Consequences of rickets in children. Rickets in children: signs and treatment

For the proper formation and growth of a healthy child's body, a sufficient amount of various vitamins and microelements is necessary. Their lack can lead to serious diseases that require the immediate help of qualified specialists. One of these diseases is rickets.

Rickets is an endocrine disease of young children, most often observed in infants under one year of age, resulting from a lack of vitamin D in the body, which leads to damage to internal organs, the nervous and endocrine systems, and the musculoskeletal system.

In infancy, the child receives the bulk of the necessary vitamins and minerals either with breast milk or from an adapted milk formula.

However, it is not always possible to replenish the body with all the vitamins necessary for growth and proper development, especially for vitamin D.

Causes of rickets in children under one year old

Since vitamin D is called the vitamin of the sun, rates of rickets in children under one year of age are much higher in countries where there is a lack of sunlight. On average, the incidence of this disease is about 40 percent of children under one year old.

The risk group includes children whose mothers in the process of carrying a pregnancy did not pay due attention to their health.

For example, the mother-to-be was on a diet, limiting her body to foods rich in animal proteins, or the last trimester of pregnancy suffered from severe toxicosis, which again led to the restriction of the intake of necessary food.

A small interval between pregnancies also gives reason to assume that the baby can get rickets, because the mother's body didn't have time to recover after a previous pregnancy and childbirth, to replenish the reserves of vitamins and trace elements, and here it is already necessary to give everything again to the unborn baby.

It also includes children born much ahead of schedule or born in the cold season, children who are bottle-fed or living in areas with adverse weather conditions.

Breastfed children may also be at risk, especially if their mothers, for fear of gaining excess weight, exclude healthy whole foods from their diet, limiting the use milk, meat and fish, and preferring low-calorie foods.

Babies at risk should be prevented from the disease with the help of medications - fortified fish oil. It can be started from the age of one month for a long period, gradually increasing the dosage.

To make it easier to remember when it is necessary to do drug prophylaxis, there is a rule of the letter "r". Vitamin D is taken only in those months in which the letter "r" is present in the name. In addition, the following causes of rickets in infants can be distinguished:

rare walks in the fresh air;
tight swaddling and, as a result, limiting the mobility of the child;
artificial feeding or feeding the baby with an unadapted milk formula;
congenital disorders and pathologies of the gastrointestinal tract, such as dysbacteriosis, lactase deficiency;
the child is often sick;
rapid weight gain, which provokes a sharp increase in the body's need for calcium.

Signs of rickets

The first signs of rickets in children under 1 year old can be detected from the first month of a baby's life. These include the following symptoms:

A few weeks after the first signs of rickets appear, in children under 1 year old, the following signs of the disease appear:

Low muscle tone.
The baby lies more, does not try to roll over, raise his head, walk or crawl.
In children with rickets, teething and fontanel closure occur much later.
The shape of the head can be deformed, become elongated, and the back of the head flattened.
There is often bloating, chest changes occur, the legs become crooked, and the pelvic bones narrow.

In order not to start this disease, parents must be carefully monitored for the slightest change in the physical condition of your baby. After all, the advanced form of rickets in infants will leave an indelible mark not only on the physical condition of the baby, some of the sick children are not able to walk or sit on their own, but also mentally (a noticeable developmental lag).

As a result of skeletal deformity, scoliosis, flat feet, changes in the pelvic bones. At an older age - myopia, anemia, weak immunity and soreness.

Classification of rickets in children

There are two degrees of rickets. The first degree is characterized by disturbances in the work of the nervous system, weakening of muscle tone, baldness and flattening of the back of the head. This degree of rickets is perfectly treated and almost never leaves visible physical changes;

The second degree is already visible at a glance, they become pronounced physical changes such as deformity of the skull, curvature of the limbs, changes in the shape of the chest and posture.

With regard to internal changes, the internal organs increase and as a result start to malfunction. After treatment, there is a chance that with age, obvious physical changes will become less noticeable or disappear altogether.

Treatment of rickets

As you know, any disease is easier to treat in the early stages, so if you suspect rickets in an infant, you should contact your doctor as soon as possible. And only after confirming the diagnosis, based not only on external signs, but also confirmed by laboratory tests and analyzes, treatment should be started as soon as possible.

You should know that even with an advanced form of rickets, the patient is not hospitalized, but treatment is carried out at home. Most often, procedures are prescribed to make up for the lack of the “sunshine” vitamin and to restore to the maximum the changes that have already occurred to the body.

That is, basically, treatment will consist of a set of procedures aimed at to change and improve the diet mothers and babies, an increase in the number of walks and correction of the daily regimen. And also do not forget about such procedures as massage and physiotherapy exercises, which include a variety of exercises.

Massage should consist of stroking the arms, legs, back of the baby. Of the exercises - breathing exercises, turning the baby from the stomach to the back and back, light swaying on the fitball and strengthening already formed reflexes (walking, sitting, crawling, etc.).

If a child is excited, often cries and is irritable, then in order to improve his mental state, he first of all needs peace, calm and quiet environment. It is worth remembering about bathing with the addition of either pine needle extract (calming effect) or sea salt (raising muscle tone). To obtain a positive effect, you must undergo at least 10 procedures.

The most effective medicine in the treatment and prevention of rickets is considered vitamin D solution. It can be oil (Devisol, Videin, etc.) and water (Akvadetrim). To take this or that drug, its dosage and duration of use should be prescribed by a doctor.

In order to avoid an overdose, it is necessary regularly take urine tests, since a large amount of vitamin D in the body can lead to vomiting, constipation, decreased appetite, urinary retention, and even convulsions.

Prevention of rickets

It should be noted that even if the baby was diagnosed with rickets, this is not yet a sentence. Timely treatment will completely get rid of the unpleasant symptoms of the disease and the child will fully recover.

And, most importantly, in order to avoid such a disease as rickets, one should stick to simple rules:

spend more time outdoors;
avoid stress;
eat right and be sure to include fish, meat, cottage cheese vegetables in your diet;
do physical exercises and do not forget about hardening the body.

- a disease of a fast-growing organism, characterized by a violation of mineral metabolism and bone formation. Rickets is manifested by multiple changes in the musculoskeletal system (softening of the flat bones of the skull, flattening of the occiput, deformity of the chest, curvature of the tubular bones and spine, muscular hypotension, etc.), nervous system, and internal organs. The diagnosis is established on the basis of the detection of laboratory and radiological markers of rickets. Specific therapy for rickets involves the appointment of vitamin D in combination with therapeutic baths, massage, gymnastics, UVI.

General information

Rickets is a polyetiological metabolic disease, which is based on an imbalance between the child's body's need for minerals (phosphorus, calcium, etc.) and their transportation and metabolism. Since rickets mainly affects children aged 2 months to 3 years, in pediatrics it is often called the "disease of the growing organism." In older children and adults, the terms osteomalacia and osteoporosis are used to refer to this condition.

In Russia, the prevalence of rickets (including its mild forms) is 54-66% among term infants and 80% among premature infants. Most children in 3-4 months have 2-3 mild signs of rickets, and therefore some pediatricians suggest considering this condition as paraphysiological, borderline (similar to diathesis - anomalies of the constitution), which is independently eliminated as the body grows older.

Pathogenesis of rickets

The decisive role in the development of rickets belongs to exogenous or endogenous vitamin D deficiency: insufficient formation of cholecalciferol in the skin, insufficient intake of vitamin D from food and impaired metabolism, which leads to a disorder of phosphorus-calcium metabolism in the liver, kidneys, and intestines. In addition, other metabolic disorders contribute to the development of rickets - a disorder of protein and microelement metabolism (magnesium, iron, zinc, copper, cobalt, etc.), activation of lipid peroxidation, multivitamin deficiency (deficiency of vitamins A, B1, B5, B6, C , E), etc.

The main physiological functions of vitamin D (more precisely, its active metabolites 25-hydroxycholecalciferol and 1,25-dihydroxycholecalciferol) in the body are: increased absorption of calcium (Ca) and phosphorus (P) salts in the intestine; obstruction of the excretion of Ca and P in the urine by increasing their reabsorption in the tubules of the kidneys; bone mineralization; stimulation of the formation of red blood cells, etc. With hypovitaminosis D and rickets, all of the above processes slow down, which leads to hypophosphatemia and hypocalcemia (low levels of P and Ca in the blood).

Due to hypocalcemia, secondary hyperparathyroidism develops according to the feedback principle. An increase in the production of parathyroid hormone causes the release of Ca from the bones and the maintenance of a sufficiently high level in the blood.

A change in the acid-base balance towards acidosis prevents the deposition of P and Ca compounds in the bones, which is accompanied by a violation of the calcification of growing bones, their softening and a tendency to deformation. Instead of full-fledged bone tissue, osteoid non-calcified tissue is formed in the growth zones, which grows in the form of thickenings, tubercles, etc.

In addition to mineral metabolism, with rickets, other types of metabolism (carbohydrate, protein, fat) are also disturbed, disorders of the function of the nervous system and internal organs develop.

Causes of rickets

The development of rickets is largely associated not with an exogenous deficiency of vitamin D, but with its insufficient endogenous synthesis. It is known that more than 90% of vitamin D is formed in the skin due to insolation (UVR) and only 10% comes from outside with food. Just a 10-minute local irradiation of the face or hands can provide the synthesis of the level of vitamin D necessary for the body. Therefore, rickets is more common in children born in autumn and winter, when solar activity is extremely low. In addition, rickets is most common among children living in regions with a cold climate, insufficient natural insolation, frequent fogs and clouds, unfavorable environmental conditions (smog).

Meanwhile, hypovitaminosis D is the leading, but not the only cause of rickets. Deficiency of calcium salts, phosphates and other osteotropic micro and macro elements, vitamins in young children can be caused by multiple rachitogenic factors. Since the most enhanced intake of Ca and P to the fetus is observed in the last months of pregnancy, premature babies are more prone to developing rickets.

The increased physiological need for minerals in conditions of intensive growth predisposes to the occurrence of rickets. A deficiency of vitamins and minerals in a child's body may be the result of an improper diet of a pregnant or lactating woman, or the baby itself. Impaired absorption and transport of Ca and P contributes to the immaturity of enzyme systems or pathology of the gastrointestinal tract, liver, kidneys, thyroid and parathyroid glands (gastritis, dysbacteriosis, malabsorption syndrome, intestinal infections, hepatitis, biliary atresia, CRF, etc.).

The risk group for the development of rickets includes children with an unfavorable perinatal history. Adverse factors on the part of the mother are gestosis of pregnant women; hypodynamia during pregnancy; operational, stimulated or rapid childbirth; mother's age is younger than 18 and older than 36; extragenital pathology.

On the part of the child, a large weight (more than 4 kg) at birth, excessive weight gain or malnutrition can play a certain role in the development of rickets; early transfer to artificial or mixed feeding; restriction of the child's motor mode (too tight swaddling, lack of baby massage and gymnastics, the need for prolonged immobilization in case of hip dysplasia), taking certain medications (phenobarbital, glucocorticoids, heparin, etc.). The role of gender and hereditary factors has been proven: for example, boys, children with swarthy skin, II (A) blood group are more predisposed to the development of rickets; Rickets is less common among children with I (0) blood group.

Rickets classification

Etiological classification involves the allocation of the following forms of rickets and rickets-like diseases:

Vitamin D-deficientrickets(calcipenic, phosphoropenic variant)
Vitamin D dependent(pseudo-deficient) rickets with a genetic defect in the synthesis of 1,25-dihydroxycholecalciferol in the kidneys (type 1) and with genetic resistance of target organ receptors to 1,25-dihydroxycholecalciferol (type 2).
Vitamin D-resistant rickets(congenital hypophosphatemic rickets, Debre de Toni-Fanconi disease, hypophosphatasia, renal tubular acidosis).
Secondary rickets with diseases of the gastrointestinal tract, kidneys, metabolism or drug-induced.

The clinical course of rickets can be acute, subacute and recurrent; severity - mild (I), moderate (II) and severe (III). In the development of the disease, periods are distinguished: initial, peak of the disease, convalescence, residual effects.

Symptoms of rickets

The initial period of rickets falls on the 2-3rd month of life, and in premature babies in the middle - the end of the 1st month of life. Early signs of rickets are changes in the nervous system: tearfulness, fearfulness, anxiety, hyperexcitability, superficial, disturbing sleep, frequent shuddering in a dream. The child has increased sweating, especially in the scalp and neck. Sticky, sour-smelling sweat irritates the skin, causing persistent diaper rash. Rubbing the head against the pillow leads to the formation of foci of baldness on the back of the head. On the part of the musculoskeletal system, the appearance of muscle hypotension (instead of physiological muscle hypertonicity), compliance of the cranial sutures and the edges of the fontanel, thickenings on the ribs ("rachitic beads") is characteristic. The duration of the initial period of rickets is 1-3 months.

During the height of rickets, which usually falls on the 5-6th month of life, progression of the process of osteomalacia is noted. The consequence of the acute course of rickets can be softening of the cranial bones (craniotabes) and unilateral flattening of the occiput; deformity of the chest with depression ("cobbler's chest") or bulging of the sternum (keeled chest); the formation of kyphosis ("rachitic hump"), possibly lordosis, scoliosis; O-shaped curvature of tubular bones, flat feet; formation of a flat rachitic narrow pelvis. In addition to bone deformities, rickets is accompanied by an increase in the liver and spleen, severe anemia, muscle hypotension ("frog" belly), looseness of the joints.

In the subacute course of rickets, hypertrophy of the frontal and parietal tubercles occurs, thickening of the interphalangeal joints of the fingers (“strings of pearls”) and wrists (“bracelets”), costal-cartilaginous joints (“rachitic beads”).

Changes in the internal organs in rickets are caused by acidosis, hypophosphatemia, microcirculation disorders and may include shortness of breath, tachycardia, loss of appetite, unstable stools (diarrhea and constipation), pseudoascites.

During the period of convalescence, sleep normalizes, sweating decreases, static functions, laboratory and radiological data improve. The period of residual effects of rickets (2-3 years) is characterized by residual deformation of the skeleton, muscle hypotension.

In many children, rickets is mild and not diagnosed in childhood. Children suffering from rickets often suffer from SARS, pneumonia, bronchitis, urinary tract infections, atopic dermatitis. There is a close relationship between rickets and spasmophilia (children's tetany). In the future, in children who have had rickets, there is often a violation of the timing and sequence of teething, malocclusion, enamel hypoplasia.

Diagnosis of rickets

The diagnosis of rickets is established on the basis of clinical signs, confirmed by laboratory and radiological data. To clarify the degree of violation of mineral metabolism, a biochemical study of blood and urine is carried out. The most important laboratory signs that allow you to think about rickets are hypocalcemia and hypophosphatemia; increased activity of alkaline phosphatase; decreased levels of citric acid, calcidiol and calcitriol. At research of KOS of a blood acidosis comes to light. Changes in urine tests are characterized by hyperaminoaciduria, hyperphosphaturia, hypocalciuria. Sulkovich's test for rickets is negative.

When radiography of tubular bones, changes characteristic of rickets are revealed: goblet expansion of the metaphyses, blurring of the boundaries between the metaphysis and epiphysis, thinning of the cortical layer of the diaphysis, indistinct visualization of the ossification nuclei, osteoporosis. Therapeutic mud can also be used to assess the state of bone tissue.

Forecast and prevention

The initial stages of rickets respond well to treatment; after adequate therapy, long-term effects do not develop. Severe forms of rickets can cause pronounced skeletal deformities, slowing down the physical and neuropsychic development of the child. Observation of children who have had rickets is carried out quarterly, for at least 3 years. Rickets is not a contraindication for prophylactic vaccination of children: vaccination is possible as early as 2-3 weeks after the start of specific therapy.

Prevention of rickets is divided into antenatal and postnatal. Prenatal prophylaxis includes the intake of special micronutrient complexes by a pregnant woman, sufficient exposure to fresh air, good nutrition. After childbirth, it is necessary to continue taking vitamins and minerals, breastfeeding, adhere to a clear daily routine, and conduct preventive massage for the child. During daily walks, the child's face should be left open for access to the skin of the sun's rays. Specific prevention of rickets in breastfed newborns is carried out in the autumn-winter-spring period with the help of vitamin D and UV radiation.

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 of the 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 ( e.g. gastrointestinal disease); 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 of a primary disease or a 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 of drugs ( glucocorticoids, anticonvulsants and diuretics); the presence of diseases that disrupt metabolism ( eg tyrosinemia, cystinuria); existing chronic diseases of the biliary tract 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 the initial stage of 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.

In addition to clinical symptoms, the diagnosis of rickets is confirmed by biochemical laboratory tests. 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 of childhood, in which a metabolic disorder occurs in a young body - calcium and phosphorus.
This disease is especially dangerous in the first year of a baby's life, when there is an active formation of 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, the daily intake of 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 a negative result, in which the child may have 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 ( product containing citric 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 the 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 case 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 the nutritional composition of 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, if medical assistance was not provided on time, the child may subsequently develop various complications, including mental retardation.

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 of the 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 children- a disease that manifests itself in infants and young children, associated with a disorder of bone formation and lack of bone mineralization. The cause of childhood rickets is D deficiency during the period of intensive growth of the child's body.

Rickets can affect children under the age of 1 year, most of which are infants and those babies who receive artificial nutrition. In the absence of proper treatment, children may experience skeletal deformities, foot deformities, malocclusion, and other physical disorders.

Causes of rickets in a child

In order to form a full-fledged bone tissue, calcium (Ca), phosphorus (P) and vitamin D must be present in the child's diet, which helps the first two trace elements to be absorbed by the body. These trace elements enter the baby's body with breast milk, and after the start of complementary foods - with egg yolk, butter, vegetables, fish, etc.

Synthesis of vitamin D occurs in the skin of a child under the influence of ultraviolet (rays of the sun). Newborns have a supply of vitamin D for 1-2 months. It accumulates in the fetus if it enters the mother's body in the last weeks of pregnancy in sufficient quantities. Starting from about three months of age, due to the depletion of its own reserves of vitamin D and active growth, the body often experiences a shortage of “building materials”. Then calcium (Ca) and phosphorus (P) begin to be washed out of the bones, the child's bone tissue becomes prone to deformation due to a decrease in its density, psychomotor development is delayed and other symptoms of rickets occur.

Also, the active form of vitamin D (calcitriol) affects the baby, with its help, interferon is produced faster.

Video treatment of rickets in a child

Risk factors for rickets in children

If the child receives mixtures that are not balanced, complementary foods are introduced late (after 8 months), and the baby is offered mainly porridge as a meal.
If the child is not exposed to sunlight for a long period (not in the sun).
If the processes of digestion and absorption of minerals in the child's body are disturbed.
If the baby was born prematurely, did not have time to "stock up" with useful substances, has problems with the digestive system.
If the newborn was born very large (the more the weight of the newborn, the more vitamins and minerals the baby needs).
Twins often have nutritional deficiencies in utero and are born prematurely.
If a child has congenital diseases of the digestive system.
If the baby has dark skin.
If the child is given anticonvulsants.

What should parents pay attention to first of all? First of all, it is necessary to observe if the baby suffers from increased (for example, when feeding, the forehead and nose sweat, the arms and legs are often wet), and also if the child has a violation or constipation. If, moreover, he often shudders, and a bald patch appears on the back of his head, then you should pay attention to all these alarming "bells" and seek the advice of a doctor.

If the parents began to carry out adequate treatment of the baby from rickets at the initial stage of the disease, no negative consequences. If the “moment is missed”, then the following complications caused by the disease may occur: the child’s skull may be deformed, an O- or X-shaped curvature of the legs may occur, a lag in motor development, muscles of the whole body, teeth will begin to be cut later than their peers.

The onset of the recovery stage is noted six months after the onset of the first symptoms, but bone deformities can last a lifetime(narrow pelvis, large bumps on the forehead, malocclusion, chest deformities in children).

Diagnosis of rickets in children

An experienced pediatrician may suspect rickets immediately after examining the child, but for an accurate diagnosis, he will most likely prescribe a urine test according to Sulkovich. If the disease is advanced, the doctor will need to find out to what extent the exchange of calcium (Ca) and phosphorus (P) is disturbed, as well as what is the bone tissue. To do this, the baby needs to take a blood test for electrolytes and vitamin D metabolites, as well as daily urine to determine the content of calcium and phosphorus, and do an ultrasound of the forearm. If rickets progresses rapidly and cannot be corrected (with hereditary forms of the D-dependent and D-resistant form of the disease), an X-ray of the bones is done.

Treatment of rickets in a child

Treatment of rickets in children should be comprehensive.

Non-specific methods include a varied diet, including breast milk (very desirable!), daily routine, regular walks in natural light, exercise therapy, herbal baths, sea salt or pine needles, etc.

Specific methods of treating rickets in children include taking vitamin D, calcium and phosphorus, and exposure to ultraviolet rays. Calculation of the dosage and duration of vitamin intake can produce only pediatrician, since when it is exceeded, hypervitaminosis may occur, which in turn is also a disease.

Attention! The use of any medicines and dietary supplements, as well as the use of any medical methods, is possible only with the permission of a doctor.

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, which is why the need for the child's body in vitamins and minerals increases. 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.

Causes

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 this case, even proper nutrition is not able 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 of internal organs.
Dark skin color. Dark-skinned babies produce less vitamin D.

Symptoms of rickets

In the early stages of rickets, newborns experience 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.

Consequences

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:

Taking 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 full breastfeeding 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 should lead a healthy lifestyle, eat right, walk in the fresh air, take vitamins prescribed by a doctor.