Symptoms of rickets in a 6 year old child. Causes and mechanisms of development of rickets

The disease called “rickets” is heard by many people. However, not everyone knows what exactly it is. From childhood I remember that thin and weak children were figuratively called “rickets,” but no one remembers why.

Of course, these days it is enough for the pediatrician who is observing the baby to have knowledge about the symptoms and treatment of rickets in children. But it is also useful for parents to familiarize themselves with information about this, because the disease overtakes children at a very early age, starting from the first months of a baby’s life.

Rickets is a disease that is caused by a lack of vitamin D in the body, leading to disruption of calcium-phosphorus metabolism, which in turn leads to changes in the process of bone formation and disorders of other vital functions of the body.

In our country, the diagnosis of “rickets” is often made, but in the vast majority of cases, when physiotherapy and vitamin D (calciferol) are prescribed as treatment, this is enough to eliminate any suspicion of the development of the disease.

Causes of rickets in children

Rickets affects children from 2 months to 3 years. But the main danger is age under one year.

Vitamin D is formed in the human body under the influence of UV rays. This radiation can be obtained while under the open sun. A small part of the radiation is also received in cloudy weather, if a person is outdoors. This type of radiation does not penetrate through glass.

The causes of rickets are different, but there is a risk group. This:

• severe pregnancy: toxicosis, concomitant diseases, difficult childbirth;
• black children;
• overweight children;
• children with low immunity, who are often sick;
• children born in winter and autumn. The fact is that babies receive calciferol in the mother’s stomach, in the last stages of pregnancy. And if a pregnant woman has not been in the sun much, then both she and the baby will experience a deficiency of bone formation elements. If the baby is also not exposed to the sun in the first months of life, then the vitamin simply has nowhere to come from;
• premature babies. They do not have time to receive an important vitamin from their mother through the placenta.

Once born, babies begin to quickly gain weight and grow, so they quickly encounter a shortage of cellular building materials.

The main reasons for the development of the disease

1. A rare stay in the open air. A high-tech urban environment implies some difficulties with walking in the fresh air, because there is dust, exhaust fumes, wind, dirt, etc. all around. Therefore, parents of a newborn often hide it in a stroller during walks so that light does not penetrate there. As a result, it turns out that the baby went for a walk, but did not receive ultraviolet radiation.
2. Poor nutrition. If the baby switches to complementary feeding, you need to monitor the variety of his diet, be sure to include fish, seafood, eggs, milk, and cheese. If the baby is still small, but for some reason the mother cannot breastfeed him, you should take a responsible approach to choosing the formula so that it contains everything necessary for the diet.
3. Metabolic disease. If a child has a problem with mineral metabolism or, for example, a pathology of the kidneys or liver, then vitamin D may simply not be absorbed by the body, no matter how much you walk the baby outside.

Signs and symptoms of rickets in a child by form of the disease

There are primary and secondary forms of rickets. They differ in the method of origin of the disease.

Primary rickets appears as an independent disease; it is the most common form of the disease, especially in infants. Secondary rickets will be considered separately.

Secondary rickets

Appears against the background of a precursor disease, which leads to disruption of metabolic processes in the body, and, as a consequence, a lack of vitamin D and disturbances in calcium and phosphorus metabolism in the patient’s body.

Among the causes of secondary rickets, diseases such as hepatic rickets, phosphate deficiency, renal tubular acidosis may be observed; the cause may be treatment for seizures, since seizures accompany the process of massive intake of calcium into the bones. With long-term use anticonvulsants the work of vitamin D is blocked, provoking the production of a protein that transports calcium to the bones.

With hypophosphatization, changes in the structure of the skeleton are pronounced, the patient's legs remain short and crooked.

Hepatic rickets is characterized by the fact that vitamin D is no longer absorbed by the body.

Changes in the body due to vitamin D deficiency

Changes in the body are characterized by a pronounced cumulative effect. The disease first manifests itself with minor symptoms in a latent form, although the body at this time is already in a critical condition.

At the stage when the softening of the bones and the removal of calcium and potassium ions from their composition becomes obvious, the disease has already developed so much that it is almost impossible to stop it without any consequences. This happens because treatment also has a cumulative nature. You cannot solve the problem by giving your baby a shock dose of vitamin D. This can lead to serious consequences for the body.

Only 10% of this important vitamin enters the body through food. The rest must be produced in the skin independently. This means that therapy should include a whole range of measures, the sum of which will allow the child’s body to overcome the disease and recover.

Symptoms of rickets in infants

In infants, the first symptoms of rickets may not be recognized by either parents or pediatricians. Typically, the onset of the disease is between 3 and 4 months of age.

These are usually behavioral signs rather than clinical symptoms.

The baby begins to behave poorly, becomes restless, and all day and night routines are disrupted. The child eats little, but often asks to eat, has problems with bowel movements, sleeps poorly, often wakes up and falls asleep.

The baby behaves restlessly, including during sleep. He tosses and turns, sweats, and the smell of sweat is sour. Because of all this, the hair on the back of the baby’s head begins to roll down, and the back of the head becomes bald.

Symptoms of rickets in children aged 1 to 2 years

Most often, rickets, which is found in children after one year, is a subacute form and lasts from infancy; it’s just that the severity of the clinical symptoms was not enough to carry out tests and make a diagnosis. Symptoms of rickets in children 2 years old can be attributed to character traits, childhood experiences, and age-related changes.

Therefore, often the main factors in detecting the disease are changes in the bone structure: scoliosis, gait disturbance, and curvature of the legs.

Acute course of the disease in children over a year old is rarely observed, since children in this age period hardly gain weight, and the growth functions of the body are aimed at stretching the skeleton, and not at increasing body weight. Due to this, the body's needs for nutrients are not critical.

Main symptoms:

• scoliosis;
• muscle weakness;
• change in the structure of the chest (indentation);
• protruding, bloated belly;
• curvature of limbs;
• nervous abnormalities.

Accompanying these symptoms frequent illnesses respiratory tract, limb fractures, pathologies of the heart, liver, spleen.

Changes in the bone apparatus

1. The appearance on the skull of areas with softened bone cover. Because of this, the shape of the head changes: it protrudes frontal bone, temporal lobes, the back of the head, on the contrary, becomes flat because the child constantly lies on it.
2. Decreased muscle tone and the entire body. The baby gets tired quickly and moves little. Does not begin to roll over, sit or crawl with peers.
3. Due to the fact that the bones become soft, deformation of the chest begins, it seems to be pressed inward, while the abdomen increases in size and looks very swollen.
4. Bone thickenings are observed in the wrist area.
5. Nodules appear on the ribs, which can be seen upon external examination. They are called rachitic rosaries.
6. Curvature of the spine and scoliosis are observed.
7. The large bones of the legs begin to bend under the weight of the body, the legs take on the appearance of two symmetrical arches. The deformity when the legs form a circle shape is called varus, the reverse deformity, in the shape of the letter X, is called valgus.
8. The eruption of teeth may slow down, they may begin to grow in the wrong order, in the future the teeth will be fragile and painful, and problems with orthopedic teeth are possible.

With proper treatment, most symptoms, such as crooked leg bones, can be eliminated, but spinal problems will remain forever.

Tissues and internal organs

Often, against the background of changes in the skeletal system, there is a decrease in immunity, diseases lymphatic system, enlarged liver and spleen.

There is a decrease in muscle tone and general lethargy of the body. The child lags behind his peers in psychomotor development.

Your baby may develop a fear of bright lights or sounds. At the same time, he is generally nervous and irritable, and cannot fully relax and spend time fully and actively.

On late stage The disease causes severe damage to the central nervous system.

In modern conditions, the disorder can be brought to such a degree only with the complete connivance of the parents; usually the disease is detected and treatment begins at an earlier stage. In everyday practice, there is a tendency towards reinsurance of medical personnel. This is expressed by the fact that vitamin D preparations are prescribed to children at the slightest suspicion of the development of rickets. Even if the diagnosis is not correct, prevention does not affect their health in any way.

Classification of rickets

Rickets is classified according to a number of parameters. Depending on the degree of damage to the body, mild, moderate and severe stages are distinguished. According to the phases of the course of rickets, there are the initial stage, acute stage, recovery stage and observation period residual effects.

According to the nature of development, the disease is divided into acute, subacute and chronic. The acute form is typical for children of the first year of life. This is due to the fact that at this age children gain weight up to 2 kg per month. In the first months of life, the baby’s body weight increases monthly by almost one and a half times. Therefore, all life support systems operate in emergency mode. Any malfunction in the body can lead to a deficiency of vitamins, including a bone formation stimulator.

The subacute form is expressed in slow development, protracted processes, which increases the risk of late detection of the disease, which complicates therapy.

A chronic disease is characterized by relapses. This is possible when therapy is not followed in full, or when preventive measures are not followed, that is, when conditions for the occurrence of rickets are repeatedly created. With secondary rickets, relapses can occur if the disease - the causative agent - cannot be completely cured.

Algorithm for the development of rickets in children

As the disease progresses, changes in the body begin in the following order:

• nervous and skeletal system: irritability and fearfulness, sleep and rest disturbances, proliferation and softening of bone tissue, growth disturbance.
• disturbances in the functioning of the muscular and cardiovascular systems, pathology of the respiratory system, and gastrointestinal tract are added
• severe complications of all of the listed symptoms of rickets in children

Treatment of rickets in children consists of complex therapy, which includes:

• taking vitamins
• treatment of concomitant diseases;
• to eliminate muscle hypotonicity;
• compliance with the baby’s diet and daily routine;
• physiological procedures.

If a child has been diagnosed with rickets, it is not enough to simply stop the symptoms. Further actions should prevent consequences and relapses as much as possible.

Therapy takes on the same cumulative nature, the rehabilitation period takes months and years, but even after the crisis has passed and there are no visible consequences, all preventive measures should be strictly observed.

Which doctor should I contact?

If you suspect the development of rickets in your baby, make an appointment with your pediatrician. The general practitioner will examine the patient and either prescribe treatment or refer you to an endocrinologist. This doctor will also conduct an examination. To confirm the diagnosis, a biochemical blood test is prescribed. In severe cases, patients are sent for skeletal x-rays to properly assess the damage to the body. Further treatment is carried out under the supervision of an endocrinologist.

Vitamin therapy

Treatment involves taking vitamin D in medicinal form according to a strict regimen. The severity of the symptoms of rickets in young and older children does not affect the dosage, since an overdose is dangerous due to intoxication of the body.

Doctors often prescribe water-based calciferol preparations without additives because it is easier to control the dose. One drop contains the daily requirement of the vitamin.

For children under one year of age, the drug is diluted in a few drops of water or milk to ensure that the required amount enters the body. Children of any age are given medicine from a spoon, and not directly from the bottle, to avoid an overdose.

Massage

Massage is part of general restorative therapy, which is prescribed to eliminate muscle hypotonicity. When the muscles return to normal, they tighten the bones and joints and help normalize their condition. To align the bones, the mechanisms of their support are developed and trained.

Nutrition

The correct diet for children includes fish, eggs, dairy products, and greens. A balanced diet does not create unnecessary stress on the gastrointestinal tract. Don't forget about water balance; it is important for children to get enough fluid in proportion to their expenses.

Pregnant women and nursing mothers should be no less careful about their health, which affects the child.

Prevention

Prevention means:

1. Maintaining a daily routine. This will ensure rest and correct metabolic processes.
2. Walking in the fresh air is an effective preventive measure for the full production of calciferol. According to Dr. Komarovsky, five to ten minutes in the sun is enough, even if only the baby’s face and hands are exposed, to get a dose of vitamin D for two to three days.

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

Characteristics of rickets in children

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

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

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

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

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

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

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

Causes of rickets in children

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

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

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

Pronation (dislocation of an arm or leg)

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

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

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

Symptoms and signs of rickets in children

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

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

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

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

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

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

Why don't doctors prescribe vitamin D?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

But even a fairly mild form of rickets can lead to curvature of the bones (hence the so common occurrence in adults with crooked legs, protruding ribs, “chicken” breasts, and protruding shoulder blades).

Treatment of rickets in children

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

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

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

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

Prevention of rickets in children

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

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

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

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

Before giving the baby, vitamin D is pipetted into a small amount (spoon) of breast milk or formula. Then the diluted vitamin is given to the child to drink.

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

The first mentions of the symptoms of rickets in children have reached our days from the works of the two hundredths of our era, but the first scientific interpretation of this pathology was given five centuries ago by the English orthopedist Gleason. Children with rickets exist all over the world, but children of the Negroid race are most predisposed to hypovitaminosis D, and therefore to the development of rickets.

Diagnosis of rickets in a child and causes of the development of the disease in children

The severe disease rickets, also known as “vitamin D deficiency,” develops in conditions long-term shortage vitamin D. Since in recent decades civilization has reached a fairly high level of development, since the average standard of living has become quite high, children, as a rule, are provided with food that contains all the necessary substances; it is extremely rare that we observe the so-called “blooming” rickets. Speaking about the symptoms and treatment of rickets in children, we usually mean individual manifestations of this disease, which arose not so much in connection with poor nutrition, but as a result of impaired absorption of nutrients in the intestines due to impaired absorption of vitamin D.

The main cause of rickets in children is vitamin D deficiency or prolonged hypovitaminosis D due to impaired metabolism of this important vitamin. When the body lacks vitamin D, the intestinal absorption of vitamin D is impaired. minerals, as calcium and phosphorus salts. The named salts are building materials for bone tissue, and in conditions of their deficiency, bone tissue begins to suffer - bones quite quickly soften and become deformed. Other systems of the body also suffer - nervous, cardiovascular, hematopoietic, respiratory, muscular. Vitamin D can be formed in small quantities in the skin under the influence of sunlight (ultraviolet part of the spectrum). And too little exposure of a child to the sun is one of the unfavorable factors that can contribute to the development of rickets. Vitamin D deficiency in the body can also develop as a result of certain intestinal diseases accompanied by impaired absorption of vitamin D. Such diseases include enterocolitis, celiac disease, etc. Some diseases of the pancreas and liver also cause poor absorption of vitamin D in the body. Very rare The reason for the development of rickets in children is a violation of the process of reabsorption of phosphates in the kidneys (this pathology is inherited). If a mother did not eat properly during pregnancy, her baby may subsequently show signs of rickets. Other causes of rickets are protein deficiency and insufficient intake of calcium and phosphorus salts into the body.

How does rickets manifest in a child: signs of the disease in children

How does rickets manifest in a child, and what are the main symptoms characteristic of this disease? Certain manifestations of this serious disease can be detected in a baby already in the third or fourth months of life. A sick child is restless, irritable, whiny, and fearful. One of the manifestations of rickets in children is sleep disturbance. The child is characterized by increased sweating. The mother may notice that the baby sweats most intensely on the head; Every time she takes the baby out of the crib, she discovers a damp spot on the pillow.

Gradually (if treatment is not started), the child’s general condition becomes more and more severe. The child does not eat well, his subcutaneous fat layer becomes thinner and disappears, and bluish strands of veins can be seen through the pale skin. Also signs of rickets in children are increased and frequent vomiting. Shortness of breath and tachycardia are noted.

As can be seen in the photo, with rickets in children, characteristic changes appear in the skeletal system:

During the disease, the bones of the skull soften (craniotabes); osteoid tissue grows; the large fontanelle does not close by the time it should close; there is deformation of the bones of the head; head size increases; tubercles appear - frontal, parietal; the back of the head becomes flattened; malocclusion occurs; the bridge of the nose sinks (and at the same time exophthalmos develops); gradually gains irregular shape chest (as if compressed from the sides, with the sternum directed forward, it resembles a chicken breast, which is what it is called “chicken breast”); “rosary beads” are formed on the ribs, which are small thickenings.

In children suffering from rickets, the tubular bones of the lower extremities also suffer over time: When a child begins to walk, the legs bend under the influence of the body weight. If the bones bend outward, a 0-shaped curvature is visible; if the bones bend inwards, an X-shaped curvature develops.

Look at the photo - a characteristic symptom of rickets in children is flat feet:

A rachitic child may experience bone fractures when falling (fractures are not typical for a healthy young child). With rickets, the spine is bent - like kyphosis or lordosis. The bones of the wrists and ankles thicken. The pelvic bones become flatter.

A child suffering from rickets erupts teeth with great delay. The tone of the abdominal muscles and smooth muscles of the intestine with rickets is reduced, as a result of which the baby’s abdomen is enlarged in size; Such a belly of a rickets child is called “frog-like.” The baby's stool is abundant; there are frequent constipation or, conversely, diarrhea. The child may experience seizures. The body's resistance during rickets is significantly reduced; rachitic children are more likely than other children to develop pneumonia and tuberculosis.

Due to impaired tone of the respiratory muscles and due to deformation of the chest, the child’s ventilation of the lungs is impaired, and breathing suffers from this. Areas of atelectasis may form in the lungs. One of the complications of rickets in children is frequent pneumonia, and these diseases are very severe. A child suffering from rickets often exhibits anemia.

Treatment of children with rickets

For successful treatment of rickets in children, the earliest possible diagnosis of the disease is of great importance. If rickets has not yet developed strongly, it will be easier to cure. And, what is very important, with timely treatment of rickets in young children there are fewer irreversible consequences. Treatment - long-term and complex - is prescribed by a doctor.

Features of treatment depend on etiopathogenetic factors and the severity of the disease. A sick child must be provided with adequate nutrition. Regular exposure of the baby to the sun and fresh air is important.

When a child is diagnosed with rickets, if the disease has developed as a result of hypo- and avitaminosis D, this vitamin is prescribed in therapeutic doses. In those cases where the cause of the disease is a malabsorption of vitamin D in the intestine, the diseases that led to the malabsorption are first treated.

Children who have developed rickets due to impaired reabsorption of phosphates in the kidneys are treated by introducing phosphates and vitamin D into the body.

Below are photos of symptoms and treatment of rickets in young children:

How to treat a child suffering from rickets using folk remedies

• take the child a decoction of the herb trifid; Preparation of the decoction: pour 1 tablespoon of dry herb with a glass of water, boil over low heat for no more than 15 minutes, then, wrapped in a towel, leave for 3-4 hours, strain; take 1 tablespoon 3 times a day;
• take equal quantities of white cabbage, carrots and beets, boil for about half an hour; to kid infancy take the decoction several times a day;
• take your child an infusion of walnut leaves; preparing the infusion: place 1 tablespoon of dry, crushed leaves in a preheated container, pour a glass of boiling water and, wrap it up, leave for about an hour, strain; take 1 teaspoon 3 times a day before meals;
• give the child general warm baths with a decoction of oat straw added to the bath water; preparing the decoction: cut 1 kg of dry straw into smaller pieces and add a bucket of water, boil for at least half an hour, strain, pour the resulting decoction into the bath;
• give the child general warm baths with an infusion of pine needles added to the bath water; preparing the infusion: pour 50-100 g of dry pine needles into a bucket of water and leave for at least 8 hours, then strain and add to bath water; alternate with baths with the addition of other products;
• a child of the first year of life regularly takes general warm baths with the addition of a decoction prepared from the following mixture of plant materials: Scots pine needles - 1 part, hay dust - 1 part, oat straw - 1 part, walnut leaves - 1 part, rhizomes with the roots of calamus - 1 part; preparation of the decoction: 200-300 g of the dried mixture, crushed to a powder, pour 1-2 liters of boiling water and heat in a boiling water bath for at least 15 minutes, then leave the product in a sealed container at room temperature for about half an hour, strain through 1-2 layers of gauze, squeeze out the remaining raw materials, pour the finished broth into bath water, stir; take the procedure at a water temperature of 36-37.5 ° C; duration of the procedure - no more than 8 minutes; You can add table (iodized) salt to the water for a full bath with a decoction of this mixture in the amount of 50-80 g per 10 liters of water.

Prevention of rickets in young children

To avoid having to resort to treatment for rickets in children, disease prevention comes to the fore. Even during pregnancy (in the last few months of pregnancy), a woman is given vitamin D for prophylactic purposes. To prevent the development of rickets in an infant, a nursing mother should take this vitamin. If the mother takes vitamin D regularly (in doses agreed with the doctor), then the child receives the vitamin through breast milk and does not suffer from hypovitaminosis.

Children who are on mixed or artificial feeding are given vitamin D in the form of one of the preparations - and strictly in the dose calculated by the pediatrician. Vitamin D supplementation for preventive purposes is carried out continuously throughout the entire first year of the baby’s life.

The prevention of rickets in young children with fish oil is very effective. The latter contains vitamins A and D2 in fairly large quantities. Prevention of rickets with fish oil is carried out as follows: the child is given fish oil for a month, then a two-week break is taken, after which the administration of fish oil is resumed.

Regular sunbathing for your baby will also help him avoid rickets. It is best to sunbathe in the morning and evening, when the spectrum of sunlight contains more ultraviolet rays and less infrared rays. It is impossible to sunbathe at home near a closed window because ultraviolet rays do not pass through the glass. In winter, the child can be irradiated with a quartz lamp. When walking with your baby during the cold season, you need to make sure that the sunlight hits the baby's face. Useful physical exercise and massage.

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Diseases associated with deficiency conditions are quite common in children. Not only infants, but also older children can get sick from them. Today we will talk about rickets in children over one year old.

What it is?

Rickets is a childhood pathology associated with pronounced violation calcium-phosphorus metabolism. This pathological condition is caused by various reasons that cause vitamin D deficiency or calciferol in the body. Normally this is biological active substance participates in the internal metabolism of calcium and phosphorus, which ensures normal concentrations of these substances.

Typically, early unfavorable signs of rickets appear in a child in the first months and within 1 year after birth. However, the disease is also registered in children and at older ages.

According to statistics, children living in northern countries are more susceptible to this disease.

Boys get rickets as often as girls. Severe vitamin D deficiency in children’s bodies leads to disruption of the exchange between calcium and phosphorus. Both of these substances provide bone strength. When calcium-phosphorus metabolism is disturbed, the child develops various unfavorable symptoms associated with a severe deficiency of biologically active substances.

Usually, the first signs of rickets are detected by a pediatrician during regular examinations of the baby. Diagnosis of the disease does not cause significant difficulties for medical specialists.

Various reasons lead to the development of the disease in children, which contribute to a decrease in calciferol levels. In some cases, the impact of causes may be combined. Find out which ones exactly causal factors caused the baby to become ill - very important. Only eliminating the cause of the disease will lead to a complete recovery of the child.

The peak incidence of rickets occurs in infancy. Typically, the first manifestation of rickets occurs during the first three months after the birth of the child. In some cases, with a mild course of the disease, clinical signs are not visible, which greatly complicates diagnosis. In such a situation, the diagnosis, as a rule, is established only by the age of 2-3 years.

The most common causes leading to calciferol deficiency in children include:

• Insufficient intake of vitamin D from food. In babies under one year of age, this is caused by rapid cessation of breastfeeding. In older children, the cause of an exogenous deficiency in calciferol intake is unbalanced and good nutrition. A lack of animal products and a vegetarian diet can cause rickets in a baby.
• Accommodation in the northern regions. The lack of solar insolation leads to the fact that an insufficient amount of endogenous (internal) vitamin D is synthesized in the child’s body. Exposure of the skin to ultraviolet rays causes a cascade of biological reactions in the baby that trigger the synthesis of calciferol.

Children who live in countries with long winters and short daylight hours, according to statistics, have a higher chance of developing rickets than their peers living in the south.

• Chronic diseases of the digestive system. The leading role is given to intestinal pathologies. Chronic enteritis accompanied by severe malabsorption various substances from food, often leads to the formation of various deficiency conditions in children. In this case, the unfavorable symptoms of rickets cannot be dealt with without treating the underlying disease.
• Prematurity and congenital pathologies. The birth of a baby earlier than planned is often the trigger for the development of rickets. This can be explained by the fact that premature baby formation of many is not completed internal organs. Intrauterine development disorders often cause various problems with health in the future.

Symptoms

The development of the disease undergoes several successive stages. The initial period of the disease is accompanied mainly by the appearance of vegetative disorders. This is manifested by disturbances in the baby’s behavior and mood. The child becomes nervous and easily irritated by small things. Children lose interest in their favorite games and try to limit active movements. Usually the initial stage lasts about a month.

This period of the disease is also characterized by the appearance of a characteristic symptom - the child’s sweating increases. Its smell also changes. The sweat becomes acrid and sour. Its abundant secretion on the skin contributes to the development of irritation and prickly heat. Children often scratch the affected areas of the skin. The change in the smell of sweat is explained by a change in its chemical composition and its constituent electrolytes due to impaired metabolism.

After the lapse of initial stage, the disease enters its peak period. This is a more unpleasant time, characterized by the appearance of numerous symptoms. The baby develops the first deformations of bone tissue. Basically, all tubular and flat bones which are actively growing. Diagnosis of the disease at this time is not difficult and does not pose a problem for the doctor.

The severity of clinical symptoms may vary.

Severe disease in children older than one year is quite rare.

The child has a characteristic curvature of the spine - scoliosis. The density and thickness of the collarbones changes. They come forward a little. The architecture of the chest structure is also disrupted.

The ribs are somewhat flattened, the intercostal spaces change. Some children develop characteristic signs of rickets: depression or bulging of the lower third of the sternum. Since ancient times, characteristic names for these conditions have been used - "shoemaker's breast" and "chicken breast". The child's appearance changes greatly. Typically, these signs appear in babies who are diagnosed too late.

The child's lower limbs change shape. They become O- or X-shaped. Typically, this symptom appears in children with severe rickets by the age of five. In order to identify this symptom, you should look at the baby from different angles. Usually the curvature of the lower extremities is clearly visible from the side.

Also during the height of the disease Muscle hypotonicity appears and various neuromuscular pathological conditions occur. In a horizontal position in sick babies it is clearly visible "frog belly". Upon examination, the child’s tummy becomes flattened and hangs somewhat towards the side surfaces of the body. This symptom is due to the presence of pronounced hypotonicity of the muscles that make up the anterior abdominal wall.

Bone deformations of the skeleton also lead to disturbances in the functioning of internal organs. Pathologies of the chest contribute to a decrease in the ventilation capacity of the lungs, which leads to the development of emphysema and other pathological conditions. Impaired breathing affects hemodynamics and vascular tone. Such combined conditions lead to the baby having problems with the functioning of the heart muscle and blood vessels.

Hypotonicity of the abdominal wall muscles and pronounced curvature of the spine contribute to compression of the internal organs. In some cases, this leads to disturbances in the functioning of the liver and spleen. Pathologies of bone tissue contribute to the development of numerous orthopedic diseases in the baby, which require appropriate treatment. On average, the peak period lasts several months.

Timely treatment helps normalize the child’s condition and improve his appearance.

The period of convalescence or recovery can range from 2 to 4 months. In some cases it lasts up to six months. If a child has suffered severe rickets, then residual symptoms of the disease may persist for a couple of years from the moment of convalescence. Usually they disappear completely after a course of rehabilitation measures.

Diagnostics

Signs of rickets in children should be detected as early as possible. Timely diagnosis will help to avoid the development of long-term complications in the child and will help return the baby to an active life. A doctor can identify the very first signs of the disease and suspect rickets during regular examinations. After a clinical examination of the child, the doctor prescribes additional tests to clarify the severity of the disorders and confirm the established diagnosis.

The following studies are used to identify the disease:

• Measurement of calcium and phosphorus in the blood. Normally, the calcium level should be 2.5-2.7 mmol/l, and phosphorus - 1.3-2.3 mmol/l. A decrease in these indicators in a child below the age norm indicates the presence of signs of calcium-phosphorus metabolism disorders.
• Determination of alkaline phosphatase. This enzyme is actively involved in the exchange between calcium and phosphorus. Normally it is up to 200 U/l. An increase in this indicator indicates the presence of metabolic disorders in calcium-phosphorus metabolism.
• Radiography. Allows you to clarify the presence of bone deformations and disruption of skeletal architecture caused by the disease. Using bone radiography, it is possible to identify specific signs characteristic of rickets: “rickets bracelets”, pathological curvatures of the spinal column, “rickets rosaries”, pathologies of the chest, bone compactions in the tubular bones. This method can only be used according to strict indications.
• CT scan. It is carried out for the same reasons as radiography of bone tissue. This method has a higher resolution and allows you to obtain the maximum exact result. The use of computed tomography allows doctors to assess the level of damage and the degree of functional impairment.

Consequences

The prognosis of the disease in children is greatly influenced by timely diagnosis and treatment. If rickets is detected in a child in the earliest stages, then, as a rule, negative complications of the disease do not occur. If the diagnosis is delayed, the baby may experience various long-term consequences of the disease, which require mandatory rehabilitation measures. The frequently encountered consequences of rickets transferred to childhood, include: moderate decrease in muscle tone, slight curvature of the lower extremities, malocclusion and others.

To eliminate the unfavorable symptoms of the disease, several therapeutic methods. The effectiveness of prescribed therapy is monitored with mandatory determination of calcium levels in the blood. During the treatment, the clinical condition of the child is also assessed. When therapy is prescribed, the baby should feel better and become more active.

Used to treat rickets in children the following principles treatment:

• Regular walks in the fresh air. Sunlight insolation is necessary for a baby suffering from rickets. Ultraviolet rays have a pronounced therapeutic effect on the children's body, increasing the internal synthesis of calciferol. Your baby should take walks in the fresh air every day. Only regularity and systematicity will allow you to achieve good and lasting results.
• Purpose medicines, containing vitamin D. Many doctors prefer water-soluble forms. The dosage of the drug should be determined by the attending physician individually for each child.

Independent selection of a therapeutic dose is unacceptable! Such self-medication can contribute to the development of a very dangerous condition in the baby - an overdose of vitamin D.

• Complete nutrition. Your baby's daily diet must include foods rich in calciferol. These include: meat, chicken, fish, eggs, milk and dairy products, cottage cheese, cheese. The baby must eat a variety of dishes that contain vitamin D. If the child receives medications with calciferol, then the diet must be discussed with the attending physician in order to avoid an overdose of this vitamin in the child’s body.
• Carrying out physiotherapy. A course of UFO (ultraviolet irradiation) helps children suffering from rickets improve their overall well-being and increases bone density. Usually it consists of 12-15 procedures. Their duration can vary: from 2 to 10 minutes. Physiotherapy has a number of contraindications and is prescribed by the attending physician.

To learn about what rickets is in children and how to treat it, see the following video.

Quite often, during the next visit to the pediatrician with a 3-4 month old child, parents may hear from the doctor a diagnosis of “rickets.” Many parents have very vague and superficial ideas about this disease; they do not know the main symptoms of the disease and have no idea possible treatment. So what is rickets and why is it dangerous when detected in children?

Rickets is a disorder of the exchange of phosphorus and calcium in the body, resulting from a lack of vitamins of group D. First of all, the absorption of calcium ions from the intestine deteriorates, and as a result of its lack, demineralization and curvature of the bones occurs.

What is vitamin D for?

Vitamin D is produced in the skin under the influence of sunlight and only a small part of it enters the body through food.

• Promotes the transport of calcium through the intestinal wall.
• Enhances the retention of calcium and phosphorus ions in the renal tubules, which prevents their excessive loss in the body.
• Promotes accelerated absorption of bone tissue with minerals, that is, strengthens bones.
• It is an immunomodulator (regulates the state of the immune system).
• It has a positive effect on the metabolism of tricarboxylic acids, as a result of which a lot of energy is released in the body, necessary for the synthesis of various substances.

Vitamin D (90%) is produced in the skin under the influence of ultraviolet rays, and only 10% of it enters the body with food. Thanks to it, calcium is absorbed in the intestines, necessary for the body for normal bone formation, proper functioning of the nervous system and other organs.

With a long-term lack of vitamin D in children, processes of bone tissue demineralization begin. This is followed by osteomalacia (softening of long bones) and osteoporosis (loss of bone tissue), which lead to gradual curvature of the bones.

Most often, children aged from 2-3 months to 2-3 years suffer from rickets, but children under 1 year of age are most vulnerable.

Causes of the disease

If there is only one cause of rickets - a deficiency of vitamin D in the child’s body, and as a result - a decrease in calcium levels, then there are a lot of factors that provoke the disease. Conventionally, they can be divided into several groups:

1. Insufficient insolation due to the baby’s infrequent exposure to fresh air, and the associated decrease in the formation of vitamin D in the skin.

1. Errors in nutrition:

• artificial feeding with formulas that do not contain vitamin D, or the calcium-phosphorus ratio is disturbed, which makes the absorption of these elements difficult;
• late and incorrect introduction of complementary foods;
• foreign breast milk often causes poor calcium absorption;
• the predominance of monotonous protein or fatty foods in the diet;
• malnutrition of a pregnant woman and mother feeding her baby with breast milk;
• introduction of predominantly vegetarian complementary foods (cereals, vegetables) without a sufficient amount of animal protein in the baby’s diet (egg yolk, cottage cheese, fish, meat), as well as fats (vegetable and animal oils);
• a state of polyhypovitaminosis, a particularly noticeable lack of vitamins B, A and some microelements.

1. Prematurity and large fetus:

• prematurity is one of the leading causes of rickets in a baby, since phosphorus and calcium begin to flow intensively to the fetus only after the 30th week (at 8 and 9 months of pregnancy), so premature babies are born with insufficient bone mass;
• It should also be taken into account that due to the relatively rapid growth of premature babies in relation to babies born at term, they need a diet rich in calcium and phosphorus;
• Large babies require much more vitamin D than their peers.

1. Endogenous causes:

• malabsorption syndromes (impaired absorption of nutrients in the intestine) accompanying a number of diseases, for example, celiac disease;
• dysbacteriosis, due to which absorption and metabolic processes are disrupted, including vitamin D;
• weak activity of the lactase enzyme, which is responsible for the breakdown of milk sugar contained in dairy products.

1. Hereditary factors and predisposition to the disease:

• abnormalities of phosphorus-calcium metabolism and synthesis of active forms of vitamin D;
• hereditary metabolic abnormalities in the body (tyrosinemia, cystinuria).

1. Other reasons:

• maternal illnesses during pregnancy;
• environmental factor: pollution of the environment - soil, and then water and food - with salts of heavy metals (strontium, lead, etc.) leads to the fact that they begin to replace calcium in bone tissue;
• colds increase the need for vitamins, including group D, but at the same time impair their absorption; Also, during illness, the number and duration of walks with the baby are reduced, which leads to insufficient insolation;
• hypodynamia (decreased motor activity), which can be caused by both a disorder of the nervous system and a lack of physical education in the family (exercise, massage, gymnastics).

Changes in the body due to vitamin D deficiency

A deficiency of vitamin D in the body leads to changes in many organs and systems.

• The formation of a specific protein that binds calcium ions and promotes their passage through the intestinal wall is reduced.
• Due to the reduced level of calcium in the blood, the parathyroid glands begin to actively produce parathyroid hormone, which is necessary to ensure a constant level of calcium in the blood. As a result of this process, calcium begins to be washed out of bone tissue, and the reverse suction phosphorus ions in the renal tubules.
• Disruptions in oxidative processes begin, demineralization of bones continues, they become soft and gradually begin to bend.
• In the zone of active bone growth, defective bone tissue is formed.
• Acidosis develops (a shift in the acid-base balance of the body to the acidic side), and then functional failures occur in the central nervous system and many internal organs.
• Immunity decreases, the child begins to get sick often, and the course of the disease is longer and more severe.

Groups of children most susceptible to rickets

• Babies with the second blood group, mostly boys.
• Overweight children, large babies.
• Premature babies.
• Children living in large industrial cities, as well as in the northern climate zone and high mountain areas, where there is often fog and rain and few clear sunny days.
• There is a genetic predisposition due to the characteristics of the enzymatic system in the Negroid race.
• Frequently and long-term ill children.
• Babies born in autumn or winter.
• Children who are bottle-fed.

Classification of rickets

Currently, several classifications of the disease are accepted.

There are primary and secondary forms of the disease. The primary form is based on a lack of intake of the vitamin from food or the synthesis of its active forms. The secondary form of rickets develops as a result of a variety of pathological processes:

• calcium absorption disorders – malabsorption syndromes;
• fermentopathy;
• long-term use of medications by the child, in particular anticonvulsants, diuretics and glucocorticoids;
• parenteral nutrition.

Depending on the type of metabolic disorders, the following are distinguished:

• rickets with calcium deficiency (calcipenic);
• rickets with phosphorus deficiency (phosphopenic);
• without changes in the level of calcium and phosphorus in the body.

According to the nature of the disease:

• acute form, in which softening of bone tissue occurs (osteomalacia) and symptoms of nervous system disorders are expressed;
• subacute form, which is characterized by a predominance of processes of bone tissue growth over its rarefaction;
• recurrent (wavy) rickets, in which frequent relapses are observed after an acute form.

By severity:

• 1st degree (mild), its symptoms are characteristic of the initial period of the disease;
• 2nd degree (moderate) – changes in internal organs and the skeletal system are moderate;
• 3rd degree (severe course) – severe disorders of the internal organs, nervous and skeletal systems, pronounced retardation of the child in psychomotor development, frequent occurrence of complications.

In relation to vitamin D, rickets is divided into two types:

• vitamin D dependent (there are types I and II);
• vitamin D resistant (resistant) - phosphate diabetes, de Toni-Debreu-Fanconi syndrome, hypophosphatasia, renal tubular acidosis.

Symptoms of the disease

Rickets is clinically divided into several periods of its course, which are characterized by certain symptoms.

1. Initial period.

It occurs at the age of 2-3 months and lasts from 1.5 weeks to a month. At this time, parents begin to notice the appearance of the first symptoms:

• changes in the child’s usual behavior: restlessness, fearfulness, flinching at sharp and unexpected sounds, increased excitability;
• decreased appetite;
• the appearance of frequent regurgitation and vomiting;
• the child sleeps restlessly, waking up frequently;
• the face and scalp often sweat, this is especially noticeable during feeding and sleep; sweat with an unpleasant sour odor, constantly irritates the skin, thereby causing itching and prickly heat;
• due to constant itching, the baby rubs his head on the pillow, rolling hair and characteristic baldness of the back of the head and temples appear;
• there is a decrease in muscle tone and weakening of the ligamentous apparatus;
• intestinal cramps, constipation or diarrhea;
• anemia develops;
• possible seizures caused by a lack of calcium in the body;
• stridor - noisy, wheezing breathing;
• The pediatrician, when feeling the seams and edges of the large fontanel, notes their softness and pliability;
• thickenings appear on the ribs, resembling a rosary.

There are no pathologies from the internal organs and systems.

1. The peak period of the disease

Usually occurs at 6-7 months of a child’s life. The disease continues to attack in several directions at once. At the same time, a number of new symptoms appear.

Bone deformation:

• the process of softening of the bones is clearly pronounced, this is especially noticeable if you feel the seams and the large fontanel;
• a slanted, flat back of the head (craniotabes) appears;
• dolichocephaly – elongation of the skull bones;
• asymmetrical head shape, which may resemble a square;
• saddle nose;
• change in the shape of the chest - “chicken breast” or “keeled” (protrusion forward), or “shoemaker’s chest” (indentation in the area of ​​the xiphoid process);
• there is curvature of the collarbones, flattening of the chest with simultaneous expansion downwards;
• curvature of the legs - O-shaped or X-shaped (less common) bone deformation;
• flat feet appear;
• the pelvic bones flatten, the pelvis becomes narrow, “flat-rachitic”;
• protruding parietal and frontal bumps (“Olympic” forehead) may appear on the head, which develop due to excessive growth of non-calcified bone tissue, but over time they disappear;
• “rachitic rosary” on the ribs, thickening in the wrist area (“rachitic bracelets”), thickening of the phalanges of the fingers (“strings of pearls”) - this is all the growth of bone tissue where it turns into cartilage;
• when palpated, there is pain in the leg bones, sometimes thickening of the knee joints occurs;
• a retraction appears at the level of the diaphragm - Harrison's groove;
• the large fontanel closes with delay - at 1.5-2 years;
• Late and inconsistent teething, malocclusion, deformation of the hard palate and jaw arches, and tooth enamel defects are noted.
• Children rarely experience pathological fractures or household injuries;
• dwarfism

Decreased muscle tone and ligamentous weakness:

• the baby has difficulty turning over onto his stomach and back, does it reluctantly and sluggishly;
• does not want to sit down, even if he is supported by the arms;
• due to the weakness of the abdominal wall in children when lying down, a symptom such as a “frog belly” is noted, and the abdominal muscles can often diverge;
• curvature of the spine - rachitic kyphosis;
• joint hypermobility is noted.

Children with rickets begin to hold their heads up, sit and walk late. The gait of children is uncertain and unstable, their knees collide while walking, and their step width is sharply narrowed. The child often complains of fatigue and pain in the legs after walking.

From the nervous system, symptoms worsen:

• excitability and irritability increase;
• the child gurgles less often, there is no babbling at all;
• restless, intermittent sleep;
• children learn poorly, sometimes even lose acquired skills;
• pronounced red dermographism appears on the skin - a change in skin color after mechanical irritation.

From the digestive tract:

• complete lack of appetite, and neither long intervals between feedings nor small portions of food contribute to its arousal;
• oxygen starvation resulting from anemia leads to a decrease in the production of many enzymes necessary for normal digestion.

On the part of the blood, severe iron deficiency anemia is observed:

• increased fatigue;
• pale skin;
• drowsiness and lethargy.

The immune system malfunctions - children get sick more often and more severely.

With severe rickets, almost all organs and systems are affected. Curvature of the chest and weakness of the respiratory muscles leads to insufficient ventilation of the lungs and frequent pneumonia. There is an enlargement of the spleen and lymph nodes. There are disturbances in protein and fat metabolism, there is a lack of vitamins A, B, C and E, as well as micro- and macroelements, especially copper, zinc and magnesium.

It is the severe degree of the disease that most often leads to complications:

• heart failure;
• laryngospasm;
• frequent convulsions, tetany;
• hypocalcemia.

1. Recovery period

Occurs by 3 years and is characterized by improvement general condition child, the disappearance of neurological disorders and excessive growth of bone tissue. The child becomes active, easily turns over from back to stomach and back, sits or walks better (depending on age). The pain in the legs goes away.

Unfortunately, muscle weakness and skeletal deformity disappear very slowly.

For some time, the level of calcium in the blood may still be reduced, but phosphorus, on the contrary, will be normal or even increased. Biochemical blood parameters confirm the transition of the disease into the inactive phase and the final period.

1. Period of residual effects

This stage of the disease is most often absent now, since rickets almost always occurs in a mild form.

Prognosis and consequences of rickets

At the height of rickets, the child develops bone deformations, in particular, an o-shaped or x-shaped curvature of the legs.

At early diagnosis and timely treatment, the prognosis of the disease is favorable. And only when severe course Rickets may cause some irreversible changes in the body:

• short stature;
• curvature of tubular bones;
• poor posture – kyphosis;
• uneven teeth, malocclusion;
• defects of tooth enamel, caries;
• underdevelopment of skeletal muscles;
• fermentopathy;
• narrowing of the pelvis in girls, which can lead to complications during childbirth.

Diagnosis of the disease

Most often, the diagnosis of rickets is based on a thorough history and examination of the child, as well as clinical symptoms. But sometimes, to determine the severity and period of the disease, additional diagnostic measures may be prescribed:

• a clinical blood test shows the degree of anemia;
• a biochemical blood test determines the level of calcium, phosphorus, magnesium, creatinine and alkaline phosphatase activity;
• radiography of the lower leg and forearm with the wrist;
• level of vitamin D metabolites in the blood.

Treatment of rickets

Treatment of the disease depends on the severity and period, and is primarily aimed at eliminating the causes. It must be long and complex.

Currently, specific and nonspecific treatment is used.

Nonspecific treatment includes a number of activities aimed at improving the general condition of the body:

• proper, nutritious nutrition, breastfeeding or adapted formulas, timely introduction of complementary foods, and it is best to give the first such children vegetable puree from zucchini or broccoli;
• correct the mother’s diet if the child is breastfed;
• observing the child’s daily routine according to his age;
• long walks in the fresh air with sufficient insolation, avoiding direct sunlight;
• regular ventilation of the room and maximum natural light;
• mandatory daily therapeutic exercises and a massage course;
• air baths;
• daily bathing in pine or herbal baths to calm the nervous system.

Specific therapy for rickets consists of prescribing vitamin D, as well as drugs containing calcium and phosphorus. Currently, there are many medications containing vitamin D. But, in any case, they are prescribed only by a doctor, based on the child’s condition. Doses are selected individually, taking into account the severity of the disease. Usually 2000-5000 IU (international units) are prescribed per day, the course is 30-45 days.

The most common drugs:

• Aquadetrim is an aqueous solution of vitamin D3. It is well absorbed, does not accumulate in the body and is easily excreted by the kidneys. Suitable for both treatment and prevention of rickets.
• Videin, Vigantol, Devisol are oil solutions of vitamin D. They are hypoallergenic and suitable for children with allergies to Aquadetrim. But they should not be given to babies suffering from dysbiosis or having problems with absorption.

After completing specific treatment, the doctor may prescribe vitamin D preparations for prevention, but in much smaller doses. Usually 400-500 IU per day is enough, which is given to the baby for two years and in the third year of life in the autumn-winter period.

Prevention of rickets

Breastfeeding plays an important role in the prevention of rickets.

Prevention of rickets should begin long before the birth of the child, even during pregnancy. Therefore everything preventive measures divided into two groups - before and after the birth of the baby.

During pregnancy, a woman must follow these rules:

• complete fortified diet;
• prolonged exposure to fresh air;
• moderate physical exercise: special exercises for pregnant women with the permission of the supervising physician;
• taking complex vitamin preparations throughout pregnancy, especially in the last trimester;
• regular monitoring by doctors to prevent complications during and after childbirth.

Prevention of rickets in a child:

• mandatory preventive intake of vitamin D if the child was born in autumn or winter (the dose and medication are prescribed by the doctor); duration of the course of prophylaxis – 3-5 months;
• proper nutrition, optimally breastfeeding;
• strict adherence to the daily routine;
• long walks in the fresh air, avoiding direct sunlight on children's skin;
• air baths;
• daily bathing;
• gymnastics classes;
• conducting massage courses;
• complete nutrition for a nursing mother, rich in vitamins; with the permission of the doctor, take multivitamin complexes.

Summary for parents

Rickets, like many other diseases, is much easier to prevent than to cure. Pay attention to your pediatrician's prescriptions and don't forget to give healthy the child is prescribed long-term “drops” - vitamin D preparations. These “drops” will preserve the health of your baby and save him from the onset of rickets - a rather serious disease, as you have seen.

Which doctor should I contact?

Treatment and prevention of rickets is carried out by a pediatrician. In case of severe disorders of the musculoskeletal system, consultation with an orthopedist is indicated; iron deficiency anemia- hematologist. If vitamin D deficiency is associated with intestinal diseases, you should consult a gastroenterologist. Violation of the formation of jaws and teeth can be corrected by a dentist.

Dr. Eleonora Kapitonova talks about rickets and its prevention:

Rickets - what to expect from it and how to prevent it

In order for a baby to grow healthy and physically strong, he must spend a lot of time in the fresh air and eat well. The healing effects of sunlight stimulate the formation of vitamin D in the skin, which is necessary for bone development. Rickets most often affects babies born in winter, when the weather is cloudy, as well as those living in the northern regions. It is necessary to prevent rickets in children. It is important not only to carry out hardening and massage, but also to ensure that the child’s body replenishes the lack of vitamin D, calcium and phosphorus.

• Description of the disease
• Forms of the disease
• Severity

Causes of rickets

• Vitamin deficiency during pregnancy
• After birth
• Other reasons

Symptoms and signs of rickets Diagnosis of rickets Treatment

• Specific therapy
• Nonspecific therapy
• Auxiliary treatment with folk remedies

Prevention of rickets in children

Description of the disease

Rickets is a pathology of bone tissue development associated with a lack of vitamin D in the body. This substance promotes the absorption of calcium and maintains the balance of calcium and phosphorus that make up the bones. Rickets affects mainly children under 2 years of age, but it also occurs in adults. This disease is not life-threatening, but its consequences can be very serious. There is deformation of the skeleton (skull, ribs, limbs, spine), disruption of the functioning of internal organs, and retardation in mental and physical development. In girls, the pelvic bones form incorrectly (the so-called flat-rachitic pelvis appears). Subsequently, this significantly complicates the course of labor and makes it impossible to give birth to a child in a natural way.

Forms of the disease

The following forms of rickets are distinguished:

1. Spicy. The disease occurs in babies in the first months of life (especially premature babies) who have not received additional vitamin D in the form of special preparations. Sometimes rickets occurs in this form in obese children who are fed mainly with food containing high content carbohydrates (porridge, pasta, sweets). Manifestations of rickets in this case (bone pain, weak muscle tone, deformation of skeletal bones, the occurrence of fractures) are pronounced and rapidly progressing.
2. Subacute. “Osteoid hyperplasia” occurs - the formation of frontal and parietal tubercles, thickening of the wrists, abnormal development ribs, finger joints and toes. This course is observed in babies older than 6 months, if prevention or treatment at the appearance of the first symptoms was insufficient.
3. Recurrent (wavy) form. Signs of rickets appear against the background of already existing manifestations of a previous disease.

Severity

Pathology occurs with to varying degrees gravity.

1st degree (mild). The beginning of changes, the appearance of the first symptoms.

2nd degree (moderate). Moderate changes appear in the skeletal system and internal organs.

3rd degree (severe). Damage to bones, internal organs, nervous system, and improper formation of the skull occurs.

There are several types of diseases similar to rickets that can develop in older children. These include, for example, “phosphate diabetes” - a lack of phosphorus in the bones. With this disease, a person has short stature, curvature of bones, despite the fact that he has a strong physique.

There is also pseudo-deficiency rickets, which occurs due to the body's inability to absorb vitamin D.

Video: Causes of rickets

Causes of rickets

The causes of rickets in a baby are:

• lack of vitamin D in the mother’s body during pregnancy;
• insufficient intake of nutrients into the body after birth;
• impaired absorption of vitamin D by the child’s digestive system.

Vitamin deficiency during pregnancy

A deficiency of vitamin D in a pregnant woman’s body occurs as a result of poor nutrition and insufficient consumption of foods containing this vitamin, as well as calcium and phosphorus. They form the basis of bone tissue and are necessary for the proper formation of the skeleton and muscles of the unborn baby. Difficult pregnancy, exposure to a harmful environmental environment, smoking – these factors contribute to the occurrence of vitamin deficiency and vitamin D deficiency.

If the pregnancy proceeded normally, the woman’s nutrition was adequate, then the newborn has a supply of these useful substances in the body for up to 1-2 months. Subsequently, it is required to be supplied with breast milk or in the form of additives to infant formula. If the birth was premature, then the beneficial substances do not have time to accumulate, and a deficiency occurs from the moment of birth.

After birth

Factors that provoke the occurrence of rickets in infants are:

1. Lack of vitamin D in breast milk due to poor nutrition of the mother.
2. Feeding a baby with formulas low content components necessary for the formation of bone and muscle tissue.
3. Swaddling too tight, restricting the baby's movements.
4. Use of anticonvulsants.
5. Feeding the baby with cow's milk, which is poorly absorbed by his digestive system.
6. Late introduction of complementary foods. After 6 months, it is necessary to gradually include vegetable, fruit, and meat purees in the diet, since breast milk alone is no longer enough to replenish the supply of vitamins and minerals. The formation of their deficiency is facilitated by the predominance of cereals in complementary feeding (semolina, for example). Their consumption promotes the removal of vitamin D from the intestines along with feces.
7. In older children, the cause of rickets may be a lack of animal products in the diet, or a predominance of plant foods, from which vitamin D absorption is poorer.
8. Insufficient exposure of the baby to the sun. Vitamin D is formed in the skin under the influence of ultraviolet radiation.

Premature babies are at risk of developing rickets.

Other reasons

If the child’s weight at birth was large, then his body’s need for useful substances higher than in children of normal weight, therefore balanced diet has special meaning for him. The risk of rickets is increased in twins and twins. A lack of vitamin D, calcium and phosphorus occurs during the period of intrauterine development, and, as a rule, such children are born prematurely.

Rickets is caused by congenital underdevelopment of the organs of the digestive system, which impairs the absorption of beneficial food components. Calcium absorption deteriorates in the presence of diseases thyroid gland. In dark-skinned children, rickets occurs more often than in light-skinned children, since their production of vitamin D under ultraviolet rays is weaker.

Children living in rural areas are more susceptible to rickets. big cities with polluted air that does not transmit ultraviolet rays well.

Note: Rickets occurs more often in boys than in girls, and the manifestations are usually more severe. In some families there is a hereditary predisposition to rickets.

Symptoms and signs of rickets

In children, an uncomplicated disease goes through 4 developmental periods: initial, peak period, reparation and recovery.

At the onset of the disease, symptoms such as baldness of the back of the head, bad dream, increased irritability, soft bones around the fontanel. This period lasts from 2 weeks to 2 months.

During the height of the disease, curvature of the bones, muscle weakness, poor teething, and impaired psychomotor development are observed. The period lasts 3-6 months.

Reparation occurs as a result of properly administered treatment. Stop pathological changes bones, muscles become stronger, signs of nervous system disorder disappear, after which recovery occurs.

The first signs by which a mother may notice the development of rickets in 1-2 one month old baby, is a decrease in his appetite (the feeding process becomes short). The baby does not sleep well, flinches at the slightest sound, and sweats profusely in his sleep. The back of his head is going bald. Digestion is impaired (diarrhea gives way to constipation).

It is necessary to draw the attention of the pediatrician to the appearance of such signs.

Symptoms of rickets in children appear over the next few months if the pathology begins to progress. The following happens:

• muscle tone weakens, the baby becomes lethargic and inactive, cannot hold his head up, sits poorly, falls to the side, cannot roll over onto his stomach;
• the child’s teething is delayed, the fontanelle closes up late, it is difficult for him to rise to his feet, he begins to walk late;
• bloating occurs;
• the deformation of the skull gradually progresses: the back of the head becomes flat, the head elongates in length, and frontal tubercles appear;
• the legs become crooked, the pelvis does not develop, the chest is not formed correctly;
• the functioning of internal organs deteriorates, signs of difficulty breathing, disturbances appear heart rate, the liver enlarges;
• mental development lags and mental disorders occur.

During the height of the disease, trembling of the hands and chin becomes noticeable in the child.

Diagnosis of rickets

Signs of rickets, as a rule, do not raise doubts among the doctor. However, to confirm the diagnosis, determine the period of development of the disease and the degree of calcium deficiency in the body, a urine test, the so-called “Sulkovich test,” is performed. Urine is collected in the morning before the first feeding. If necessary, urine excreted during the day is analyzed for calcium and phosphorus content.

By biochemical analysis, the concentration of calcium, phosphorus and vitamin D in the blood is determined, and the content of the enzyme necessary for the absorption of phosphorus (“alkaline phosphatase”) is determined.

The degree of bone deformation and disturbances in the condition of internal organs is determined using ultrasound and x-rays.

Treatment

To eliminate and alleviate the manifestations of rickets, specific and nonspecific therapy is carried out. They must be started immediately after diagnosis.

Specific therapy

Treatment with vitamin D preparations is carried out in a dose corresponding to the period of development of the disease and the nature of the symptoms. A Sulkovich test is performed once every 7-10 days to monitor the progress of treatment and adjust the dosage. If a noticeable effect appears, then after 1-1.5 months the dose is reduced.

To prevent relapses, the drug is taken in a reduced dose until the age of 2, and then until the age of 3 - only in winter.

There are vitamin D preparations dissolved in water and preparations in the form of oil solutions. Water-soluble vitamin D is absorbed better by the body and remains in the liver longer, showing its activity. Oil preparations (devisol, viden) are more often prescribed in cases where the baby has a tendency to constipation.

The main drug in the treatment of rickets in children is Aquadetrim. The dose is selected individually for each child to avoid side effects.

A course of ultraviolet irradiation is carried out with gradual increase doses. This stimulates the body’s own vitamin D production and improves its absorption.

Video: The first signs of rickets

Nonspecific therapy

It is carried out to improve the absorption of calcium in the child’s body by restoring the acid-base balance. For this purpose, a citrate mixture (an aqueous solution of sodium citrate) and dimephosphone are used. Potassium orotate is given to improve metabolism.

If the level of calcium in the blood is low, calcium gluconate and other calcium preparations are prescribed. To strengthen the body, therapy with vitamins C and group B is carried out. In the presence of anemia, iron supplements (maltofer, tardiferon) are prescribed.

Medicinal baths are used. Special massage and therapeutic exercises are performed.

It is recommended to increase the duration of walks in the fresh air, as well as make adjustments to the child’s diet, including egg yolks, cottage cheese and other foods with increased content calcium and phosphorus. During treatment infants It is recommended to reduce the consumption of cereals, introduce complementary foods, accustoming the baby to vegetable and meat purees.

Auxiliary treatment with folk remedies

When the first signs of rickets develop in a baby, it is useful to bathe him in salt water or with the addition of pine decoction. Pine baths are used to calm the child’s nervous system. To prepare it, pour pine extract into warm water (1 teaspoon per 1 liter of water). The child is placed in the bath for 10-15 minutes.

Bathing in salt water is carried out if the child is lethargic. Use table or sea salt at the rate of 2 tbsp. l. for 10 liters of water. After the bath, you need to wash off the salt by pouring clean water over your baby.

To replenish calcium deficiency, you can prepare a mixture of finely crushed eggshells, ¼ cup of lemon juice and 1 cup of water. Give medicine after meals.

Prevention of rickets in children

Preventing the development of rickets in a child must be taken care of even before birth. During pregnancy, women should take vitamins (such as Gendevit) to correct deficiencies useful elements, which inevitably arises due to the increased demand associated with fetal growth. It is important to take vitamin D tablets in the last 2 months before giving birth, especially if the woman lives in areas where the summer is short or the baby is due to be born in the autumn-winter period. The drug is taken strictly in doses prescribed by the doctor, since excess vitamin D is just as harmful to the unborn child as its deficiency.

A pregnant woman should eat well, spend a lot of time outdoors under the influence of ultraviolet radiation emitted by the sun, avoid infectious diseases and colds, and regularly undergo the necessary tests.

After the birth of a child, it is necessary to strive to maintain the possibility of feeding him with full-fledged breast milk for at least 5-8 months. From 6 months it is necessary to begin complementary feeding, gradually introducing into the diet fortified foods rich in calcium and phosphorus (egg yolks, liver, meat, butter).

If necessary, the pediatrician prescribes prophylactic intake of fish oil or vitamin D supplements for children at risk.

Video: Doctors' recommendations for detecting and treating rickets

The diagnosis of rickets in children is quite common in pediatric practice. Its incidence depends on the socio-economic and cultural level of the population, hygienic conditions life, feeding a child, genetic predisposition. What is the essence of pathology? How long does it last and how dangerous is it for the child’s health? And what needs to be done to avoid this disease? Let's figure it out in order.

Pathogenesis

As a result of disturbances in mineral metabolism, primarily phosphorus-calcium, the correct formation of the skeleton is disrupted and the function of internal organs and entire systems changes.

Many people know that a lack of vitamin D plays a decisive role in the pathogenesis of rickets. But not everyone is aware that it is not a deficiency of calciferol in food, but a disruption in the synthesis of vitamin D metabolites in the epidermis and capillaries of the skin that leads to the development of a disease such as rickets.

It is the active metabolites that contribute to better absorption of calcium and phosphorus in digestive tract, block excessive excretion of these elements in the urine, catalyze the synthesis of calcium-binding protein. And most importantly, they stimulate the “incorporation” of calcium into bone tissue.

But other vitamins are also necessary for normal bone tissue development. Thus, a lack of vitamins A and B1 leads to the development of osteoporosis. Vitamin C promotes better absorption of calciferol and enhances its effect. Therefore, the cause of rickets is actually polyhypovitaminosis.

The same applies to microelements. Not only calcium and phosphorus deficiency leads to disease, although it is a leading pathogenetic factor. Children develop rickets with a concomitant deficiency of zinc, iron, cobalt, copper and magnesium.

The essence of the disease

• Lack of calcium directly in the bones leads to their softening. As a result, the bones become deformed from the load. This situation is generally not dangerous for the life of the body. But other organs and systems also suffer from a lack of microelements in the blood: cardiovascular, nervous.
• Against the background of mineral imbalance, bacterial and fungal infections occur. Therefore, the body tries to equalize the level of calcium and phosphorus in the blood and, through increased function of the parathyroid glands, flushes them out of the bones. This further aggravates the condition of the bone tissue.

Ultimately, hypovitaminosis D leads to disruption of other types of metabolism: protein, carbohydrate and fat.

Causes and ricketogenic factors

The development of the disease is promoted by insufficient synthesis of vitamin D and its metabolites, as well as a deficiency of exogenous calcium and its excessive release.

• Vitamin D is synthesized under the influence of ultraviolet light, therefore, insufficient insolation can lead to its deficiency in the body. This mainly concerns children living in areas with insufficient insolation. Pathology can also develop in children who are contraindicated to be in the sun. Although 10 minutes of exposure to the sun, even with clothes on, is enough to synthesize vitamin D in the amount of daily requirement.
• Insufficient intake of calcium from the outside is associated with poor nutrition of both the pregnant woman and the child. Intensive calcification of bone tissue occurs in the last months of pregnancy. Therefore, premature newborns are at greater risk of developing rickets. In full-term infants, during the first two months of life, calcium from the mother’s blood is used to build bones. Then, due to intensive growth, its reserves are depleted. Unbalanced artificial or cow's milk feeding, late feedings contribute to exogenous calcium deficiency.
• Malabsorption in the digestive tract is caused by immaturity of the enzyme system, perverted binding with phytic or oxalic acid into stable compounds, diseases of the stomach, intestines, liver, and obstruction of the bile ducts.
• Massive release of calcium through the gastrointestinal tract occurs with steatorrhea (“fatty” stools), through the kidneys – with nephrological diseases and the same lack of vitamin D.

Diagnostics

The leading role in the diagnostic search is played by the symptoms of rickets, x-ray examination of long bones, blood and urine tests for microelements and enzymes, and the Sulkovich test in children (determining the level of calcium in the urine).

Clinical and laboratory studies are necessary to exclude diseases with similar changes in the skeleton: tuberculous spondylitis, congenital hip dysplasia, chondrodystrophy, hypothyroidism, congenital syphilis, Down's disease.

Symptoms of the disease

The appearance and intensity of symptoms depends on the period of rickets, the severity of the process and the nature of the course. In this regard, there are 3 working classifications of the disease.

By periods:

• convalescence;
• residual phenomena.

By severity:

• light (I)– weak pronounced changes from the nervous and skeletal systems;
• medium (II)– moderate signs of damage to the nervous, muscular and skeletal systems, enlargement of the liver and spleen;
• heavy (III)– a vivid clinical picture with bone deformation, loose joints, muscle hypotonia, enlarged liver and spleen, involvement of the cardiovascular, respiratory and digestive systems in the process.

According to the nature of the flow:

• acute(the phenomena of softening and deformation of bone tissue predominate - signs of rickets in infants);
• subacute(characterized by bone hyperplasia with the formation of tubercles and nodes);
• relapsing course(periodic change of acute and subacute course).

From two months of a child’s life, when calcium reserves are depleted, the initial period of rickets is diagnosed. First, changes appear in the autonomic nervous system: anxiety, poor sleep, increased sweating (especially of the head), excessive vasomotor sensitivity of the skin.

After about a month, changes in bone tissue appear, which indicates the beginning of the height of the disease.

Important! With rickets, the entire skeleton is affected, but primarily those bones that grow most rapidly during a given age period. Therefore, bone deformations can be used to judge the time of onset of the disease. Typically, all bone symptoms of rickets in children have time to develop before one year.

Deformation of the skull bones occurs in the first 3 months of life, the trunk and chest - from the third to the sixth, and the limbs - in the second half of the year.

• With rickets in infants, the posterior fontanel softens, and the edges of the anterior one become soft.
• The flat bones of the skull also soften, which can bend under pressure and then return to their previous position (craniotabes). As a result of uneven distribution of pressure on the head (with constant lying on the back or side), a deformation of the skull develops - a flat back of the head, asymmetry of the head. To balance intracranial pressure the frontal and parietal tubercles increase, which gives the head a square shape.

Photo: craniota without rickets in children Changes in the chest during the acute period are characterized by softening of the ribs with the appearance of lateral depressions and a transverse depression corresponding to the attachment of the diaphragm. In this case, the sternum protrudes forward in the form of a keel, and the xiphoid process is depressed. These are quite common symptoms of rickets in infants. In the future, kyphosis or scoliosis is possible. In the subacute period, thickenings—rosaries—appear in the area of ​​the sternocostal joints.

The bones of the limbs and pelvis are the last to be involved in the process. The acute course is characterized by curvature of long bones, mainly legs (O-shaped or X-shaped deformations), as well as the pelvis (flat rachitic pelvis). In the subacute period, “rachitic bracelets” (or “strands of pearls”) are formed in the area of ​​the epiphyses.

Simultaneously with defeat bone skeleton muscle hypotonia develops, which leads to loosening of the joints, an increase in the range of motion in them, and a flattened abdomen (“frog belly”).

During the period of convalescence, the main symptoms subside: The functioning of the nervous system is restored, bones are compacted, their deformation is reduced, metabolic processes are normalized.

With timely and adequate treatment, signs of rickets in children disappear after a year. After moderate or severe rickets, bone deformations and an enlarged liver and spleen may remain.

Rare forms

• Congenital rickets develops in utero. It is caused by poor nutrition, hypovitaminosis, and pathology of the endocrine or skeletal system of a pregnant woman. Especially if these problems arose in the third trimester. A child is born with all the clinical manifestations of rickets.
• Late rickets– essentially a progression or exacerbation of the process in children 5 years old. It manifests itself as a decrease in appetite, increased sweating, deformation and pain in the legs, which is accompanied by anemia.

Did you know? On average, rickets most often affects children under one year of age, less often - up to 2 years of age, and very rarely - at 3-4 years of age.

Treatment

Nonspecific treatment includes:

• diet therapy (nutrition correction, freshly squeezed juices, boiled vegetables 1 month ahead of schedule, liver, meat, yolk);
• active motor mode, air baths;
• massage and physical therapy;
• medicinal baths (salt, pine needles);
• thermal procedures ( paraffin applications, warming up with sand).

Specific treatment is based on the administration of vitamin D under the control of calcium levels in the blood and urine. Only a doctor knows how to treat rickets with medication, who individually selects the dosage of medications depending on the clinical picture of rickets. In addition to ergocalciferol, other vitamins are prescribed, as well as ATP and Dibazol. Calcium supplements are indicated only in the acute period.

After the end of specific therapy, a citrate mixture is prescribed for a month, and then 2 courses of ultraviolet irradiation at intervals of a month.

Prevention

Similar to treatment, the prevention of childhood rickets consists of nonspecific and specific methods.

• In the antenatal period it is– rational, nutritious nutrition of a pregnant woman, her physical activity and stay in the fresh air. Specific methods include ultraviolet irradiation and artificial fortification in the last trimester.
• In the postnatal period– massage and gymnastics, air baths, breastfeeding or feeding with adapted formulas, timely and adequate (by age) complementary feeding. As a specific prevention, premature babies are prescribed a course of ergocalciferol 2 weeks after birth, then a citrate mixture, and finally ultraviolet irradiation. In full-term babies, such specific measures begin 1 month after birth. If the mixtures are rich in vitamins, the dose of ergocalciferol is reduced by half.

Video about proper massage

One of the important methods of treating rickets is general massage bodies. But you need to know the sequence of massage movements and their strength. The video will tell you about all the intricacies therapeutic massage in children.

If you follow the regime of routine pediatric examinations, the doctor will identify symptoms of rickets in children and prescribe appropriate treatment. Don’t ignore going to the clinic - and everything will be fine! Have you encountered the problem of rickets in your family? Have you carried out antenatal prevention of hypovitaminosis D? We will be very interested to hear about this from your comments.

Rickets is a clinical syndrome based on a violation of the deposition of mineral substances in the matrix of the bone tissue of a growing organism. According to modern data, rickets unites a number of diseases that have similar anatomical and clinical changes. Changes occur in the growth zones of tubular bones. With the beginning of mass prevention, a detailed clinical picture of rickets is quite rare, but the relevance of the problem is still not lost. Even mild forms of rickets are accompanied by hypoxia, impaired immunity, general reactivity of the body and negatively affects physical development. Rickets is not a life-threatening disease. Its outcomes can pose a danger, for example, the formation of a flat-rachitic pelvis in girls, which can subsequently complicate the course of labor and even make natural delivery impossible.

Causes of rickets

Childhood rickets is a multifactorial disease. In its development, both internal and external reasons matter. The characteristics of the course of pregnancy and the lifestyle of the pregnant woman also contribute.

Human skin is capable of synthesizing vitamin D under the influence of sunlight. Therefore, insufficient exposure of a child to the sun and a climate unfavorable in terms of the number of sunny days can easily provoke D. Closely built cities and smoke in the air also contribute to a deficiency of sunlight. The color of the skin makes its own adjustments to the activity of synthesis; the more tanned the skin, the slower the synthesis of vitamin D occurs.

Vitamin D enters the body through food. In terms of content in food, this is not the most popular vitamin. Vitamin D obtained from plant products (ergocalciferol) is recognized as less active than vitamin D from animal products (cholecalciferol). The largest amount of cholecalciferol is found in cod oil, milk, egg yolks, butter, livers of birds and fish. Diet also supplies calcium and phosphorus, which are necessary for the synthesis of bone tissue. Therefore, nutritional defects are another cause of childhood rickets.

Phytates, phenobarbital, glucocorticosteroids are all groups of drugs that block vitamin D receptors. Eating large amounts of grains increases the loss of vitamin D in feces, making it difficult to absorb it in the intestines because they contain phytate.

Malabsorption syndrome, which manifests itself as impaired small intestine absorption can also cause rickets.

In the body, cholecalciferol is absorbed in the small intestine and is converted first in the liver to 25-OH-D3, then in the kidneys to 1,25-(OH)2-D3 and 24,25-D3. A second renal metabolite (24,25-D3) is involved in the formation of bone collagen and activates bone calcification. All these processes occur under the action of enzymes. Any disruption of enzyme activity or malfunction of the kidneys and liver can disrupt the chain of transformations. As a consequence, hypovitaminosis D. Diseases of the kidneys and liver are the next cause of the development of rickets.

The balance of calcium and phosphorus in the body is possible only with normal functioning of the C-cells of the thyroid gland and parathyroid glands. The thyroid hormone thyrocalcitonin inhibits the absorption of calcium in the intestine, accelerates its excretion in the urine, and inhibits bone resorption. The hormone of the parathyroid glands, parathyroid hormone, has the opposite effect, increases the excretion of phosphorus in the urine, and deposits calcium in the bones when there is an excess of it in the blood. Violation of homeostasis in this system also leads to the development of rickets.

The conditions for the development of rickets are created by: pathological pregnancy, unbalanced nutrition of a nursing mother, premature birth of a child, illness of the newborn. It is known that in the last months of pregnancy, the body of the unborn baby begins to make a supply of phosphorus and calcium. This is why it is so important for a pregnant woman to eat right. This also explains the fact that children born prematurely simply did not have time to depot these important microelements.

Symptoms and signs of rickets

The concept of rickets is purely pediatric because rickets occurs up to 3 years of age. The most rapidly growing bones suffer. Vitamin D deficiency causes a number of changes in the body's functioning. First of all, changes occur in the functioning of the kidneys, the absorption of phosphorus in the tubules decreases, the excretion of phosphates in the urine increases, hypophosphatemia develops, and the deposition of calcium compounds in bone tissue is disrupted. In an attempt to compensate reduced level phosphorus, organic compounds of nervous and muscle tissue begin to release phosphorus atoms. As a result: demyelination of nerve trunks (predominance of excitation on initial stages rickets), a violation of energy metabolism in muscle tissue, a decrease in its tone.

Absorption of calcium from the intestine is reduced due to insufficient synthesis of calcium transport protein. This results in increased hypocalcemia and compensatory bone resorption.

A reduced level of calcium in the blood activates parathyroid glands, increasing the production of parathyroid hormone, which, trying to maintain calcium homeostasis in the body, removes calcium in the urine. As a result of all these changes, the bones soften, they become pliable and unable to hold the body weight in the correct position and resist muscle traction, the skeleton becomes bent.

First of all, rickets in children is manifested by changes in behavior, sleep suffers, and children become restless. causes disorders in the muscular-ligamentous apparatus. Muscle contractility decreases, joint laxity occurs, and static functions are delayed. Violated external breathing because the intercostal muscles and diaphragm, which are responsible for breathing, suffer. Shortness of breath, disturbances in pulmonary ventilation occur, and the likelihood of inflammatory changes and atelectasis increases. It is possible to expand the boundaries of the heart due to a decrease in myocardial contractility. Hypotonicity of the intestines leads to constipation. The intensity of osteogenesis processes decreases, as a result of delayed teething.

The scales soften occipital bone, sutures, the chest and pelvic bones are deformed, the spine and tubular bones are bent, thickenings appear at the junction of the cartilaginous tissue of the ribs into the bone tissue, on the hands, so-called “bracelets”, on the fingers – “strings of pearls”, on the anterolateral surfaces of the chest - “rosary beads”. “Olympic forehead” is hyperplasia of the parietal, frontal and occipital tubercles.

Rickets in infants is manifested mainly by symptoms from the nervous system: anxiety, sleep disturbances, sweating (the first sign of rickets), chin tremor while crying, the baby shudders during sleep. However, the first sign of rickets is not a pathognomonic sign for making a diagnosis of rickets. Sweat irritates the skin and it begins to itch, which increases the baby's anxiety. He restlessly rubs his head against the pillow, eventually wiping out the hair on the back of his neck. The child is fearful and constipated. Red dermographism is noted. Signs of rickets in infants also include late closure of the large fontanel and delayed teething. Before the fontanelle closes, initial rickets in infants can be suspected by the softening of its edges and bones along the sutures.

There are several variants of the course of rickets:

— An acute course is observed in children who have not received prophylactic doses of vitamin D. The first signs of rickets rapidly progress. The clinical picture becomes bright, the processes of destruction of bone tissue predominate. Neurological and autonomic manifestations are well expressed. This course is typical for large children who are predominantly fed carbohydrates.

— Subacute variant of the course of rickets. The entire clinic is moderately expressed. Changes in the biochemical blood test are not sharp. Osteoid hyperplasia predominates. Occurs in children who received vitamin D prophylaxis and were breastfed or received infant formula containing vitamin D.

— The recurrent course is characterized by alternating periods of exacerbation and subsidence with the preservation of residual effects. On radiographs with this course of rickets, several bands of calcification are noted in the metaphyses of the bones. Rickets acquires this course due to unfavorable living conditions of the child, improper feeding and care, and non-compliance with preventive measures.

With severe bone deformities, complications may develop. Curvature of the chest can cause compression of the lungs, which creates favorable conditions for the development of pneumonia, tuberculosis and other infectious diseases of the lungs. In addition, this is a pronounced curvature of posture. Deformation of the skull bones can cause mental retardation up to its severe degrees. Deformation of the pelvic bones is most significant for girls because it can provoke complications. Children who have suffered from rickets have fractures more often than other children; this occurs due to altered bone structure. Curvature of the limbs and muscle weakness slow down the normal physical development of children.

Signs of rickets in children are often combined with increased susceptibility to viral and infectious diseases, since the functioning of the immune system is significantly suppressed.

rickets: photo of a baby

Degrees, stages and forms of rickets

Signs of rickets in children can be divided into several degrees of severity:

- Mild degree. Symptoms of rickets are mild and are observed mainly due to the nervous system, both central and autonomic. Describe mild degree severity can only be signs of rickets in infants. Violations of internal organs are minor.

— Moderate rickets is already represented by bone deformities. Mild symptoms become more severe. The ribcage flattens on both sides, resulting in a keeled chest shape. Popularly called “chicken breast”. The lower border of the chest expands to form the Harrison's groove. The lower limbs begin to bend; deformities can be either varus or valgus. The syndrome of osteoid hyperplasia is pronounced, the parietal tubercles of the skull are moderately hypertrophied. You can detect the beginning formation of “rosaries” on the fifth, sixth, seventh and eighth ribs in the places where they transition from the cartilaginous part to the bone. There are minor disturbances in the functioning of internal organs.

— Severe rickets is indicated by pronounced muscle and bone changes. This is “blooming” rickets, which is difficult not to notice. A rachitic hump appears because the static functions of the muscular system are disrupted. “Strings of pearls”, “rachitic bracelets”, craniotabes, all these changes are expressed in the most vivid way. Physical development is delayed. and associated microcirculation disorders cause malfunction of internal organs. Possible exophthalmos, hepato- and splenomegaly.

Rickets occurs in several stages (periods) passing into each other:

Initial rickets. Its manifestation falls on the lot of 2 and 3 month old children. For premature babies, this is the end of 1 month of life. This period lasts 4 - 6 weeks in acute cases and can last up to 2 - 3 months in subacute cases. The child's behavior changes, shuddering appears when there is a flash of light, during sleep, or when loud sounds occur. Plus, all other signs of rickets in infants can be found in the child. Changes in the biochemical blood test are insignificant; a decrease in phosphorus can only be detected; calcium levels do not change.

If the initial period went unnoticed by the pediatrician and parents and appropriate measures were not taken, then the next period begins - this is the period of height. This period lives up to its name because all symptoms progress. To approximately determine the age of manifestation of rickets, you can use knowledge of the periodicity of active bone growth. The bones of the skull grow most rapidly in the first months of a child’s life. Then the bones of the chest take the baton. She becomes “vulnerable” starting from the 6th month of life. At 10-18 months, tubular bones actively grow.

During the peak period, muscle hypotonia becomes so pronounced that a “jackknife” symptom can be observed; the child can be given any bizarre shape, muscle tone will not interfere with this. An x-ray image reveals that the metaphyseal zone of the bones takes on a goblet shape, and the zones of preliminary calcification are blurred. It should also be noted that clear signs of rickets on x-ray can be detected in a child by 3 months of age.

Blood biochemistry becomes more informative, hypophosphatemia increases, hypocalcemia manifests itself, and alkaline phosphatase activity increases significantly. The peak period can occur in two variants: in the form of a calcium-penic or phosphopenic variant.

The phosphopenic variant is manifested by sluggish, apathetic behavior of sick children. Symptoms of muscle hypotension, weakness of the ligamentous-articular apparatus, and separation of the rectus muscles of the anterior abdominal wall predominate. Against their background, signs of osteoid hyperplasia develop. If you conduct a blood test to determine the level of parathyroid hormone and calcitonin, then an increased level of both the first and the second is determined.

The calcium penic variant is more often defined as spasmophilia. The most striking manifestation of this condition is high convulsive readiness. There is tremor of the hands and chin during crying, regurgitation, and impaired intestinal motility. Children, in contrast to the previous version of the course, are restless and sweating. White dermographism is noted. There is a high level of parathyroid hormone in the blood, but a decreased level of calcitonin.

The period of height is followed by a period of reparative processes. The children's well-being improves, and vegetative and neurological disorders are eliminated. At the same time, muscle hypotension does not go away for a long time. Biochemical blood parameters gradually return to normal levels. The return of biochemical blood parameters to normal indicates the onset of last period, residual effects. This period is characterized by the persistence of irreversible changes in the bone skeleton and musculoskeletal system (joint laxity, hypotension).

There are a number of rickets-like diseases from which exogenous classical rickets should be differentiated. The peculiarity of these diseases is that their manifestation occurs at an older age than with rickets and they are extremely resistant to treatment even with large doses of vitamin D:

— Phosphate diabetes has an autosomal dominant type of inheritance, possibly linked to the X chromosome. Its development is associated with impaired absorption of phosphorus in the kidney tubules, which is excreted in the urine. Children with this disease have short stature, strong build, and rickets-like bone curvatures. The blood has high alkaline phosphatase with normal calcium levels.

— Pseudodeficiency rickets. Inheritance is an autosomal recessive type. The disease is associated with disruption of the receptor apparatus of target cells; they become insensitive to vitamin D metabolites. Another variant of this disease is associated with a defect in kidney hydroxylase. Clinically manifested as “blooming rickets.”

- Hypophosphatasia. Rare disease. Characterized by a complete or partial absence of alkaline phosphatase activity in the tissues of the body. Manifested by severe rickets.

- De Toni-Debreu-Fanconi disease. Severe tubulopathy is accompanied not only by delayed physical development, but also by mental retardation, up to its severe degrees.

rickets: photos of children

Treatment of rickets

If a child is diagnosed with rickets, treatment begins immediately. Treatment methods can be divided into specific and nonspecific. Specific is treatment with the appointment of doses of vitamin D adequate to the period and nature of the course of rickets; it is also possible to prescribe general ultraviolet irradiation. Therapeutic doses of vitamin D are: for mild degrees - course 300,000 - 400,000, daily 4000 - 5000 IU; for average - course 400,000 - 500,000, daily 5,000 - 10,000 IU; for severe cases - course 600,000 - 800,000, daily 10,000 - 15,000 IU.

It has been proven that water-soluble forms of vitamin D are most completely absorbed in the intestines and are better absorbed by the body than oil solutions, which were still widely used to treat rickets.

The main drug for the treatment of rickets is Aquadetrim; one drop of its solution contains 500 IU. Start taking the drug with a dose of 2000 IU; if no side effects occur during the first 3-5 days, then the dose should be increased to the required therapeutic dose. After 2-3 weeks, if the result is good, the total duration of treatment will be 30-45 days. As soon as this stage ends, the use of a prophylactic dose of vitamin D begins.

During treatment, a Sulkovich test is performed once every seven to ten days to avoid an overdose of vitamin D.

Children with severe rickets, after completing the main course of treatment, are given anti-relapse therapy after 3 months, except for the summer months. 2 weeks after the start of drug therapy, exercise therapy and massage are additionally prescribed. They stimulate metabolic processes in bone tissue and muscles, improve the child’s mood and well-being.

It is also recommended to arrange pine baths for restless children, salt baths, on the contrary, for lethargic children. Pine baths are done like this: add 1 teaspoon of pine extract to 1 liter of water. The water temperature should be 37 degrees. The first bath lasts 10 - 15 minutes, then the bathing time can be increased. Salt baths are prepared in a similar way: for 10 liters of water, 2 tablespoons of table or sea salt. After the bath, the child is doused with clean water. Herbal decoctions can also be added to the bath when bathing.

Ultraviolet irradiation. Treatment begins by determining the child’s individual tolerance (biodose) to ultraviolet radiation. The procedures are carried out every other day, increasing the irradiation time. The course of such therapy lasts from 15 to 25 days. During the peak period, in the presence of signs of spasmophilia (rachitogenic tetany) and in acute cases, ultraviolet therapy is contraindicated.

Since rickets may not always be caused only by a lack of vitamin D, no less attention should be paid related methods treatment than specific.

A citrate mixture is prescribed to enhance calcium absorption, improve ossification processes, and reduce acidosis. The mixture contains lemon acid 35 g, water 250 ml, sodium citrate 25 g. The mixture is prepared at the pharmacy.

B vitamins, ascorbic acid to eliminate acidosis, 15% dimephosphone solution, and potassium orotate, which promotes the synthesis of calcium-bound protein and the excretion of proteins, are also prescribed.

If there is a decrease in calcium, then children are required to be prescribed calcium supplements (Calcium Gluconate, Calcium Lactate, Calcium Glycerophosphate) age dosage. The course of treatment is 3 weeks. At home, eggshells prepared in a certain way can be considered a source of calcium. It should be taken 1/3-1/4 teaspoon along with lemon juice diluted with water 1:4 or a solution of citrate mixture, the course of administration is 10-14 days.

Rickets also makes its own adjustments to the child’s nutrition. Babies earlier normal deadlines products containing vitamin D and calcium are introduced, i.e. egg yolk and cottage cheese. When artificial feeding, it is recommended to increase the amount of vegetable puree and reduce the consumption of porridge and kefir; complementary foods are introduced earlier than usual.

If the signs of rickets in children are pronounced, have a progressive course and do not respond well to the recommended treatment with vitamin D, you should think about other forms of rickets (rickets-like diseases).

Preventive vaccinations are done according to the national vaccination calendar after one and a half months.

Prevention of rickets

The fetus has a huge need for calcium, which goes towards building the bone skeleton. As pregnancy progresses, the need does not decrease at all; calcium storage begins at the end of pregnancy. Calcium transport occurs actively through the placenta from mother to fetus. The same amount of calcium in the mother’s blood is the same amount of calcium in the fetal blood.

Antenatal prevention of rickets is that a pregnant woman should first of all eat well, lead an active lifestyle, and walk more. It is undesirable to prescribe vitamin D to a pregnant woman, because if the dosage is not observed, it has a teratogenic effect. Although pregnant women with extragenital pathology are recommended to take additional vitamin D from 28-32 weeks of pregnancy and a duration of 8 weeks. In recent months, Decamevit has been indicated.

After the baby is born, it is necessary to take it outside as early as possible during daylight hours. In summer, air baths in the shade of trees are welcome. Natural feeding with timely introduction of complementary foods is preferable. It is believed that a child receiving mother's milk is much less likely to develop rickets, especially if the mother takes vitamin complexes for nursing women.

Specific prevention of rickets begins at four to five weeks of age and consists of taking an aqueous solution of vitamin D. Previously used in Soviet time fish oil has lost its relevance. The prophylactic dose of vitamin D solution is 500 IU per day. This dose fully covers the child’s needs and is recommended in all countries of the world. The drug should be taken in the morning.

If a newborn is at risk of premature closure of the fontanel, then vitamin D intake begins at 3 months of age, unless there are other recommendations from a pediatric neurologist.

After a year prophylactic dose vitamin D increases and amounts to 1000 IU per day. The vitamin is taken year-round, with the exception of the summer months. Although in climatic zones unfavorable in terms of the number of sunny days, the drug is continued to be taken in the summer months. At 2 years of age, the drug usually ends.

For specific prevention of rickets with vitamin D, you can also use an oil solution (Ergocalciferol). But it should be remembered that it is much less easily absorbed by the body.

Contraindications for taking vitamin D are: intracranial birth trauma, small size of the large fontanel, hypoxia. Taking vitamin D is possible only after consulting a pediatric neurologist. An absolute contraindication to taking vitamin D supplements is its individual intolerance, hypophosphatasia, idiopathic calciuria, organic damage to the nervous system. Prevention is also not carried out for children who are fed with adapted milk formulas, since vitamin D is already present in their composition in the required quantity.

Prevention of rickets in premature infants is carried out depending on the degree of prematurity. At grade 2-3, the dose of vitamin D will be 1000 - 2000 IU for the entire first year of life and 500 IU for the entire second year of life. For 1st degree of prematurity, 400–500 IU starting from 10–14 days of the child’s life during the first two years, with the exception of the summer months.

Medical examination is carried out after severe and moderate rickets. It lasts 3 years.