What does rickets mean in babies. How to identify rickets in a child? The pediatrician tells about the symptoms of rickets and its prevention. What does rickets look like in children?

For the treatment of rickets, therapeutic doses of vitamin D are prescribed, however, it should be noted that due to an excess of this drug, a child can also have serious complications ( e.g. kidney dysfunction, allergic attacks, liver problems). To avoid such consequences, before giving a child vitamin D, you should carefully read the doctor's instructions and, if necessary, directly consult with a specialist.

What are the degrees of severity of rickets?

There are the following degrees of severity of rickets:

first degree ( light);
second degree ( moderate);
third degree ( heavy).

The severity of rickets	Clinical manifestations
First degree (light)	The nervous system is affected, and minor changes in the bone structure are also observed. *The manifestations of the first degree of severity of rickets are:* irritability; anxiety; tearfulness; excessive sweating ( most often at night); startling in sleep; softening of the edges of a large fontanel.
Second degree (moderate)	It is characterized by a more pronounced lesion of the bone, muscle and nervous systems. *With the second degree of severity of rickets in a child, the following manifestations are observed:* pronounced changes in the bones of the skull ( increase in frontal tubercles and formation of parietal tubercles); a number of thickenings at the junction of the ribs with the sternum ( "rachitic rosary"); horizontal depression of the chest ( "Harrison's Furrow") curvature of the legs; muscle hypotonia, resulting in a protrusion of the abdomen ( "frog belly"); delay in motor development; an increase in the size of a large fontanel; enlargement of the spleen and liver ( hepatosplenomegaly).
Third degree (heavy)	Long tubular bones are affected, and an aggravation of all of the above symptoms is also observed. *With the third degree of rickets, the following pathological changes are formed:* deformity of the bones of the lower extremities ( baby's legs take an O-shape or an X-shape); more pronounced deformation of the bones of the skull ( head becomes square); gross deformity of the chest "chest shoemaker"); spinal deformity ( "rachitic kyphosis"); exophthalmos ( bulging eyes); retraction of the bridge of the nose; pathological thickening in the wrist ( "rachitic bracelets"); pathological thickening of the phalanges of the fingers ( "strings of pearls"); flattening of the pelvis; curvature humerus; flat feet; anemia.

Depending on the severity of rickets, therapeutic doses of vitamin D2 are prescribed in the following order:

with rickets of the first degree of severity assigned two to four thousand international units per day for four to six weeks; the course dose is 120 - 180 thousand international units;
with rickets of the second degree of severity assigned four to six thousand international units per day for four to six weeks; the course dose is 180 - 270 thousand international units;
with rickets of the third degree of severity eight to twelve thousand international units are assigned per day for six to eight weeks; the course dose is 400 - 700 thousand international units.

What are the types of rickets?

There are the following types of rickets:

vitamin D-deficient ( classical) rickets;
secondary rickets;
vitamin D-dependent rickets;
vitamin D-resistant rickets.

Types of rickets	Description
*Vitamin* D-deficient (classical)rickets	This type of rickets most often occurs in the first years of a child's life. The period of development of children from two months to two years is considered the most dynamic, while the growing body's need for phosphorus and calcium increases. Vitamin D-deficient rickets occurs when the child's body does not receive the necessary resources due to insufficient intake of vitamin D from food or due to a violation of the system that provides the delivery of phosphorus and calcium. *The occurrence of classic rickets is accompanied by such predisposing factors as:* mother's age ( over thirty-five and under seventeen years of age); vitamin and protein deficiency during pregnancy and lactation; complicated childbirth; the weight of the child at birth is more than four kilograms; prematurity; pathological processes during pregnancy ( for example, a disease gastrointestinal tract ); toxicosis during pregnancy; insufficient exposure of the child to the fresh air; artificial or mixed feeding in the early period of a child's life; pathological processes in a child skin, kidney, liver disease).
*Secondary rickets*	This type of rickets develops against the background primary disease or an existing pathological process in the body. *There are the following factors contributing to the development of secondary rickets:* malabsorption syndrome ( poor absorption of essential nutrients); long-term use of certain groups medicines (glucocorticoids, anticonvulsants and diuretics); the presence of diseases that disrupt metabolism ( eg tyrosinemia, cystinuria); available chronic diseases bile ducts and kidneys; parenteral nutrition ( intravenous administration of nutrients).
*Vitamin D dependent rickets*	This type of rickets is a genetic pathology with an autosomal recessive type of inheritance. In this disease, both parents are carriers of the defective gene. *There are two types of vitamin D dependent rickets:* type I- a genetic defect that is associated with impaired synthesis in the kidneys; type II- due to genetic resistance of target organ receptors to calcitriol ( active form of vitamin D). In 25% of cases, vitamin D-dependent rickets is found in a child due to the consanguinity of his parents.
*Vitamin D-resistant rickets*	*The development of this type of rickets is facilitated by such background diseases as:* renal tubular acidosis; phosphate-diabetes; hypophosphatasia; de Toni-Debre-Fanconi syndrome. *In this case, the following pathological changes may occur in the child's body:* the functions of the distal urinary tubules are disrupted, as a result of which a large amount of calcium is washed out with urine; the process of absorption of phosphorus and calcium in the intestine is disrupted; a defect in the transport of inorganic phosphates in the kidneys is formed; the sensitivity of the epithelium of the tubules of the kidneys to the action of parathyroid hormone increases; there is insufficient activity of phosphatase, as a result of which the function of the proximal renal tubules is impaired; insufficient production of 25-dioxycholecalciferol in the liver ( increases calcium absorption from the intestine).

What are the first signs of rickets?

Most often, the development of rickets occurs in children aged three to four months. With a lack of vitamin D, first of all, the nervous system of the child suffers. A child with rickets, as a rule, is restless, irritable, tearful, does not sleep well and shudders in his sleep. There is also increased sweating, which occurs most often during feeding and sleep of the child. Due to a violation of metabolic processes, the child's sweat, like urine, acquires an acidic character and a corresponding sharp sour smell. Due to sweating and friction of the head on the pillow, the child has baldness at the back of the head. "Acid" urine, in turn, irritates the baby's skin, causing diaper rash.

also in initial stage rickets, the child loses his skills acquired by three to four months. The baby stops walking, rolls over. There is a delay in the psychomotor development of the child. Subsequently, such children begin to stand, walk late and, as a rule, their first teeth thin out later.

If time does not attach importance to the first manifestations of rickets, then later the development of this disease can lead to more serious disorders of the skeletal and muscular systems.

Apart from clinical symptoms The diagnosis of rickets is confirmed by biochemical laboratory research. These tests determine the amount of phosphorus and calcium in the child's blood. With rickets, the above indicators ( phosphorus and calcium) are reduced.

When the first signs of rickets appear, it is strongly recommended:

immediately consult a doctor;
refrain from self-medication;
make sure that the child receives the dose of vitamin D strictly prescribed by the doctor;
regularly walk with the child in the fresh air;
monitor the child's nutrition, it should be regular and rational ( increase intake of foods rich in vitamin D);
regularly do massage and gymnastics to the baby;
comply with the regime of work and rest.

Which vitamin deficiency leads to rickets?

Rickets is considered to be a "classic" disease childhood, in which in a young organism there is a metabolic disorder - calcium and phosphorus.
This disease is especially dangerous in the first year of a baby's life, when there is an active formation bone tissue. Rapidly developing, this disease usually leads to serious changes in the bone structure of the child, affecting also his nervous and muscular systems. These pathological changes occur due to a lack of vitamin D, which, in turn, is a regulator of metabolism in the human body.

Vitamin D is considered universal. This is the only vitamin that can enter the human body in two ways - through the skin under the influence of ultraviolet rays, and also through the mouth, entering the body with food containing this vitamin.

The following foods are rich in vitamin D:

fish fat;
fish caviar;
butter, margarine;
vegetable oil;
sour cream, cottage cheese, cheese;
egg yolk;
liver ( beef, pork, chicken).

Regular intake of vitamin D helps to normalize the process of absorption in the intestines of such essential elements as phosphorus and calcium, their deposition in bone tissue and the reabsorption of phosphates and calcium in the renal tubules.

That is why vitamin D is prescribed in the last trimester of pregnancy, since during this period of time a woman prepares her body not only for birth, but also for further feeding of the child.

A prophylactic dose of vitamin D is also given to the child immediately after birth. It is taken from October to May, that is, in those months when there is not enough sunlight. From May to October, vitamin D is usually not prescribed, but regular walks with the child in the fresh air are strongly recommended.

Prescribing an individual dose of vitamin D will depend on the following factors:

the age of the child;
features of genetics;
type of feeding the child;
severity of rickets;
the presence of other pathological processes in the body;
season ( the weather of the area where the child lives).

The recommended daily intake of vitamin D is 400 IU. international units) for children under one year old and 600 IU for children from one year to thirteen years of age.

For any pathology daily allowance vitamin D is prescribed by a doctor.

It should be noted that an overdose of vitamin D can lead to serious consequences. Therefore, in order to avoid this complication, the child is recommended to conduct a Sulkovich test every two to three weeks. This test consists in determining the presence and level of calcium in the test urine.

Urine for this sample is collected in the morning, before meals.

The results of the study are determined depending on the degree of turbidity of the urine:

minus is negative result, in which the child may experience a lack of vitamin D;
one or two pluses are considered normal;
three or four plus points indicate increased calcium excretion.

If the result of the study is as positive as possible, then the intake of vitamin D is stopped.

What care is needed for a child with rickets?

Childcare is an important aspect of rickets treatment. At the same time, high-quality child care should be carried out both in the hospital and at home.

When caring for a child with rickets, medical personnel should perform the following actions:

monitor the behavior of the child;
perform inspection and palpation of fontanelles ( big and small);
to check the fusion of cranial sutures;
to make a thorough examination of the chest of children four to six months old in order to determine the pathological thickening of the costal-sternal joints;
to monitor the thickening of the epiphyses of the bones of the lower leg and forearm, as well as the curvature of the bones in children older than six months;
determine the motor activity of the child, as well as the state of muscle tone;
make adjustments to the child's nutrition;
teach the rules of care for the parents of the baby.

As prescribed by the doctor, the following manipulations are carried out:

therapeutic doses of vitamin D are prescribed;
a child in the third - fourth month of life, who is breastfed, is introduced into the diet with juices, fruit decoctions, vegetable purees, egg yolk and cottage cheese ( children who are on artificial and mixed feeding, the first complementary foods are introduced one month earlier);
Enzymes are given with food e.g. pancreatin, pepsin) and hydrochloric acid, which are necessary for the child to improve digestion;
also, in order to reduce the degree of acidosis, vitamins of group B are prescribed along with nutrition ( B1, B2, B6), vitamin C and citrate blend ( a tool that contains lemon acid, sodium citrate and distilled water);
the nurse monitors the calcium content in the urine ( using the Sulkovich test);
calcium is prescribed in the form of a five percent solution, which is given to children orally ( in the mouth) at the first signs of bone softening;
physiotherapy exercises and massage are regularly carried out;
coniferous and salt therapeutic baths are prescribed ( the course includes ten to fifteen baths);
a course ( consisting of 20 - 25 sessions) ultraviolet irradiation at home, in the winter.

Mother's care of the child, in turn, should include the following actions:

Daily walks with the child in the fresh air. At the same time, the total time spent on the street should be at least five hours in the summer period and about two to three hours in the winter period ( temperature dependent). When walking with a child, it is necessary to ensure that his face is open.
Regular exercise. It is recommended to perform flexion and extension movements of the child's arms and legs, as well as to perform adduction and abduction of the baby's limbs.
Regular hardening of the child. It is necessary to harden the baby gradually. For example, while bathing with warm water, at the end it is recommended to rinse the child with water one degree lower. Then, as you get used to it, during subsequent bathing, the degree of water can be reduced below.
Proper organization of the daily routine for the child.
Monitor the regularity and rationality of nutrition. Complementary foods that are introduced should be appropriate for the age of the child. You also need to increase your intake of foods rich in vitamin D ( e.g. liver, fish, egg yolk, butter, cottage cheese).
Accurate implementation of actions prescribed by the doctor.

Can rickets be cured?

You can completely cure rickets, but for this you will need to do the following:

It is very important to timely detect the first symptoms of this disease, since the treatment of rickets at an early stage contributes to the speedy recovery of the child. The first manifestations of rickets are usually excessive sweating, mainly observed at night and after feeding the baby, anxiety and irritability, tearfulness, sleep disturbance, manifested by frequent shudders, itching, and baldness of the back of the head.
If you suspect rickets, you should immediately consult a pediatrician. Self-treatment in this case is strictly contraindicated. The doctor, in turn, can immediately diagnose rickets based on clinical manifestations of this disease or prescribe certain diagnostic procedures to detect pathology. After confirmation of rickets, the child will be prescribed appropriate treatment.
Treatment of rickets includes the rational feeding of the baby, the organization of a mobile lifestyle, vitamin therapy, regular walks in the fresh air, as well as the elimination of the causes that caused the disease. At the same time, all stages of treatment should be carried out strictly according to the doctor's prescription.

Rational feeding
The child's food must be complete. It should contain all the necessary nutrients. Especially with rickets, food rich in vitamins and trace elements is useful. The best food in this case is the mother's breast milk, which is rich in vitamins, amino acids, enzymes and immune bodies. The composition of breast milk is optimal for the child, as it best meets his nutritional needs. In the event of a forced transfer of the baby to mixed and artificial feeding, it will be more rational to use adapted milk formulas, the nutritional composition of which is as close as possible to nutritional composition breast milk.

Examples of adapted milk formulas include brands such as:

"Detolact";
"Baby";
"Vitalakt".

For a child between the ages of two and four months, the doctor may also prescribe the introduction of complementary foods in the form of vegetable puree.

Organization of a mobile lifestyle
This includes massage, as well as the use of various gymnastic exercises ( for example, adduction and abduction of the arms, as well as flexion exercises of the upper and lower extremities). These procedures have a positive effect on the metabolic processes in the skin, thereby increasing the productivity of vitamin D. Massage is usually done two to three times a day for eight to ten minutes.

Regular outdoor walks
Walking with a child should be at least two to three hours a day, especially on sunny days. This procedure contributes to the formation of vitamin D in a child, which is synthesized in the skin under the influence of ultraviolet rays.

vitamin therapy
The main method of treating rickets is the therapeutic use of vitamin D. When using this remedy, it is necessary to strictly follow the doctor's recommendations, since an overdose of vitamin D may lead to intoxication of the body.

What head changes are observed in rickets?

At the onset of the disease, no major changes in the head occur. The child during this period has increased sweating, especially in the area of the scalp ( in 90% of children). In this regard, during sleep, friction of the back of the head against the pillow is created, and the baby develops areas of baldness with a clearly visible venous network due to hair loss.

With the subsequent progression of the disease, there is some softening of the edges of the large fontanel, as well as bones at the site of the passage of the sagittal ( located between the parietal bones) and occipital sutures.

The height of the disease is characterized by thinning and softening of the bones of the skull ( craniotabes). These pathological changes in the bones are especially pronounced in the region of the large and small fontanelles, as well as in the area where the sutures of the skull pass. In this regard, a large fontanel in a child closes quite late, by two to three years. Also, the baby shows alignment of the parietal and occipital bones.

From the side of the bones of the facial section, the following changes are observed:

jaw misalignment ( top and bottom);
malocclusion;
narrowing of the arch of the sky;
possible narrowing of the nasal passages.

Teething occurs much later, plus the order of their exit may be disturbed ( extremely rarely, teeth can erupt earlier, at the age of four to five months). In children with rickets, various defects in tooth enamel and the formation of caries are often observed.

It should also be noted that with the progression of the disease, an increase in the frontal and parietal tubercles occurs, due to which the head increases in size and externally takes on a square shape.

The development of these pathological changes in the head largely depends on:

the age of the child;
the severity of the disease;
individual characteristics of the baby's body.

It should be noted that timely detection of the disease, as well as adequately selected treatment, provide a favorable prognosis for the cure of rickets. However, in case if health care was not provided on time, the child may subsequently develop various complications, including a lag in mental development.

Is it necessary to take calcium for rickets?

Calcium plays an indispensable role in the growth of a child. Thanks to calcium, the bone skeleton becomes strong, able to withstand heavy loads. In addition, the participation of calcium is indispensable in the processes of blood coagulation, as well as in the functioning nervous system.

The need for calcium supplementation occurs when a child has hypocalcemia ( decrease in certain levels of calcium in the blood plasma). With rickets, this condition can occur with active bone mineralization, as well as in premature or low birth weight children.

It should also be noted that calcium preparations for rickets can be prescribed if the child has various changes in the skeletal system.

Rachitic changes in the skeletal system can occur due to:

slow bone formation hypogenesis);
excessive formation of osteoid tissue ( osteoid hyperplasia);
bone softening ( osteomalacia).

Children who are regularly breastfed, calcium preparations, as a rule, are not prescribed, since its presence in breast milk is sufficient.

Examples of calcium preparations include Calcium gluconate and Complivit. For complete absorption, calcium preparations are usually prescribed in combination with vitamin D.

Calcium-rich foods include:

processed cheese;
cottage cheese;
sour cream;
cheese;
beans;
peas;
almond;
pistachios.

Rickets in a child: forewarned is forearmed!

What is rickets?

The health of children is a close object of attention of parents. In order for a growing organism to form correctly, it needs a whole complex of vitamins and minerals. minerals. Most of them the child receives during breastfeeding or feeding with an adapted mixture. But the need for vitamin D is not always replenished even if these rules are followed, so many mothers know firsthand what rickets is.

Rickets- This is a metabolic disease that occurs when there is a deficiency in the body of vitamin D (calciferol), while the child's musculoskeletal system, internal organs, nervous, and endocrine systems are affected.

Causes of rickets in children

According to various sources, the symptoms of this disease are observed in about 40 percent of children under one year old. In countries where there is a shortage of sunlight, this figure is higher.

Most often, rickets in children under one year old occurs because, while still pregnant, a woman did not pay due attention to her lifestyle and health. For example, if the expectant mother had a hard time enduring the last months of pregnancy, she had late toxicosis, or she was too fond of diets, she limited the consumption of products that contain animal proteins.

In the postnatal period, premature babies, babies born in the cold season, “artificial” babies and babies living in adverse conditions are at risk of getting sick with rickets. Rickets in infants can provoke an unhealthy diet of the mother: if, fearing to gain excess weight, she eats too little, prefers low-calorie foods, limits the consumption of milk, meat and fish.

In addition, there are the following causes of rickets:

insufficient exposure of the child to the fresh air in general and the sun in particular;
tight swaddling and limited motor activity of the child;
lack of breastfeeding, early transition to mixed or artificial feeding (mothers who use unadapted milk formulas are especially at risk);
disorders of the gastrointestinal tract, congenital pathologies (celiac disease, lactase deficiency, dysbacteriosis);
tendency to frequent diseases;
taking anticonvulsants;
rapid weight gain in a child (in this case, the need for calcium increases).

How to determine rickets in infants - SYMPTOMS

The disease manifests itself gradually.

The first symptoms of rickets can be detected at 4-8 weeks of a baby's life:

child does not eat well his appetite decreases, his usual portion is not fed, and the feeding process itself takes less time than usual;
baby becomes restless shudders for no reason, often tosses and turns during sleep, becomes more capricious and shy;
sleep disorders: the baby does not fall asleep well, often wakes up for no reason, shudders or cries loudly in a dream, the dream itself is short and superficial;
increased sweating: even in cool weather, the child gets wet, wakes up in wet clothes, sweat has a specific sour smell and taste, diaper rash and prickly heat reappear after treatment;
hair falls off at the back of the head. ;
stool disorders are noted: despite the usual diet, diarrhea, constipation may occur.

If this is ignored, after a few weeks, infants develop the following signs of rickets:

Muscles are in low tone;
The kid does not hold his head well, is in no hurry to roll over on his stomach, crawl, walk;
Teeth erupt later;
Later, the fontanel closes;
The shape of the skull may change: the head becomes elongated, the back of the head becomes flat, frontal tubercles appear;
Bloating
The chest is deformed, the pelvis becomes narrow, the legs are bent.

Severe forms of rickets impose on the physical condition, and on the psyche of the child: a noticeable lag in development. There are gross deformities of the chest, bones of the skull, limbs.

In some, especially neglected cases, children cannot sit and stand up on their own. On the part of the cardiovascular system, there is difficulty breathing, tachycardia. The liver increases in size.

It is possible to cure rickets - TREATMENT

Any disease is easier to cure if you start doing it at an early stage, so if you suspect rickets, you should contact your pediatrician. It is he who will establish the final diagnosis and tell you how to treat rickets.

Even if this disease has passed into a severe stage, doctors rarely resort to hospitalization. They usually prescribe a procedure that can be done at home, designed to eliminate the lack of vitamin D and correct the violations that have occurred in the body.

Treatment of rickets is based on a set of procedures for correcting the daily regimen, physical activity (walking) and the diet of mother and child.

It is necessary to take more walks in the fresh air with the baby. If the weather favors, you can take air baths,. sunbathing MOST effective, but in hot weather it is necessary to avoid overheating ().

The diet of the child should contain a sufficient amount of protein and minerals (calcium and phosphorus are especially important), vitamins.

Massage

The state of health is positively affected by physiotherapy exercises, massage. Such a complex should include breathing exercises, stroking the legs, arms, feet, abdomen, chest and back. To strengthen the muscles of the baby, you need to turn from the back to the tummy, fix the reflexes of walking and crawling (supporting the child, give him the right position). Swinging on a fitball or on your hands will help calm the child's nervous system.

Video

To overcome tearfulness, lethargy, irritability, to normalize the mental state of the child, it is necessary to protect him from excessive impressions and external stimuli (noise, bright light).

Bathing

With increased excitability of the baby, baths with the addition of pine needles extract can have a good therapeutic effect (1 teaspoon per 10 liters of water at room temperature). They are shown to excitable kids. If the baby's muscle tone is reduced, he has lethargy, baths containing sea salt can help. To prepare the solution, add 2 tablespoons of salt to 10 liters of warm water. 10-12 procedures are enough to provide a positive effect.

Medicines for rickets - VITAMINS

All medicines should be taken only as prescribed by a doctor!

Medicines:

Aquadetrim- an aqueous solution of vitamin D3 (colcalciferol)
Devisol, Vigantol, Videin- Oil solutions of vitamin D3

Among the drugs that are taken for rickets, vitamin D solution is recognized as the most effective.

But even here there are nuances: vitamin D3 is more effective than vitamin D2, and an aqueous solution has a longer effect and is absorbed by the body better than alcohol or oil.

In any case, vitamins for rickets should be prescribed by a pediatrician, he will also select the type of drug, its dosage, and determine the timing of treatment.

Often, a therapeutic dose of vitamin D (it is 2000-5000 IU) should be taken for 30-45 days, and then a maintenance (prophylactic) dose should be taken daily - from 400 to 500 IU. one drop oil solution vitamin D3 contains approximately 420 IU of cholecalciferol.

Taking vitamin D should be accompanied by constant monitoring of urinalysis in order to avoid overdose, because large doses of it can have a toxic effect on the body. An overdose of this drug can cause a decrease in appetite, nausea, vomiting, urinary retention, constipation, and even cramps in the limbs.

If anemia occurs against the background of rickets, it is treated with iron preparations in the form of syrup or drops.

By following all the requirements, you can very quickly improve the condition of the child.

Rickets is easier to prevent than to cure - PREVENTION

The health of the child must be taken care of long before his birth - during planning, as well as during pregnancy. Around the 28th week of intrauterine development, the child's body begins to actively store vitamins. Vitamin D is stored in the liver, adipose and muscle tissues of the fetus. During this period, a pregnant woman should carefully monitor her lifestyle:

regularly visit the doctor of the antenatal clinic;
eat regularly and nutritiously;
spend more time outdoors;
protect yourself from colds and infectious diseases;
walk a lot.

Prevention of rickets is carried out from the birth of a child and is especially needed for premature babies, with insufficient weight, in the first months of life, as well as those born in the autumn-winter and even spring periods. It is enough to follow the regimen, walk for a long time in the fresh air, get a lot of sun, temper and physically develop the child.

Prevention of rickets video:

Breast-feeding- the best protection against many diseases, but only if your menu contains the necessary amount of useful substances. A nursing mother needs to streamline her diet: eat more dairy and sour-milk products, take multivitamins (). If your baby is “artificial”, you need to choose such an adapted milk mixture that would most closely resemble the composition of human milk. ()

In the future, when introducing complementary foods, it should be borne in mind that vitamin D is found exclusively in animal products (meat, liver, butter, egg yolk) and systematically offer them to the baby. You can not abuse semolina. In addition to the fact that she can cause allergic reactions It also interferes with calcium absorption in the small intestine.

Fish fat

Children from the "risk group" are recommended to carry out drug prevention of rickets. One of the most popular remedies is fortified fish oil. It can be given to children from the age of four weeks, gradually increasing the dose.

It should be remembered that prevention is carried out under the supervision of the local pediatrician.

For the purpose of prevention, drugs (vitamin D, fish oil) must be given for a certain period.

There is a so-called rule of the letter "r" - to apply vitamins in those months of the year, in the name of which the letter "r" is present. May and the summer months are usually sunny, so there is no need for drug prophylaxis.

Rickets should not be left to chance - CONSEQUENCES

Consequence of rickets

Most often, rickets does not pose a danger to the life of the child. But if nothing is done, the symptoms go away, but the effects of rickets remain. Often children who have been ill with this disease suffer from caries of milk and permanent teeth. Curvature of the legs. There may be developmental delays.

Due to changes in the skeleton, scoliosis, flat feet, and pelvic deformity may occur. In schoolchildren, the echoes of rickets are manifested in the form of myopia, anemia, reduced immunity and soreness (frequent bronchitis and pneumonia).

Older adults may develop osteoporosis.

A general ailment of the body that occurs when there is a violation associated with an insufficient content of vitamin D, mineral metabolism of Ca (calcium) and P (phosphorus).

This disease is characterized primarily by a change in the nervous, and to a greater extent, bone systems, as well as a violation of the absorption and metabolism of calcium and phosphorus minerals.

The significance of rickets, according to scientists, is determined by the fact that in severe cases it slows down growth and further and can lead to irreversible modification of the bones.

With this disease, the percentage of diseases associated with long-term infections of the upper respiratory tract increases.

Causes of rickets in children?

The causes of rickets in children have been known for a long time, this disease is

emaciated organism. It is often found in areas where there is not enough sunlight, in large cities, less often in villages and villages.

The disease is seasonal, more often occurs when there is little ultraviolet rays, and this is in winter and spring, which indicates a lack of sunlight as a causative factor.

More often rickets occurs in children on artificial feeding, also with a monotonous and unbalanced diet, for example, they are fed with cow's milk alone. Vitamin D is produced only under the influence of ultraviolet rays, so the lack of ultraviolet rays can lead to rickets. Found in foods: milk, eggs, butter, vitamin D, together with the influence of sunlight, covers the needs of an adult in this vitamin, however, in children with a rapid growth of the body, this need is increased.

Rickets usually affects babies (3-24 months), but it may develop earlier. With very poor care, as well as with a special state of metabolism, this ailment can be observed in older children.

Symptoms and degrees of rickets in children.

Characteristic changes in a blood test taken from a vein are always: a very small amount of phosphorus, slightly reduced calcium levels and high activity of alkaline phosphatase.

With 1 degree of rickets in children.

At about the age of about, parents notice that there are changes in the behavior of the baby, he becomes more restless and irritable, or vice versa, lethargic, there is profuse sweating, itching appears, so he rubs the back of his head against the pillow and a bald spot forms, then the bones of the skull become thin and soft, and so thus the skull becomes flat.
In connection with the increase and growth of bone tissue, the frontal parts of the skull increase, the parietal bones become in the form of tubercles, the skull takes on a square shape.
With rickets, there is a delay in teething, as well as their erratic appearance in the future.

With 2 degrees of rickets in children.

In the second degree, swelling begins to appear in the region of the ribs, which is visible during examination, "rachitic beads" are also visible.
Changes occur, the chest is deformed and becomes like a chicken breast, which is fraught with serious consequences, as it negatively affects breathing.
The spinal column also changes: if the child is planted very early, the formation of kyphosis (stoop) and scoliosis (curvature of it to the right or left) may begin, the pressure of the spine on the pelvis leads to the formation of a narrow pelvis associated with rickets, which in girls in in the future will be a serious problem during childbirth.
Quite early in the area of the wrist and ankles, outgrowths of bone tissue form, which look like bracelets.
Later, when the child, a whole chain of changes occurs in the lower extremities, that is, the legs take the form of X-shaped and O-shaped, and therefore fractures can occur.

With 3 degrees of rickets in children.

The most severe degree. There is a serious deformation of the shape of the bones. One cannot but agree that such a child, pale and with a large "frog" belly, formed as a result of weak abdominal muscles, causes a feeling of pity and pain not only for medical personnel, but also for others.
However, rickets is not only a disease of the skeletal system, but there is also a weakening of the muscles, ligaments and joints, constipation often appears, hemoglobin in the blood decreases, there is an increase in the liver and spleen, such children are prone to frequent relapses of protracted infections of the upper respiratory tract.
In advanced cases, severe bone curvature can cause disability in the future.

How to treat rickets.

To treat the causes of rickets in children, vitamin D3 is prescribed - an aqueous solution of "Aquadetrim" in drops, the doctor selects the dosage, the approximate therapeutic dose is 6-10 drops, the course can last up to two months, then the dosage is reduced to prophylactic, this is 1 - 2 drops daily until summer, bright sun. The dosage must be strictly observed as prescribed by the doctor, severe violations can occur with an overdose of vitamin D or even when it is prescribed in normal doses, due to an individual increase in sensitivity.

If the child, after the appointment and taking vitamin D, began to eat poorly or refuse to eat at all, vomiting appeared, combined with constipation, stunting, this must be reported to the doctor in order to undergo an examination.

The leading biochemical shift in this case is hypercalcemia. When making a diagnosis, it is important to establish the presence of elevated calcium in and the presence of calcium in the urine using the Sulkovich test. In treatment, the most important thing is the immediate restriction of calcium intake.

Prevention of rickets.

Prevention of rickets with vitamin D in a full-term baby begins already 3-4 weeks, in a premature baby at the age of 2 weeks, regardless of the time of year, vitamin D should be given to the child. In the summer, when the child spends a lot of time in the sun, prevention is not carried out in full-term vitamin D. In preventing the causes of rickets in children, good care for the baby, proper balanced nutrition, and timely complementary foods play an important role. Walks in the open air,

If our parents followed the advice of doctors almost unquestioningly, then modern mothers often question the recommendations of pediatricians. And this is understandable: the abundance and inconsistency of information can confuse anyone. On the forums on the Internet, disputes are increasingly flaring up about the need to prescribe vitamin D to infants. An overdose of it leads to serious consequences, and our children eat well, walk a lot, where does rickets come from? That's what mothers think. Everything seems to be correct. But sometimes vitamin D is vital for the baby and saves him not only from a lack of calcium, but also from health problems in the future.

Insidious disease

Rickets is a disease caused by a lack of calcium and phosphates in the body of a child, expressed in impaired bone mineralization, growth retardation, bone deformities, and vegetative vascular dysfunction. To understand why the lack of calcium and phosphorus lead to the development of such a complex disease, it is necessary to determine the role of these minerals in the human body. First of all, they are the constituent components of bone tissue, the building blocks necessary to build our skeleton.

Calcium is responsible for muscle contraction, helps work nerve cells, regulates the tone of the autonomic nervous system, is part of protein molecules, hormones and enzymes. Phosphorus is no less valuable substance. It provides energy processes, participates in glucose metabolism. And here the question arises: if these minerals are so important for the body, then why do only small children suffer from rickets?

The fact is that a colossal burden falls on the baby: its growth in the first year of life increases by an average of 1.5-2, and its weight increases by 3 times! And this is despite the relative immaturity of various systems, and, accordingly, compensation mechanisms. Therefore, even a small deficiency of certain substances affects the health of the baby. Premature babies are especially susceptible to the development of rickets. Adults have long gone out of a period of intensive growth, so a calcium deficiency for them may go unnoticed and not cause discomfort.

Why are they sick?

Prerequisites for the occurrence of rickets often develop even before the birth of the baby.

The risk of developing rickets in the first year of life increases several times if the expectant mother suffered from preeclampsia or followed a vegetarian diet during pregnancy.
Rickets often develops in formula-fed children if the principles of rational nutrition are not followed, as well as with prolonged breastfeeding, when the mother refuses to introduce complementary foods in a timely manner.
A lack of calcium and phosphates can be observed in a baby with a syndrome of impaired intestinal absorption (malabsorption), which develops for various reasons: lactase deficiency, celiac disease, intestinal infections. Rickets can be provoked by hereditary diseases, convulsive syndromes (with long-term use of Luminal), kidney and liver diseases.

To drink or not?

Prevention of rickets begins during pregnancy. The expectant mother should spend more time in the fresh air, eat well (the presence of dairy, meat products, eggs, vegetables and fruits is mandatory in the diet). In conditions middle lane Pediatricians usually prescribe a prophylactic dose of vitamin D to healthy children in the first year of life, which should be taken from October to May. In the period from May to September, vitamin D should not be taken prophylactically, since at this time a sufficient amount of it is produced under the influence of solar radiation.

If a child has rickets, the doctor prescribes vitamin D at a dose greater than the prophylactic dose. Treatment of rickets should be not only medication, be sure to include in therapy walks in the fresh air, swimming, hardening, massage. If your baby suffers from rickets, do not rush to put him on his feet. Due to the lack of calcium and phosphorus, the baby's bones become soft and easily deformed, acquiring an ugly O- or X-shape.

Did the girl get rickets? Try not to plant it longer: there is a danger of deformation of the pelvis. In this case, the baby may have problems with childbearing in the future. Remember that if the dosage is not observed, acute or chronic vitamin D poisoning may develop. Clinically, acute intoxication is manifested by the general serious condition of the child, thirst, vomiting, a sharp decrease in body weight, convulsions. Stop taking vitamin D immediately and call an ambulance.

Chronic vitamin D poisoning manifests itself in the form of poor appetite, weakness, irritability, sleep disturbance, early closure of the large fontanel, increased blood pressure, the formation of kidney stones. Stop taking vitamin D and contact your doctor immediately. If you notice signs of rickets in your baby, be sure to consult a pediatrician, as self-administration of vitamin D can cause serious consequences.

The main signs of rickets

The clinical picture of the disease depends on the degree of insufficiency of calcium and phosphorus and, accordingly, is increasing.

The mild form of rickets is characterized by:

increased neuropsychic excitability, manifested in the form of frequent irritable crying, anxiety, poor sleep;
slight growth retardation;
suppleness and soreness of the bones of the skull;
slow closure of a large fontanel;
flattening of the neck;
dull color and fragility of hair, the formation of bald patches on the back of the head. Such a baby cries a lot, wakes up easily. Due to the increased sweating of the child, the mother often has to change his clothes, he grows slowly, such a baby does not erupt for a long time, the pace of psychomotor development slows down (later it starts to hold its head, roll over, rise on its arms).

With moderate form of rickets all of the above signs become more pronounced, in addition, attention is drawn to:

unusual shape of the head: a flattened occiput, pronounced frontal and parietal tubercles - the so-called buttock-shaped skull;
chest deformity: the child's chest looks sunken or, conversely, takes the form of a keel;
noticeable intercostal spaces, Harrison's furrow attracts attention - the border between the chest and abdomen takes the form of a groove;
the stomach becomes like a frog due to severe muscle hypotension;
noted fatigue, the baby prefers to stay in the crib for a long time, refuses to play;
violations of the nervous system can manifest itself in the form of trembling of the chin, pens;
if by this time the baby has learned to stand up, the deformation of the legs becomes noticeable: they look like the letters "X" or "O".

A severe form of rickets is manifested:

pronounced lag in physical and mental development;
gross deformities of the skull, chest, limbs;
such children are usually unable not only to get out of bed, but even to sit without support;
in addition, babies may experience shortness of breath (dyspnea), increased heart rate, and an increase in the size of the liver;
at this stage of the disease, the child's bones become so brittle that they break easily even from small external influences.

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Rickets in children is a disease associated with a lack of vitamin D and a violation of calcium metabolism in the body, most often found in infants. Children born with low birth weight are most susceptible to it. Rickets does not pose a danger to the patient's life, however, if left untreated, deformation of the bone apparatus occurs.

Characteristics of the disease

For the normal formation of bone tissue, calcium, phosphorus and vitamin D are required. These substances enter the child's body with food (breast milk, vegetable oil, vegetables, fish). Part of vitamin D is formed under the influence of sunlight.

Children are born with a supply of vitamins and minerals, so up to 2 months the formation of bone tissue occurs normally. In the future, the reserves are exhausted, because of which the need child's body increases in vitamins and minerals. If it is not satisfied, calcium and phosphorus begin to be washed out of the bones. This leads to the appearance of the first signs of rickets.

The child has a delay in physical and mental development, muscle weakness, skeletal deformity.

The reasons

The following provoking factors contribute to the development of rickets:

Deficiency of nutrients and vitamins in the diet. The risk group includes children who receive unbalanced mixtures instead of breastfeeding.
Late introduction of complementary foods. The development of the disease is facilitated by the predominance of cow's milk and cereals in the diet of a child older than 6 months.
Rare exposure to sunlight.
Violation of digestion and absorption of nutrients in the intestine. Children with diseases of the gastrointestinal tract are susceptible to rickets. In that case, even proper nutrition unable to meet the needs of the body.
Prematurity. Children born prematurely do not have time to accumulate reserves of vitamins and minerals, moreover, they often have an immature digestive system.
Large birth weight. Large children need more nutrients.
Birth from multiple pregnancy. Lack of calcium and vitamin D occurs even during fetal development. In addition, such children are often born prematurely.
Congenital pathologies internal organs.
Dark skin color. Dark-skinned babies produce less vitamin D.

Symptoms of rickets

On the early stages rickets in newborns have the following symptoms:

Increased sweating. Even at normal air temperature, when feeding, drops of sweat appear in the forehead and nose, palms and soles are characterized by high humidity.
Behavior change. The child does not sleep well, behaves restlessly, often shudders.
Loss of hair in the back of the head.
Constipation. With rickets, muscle tone decreases, including those that make up the intestinal walls. The deterioration of peristalsis contributes to the retention of feces.

These signs appear in infants 3-4 months of age. At the beginning of treatment at this stage, dangerous complications do not develop.

In the absence of therapeutic measures, rickets progresses, infants develop specific signs:

Deformities of the skeletal system. Characteristic manifestations are a flat nape, an "Olympic forehead" (high, convex), O- or X-shaped curvature of the legs.
A pronounced decrease in muscle tone, due to which another characteristic sign arises - “frog belly”.
Violation of motor development. The child cannot hold his head, roll over, sit up and crawl at a time when his peers begin to master these skills.
Late appearance of the first teeth.
Pathologies of internal organs (primarily the digestive system).

In the future, the child's condition improves, but the resulting bone deformities remain for life. These include:

narrow pelvis;
large frontal tubercles;
malocclusion;
narrow pelvis;
laterally compressed, convex chest in front;

Diagnostics

For children and adolescents use:

Primary inspection. The disease in the later stages has symptoms that make it possible to easily make a preliminary diagnosis.
Blood chemistry. The characteristic signs of rickets are: a decrease in the level of calcium and phosphorus, calcitriol and calcidiol, an increase in the activity of alkaline phosphatase.
Biochemical study of urine. Helps to detect increased amounts of phosphorus and calcium excreted by the kidneys.
X-ray examination of long bones. The images reflect the pathological changes characteristic of rickets - the expansion of the metaphyses, the disappearance of the boundaries between the epiphyses and metaphyses, the thinning of the upper layer of the bone, the fuzzy visualization of the ossification nuclei, and the decrease in tissue density.
Densitometry. Used to assess the general condition of the bones.

Treatment of rickets in a child

Treatment for children under one year old includes:

Massage and physical therapy. The complex includes breathing exercises, stroking the upper and lower extremities. Strengthening the muscles is facilitated by turns from the back to the stomach, training crawling and walking reflexes. Exercises on the fitball calm the nervous system.
Reception of calcium and vitamin D. With rickets, doctors prescribe Aquadetrim, Videin, Vigantol. Vitamin D3 is more effective, the aqueous solution is better absorbed by the child's body. The course of treatment lasts 30-45 days, then the drugs are taken in maintenance doses. Taking vitamins should be accompanied by regular urinalysis. This will help to avoid an overdose that adversely affects the general condition of the body.
Physiotherapeutic procedures (UVI, paraffin baths, therapeutic baths). They improve the general condition of the body, promote the absorption of drugs, eliminate the unpleasant symptoms of the disease.
Warm baths. To normalize the state of the nervous system, coniferous baths are used (for 10 liters of water, take 1 tsp of coniferous extract, which can be purchased at a pharmacy). The duration of bathing is 10-15 minutes. The procedure is recommended to be carried out before going to bed. With a decrease in muscle tone in 10 liters of water, add 2 tbsp. l. salt. To improve the condition of the child, 10 sessions are enough.

Effects

In children with severe vitamin D deficiency, milk and permanent teeth are often destroyed.

Dangerous rickets lag in mental and physical development, curvature of the spine of varying degrees.

In schoolchildren and adolescents, immunodeficiency states, anemia, and myopia are found. Children are prone to colds and infectious diseases. In older people, osteoporosis develops early.

Prevention

Dr. Komarovsky believes that rickets is easy to prevent. This helps:

Reception fish oil. Prevention is carried out from October to April. In areas with insufficient solar activity, do not take breaks in taking the drug. Premature babies are given maximum doses of vitamins.
Proper nutrition. An important role in the development of the child is played by the full breast-feeding in the first months of life. After 4 months, it is recommended to introduce the first complementary foods.
Regular walks in the fresh air. In the summer, it is not recommended to wrap up the child, the face, arms and legs should be exposed to indirect sunlight.

Caring for the health of the unborn child begins during pregnancy. A woman must lead healthy lifestyle life, eat right, walk in the fresh air, take vitamins prescribed by the doctor.