Rickets in children: symptoms and treatment. How to avoid rickets in a child? Modern approach to the treatment of rickets in children

Rickets is a disease that is associated with an insufficient amount of vitamin D in the body of a newborn. Alas, it is still found in our kids. The disease is dangerous for the little man, as it disrupts calcium-phosphorus metabolism. To notice the symptoms in time and start treatment is the primary task of parents and doctors.

What is rickets in children up to a year. Stages of development of the disease

Formation bone tissue the baby, begun in the womb, continues throughout the first year after birth. With a lack of vitamin D, the baby may develop rickets - a dangerous childhood disease accompanied by softening of the musculoskeletal tissue. As a result, the child's bones are bent, and the normal work a number of internal organs.

Rickets can be recognized by a variety of signs.

1. This and softening around a large fontanelle of bone tissue , an increase in the frontal tubercles and a thickening of the occiput. Subsequently, the curvature of the bones begins.
2. Malfunctions in the work of the central nervous system . The baby often cries, gets scared for no reason, becomes lethargic.
3. The child develops unreasonable sweating . The baby's head is often wet, usually after feeding or sleeping.
4. Weakening of muscle tone , manifested in flabbiness of the muscular system;
   appearance skin itching and hair loss.
5. Slowdown of physical development.
6. Late teething.
7. Dense formations on the ribs baby (rachitic rosary).

The first symptoms of the disease may appear as early as 2-3 months. Sometimes babies are born with initial signs rickets.

The disease is divided into 3 stages

• Light form when minor changes are noticeable on the part of the muscle tissue. The disease lasts from a week to a month, then passes into the next stage. At timely treatment passes without consequences for the health of the crumbs.
• Medium when the deformation of the limbs and skull of the baby is clearly noticeable.
• Severe form manifested by softening and deformation of the bones not only of the limbs, but also chest. At the same time, it is difficult for the baby to breathe, he has a disorder in the work of all internal organs.

Why is my child diagnosed with rickets? Understanding the reasons

Why in our time, when replenishing the body with the missing vitamins and minerals is not difficult, children are still diagnosed with rickets?

Certain categories of children are primarily at risk.

• premature babies in which, due to the underdevelopment of a number of body functions, the absorption and assimilation of vitamin D is difficult.
• big kids born with a large weight and requiring a high content of vitamins of group D in the body.
• Babies deprived of breast milk and receiving nutrition in which there is not enough phosphorus-calcium elements.
• Babies who are breastfed by their mother , but at the same time she eats improperly, which is why the milk lacks substances that ensure the healthy development of the crumbs.

It may happen that the diagnosis is made erroneously, based on only one of the signs. To complete the picture, the doctor must prescribe a series of tests to determine the content of calcium and phosphorus in the blood, activity alkaline phosphatase.

Allow to clarify the diagnosis and x-ray, ultrasound data.

The signs by which the doctor diagnoses rickets may correspond to others, no less dangerous. Therefore, in order to understand what exactly the little man is sick with, accurate diagnosis is so important.

What signs determine rickets in a child up to a year

The first symptoms of the disease appear on

1. The child is often naughty and sleeps little.
2. If you carefully consider a large fontanelle and feel its edges, you will notice marked thinning of the bone tissue .
3. The child has increased sweating , which is accompanied by a sour smell, as well as itching, especially in the back of the head. The baby feels discomfort and rubs his head against the pillow. At the same time, his hair is worn out.
4. Rickets manifests itself slower bone growth especially the legs. The baby has a growth retardation and a distortion of body proportions.
5. Possible muscle hypotonia or looseness of the joints, an increase in the size of the tummy.
6. Decreases physical activity crumbs , the child becomes lethargic and phlegmatic, does not eat well.

Later manifestations of rickets include limb deformity . The baby's legs are bent, forming the letters O or X. In the area of ​​\u200b\u200bthe shins and forearms, rickety bracelets are observed - thickenings on the bone tissue.

Children who have rickets, lying on their backs, easily pull the leg to the head and can even put the heel on their shoulder.

How to treat rickets in babies

If the diagnosis of the disease is confirmed, treatment should be started immediately.

Need to start with non-specific forms treatment is right balanced nutrition and regime

• The child must walk fresh air at least 4 hours a day . In spring and summer, he needs to be in the sun more often.
• Breast milk is the best food for babies , which contains the necessary amount of phosphorus and potassium. If a breast-feeding impossible, you need to use mixtures adapted to the child's body and containing a complete set of vitamins and trace elements necessary for the baby.
• A sick child needs to introduce complementary foods on time from one-component puree (broccoli, zucchini), gradually add butter and vegetable oil, fruits, juices, cereals, vegetables, cottage cheese and meat products to baby food.
• Daily baths with coniferous extract are useful for a child. or saline solution calming the nervous system and supporting the immune system.
  Massage and hardening will help to quickly cope with the disease.

Drug treatment is carried out as prescribed by the pediatrician and under his supervision. The baby is prescribed medications that contain vitamins of group D, calcium and phosphorus.

AT recent times doctors prefer to prescribe vitamin D in the form aqueous solution, since it is quickly absorbed into the baby's blood and does not lead to gastric disorders. (Akvadetrim). Oil solutions (Videhol, Vigantol or other drops) are prescribed to children if they are allergic to water preparations.

These drugs regulate the exchange of phosphorus and calcium in the body and contribute to the formation of bones and teeth.

When treating a baby, it is important to strictly observe the dosage of the medicine that the attending physician prescribes, based on the stage of the disease. For each child, the dose is selected individually. This takes into account age, heredity, diet and other factors.

Usually, daily dose the drug is from 2 to ten drops. Begin treatment with a minimum dose, gradually increasing it to a therapeutic norm that can produce a therapeutic effect.

If taking vitamin D does not lead to the desired result, then the baby lacks not only this drug, but also other vitamins. In this case, he is prescribed multivitamins (Biovital gel, Multi tabs and other children's vitamin preparations).

For complex treatment rickets crumbs are assigned an occupation physical therapy and massage sessions, which are selected based on the condition of the child and the stage of the disease. Massotherapy activates metabolic processes in skin. This helps the body produce vitamin D.

When conducting therapeutic exercises you need to remember that a sick baby gets tired quickly, so it is advisable to strictly dose classes.

Physical therapy classes must include exercises that develop correct breathing. To do this, very young children lightly press on the chest, for a grown-up baby they combine pressure with crossing the arms.

Since children become excitable with rickets, more stroking exercises are used during massage sessions, reducing or eliminating shock and patting techniques.

Prevention of rickets in children up to a year

It is necessary to engage in the prevention of rickets not from the first days of a child's life, but at a time when he is still in the womb. Then the probability of occurrence of the disease will be minimized. The exception is congenital rickets, when the mother's pregnancy is very difficult, for example, with a prolonged period of toxicosis.

In other cases, if the mother walked a lot during pregnancy, went in for physical education, ate well and took multivitamin complexes, the baby’s body received everything necessary for its healthy development even before birth. Among these children, the incidence of rickets is significantly reduced.

Preventive measures to prevent rickets in infants are carried out from the age of three weeks. At this time, the pediatrician prescribes the baby 2 drops of Aquadetrim per day.

In addition, doctors recommend taking a urine test (Sulkovich samples) once a month to determine the amount of calcium in it. This study cannot be neglected, since with nonspecific prophylaxis there may be an overdose of vitamin D. This is just as harmful to the child's body as its deficiency.

Dr. Komarovsky advises as preventive measures children from 6 months to use baths with sea salt.

It is impossible to leave rickets without attention and treatment, since the consequences of this unsafe disease will remain in a person for life, making their unpleasant and sometimes unsafe adjustments. Start taking care of your baby from the first days of pregnancy!

Proper nutrition of a pregnant woman, nursing mother and child is the key to the health of the baby and eliminates the development of rickets.

Deficiency-related diseases are quite common in children. Not only babies, but also older kids can get sick with them. Today we will talk about rickets in babies older than one year.

What it is?

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

Usually, early adverse signs of rickets appear in a child in the first months and within 1 year after birth. However, the disease is also recorded in children and at an older age.

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

Boys get rickets just as often as girls. Severe deficiency of vitamin D in the child's body leads to a violation of the exchange between calcium and phosphorus. Both of these substances provide bone strength. With a disturbed calcium-phosphorus metabolism, a child develops various adverse symptoms associated with a pronounced deficiency of biologically active substances.

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

The reasons

Various causes lead to the development of the disease in babies, which contribute to a decrease in the level of calciferol. In some cases, the impact of causes may be combined. Understand exactly what causal factors caused a disease in the baby - it is very important. Only the elimination of the cause of the disease will lead to full recovery child.

The peak incidence of rickets occurs in infancy. Usually the first manifestation of rickets occurs within the first three months after the birth of a child. In some cases, when easy course disease Clinical signs are not visible, which greatly complicates the diagnosis. In such a situation, the diagnosis is usually established only by the age of 2-3 years.

The most common causes leading to a deficiency in the children's body of calciferol include:

• Insufficient intake of vitamin D from food. In babies up to a year, this leads to the rapid abolition of breastfeeding. In older children, the cause of exogenous deficiency in the intake of calciferol is an unbalanced and inadequate diet. No animal products and vegetarian food can cause rickets in the baby.
• Accommodation in the northern regions. The lack of solar insolation leads to the fact that an insufficient amount of endogenous (internal) vitamin D is synthesized in the child's body. Exposure to the skin of ultraviolet spectrum rays in the baby causes a cascade of biological reactions that trigger the synthesis of calciferol.

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

• Chronic organ diseases digestive system. The leading role is given to intestinal pathologies. Chronic enteritis, accompanied by a strong malabsorption of various substances from food, often leads to the formation of various scarce states. Without treatment of the underlying disease in this case, the adverse symptoms of rickets cannot be coped with.
• Prematurity and congenital pathologies. The birth of a baby earlier than planned is often the trigger for the development of rickets. This can be explained by the fact that a premature baby has not completed the formation of many internal organs. Violations of intrauterine development often cause various health problems in the future.

Symptoms

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

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

After the lapse of initial stage, the disease goes into a period of peak. This is a more unpleasant time, characterized by the appearance of numerous symptoms. The baby has the first deformations of the bone tissue. Basically, all tubular and flat bones that are actively growing are involved in the process. Diagnosis of the disease at this time is not difficult and does not present a problem for the doctor.

expressiveness clinical symptoms may be different.

Severe course diseases in babies older than a year is quite rare.

The child has a characteristic curvature of the spine - scoliosis. Changes in the density and thickness of the clavicles. They come forward a little. The architecture of the structure of the chest is also disturbed.

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

Shoemaker's Chest

chicken breast

The child's shape changes lower extremities. They become O- or X-shaped. Usually this sign appears in babies with a pronounced course of rickets by the age of five. In order to identify this symptom, you should look at the baby with different angles vision. Usually, the curvature of the lower extremities is clearly visible from the side.

Also during the height of the disease muscle hypotonia appears and various neuromuscular pathological conditions join. AT horizontal position in sick babies is well traced "frog belly". On examination, the child's tummy becomes flattened and hangs somewhat to the side surfaces of the body. This symptom is due to the presence of pronounced hypotonicity of the muscles that make up the anterior abdominal wall.

frog belly

Bone deformities of the skeleton also lead to disturbances in the functioning of internal organs. Pathologies of the chest contribute to a decrease in the ventilation capacity of the lungs, which leads to the development of emphysema and other pathological conditions. Respiratory failure affects hemodynamics and vascular tone. Such combined conditions lead to the fact that the baby has problems in the work of the heart muscle and blood vessels.

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

Timely prescribed treatment helps to normalize the child's condition and improve his appearance.

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

Diagnostics

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

The following studies are used to detect the disease:

• Measurement of calcium and phosphorus in the blood. Normally, the level of calcium should be - 2.5-2.7 mmol / l, and phosphorus - 1.3-2.3 mmol / l. The decrease in these indicators in a child is lower age norm indicates the presence of signs of impaired calcium-phosphorus metabolism.
• Determination of alkaline phosphatase. This enzyme is actively involved in the exchange between calcium and phosphorus. Normally, it is up to 200 IU / l. An increase in this indicator indicates the presence of metabolic disorders in calcium-phosphorus metabolism.
• Radiography. Allows you to clarify the presence of bone deformities and a violation of the architecture of the skeleton caused by the disease. With the help of bone radiography, specific signs characteristic of rickets can be detected: "rachitic bracelets", pathological curvatures spinal column, "rachitic rosary", pathologies of the chest, bone seals in the tubular bones. This method can be used only under strict indications.
• CT scan. It is carried out according to the same indications as radiography of bone tissue. This method has a higher resolution and allows you to get the most accurate result. The use of computed tomography allows doctors to assess the level of damage and the degree of functional impairment.

Effects

The prognosis of the disease in children is greatly influenced by timely diagnosis and treatment. If rickets in a child was detected at the most early stages, then negative complications of the disease, as a rule, do not occur. With a belated diagnosis, the baby may experience various long-term effects diseases that require mandatory rehabilitation activities. To the common consequences of rickets transferred to childhood, include: a moderate decrease in muscle tone, slight curvature of the lower extremities, malocclusion and others.

Treatment

To eliminate the adverse symptoms of the disease, several therapeutic methods are prescribed. Monitoring the effectiveness of the prescribed therapy is carried out with the obligatory determination of the calcium content in the blood. During the treatment, it is also assessed and clinical condition child. When prescribing therapy, the baby should feel better and become more active.

For the treatment of rickets in babies, the following principles of treatment apply:

• Regular walks in the fresh air. Insolation sunlight essential for a child with rickets. Ultraviolet rays have a pronounced therapeutic effect on the children's body, increasing the internal synthesis of calciferol. The baby should take walks in the fresh air every day. Only regularity and consistency will achieve a good and lasting result.
• Complete nutrition. In the daily diet of the baby, foods rich in calciferol must be present. These include: meat, chicken, fish, eggs, milk and dairy products, cottage cheese, cheese. The baby must eat a variety of foods that contain vitamin D. If the child receives medications with calciferol, then the diet must be discussed with the attending physician in order to avoid an overdose of the intake of this vitamin in the child's body.
• Conducting physiotherapy. A course of UVR (ultraviolet radiation) helps babies suffering from rickets improve their overall well-being and increase bone density. Usually it consists of 12-15 procedures. Their duration can be different: from 2 to 10 minutes. Physiotherapy has a number of contraindications and is prescribed by the attending physician.

For information on what rickets is in children and how to treat it, see the following video.

• Rickets
• Doctor Komarovsky
• In infants
• In children from 1 year

Rickets in children- a disease caused by vitamin D deficiency. Vitamin D is produced by the skin under the influence of ultraviolet rays, and is also found in some products. Vitamin D actively promotes the absorption of calcium from the intestines and its proper distribution in the body, which is very important for the development of bone tissue, the functioning of the central nervous system, and other organs. Most often rickets occurs in children younger age, i.e. in the first three years of life.

Signs of rickets in children

The initial period of rickets.

Currently, it is believed that congenital rickets does not happen. What used to be taken as a congenital form of this disease, in fact, are malformations of the skeletal system. First signs of rickets in children occur more often at 2-3 months of age. Parents notice a change in the child's behavior: anxiety, fearfulness, excessive excitability appear - start at a loud cry, a sudden flash of light, etc. Sleep becomes superficial, disturbing. There is increased sweating, especially of the face and scalp. sweat has sour smell, irritates the skin, causing itching. The child rubs his head against the pillow, baldness of the back of the head appears. Normal for this age high tone muscle is gradually replaced by hypotension, that is, reduced muscle tone. When feeling the bones of the skull, it is possible to reveal the compliance of the sutures and the edges of the large fontanel. There are thickenings on the ribs ("rosary"). From the side of internal organs there are no changes.

Rickets period.

Most often period of rickets occur at the end of the first six months of life and is characterized by even more significant neuromuscular disorders, up to a delay in psychomotor and physical development: the child reluctantly turns on his stomach and back, does not make an attempt to sit down when he is pulled by the handles, rarely hums, there is no babble (pronunciation syllables).

The processes of osteomalacia, that is, softening of the bones, are especially pronounced in acute cases, are observed in the flat bones of the skull. Over time, flattening of the occiput may develop, often unilateral. Changes in the configuration of the chest characteristic of this period are its “depression” in the lower third of the sternum (“shoemaker’s chest”) or “bulging” (“chicken breast”). Perhaps O-shaped, and also (much less often) X-shaped curvature of the legs and the formation of a narrowed (“flat-rachitic”) pelvis. Sometimes there is proliferation of non-calcified bone tissue (the growth of which normally stops after calcification), leading to the formation of frontal and parietal tubercles, an increase in head circumference, a thickening in the wrist area (“bracelets”), in places where bone tissue passes into cartilaginous tissue on the ribs (“rosary beads”). ").

Characteristic for rickets changes in the bones can be seen on x-rays. However, at present, the diagnosis of rickets is almost always carried out according to the clinical picture, and only bone changes are taken into account. X-ray studies due to their side effects are not used for this purpose.

The recovery period of rickets.

This period is characterized by an improvement in the child's well-being, the elimination of neurological disorders. Static functions improve or normalize - the child begins to sit, stand and walk better (according to age), however, muscle hypotension and skeletal deformity persist for a long time. The level of phosphorus reaches the norm or slightly exceeds it. A slight decrease in calcium in the blood may persist.

Normalization of biochemical parameters indicates the transition of rickets from the active to the inactive phase - the period of residual effects. Now this period is most often absent, since rickets, as a rule, proceeds in a rather mild form, leaving no consequences. Previously, especially in war time, in children who had rickets, for the rest of their lives they had an excessively large head, a deformed chest, twisted legs, and a narrow pelvis (in women, this often caused complicated childbirth).

The active phase of rickets is observed only in children under one year old during a period of rapid growth. Now they do not diagnose "late rickets" for children of preschool and school age, when there is no longer a rapid growth of the child's body. Pain in the limbs and their deformities at this age (what used to be taken for late rickets) are actually due to other reasons.

Treatment of rickets in children

Nonspecific treatment of rickets in children:

• rational (natural) feeding;
• organization of the daily routine corresponding to the age of the child;
• security long stay a child outdoors with sufficient insolation (1);
• physiotherapy and massage;
• hardening;
• treatment of comorbidities.

Specific treatment for rickets in children:

The issue of additional administration of calcium and phosphorus preparations has not been fully resolved. It is believed that if the child's diet is well balanced, then the additional administration of calcium, especially simultaneously with vitamin D, can lead to the development of hypercalcemia. Many doctors prescribe phosphorus preparations, especially for premature babies. Magnesium preparations are often added, which contributes to the use of natural reserves of vitamin D, phosphorus and calcium.

Prevention of rickets in children

Prevention of rickets before the birth of a child:

• complete nutrition of a pregnant woman;
• long walks in the fresh air;
• physical education;
• constantly (three months before pregnancy and throughout pregnancy) - a complex of vitamins with micro- and macroelements for pregnant women ("pregnavit", "mother", "vitrum prenatal", etc.).

The expectant mother should not only spend as much time as possible in the air, which most of them do, but also be sure to engage in physical education (a set of exercises for pregnant women). In no country in the world, except Russia, do they treat a pregnant woman as a seriously ill person. In our country, unfortunately, caring for a future mother often comes down to advice: "Lie down, rest, do nothing, don't move."

Pregnant women are not prescribed UVR and large doses of vitamin D, which was common a few years ago, as there is evidence that in children whose mothers received UVR during pregnancy, damage to the nervous system develops more often and is more severe. At large doses vitamin D, the placenta is easily damaged, children develop intrauterine growth retardation, that is, children are born weakened, with various diseases of the internal organs.

The expectant mother should be under constant supervision in the antenatal clinic from the early stages of pregnancy, since the prevention of various complications greatly contributes to the birth healthy child, which also prevents the subsequent development of rickets.

Prevention of rickets in children after birth:

• proper feeding (for example, iron deficiency was found in all children with rickets, often in the absence of vitamin D deficiency);
• daily routine corresponding to the age of the child;
• walks in the fresh air and at the same time the rejection of air baths in direct sunlight (walks in the shade of trees);
• hardening;
• massage and gymnastics;
• the constant intake by the nursing mother of multivitamins or special mixtures enriched with micronutrients (i.e. vitamins and trace elements);
• as prescribed by a doctor - multivitamins for infants (Multi-Tabs, Polivit Baby, Biovital Gel, etc.); the question of prophylactic intake of vitamin D should be decided by the doctor.

AT prevention of rickets in children breastfeeding is definitely number one. Up to 4-6 months, the baby should be fed only breast milk. With proper nutrition of the mother, especially if she continues to continuously take either special multivitamins or mixtures for pregnant and lactating women enriched with micronutrients (“Fabulous nutrition for pregnant women and mothers”, “Enfa Mama”, etc.), breast milk completely covers the child’s need for vitamins and microelements. After 4-6 months, it is necessary to introduce complementary foods (vegetable and fruit purees, cereals, juices, meat, fish). With artificial feeding, adapted, that is, as close as possible in composition to breast milk, mixtures the child also receives a sufficient amount of micronutrients. However, to prevent rickets is not enough only proper feeding. They also play an important role correct mode days with long walks, hardening, massage and gymnastics.

Pediatricians say: "Better a little rickets than hypervitaminosis D." And indeed it is. AT modern conditions, as already mentioned, rickets proceeds quite easily, with proper treatment leaving almost no consequences. Hypervitaminosis D (D-vitamin intoxication) is a disease caused by both direct toxic effect drug for cell membranes, and its increased content in the blood and urine, which causes the deposition of calcium salts in the walls of blood vessels, primarily the kidneys and heart. In the future, this often leads to chronic pyelonephritis, chronic kidney failure that is, the child becomes disabled. Hypervitaminosis D is not always caused by an overdose of vitamin D - it can be associated with individual hypersensitivity to this vitamin, when even moderate doses lead to intoxication.

There are acute and chronic D-vitamin intoxication. Acute D-vitamin intoxication develops more often in children of the first six months of life with a massive intake of vitamin for a relatively short period of time (2-3 weeks). With individual hypersensitivity, it manifests itself from the very beginning of the administration of the drug in doses close to physiological. Appetite is sharply reduced, vomiting is often observed, body weight decreases rapidly, dehydration occurs, thirst develops, stools tend to be constipated, but may be unstable and liquid. The child may lose consciousness for a short time, sometimes there are convulsions.

Chronic D-vitamin intoxication occurs against the background of long-term (6-8 months or more) administration of the drug in moderate doses, but still exceeding physiological need in him. characterized by less pronounced clinical picture: increased irritability, poor sleep, weakness, joint pain, gradual increase in dystrophy, premature closure of the large fontanel, and, most importantly, changes in the cardiovascular and urinary systems with the development in the future of chronic damage to the heart muscle and renal tissue.

Treatment of hypervitaminosis D is carried out in a hospital. It includes the abolition of vitamin D and insolation, the appointment of vitamins A, E, intravenous administration liquids in combination with diuretics. AT severe cases short course of prednisolone

Evgenia Kapranova
Associate Professor of the Department of Children's Diseases of the Moscow Medical Academy. THEM. Sechenov, Ph.D.

Rickets is a disease characterized by a violation of phosphorus-calcium metabolism. This diagnosis is usually made in children early age against the background of an insufficient amount of vitamin D in the body - calciferol. Chronic deficiency of this microelement leads to disruption of the supply of phosphorus and calcium to the bone and cartilage tissue. As a result of this, there irreversible changes in the formation and mineralization of bones, which causes rickets in children.

Most people consider this diagnosis a relic of years, so rickets is often called not a medical, but a social problem, since it is associated with a violation of the conditions for caring for a child. Undoubtedly, the modern standard of living of the population and the improvement of the general socio-economic situation in the country should help to make this disease a thing of the past.

But despite this, rickets still poses a threat to the health of children in the first years of life.

Rickets is a disease that affects the musculoskeletal system. Most clearly, the signs of pathology are manifested in infants and young children - a few months after birth and up to 5 years. Rarely, a similar situation develops in an adult, but in this case we are talking about osteomalacia - a pathological softening of the bones.

Changes in bone tissue against the background of rickets are caused by a chronic lack of phosphorus and calcium.

Typically, these micronutrients enough contained in food, but in order for them to be fully absorbed by the body, vitamin D or calciferol is needed - a substance that helps phosphorus and calcium penetrate into the bone and muscle tissue, into nerve fibers, pre-preparing them.

Vitamin D enters the body of children from food products and special pharmacy supplements. Also, calciferol is independently formed in the skin of a child under the influence of direct ultraviolet rays from products of cholesterol derivatives (which is why any restrictions on baby food are prohibited).

The main causes of rickets are:

• malnutrition;
• insufficient exposure to open sunlight;
• disorders of vitamin D and cholesterol metabolism.

Also, experts identify a whole list of predisposing factors contributing to the development of rickets:

• the weight of the child is more than 4 kg at birth;
• refusal to breastfeed;
• the use of non-adapted mixtures for artificial feeding;
• difficult childbirth;
• limitation motor activity child;
• rare walks;
• disruption of the digestive tract;
• frequent infectious and viral diseases;
• treatment with anticonvulsants;
• rapid growth and weight gain in a child requiring increased amount calcium in the body.

Usually, children born prematurely as a result of the disease are affected. They may develop symptoms of rickets as early as the second week after birth. This is explained general weakness their body and the unpreparedness of the digestive system to normally accept and assimilate food against the background of physiological immaturity.

The exception is congenital form rickets, the causes of which are the unsatisfactory condition of the placenta and the meager diet of the mother during pregnancy.

In rare cases, doctors are faced with rickets, independent of the presence of vitamin D in the body. In this disease, both calciferol, and phosphorus, and calcium are in the child's body within the normal range, but due to the existing pathologies in the liver and kidneys, as well as when taking certain medications (corticosteroids, barbiturates, etc.), calcium and phosphorus are not can be converted into an accessible form for full assimilation by the body.

Symptoms and Diagnosis

The first signs of rickets in children appear imperceptibly and most parents do not pay due attention to them, attributing everything to the whims and behavior of the child.

So, we list the main symptoms of the disease:

• sleep problems, sleep disturbance biological rhythm sleep and wakefulness;
• sudden fearfulness of the child, unexplained anxious behavior;
• sluggish inhibited state, lack of interest in the surrounding reality;
• severe irritability, constant whims for no apparent reason;
• excessive sweating, especially during feeding, while the sweat has an unpleasant sour smell;
• irritation and itching of the skin;
• lack of hair in the occipital region due to the fact that the child rubs against the pillow during sleep;
• constant ammonia smell from the genitals, diaper rash and irritation on the genitals due to contact with urine;
• convulsive syndrome, especially during sleep;
• persistent digestive problems - diarrhea or constipation.

These signs of rickets usually develop a few months after the birth of a child. The onset of the disease usually occurs in the cold season - late autumn or winter-spring period.

The first symptoms of rickets affect the behavior of the child to a greater extent: he becomes extremely capricious and demanding, nervousness is associated with excessive sweating, itching and irritation of the skin, characteristic baldness of the occipital part of the head.

If you leave these symptoms without due attention, then by six months the child will already have full picture diseases.

Following the first symptoms of the disease, there is a delay in physical development: the baby begins to later raise and hold his head, sit down and walk, he has milk teeth later, and the fontanel remains open longer than the due date.

Both the pediatrician and parents must pay attention to all this and carry out in a timely manner biochemical research blood: changes in the analysis will indicate a low concentration of phosphorus and increased activity phosphatase.

Signs of rickets that appear in a later period are already an independent irreversible pathology. The danger lies in serious violations development, leading to disability.

Children's rickets affects cartilage and bone tissue, immune system and internal organs. Children suffering from rickets from the first months of life are more likely to develop infectious and viral diseases.

The following symptoms indicate the complications of rickets:

• pathological enlargement of the spleen and liver;
• chronic anemia;
• abnormal joint mobility;
• hypotension of muscles, for example, the abdomen - it becomes flat and shapeless when the child lies on his back;
• unnatural curvature of the legs with the letters O or X (appears from the moment the child begins to walk);
• retraction or protrusion of the chest;
• rachiocampsis;
• rachitic growths on the ribs, visible to the naked eye;
• softening of the bones of the skull;
• bone growths along the superciliary arches, parietal and frontal protrusions;
• a noticeable increase in head volume;
• thickening of the ankles and wrists - rachitic "bracelets".

If treatment is delayed, the consequences can be catastrophic. In the future, a hump forms in the child against the background of a curvature of the spine, specific bone thickenings appear on it. Anatomically underdeveloped pelvis and pathological formation of cartilage and bone tissue lead to the development of hip dysplasia.

Also, the list of complications can be supplemented with flat feet, asymmetry of the skull and disability of the child. Residual symptoms of rickets remain with a person throughout his subsequent life. We are talking about a stable deformation of the skeleton.

The diagnosis is made on the basis of examination and laboratory and instrumental research methods. If rickets is suspected, the pediatrician sends a small patient for consultations to a pediatric surgeon and orthopedist, who know how to identify rickets at an early stage.

Specialists may prescribe the following additional studies:

• biochemical analyzes of urine and blood to determine the amount of phosphorus, calcium and calciferol;
• computed tomography and X-ray examination, which allows to examine the lesions of cartilage and bone tissue in the body.

Based diagnostic examination the doctor selects the appropriate treatment or prescribes preventive measures.

Treatment

The primary task in the treatment of rickets is the biochemical normalization of the amount of missing trace elements in the body. A huge role in this case is played by specific drugs with vitamin D.

They are available in the form of tablets and drops and are used depending on the age of the child. With a therapeutic and prophylactic purpose, the following drugs are prescribed: Aquadetrim, Vigantol, Devisol and many others. The drug and dosage of the drug should be selected by the doctor according to an individual scheme.

Improving the child's condition against the background conservative treatment comes quickly, this can be verified by radiographic and biochemical changes. After the start of taking the drug with calciferol, within one week, the concentration of phosphorus increases significantly, the activity of alkaline phosphatase decreases, and the level of calcium in the blood temporarily decreases.

Positive changes also appear on the radiograph: the ossification nuclei become more visible, the bone tissues become stronger, and new epiphyseal lines are found.

The second point in the treatment of rickets is physiotherapy.

With its help, it is possible to accelerate the development of the child and the assimilation of trace elements by his body. Children suffering from rickets should move more, develop muscles and joints. Physiotherapy can be carried out as soon as the child is 6 months old.

Usually, the treatment complex includes massage, balneotherapy, electrophoresis using phosphorus and calcium ions, ultraviolet baths and therapeutic exercises.

Surgical treatment is necessary if the disease has progressed to severe stage . In this case, vitamin therapy and massage become ineffective, because in musculoskeletal system The child has undergone major changes.

Bone deformities can only be corrected surgery. It will help to give the bones and joints a natural physiological position. recovery period after surgical treatment largely depends on the nutrition of the child, the presence in his body of the necessary trace elements and vitamins.

In most cases, rickets is not life threatening. But if you do not engage in the prevention and treatment of this disease, then its symptoms can subside over time, and the consequences will remain for the rest of your life.

Many children who have been ill at an early age mild form rickets and who have not received appropriate treatment, with age they begin to suffer from caries, curvature of the legs, and even lag behind in physical and mental development.

Pathological changes affecting the bone and cartilage tissue cause flat feet, scoliosis and pelvic deformity.

At school age, such children are often diagnosed with myopia and anemia, and infectious and colds. As adults, they suffer from osteoporosis and brittle bones.

Fortunately, today medicine can cope with this disease: the neglected form of rickets in modern children is becoming an exception.

At the same time, the task of parents remains paramount: do not miss unpleasant symptoms diseases, carefully monitor the development and condition of your child in order to maintain his health for many years.

Useful video about the signs of rickets in children

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The problem of rickets has been known for several centuries, but is still relevant today: in Russia, according to various studies, from 40 to 60% of children suffer from rickets.

In the article you will find the causes, types, symptoms, ways to prevent and prevent the development of rickets in children.

Rickets is a consequence of a lack of phosphorus and calcium salts due to a violation of calcium-phosphorus metabolism in the body.

The appearance of the disease is almost always associated with a lack of vitamin D (lack of sun exposure and exposure to fresh air, not proper nutrition mother, unsuitable formula for feeding).

As a result, the growth and development of bones is disrupted with all the ensuing consequences.

Rickets usually affects infants between two months and a year old.. Older children, adolescents and adults may experience the consequences of rickets in the form of curvature of the legs, spine, flat feet, improper development teeth and other bone defects.

Rickets transferred in infancy can produce irreversible changes in the body.

The reasons

In addition to the main factors leading to the development of the disease (vitamin D deficiency and disorders of calcium-phosphorus metabolism), there are several more:

• rapid growth of the body;
• metabolic disease;
• prematurity;
• unsuitable formula for feeding;
• malnutrition of the mother with prolonged breastfeeding;
• malabsorption syndrome - a violation of the absorption of nutrients in the intestine and, as a result, their loss;
• hereditary disorders of vitamin D metabolism;

Types of diseases and symptoms of each of them

Damage in children can be classified according to the stage of the disease (initial, peak, reparation, residual), severity (mild rickets, moderate, severe) and by nature (acute, subacute, recurrent).

Stages of rickets

initial stage

Symptoms of the initial stage of rickets in infants are difficult to recognize. They appear quite early: at 2-4 months of life (in premature babies - up to 1 month). The manifestations of the disease may not affect the appearance of the child in any way, but deviations in behavior appear: the child is naughty, shudders, and worries.

Later, the first serious sign appears - baldness at the back of the head. With rickets, children sweat a lot, their sweat is characterized by an unnatural sour smell.

Razgar

At this stage, physiological changes in the child are clearly visible. A square head syndrome appears (an asymmetric shape of the skull, in which the back of the head is flattened and the forehead begins to bulge - the so-called "Olympic forehead").

Chest changes, called cobbler's breasts, are also seen at this stage. This is due to the seals that form at the junction of bone tissue with cartilage (rachitic beads).

The height of the disease is accompanied by a curvature of the child's legs (X-shaped and O-shaped legs), seals on the wrists (rachitic bracelets), curvature of the spine (the so-called rachitic hump appears), due to weak muscle sinking, a “frog belly” appears.

Reparations

It's a period of fading clinical manifestations rickets. Signs of the active course of the disease disappear. The content of phosphorus in the body is normalized, while there is still a deficiency of calcium.

Residual signs

Appear at the age of two or three years after suffering rickets.

Among them are:

• bone deformities;
• enlarged organs: liver and spleen;
• lack of appetite;
• anemia;
• unstable chair;
• violation of the nervous, muscular and circulatory system.

The severity of rickets

Light (1 degree)

With a mild degree of the disease, the bones are not seriously deformed, only a slight flattening of the occiput and thickening of the tissues in the growth zones can be observed.

In children who have been ill mild degree rickets, usually not manifested residual effects after recovery.

Medium (2 degree)

In the second degree of rickets, albeit not very serious, but distinct bone deformities (legs, chest, head, etc.) are already manifested. A “frog belly”, muscular hypotension is formed.

Severe (3 degree)

On the last stage diseases due to softening of the bone tissue, serious deformities occur, such as "shoemaker's chest" (or "chicken breast"), rachitic kyphosis (spinal deformity), exophthalmos (displacement eyeball, which leads to bulging of the eyes), confluence of the bridge of the nose.

Due to the delay in the development of motor and static functions, the child cannot stand up, sit down, walk.

The nature of the flow

Spicy

Acute rickets can be associated with prematurity and usually occurs in infants under six months of age. In this case, it can also occur in full-term children, but with increased body weight.

Symptoms of acute rickets are osteoporosis and softening of the bones, resulting in deformity.

Subacute

Subacute rickets develops slowly and latently. Severe osteoid hyperplasia, anemia and muscle atony are observed.

recurrent

A disease is called relapsing, the symptoms of which occur again and again after subsiding active stage diseases. Will continuously progress in the absence of treatment and prevention of relapses (or with inadequate treatment).

Treatment of rickets in children

In the treatment of rickets, an individual approach is practiced to each child. It will depend on the age of the patient, the nature of the course and the severity of the disease.

General treatment recommendations include:

1. A balanced diet for a child. When breastfeeding, the mother should receive everything from food essential vitamins and trace elements, lead healthy lifestyle life. If breastfeeding is not possible, the baby should be fed an adapted vitamin D formula.
2. Compliance with sleep and wakefulness, walks in the open air.
3. Special massage, children's gymnastics.
4. Proper child care.

Separately, vitamin D2 is treated in the following dosage:

1. Rickets of the first degree - dosage up to 2-4 thousand IU per day, course 6 weeks.
2. Rickets of the second degree - a dosage of 4-6 thousand IU per day, a course of 6 weeks.
3. Rickets of the third degree - dosage from 4-6 thousand IU per day, course up to 8 weeks.

For children from three months, instead of D2, 10-12 UVR sessions can be prescribed.

Additional treatments:

1. Coniferous baths (allowed for children older than 5 months). To do this, dilute 0.5 tablespoon coniferous extract in 10 liters warm water and bathe the baby for 5-10 minutes.
2. Salt baths (for children from 5 months). Dilute 100 grams of salt in 10 liters of water and bathe the child for 3-5 minutes.
3. Vitamins A, groups B, C (the dose is prescribed by the doctor depending on the age of the child).

Attention! Do not self-medicate, strictly follow the instructions of the doctor.

Prevention of rickets

Preventive measures to avoid rickets are carried out both before and after the birth of a child.

Much depends on the state of health and behavior of the mother before the birth of the child. Proper nutrition is recommended, which includes the required amount of proteins, fats, carbohydrates, microelements. Outdoors should be spent at least two hours a day.

The high quality of mother's milk reduces the risk of rickets in the child. Milk should have enough calcium and vitamin D. To achieve such results, it is recommended to take a multivitamin, which the doctor will help you choose.

Timely introduced complementary foods, massage, gymnastics, outdoor walks will also help protect the child from rickets.

If symptoms of rickets are detected, you should immediately consult a doctor, undergo an examination and receive the necessary course of treatment. Remember that the consequences of rickets can ruin a child's health for life.