Parasitic diseases in children (enterobiosis, ascariasis). How to identify and treat parasitic diseases in children Parasitic diseases in children symptoms

Clinical manifestations of helminthiases are largely non-specific and can be hidden under the guise of infectious and non-infectious diseases, which makes their diagnosis difficult.

Nematodoses:

Ascariasis

Infection occurs by swallowing mature ascaris eggs (with contaminated vegetables, fruits). In the small intestine, ascaris larvae emerge from the eggs, which pass through the mucous membranes, penetrate the blood vessels, enter the liver, and from there to the lungs. Then they enter the pharynx through the tracheobronchial tree, are swallowed and mature in the small intestine to adult forms. The migration phase is 10-12 days. The interval from ingestion of roundworm eggs to the development of sexually mature forms is about 8 weeks. In the absence of treatment, the life expectancy of roundworm reaches 12-18 months.

clinical picture. In children, the infection is often asymptomatic. Some patients have nonspecific disorders of the gastrointestinal tract. The early phase of the disease (migratory) is characterized by acute transient pneumonitis (Leffler's syndrome) with fever and severe eosinophilia; cough, chest pain, dry and moist rales in the lungs. Urticarial rash may appear on the hands and feet.

In the late phase (intestinal), dyspeptic symptoms develop (decreased appetite, morning sickness, vomiting, stool disorders). Pain in the abdomen, headaches, poor sleep are noted. Intestinal obstruction, perforative, appendicitis, mechanical obstruction of the airways, blockage of the bile duct may occur. Helminths can leave with feces and vomit. In the peripheral blood, hypochromic anemia, eosinophilia, and an increase in ESR are observed.

The diagnosis is based on clinical symptoms and the detection of roundworm eggs in the feces. Sometimes adult roundworms are found in feces or vomit.

The prognosis depends on the massiveness of the invasion, more often favorable.

Treatment. The most effective are piperazine preparations that affect both mature and immature roundworms of both sexes (efficiency 90-95%). More often, piperazine adipate is used (2 consecutive days, 2 times a day 1 hour before meals or 0.5-1 hours after meals). In recent years, in the treatment of children older than 2 years, mebendazal (Vermox) has proven itself well, which is prescribed 100 mg 2 times a day for 3 days.

Prevention. Compliance with the rules of personal hygiene.

trichuriasis

The clinical picture is varied and depends on the intensity of the invasion. Infected children usually have pallor, weight loss, loss of appetite, nausea, vomiting, salivation, abdominal pain (often in the right iliac region). In severe cases, fainting, headaches, dizziness, seizures may occur. In the blood, hypo- and normochromic anemia, leukocytosis, eosinophilia, and an increase in ESR are noted. Possible complications such as appendicitis (with intense invasion), colitis, prolapse of the rectum.

The diagnosis is made on the basis of clinical findings and the detection of whipworm eggs in the feces.

Treatment. Specific treatment includes a number of drugs. Difezil (a derivative of naftalan) is administered orally on an empty stomach (1 hour before breakfast) 1 time per day for 3-5 days. In the treatment of trichuriasis, naftamon, thymol, oxygen therapy and dithiazanin can also be used.

Prevention. Carry out deworming of patients; strict observance of rules of personal hygiene is necessary.

Enterobiasis

clinical picture. One of the main symptoms is perianal itching, leading to restless sleep and irritability of the child. There are pains in the abdomen, loss of appetite. Symptoms of damage to the nervous system (headaches, dizziness, memory loss, convulsions, enuresis) may occur. When scratching the perianal area as a result of secondary bacterial infection, severe dermatitis may develop.

The diagnosis is based on the detection of pinworm eggs in a scraping from the perianal area or helminths on the surface of the feces.

Treatment. Pirvinium pamoate has a high selective activity (5 mg per 1 kg of body weight in the form of a dragee or suspension). Piperazine adipate is taken in the same doses as for ascariasis.

Prevention. Thorough wet cleaning, frequent change of linen, washing the child at night with warm water and soap, frequent hand washing, separate bed.

Trematodoses:

Opisthorchiasis

clinical picture. In the acute period of invasion (2-4 weeks after infection), fever, muscle and joint pain, itchy skin rashes, swollen lymph nodes, liver, and less often spleen are noted. In the blood - eosinophilia, sometimes eosinophilic leukemoid reaction. In the chronic period, symptoms of damage to the liver, bile ducts, gallbladder and pancreas predominate. In addition to pain in the right hypochondrium, there may be dyspeptic symptoms (nausea, vomiting, salivation). Subfebrile condition is often noted. In the blood, signs of anemia, eosinophilia, increased ESR are found.

Diagnosis. It is put on the basis of clinical data, taking into account the epidemiological history, is confirmed by the detection of fluke eggs in the feces and duodenal contents.

Treatment. Chloxil is a specific agent in the treatment of opisthorchiasis. The treatment cycle is 2 days. The daily dose is from 0.1 to 0.15 g per 1 kg of body weight (3 times a day after meals), the drug is washed down with 100 ml of milk.

Prevention. Protection of water bodies from pollution by faeces. Adequate cooking of edible fish.

Fascioliasis

clinical picture. The acute period of fascioliasis (1-8 weeks after infection) is characterized by malaise, weakness, fever, headaches, and sometimes itchy urticaria. Nausea, vomiting, pain in the right hypochondrium and epigastric region are noted. The liver and spleen enlarge, moderate jaundice develops. In the blood, eosinophilic leukocytosis, an increase in ESR are noted. After 1.5-2 months, the disease becomes chronic, characterized by symptoms of biliary dyskinesia, the development of cholangitis, cholecystitis, hepatitis and cirrhosis of the liver.

Treatment. Apply chlorine. Specific treatment is combined with pathogenetic and symptomatic therapy (appointment of diet, choleretic agents, physiotherapy, vitamin therapy).

Prevention. The use of water from stagnant reservoirs only in boiled form.

Cestodoses:

tenidosis

clinical picture. Both diseases have a similar clinical picture. Usually there are dyspeptic disorders: changes in appetite, nausea, vomiting, heartburn, sometimes pain in the epigastric region, stool disorders. Characterized by malaise, headache, dizziness, poor sleep, convulsions.

Diagnosis. Based on clinical data and detection of helminth segments in feces.

Treatment. A specific drug in the treatment of both helminthiases is niclosamide (orally 1 g for 1 day, then 0.5 g for 6 days).

Hymenolepiasis

clinical picture. Characterized by abdominal pain, nausea, salivation, decreased appetite, loose stools, as well as headaches, dizziness, and sometimes convulsions.

The diagnosis is made when eggs or helminths are found in the feces.

Treatment. Effective niclosamide. Fern extract, pumpkin seeds can be used.

Echinococcosis

With echinococcosis of the lungs, cough with sputum, sometimes with an admixture of blood, shortness of breath, chest pains are noted. Dullness of percussion sound, bronchial tone of breath, dry and wet rales are characteristic. Bubbles can break into the bronchi and pleural cavity, causing anaphylactic shock.

The diagnosis is made on the basis of clinical findings and the results of an intradermal antigen test.

Surgical treatment.

Protozoonoses

The causative agent is entamoeba histolytica, which is excreted in the form of cysts and (or) vegetative forms with the feces of carriers. Each of the swallowed cysts subsequently leads to the formation of eight vegetative forms, which continue to multiply by division. Vegetative forms cause invasive disease.

clinical picture. The disease is often asymptomatic or without specific symptoms. In this case, bloating, flatulence, constipation, and occasionally diarrhea are sometimes noted. The usual clinical manifestation is diarrhea with tenesmus. Ulcerative changes can lead to perforation of the colon. Liver abscess develops due to metastasis through the portal vein system. Another localization of the process (in the lungs, brain and skin) is a consequence of the adjacent or hematogenous spread of infection from the liver or from the primary focus in the colon.

Diagnosis is usually made by recognizing entamoeba histolytica in the stool or tissue from the site of injury. Numerous serological tests exist, including indirect immunofluorescence, enzyme immunoassay, and indirect hemagglutination, which is the most commonly used.

Treatment. With an infection with an asymptomatic and mild course without diarrhea and ulcerative changes, quiniofon should be prescribed. The cycle of treatment with quiniofon is 8-10 days. In moderate to severe disease and extraintestinal amebiasis (for example, with a liver abscess), metronidazole should be prescribed, and then quiniofon.

Prevention. Identification of the source of infection, hospitalization of patients, sanitary and hygienic measures.

Leishmaniasis is among the zoonotic infections; the pathogen is transmitted to humans from sick dogs and wild animals, when bitten by mosquitoes, as well as from sick people. In the CIS countries, cutaneous and visceral leishmaniasis is predominantly common.

clinical picture. Cutaneous leishmaniasis is characterized by skin lesions at the site of a mosquito bite. There are three main varieties of visceral leishmaniasis: Indian, Sudanese and Mediterranean.

The incubation period for leishmaniasis varies from a few days to several months (3-5 months on average). During the course of the disease, three periods are distinguished: initial, peak period and cachectic.

The initial period is characterized by lethargy, dysphoria, loss of appetite, pallor of the skin, and a slight enlargement of the spleen. These symptoms are followed by an increase in body temperature. In the peripheral blood, moderate leukocytosis is found, followed by leukopenia, lymphocytosis, monocytosis, eosinopenia, and increased ESR.

In the peak period, the main symptom is fever with an undulating course. Hepatosplenomegaly is very typical. 2-3 months after the onset of the disease, severe anemia develops (lower hemoglobin levels). At the same time, leukopenia, relative lymphocytosis, monocytosis, thrombocytopenia, a sharp increase in ESR (up to 30-90 mm / h) are noted. The skin becomes waxy or pale grayish; edema appears. Appetite decreases, vomiting is occasionally noted. Diarrhea may alternate with constipation.

If left untreated, a cachectic period develops, characterized by severe exhaustion and edema. Appear petechial rash, hemorrhages in the subcutaneous adipose tissue, nosebleeds. Characterized by the addition of complications, such as: bronchitis, pneumonia, pleurisy, otitis, pyelonephritis, enteritis, etc. In severe forms and untreated, the prognosis is unfavorable.

Diagnosis is based on clinical findings and microscopic detection of Leishmania in peripheral blood, bone marrow punctate, lymph nodes, or spleen. Serological reactions are used (formol, antimony and with distilled water).

Treatment. With visceral leishmaniasis, antimony preparations (solusurmin) are effective: a 20% solution of solyusurmin is administered intravenously 1 time per day. The duration of treatment is 10-20 days. If there is no effect, amphotericin B is prescribed. Antibacterial drugs are indicated for the treatment of an attached infection. Stimulating therapy is also needed: blood transfusions, vitamin therapy, etc.).

Prevention. Destruction of animals with leishmaniasis, anti-mosquito measures. Timely detection and treatment of patients with leishmaniasis.

Giardiasis

clinical picture. Allocate intestinal, hepatic and mixed forms of the disease. The first is characterized by the development of enterocolitis, colitis. There are loose stools of a fermenting nature, steatorrhea, flatulence. Intoxication is absent, appetite is not disturbed. Giardiasis of the biliary tract accompanies angiocholecystitis of various etiologies, is the cause of their exacerbation and relapse. Persistent giardiasis can lead to severe damage to the biliary tract and liver. Most often, giardiasis is asymptomatic.

The diagnosis is based on the detection of Giardia in feces or duodenal contents.

Treatment. Specific agents are furazolidone and aminoquinol.

According to their structure and shape, worms are divided into two groups: nematodes and flatworms. Flatworms are divided into tapeworms and flukes.

Trematodes are distinguished by a flat leaf-shaped body and have one or two suckers. These worms are both very small (1-3 mm) and quite large (more than 10 cm).

Cestodes - worms that have a long body, similar to a ribbon, which consists of a head, neck and individual segments. These worms reach a length of more than 10 m. The number of segments of these worms ranges from 12 to 1000.

Nematodes are worms that have an elongated, filamentous body and a round cross section. The length of nematodes varies from 1 mm to 1 m. Sometimes there are individuals of much greater length (8-10 m).

Other types of worms carry out the larval phase in one host, and in adulthood they live in another (bovine and pork tapeworm, echinococcus, etc.). Some worms have an even more complex life cycle, changing three hosts during it (wide tapeworm). Usually, adult worms live in the intestines, but there are also worms that live in the muscles, heart, liver, kidneys, brain, eyes and blood of a person. In order to stay in the tissues of the body, worms have special organs: suckers, flat hooks or peculiar teeth.

• Nematodes (roundworms);
• Cestodes (flat and tapeworms);
• Trematodes (flukes).

Nematodes are the most common type of worms, most often affecting children's organisms.

These include:

• pinworms (cause enterobiasis);
• trichinella (cause the disease trichinosis);
• roundworms (provoke ascariasis);
• whipworm (causes trichuriasis).

Cestodes (flatworms or tapeworms) include:

• a wide ribbon that provokes the disease diphyllobothriasis;
• echinococcus causes echinococcosis;
• bovine tapeworm causes teniarinhoz;
• pork tapeworm causes taeniasis;
• pygmy tapeworm provokes hymenolepiasis.

• opisthorchis causes opisthorchiasis;
• hepatic fluke or hepatic fasciola causes fascioliasis;
• The pulmonary fluke Paragonimus provokes the disease paragonimiasis.

Symptoms of helminthiases are pronounced when the helminth reaches puberty and large sizes. Therefore, common symptoms include the following:

• weight loss;
• signs of general intoxication;
• increased fatigue;
• weakness;
• dysfunction of the central nervous system;
• headaches and dizziness.

Helminths of a certain type cause specific symptoms in a child, which are due to its localization and the specifics of life. Thus, with enterobiasis, a symptom characteristic only of this disease is observed in the form of severe itching around the anus, which is especially pronounced at night. At this time, the sphincter is relaxed in the child, which allows female pinworms to freely go outside to lay eggs in the perianal folds.

• fever;
• general weakness;
• swollen lymph nodes;
• arthralgia and swelling of the legs;
• skin rashes;
• bruxism (teeth grinding during sleep);
• dry cough;
• muscle pain;
• increased salivation;
• weight loss;
• eosinophilia;
• allergic reactions;
• the presence of volatile infiltrates in the lungs;
• bronchitis;
• pneumonia;
• dyspnea.

When the larvae become sexually mature individuals, they are localized in the small intestine, where they mate and lay eggs. In this case, the disease appears with various symptoms from the gastrointestinal tract:

• nausea;
• vomit;
• stool disorder;
• diarrhea and constipation;
• stomach ache;
• bloating;
• weight loss;
• flatulence;
• loss of appetite.

A complication of ascariasis can be:

• appendicitis, since helminths are able to penetrate into the appendix;
• mechanical jaundice;
• inflammation of the pancreas;
• intestinal obstruction.

With trichinosis, the following symptoms are observed:

• muscle pain, since trichinella is able to localize in the muscles, causing inflammation in the tissues;
• high temperature above 38°C;
• swelling of the face (a characteristic sign of trichinosis).

Helminthiases caused by trematodes (flukes) are manifested by the following symptoms:

• damage to the liver and biliary tract;
• enlargement of the spleen and liver;
• the development of pancreatitis;
• disturbances in the work of the nervous and digestive systems.

Diagnosis of helminthiases in children

To identify helminthiases in children, the following clinical studies are carried out.

1. General blood analysis. In the acute stage, an increase in eosinophils is observed, which eloquently indicates an allergic reaction in the body.
2. Blood chemistry. There is an increase in biochemical tests, such indicators as ALT and AST, bilirubin, thymol test, alkaline phosphatase.
3. The most effective are serological research methods: RIF, ELISA, RNGA, RSK.
4. Until now, the most popular diagnostic method is the analysis of feces for worm eggs and scraping for enterobiasis.
5. In case of echinococcosis, instrumental methods (radiography, ultrasound, CT, MRI, endoscopy in children) are effective diagnostic methods that reveal cysts of the liver, lungs, and brain.
6. With trichinosis, a biopsy of the muscles and skin is performed in order to identify helminth larvae.
7. When opisthorchiasis examine the duodenal fluid and the contents of the duodenum.
8. Also, bile and sputum can serve as material for research.

Treatment of helminthiases in children

For the treatment of helminthiasis in children, anthelmintic drugs are used. The choice of drug is based on several factors:

It is also necessary to choose a drug that would have:

For the treatment of helminthic invasions in children, apply:

• albendazole and mebendazole are prescribed for the treatment of enterobiasis, ascariasis, trichinosis, trichuriasis;
• helminthox for children is used in the treatment of enterobiasis, ascariasis, trichuriasis, ankylostomiasis and trichostrongylidosis.
• pyrantel is prescribed for children with enterobiasis and ascariasis;
• Praziquantel is used to treat schistosomiasis, diphyllobothriasis, and taeniasis.

For successful treatment, deworming of children in preschool groups, all family members, and even pets is carried out. A necessary measure is the observance of a hygienic regime for the prevention of re-infection (reinfestation).

Additional treatment is carried out:

• antihistamines to relieve allergy symptoms,
• treatment with enzymes, sorbents and hepatoprotectors to restore the organs of the digestive system;
• to eliminate intoxication and maintain the immune system, immunocorrectors and immunostimulants are prescribed;
• glucocorticosteroids for the treatment of complications or chronic inflammatory processes exacerbated by helminthiasis.
• multivitamin and mineral complexes to improve appetite and restore the body.

Prevention of helminthic invasions in children

The main prevention of helminthiases in children is the observance of the rules of personal hygiene.

Therefore, we can name precautionary measures for the prevention of helminthic invasions.

Methods of infection

The child comprehensively studies the world around him, including tasting. He is still poorly versed in the rules of hygiene, open to communication with any animals, including street animals.

Contact with a contaminated surface

This happens on the street - from the ground, sand, benches and toys. Playing with an infected peer, using shared items causes helminthiasis.

Many children like to gnaw their hands, bite their nails, and already in adult school age they do not comply with hygiene requirements. Coming from the street, they forget to wash their hands or wash them thoroughly enough, without soap, and if only faster.

Public places, large shops and playgrounds are a serious danger to children. In places where there are a lot of people, you need to prevent the child from grabbing everything with his hands.

The use of water from reservoirs during bathing, and even poor-quality tap water, can cause helminthiasis.

Through contact with infected individuals

Through an insect bite

The presence of worms in the mother

Helminths enter the body from the outside, begin their life cycle. They lay eggs, from which larvae emerge, migrating through the body. They get into any organs and destroy them.

The main provocateurs of helminthiasis in childhood are:

Important: Almost 85% of the total number of helminthiases is recorded in children under 14 years of age.

Symptoms

• proteins;
• glucose;
• hormones;
• carbohydrates;
• vitamins.

Usually the first signs of helminthiasis appear after 2-6 weeks. The acute phase is observed up to 4 months, then the chronic phase begins.

Reference: the most common invasion is enterobiosis. They hurt most children at different ages.

When infected with pinworms

The main signs of a pinworm infection are:

Ascaris

When the larvae move through the body, multiple lesions of various organs appear. Observed:

• rise in temperature;
• enlarged lymph nodes;
• dry cough interspersed with blood;
• enlargement of the spleen and liver;
• a characteristic feature - rashes on the hands and feet, allergic dermatitis;
• appendicitis with the accumulation of larvae in the blind process.

Children also have a variety of disorders of the nervous system - drowsiness, lethargy, nervousness, sometimes convulsions and seizures.

Recall that enterobiasis is called infection with pinworms. This is one of the types of helminthiasis, the most widespread among all ages. Enterobiasis can be recognized by the following signs:

1. Burning and itching in anus. At the site of scratching, there are damage to the mucous membranes.
2. Allergy symptoms - dermatitis, conjunctivitis.
3. Weight loss and growth retardation.
4. Unsteady stool, other signs of dyspepsia.
5. Babies often get sick with various types of infectious diseases.

There is a decrease in cognitive abilities, mental instability.

Typical symptoms of invasions of various types in children:

1. Opisthorchiasis. Pathogens infect when eating fish that has not been thermally processed enough. Digestive disorders are present, the liver and pancreas are affected.
2. Toxocariasis. Accompanied by fever, eosonophilia, swollen lymph nodes. Liver, spleen, eyes, heart suffer.
3. Trichuriasis. Causes whipworm invasion. Often has no symptoms, is not diagnosed for a long time. In severe cases, diarrhea with blood is observed.

With a long course, children begin to noticeably lag behind in development, often get sick and weaken.

What is the danger of helminthiasis

Enterobiasis is often accompanied by urticaria, lesions of the mucous membranes of the genital organs, urinary incontinence.

With opisthorchiasis, the main blow falls on the liver and pancreas, as a result of which pancreatitis and cholecystitis are possible.

How to diagnose an infection in a child

Diagnostic measures:

• studies of secretions - feces on eggs, vomit, sputum, scraping from the anus, coprogram;
• serological - ELISA, RIF, others;
• blood for eosinophilia, bilirubin, alkaline phosphatase, immunoglobulin E;
• PCR study;
• tissue biopsy of damaged organs in severe lesions;
• skin allergy tests.

Ultrasound, X-ray, CT or MRI, endoscopic examinations help to check the condition of the organs.

In addition to specific drugs, a whole group of other drugs are used that contribute to the restoration of the body.

Antihelminthic drugs

All drugs are prescribed in a short course, often at one time. The dose is selected according to the body weight of the child.

For your information: treatment with antihelminthic drugs is usually prescribed to the entire environment of a sick child.

Taking probiotics

Immunostimulating drugs

Enterosorbents

An enema with soda helps with pinworms. For 250 milliliters of water, take ½ teaspoon of soda. Do it 2-3 times a day.

Before using all means, the advice of a pediatrician is necessary.

Preventive measures

A child needs to be taught from an early age to cleanliness and hygiene. Hands should be washed more often: after returning from the street, playing with animals, visiting the toilet, before eating.

Parents need to carefully monitor the child and his health. Regularly cut nails, change underwear, exclude food on the street, monitor the health of pets.

Prevention includes the formation of the correct behavior skills on the street and in public places - do not put your hands in your mouth, do not eat in dubious places.

Enterobiasis- helminthiasis caused by a round helminth pinworm.

Ascariasis- a disease caused by the helminth ascaris.

Symptoms. Clinical manifestations larval stage ascariasis are characterized by allergic manifestations, swollen lymph nodes, the development of pulmonary syndrome: the appearance of shortness of breath, chest pain, cough, and the development of severe asthmatic conditions is possible. intestinal stage ascariasis is manifested in the mechanical effect of ascaris on the intestinal walls, deterioration of the intestinal microflora, decreased gastric secretion, dyspeptic disorders, weight loss, and decreased immune status.

Ascariasis can often occur with mild symptoms: neurasthenia, dyspeptic disorders, decreased performance. But sometimes the course becomes severe - there are focal lesions of the lungs, urticaria, fever, intestinal obstruction, liver abscesses, appendicitis may develop.

1. Organization and conduct of hygienic training for kindergarten staff on the following issues:

- sanitary and hygienic requirements for the maintenance and equipment of preschool institutions;

- personal hygiene of service personnel, proper care of children, instilling personal hygiene skills in children;

- sanitary and educational work on the prevention and control of helminthiasis (basic information about helminthiasis and measures to combat them).

2. Testing sessions with staff through questionnaires or interviews.

3. Theoretical training of parents (lectures on the pathogenic role of helminths, ways of infection, prevention and sanitary and hygienic regime in the family, etc.).

11. Rickets and spasmophilia. Etiology, symptoms, care of sick children and prevention

Rickets - a disease associated with damage to the bone, muscle, nervous systems, internal organs due to hypovitaminosis D.

Etiology. One of the main factors is vitamin D deficiency of exogenous or endogenous origin. In addition to improper feeding and nutritional deficiency of vitamin D, it can also be caused by a violation of the formation of its active forms in the body with a lack of ultraviolet rays (in winter and autumn, in cities), diseases of the liver and kidneys (they form active forms of the vitamin). A certain role is played by prematurity (immaturity of enzyme systems), rapid growth of the child, insufficient intake of calcium and phosphorus salts.

clinical picture. According to severity, the following degree of rickets:

I degree (light)– small changes in the nervous and muscular systems; does not give residual effects.

II degree (moderate) – pronounced changes in the bone, muscle, nervous and hematopoietic systems, moderate dysfunction of internal organs, a slight increase in the size of the liver and spleen, anemia;

III degree (severe) – pronounced changes in the central nervous, skeletal and muscular systems, internal organs. Frequent complications.

Initial period more common on 2 – 3rd month, but may appear throughout the first year of life. Sweating, nape baldness, anxiety, muscular dystonia; unsharp softening of the edges of a large fontanel. Duration 2 – 3 weeks There are no radiological changes.

AT peak period diseases, along with the phenomena of inhibition of the nervous system, changes in the bones appear; changes in the bones of the skull, chest, limbs. Bone changes, hardly noticeable with rickets of the I degree and distinct with the II degree, turn into deformation with rickets of the III degree. Violations of static functions, functions of internal organs, muscle hypotonia are revealed, anemia is added. With rickets II and III degree, the spleen and liver are enlarged. On 2 – At the age of 3, there are only consequences in the form of bone deformities, sometimes anemia.

At acute course there is a rapid development of symptoms of rickets. In the initial period – severe anxiety, severe sweating, in the midst of the disease, a significant softening of the bones, severe hypotension of the muscles. The acute course is observed more often in the first months of life, especially in premature and rapidly growing children.

Subacute course characterized by a slower development process. More common in children older than 6 – 9 months, as well as in children with malnutrition. The phenomena of bone softening are much less pronounced. Osteoid hyperplasia prevails over osteomalacia, there are frontal and parietal tubercles, rosaries on the ribs, thickening of the epiphyses of tubular bones.

Recurrent course accompanied by intermittent conditions, usually better in summer and worse in winter.

Care of sick children. An important role is played by rational nutrition, normalization of the regimen with sufficient exposure to fresh air, massage, and gymnastics. Taking prescribed vitamin D preparations, calcium and phosphorus salts; ultraviolet therapy.

Forecast with timely treatment and elimination of the cause, it is favorable. In severe cases, there may be a delay in psychomotor development, skeletal deformity and impaired posture.

Prevention. Rational nutrition, sufficient insolation, outdoor stay, sanitary and hygienic regime, hardening, proper education. Vegetables and fruits should be introduced into the child's diet in a timely manner. Complementary foods should contain a sufficient amount of vitamins, salts. Foods containing natural vitamin D 3 (egg yolk, fish oil) are important. The addition of citric acid (25% solution, 1 teaspoon 3 times a day) to the nutrition of an artificially fed child promotes the formation of easily absorbed calcium citrate, and, consequently, the absorption of phosphorus. Flour dishes, cereals contain phosphorus in a form that is poorly digestible by a child and can contribute to the development of rickets, therefore it is desirable that their number in the daily diet of a child of the 1st year of life does not exceed 180 – 200

Spasmophilia - a disease of young children, characterized by a tendency to tonic and clonic-tonic convulsions due to hypocalcemia.

Etiology. The content of calcium in the blood serum in rickets decreases in the initial phase, during exacerbation. Calcium absorption is also impaired in digestive disorders and intestinal infections. In connection with the drop in the level of calcium, the excitability of the nervous system increases significantly, up to a convulsive syndrome.

Symptoms. Latent spasmophilia is detected when examining the symptoms of Khvostek (tapping with a finger at the exit point of n. facialis on the zygomatic arch and in the angle of the lower jaw causes a rapid contraction of the facial muscles), Trousseau (squeezing the shoulder with a tonometer cuff or fingers causes a spasm of the muscles of the hand – "obstetrician's hand"), flexion of the fingers when tapping in the region of the external condyle of the elbow).

Manifest spasmophilia manifested by generalized tonic and clonic convulsions, spasm of the muscles of the hand – "obstetrician's hand", sometimes paroxysmal laryngospasm in the form of a slight narrowing of the glottis or short-term, but complete closure.

The diagnosis is made on the basis of the child's signs of rickets and symptoms of increased neuromuscular excitability, the detection of hypocalcemia, and alkalosis.

First aid during an attack. At laryngospasm– fresh air, splashing with cold water, ammonia vapors, patting on the body, changing the position of the body. For convulsions - anticonvulsants prescribed by a doctor in suppositories or medicinal enema, call an ambulance.

Forecast favorable with timely treatment.

Prevention - see Rickets.