorrectly, thickenings appear on the collarbones. The epiphyses of the bones of the forearm also grow, the wrist thickens as if wearing a "rachitic bracelet". The phalanges of the fingers are also subject to deformation, "strings of pearls" are created.
7. Curvature of the bones of the lower extremities. The child's legs are deformed, they become like the letter X or O. The doctor makes a diagnosis: valgus or varus deformity of the limbs. The bones of the pelvis rarely change, and flat feet are detected in almost all cases of rickets.
8. Changes in the musculoskeletal system. The muscles of the crumbs become weak, flabby, the stomach becomes flattened, “froglike”. The joints are characterized by looseness, pathological mobility, an increase in the range of motion, the child easily throws his leg over his head. The kid lags behind in physical development from his peers.
9. Damage to all organs. Damage to muscle and bone tissue affects all organs. The diaphragm becomes flabby and cannot perform its function, pulmonary ventilation is disturbed. This is manifested by shortness of breath, lung diseases, pneumonia easily develop.
10. The cardiovascular system also suffers. Flaccid heart muscle cannot contract properly. Blood pressure decreases, the heart increases in volume, the pulse quickens.

convalescence period

During the recovery period, the disease reverses. The manifestations of neurological disorders gradually disappear, the baby's teeth erupt. The affected organs begin to perform their function better, the general well-being of the child improves.

Residual period

The severe course of the disease leads to deformation of the limbs, which persists for a long time. Residual effects require long-term rehabilitation and treatment. Such situations occur with advanced, unrecognized rickets in time. The consequences can remain for the rest of the child's life, children develop flat feet, scoliosis, and vision is impaired.

The severity of rickets

Depending on the severity of the clinical manifestations of rickets in infants, there are 3 degrees of the disease.

• Mild course of rickets, rickets of the 1st degree. In infants, rickets of the 1st degree proceeds quite easily, there are no disturbances in psychomotor development. Damage to bone and muscle tissue is mild and is reversible with proper treatment.
• Rickets of moderate severity, 2nd degree of rickets. The manifestations of rickets are quite pronounced, the weakness of the muscles and ligamentous apparatus attracts attention. The child's static functions are disturbed, the spine is deformed, the stomach becomes large, rounded, the abdominal muscles diverge.On the part of the heart, weakness, muffled heart tones, increased heart rate, anemia are noted. Possible indigestion, respiration. Such children lag behind in physical and mental development.
• Severe rickets, rickets grade 3. Differs in severe violations of all organs and systems. The nervous system is significantly affected, the child is lethargic, inhibited, does not respond to others.

The patient's skeletal system is deformed, the muscles are extremely flaccid. The child loses the ability to move, forgets the acquired skills. The work of the heart, respiratory and digestive systems is seriously disrupted, severe anemia develops.

The course of rickets

Rickets is divided not only into periods and severity of the disease. The clinical manifestations of the disease are diverse, so experts have identified the course of the disease in the classification.

• Acute course. Rickets develops quickly, it manifests itself in the defeat of the nervous system and osteomalacia - softening of the bones. The head becomes angular, the back of the head is flattened, the chest is squeezed from the sides, and the bones of the legs may be bent.Such a course is typical for premature babies, children with impaired metabolism, who have had severe infectious diseases.
• Subacute flow. In the subacute course, the bone tissue is affected slowly, gradually. The formation of osteoid tissue is increased, deformed. Parietal and frontal tubercles grow, the head acquires a square shape. Bone tissue cells are deposited on the phalanges, wrists - “strings of pearls”, “rachitic bracelets”.Subacute course occurs in children with, with insufficient.
• Recurrent, undulating course. The periods of improvement are short, the disease reappears. A relapsing course occurs with incorrect, inadequate treatment of rickets.

Diagnosis of rickets

According to the doctor Komarovsky, all of the listed symptoms and manifestations of the disease do not allow a diagnosis of rickets. To clarify the nosology, laboratory and radiological confirmation is required.

Biochemical blood tests will help determine the degree of electrolyte imbalance. With rickets, there is a decrease in the concentration of calcium and phosphorus in the blood and an increase in alkaline phosphatase.

Is it possible to diagnose rickets with the help of Sulkovich's test? No, this test measures the amount of calcium in the urine. The analysis is good for adjusting the dose of vitamin D, but cannot be used as the only criterion for making a diagnosis.

On the x-ray, the specialist will determine if there are bone deformities, how pronounced they are, what is the structure of the bone. Normally, in the picture, the bone structure looks homogeneous, with rickets, areas with insufficient and excessive mineral content are determined. With a long-term severe course of the disease, a replacement of bone tissue with connective tissue is observed, which indicates the neglect of the process.

Treatment of rickets in infants

To achieve a long lasting result, therapy should include several important points.

• Determination of the factor that caused the disease. A child diagnosed with rickets should be comprehensively examined. Without treating the cause of the disease, it is impossible to completely get rid of the symptoms of the disease.
• Taking medications. For the treatment of rickets, the use of an aqueous solution of vitamin D3 is most effective. The dosage of the drug is selected by a specialist individually. Doctors recommend checking the calcium content in the child's blood to evaluate the effectiveness of therapy.High doses of vitamin D3 lead to the development of hypervitaminosis, so self-treatment of rickets is unacceptable.
• Treatment of concomitant diseases. Specialists will determine the amount of necessary therapy for diseases of the respiratory, cardiovascular, nervous system. These systems are most often affected in rickets.
• Proper nutrition and regular walks. Daily walks and proper nutrition will help the baby cope with the problem. It is necessary to give the baby foods rich in the treasured vitamin D daily. These include cheese, cottage cheese, dairy products, fish liver, and seafood.Walks should be regular, in any weather. Without the systematic production of vitamin D by the baby's skin, it is impossible to achieve a lasting result.
• Physiotherapy procedures. Massage, gymnastics strengthen the musculoskeletal system of the crumbs, help fight the disease. The course of ultraviolet irradiation strengthens bone tissue, improves the overall well-being of the crumbs.

Prevention of rickets

Moms should know that preventing rickets is quite simple. The child should receive the required dose of the vitamin daily. For babies, the best prevention is -