How to treat rickets in premature babies? Signs of rickets in infants, treatment, causes, stages of rickets in children How rickets begins in a baby.

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

Characteristics of rickets in children

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

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

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

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

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

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

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

Causes of rickets in children

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

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

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

Pronation (dislocation of an arm or leg)

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

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

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

Symptoms and signs of rickets in children

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

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

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

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

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

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

Why don't doctors prescribe vitamin D?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Treatment of rickets in children

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

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

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

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

Prevention of rickets in children

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

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

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

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

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

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

– a disease of a rapidly growing organism, characterized by impaired 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, deformation of the chest, curvature of the tubular bones and spine, muscle hypotonia, etc.), nervous system, and internal organs. The diagnosis is established based on the identification of laboratory and radiological markers of rickets. Specific therapy for rickets involves the administration of vitamin D in combination with therapeutic baths, massage, gymnastics, and ultraviolet radiation.

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 a “disease of the growing body.” 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 full-term young children and 80% among premature infants. Most children at 3-4 months have 2-3 mildly expressed signs of rickets, and therefore some pediatricians suggest considering this condition as paraphysiological, borderline (similar to diathesis - constitutional anomalies), which is eliminated on its own as the body matures.

Pathogenesis of rickets

The decisive role in the development of rickets belongs to exo- or endogenous vitamin D deficiency: insufficient formation of cholecalciferol in the skin, insufficient intake of vitamin D from food and disruption of its 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 - metabolic disorders of protein and microelements (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: enhancing the absorption of calcium salts (Ca) and phosphorus (P) in the intestine; preventing the excretion of Ca and P in the urine by increasing their reabsorption in the kidney tubules; mineralization of bone tissue; stimulation of red blood cell formation, 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 maintains its sufficiently high level in the blood.

A change in acid-base balance towards acidosis prevents the deposition of P and Ca compounds in the bones, which is accompanied by impaired calcification of growing bones, their softening and 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, rickets also disrupts other types of metabolism (carbohydrate, protein, fat), and disorders of the nervous system and internal organs develop.

Causes of rickets

The development of rickets is largely associated not with 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 10 minutes of local irradiation of the face or hands can provide the synthesis of the level of vitamin D required by 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 levels of natural insolation, frequent fog and cloudiness, and 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 macroelements, vitamins in young children can be caused by multiple ricketogenic factors. Since the most increased supply of Ca and P to the fetus is observed in the last months of pregnancy, premature babies are more prone to developing rickets.

The occurrence of rickets is predisposed by an increased physiological need for minerals under conditions of intensive growth. A deficiency of vitamins and minerals in a child’s body can be a consequence of an improper diet by a pregnant or lactating woman, or by the baby herself. Impaired absorption and transport of Ca and P is facilitated by 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, chronic renal failure, etc.).

The risk group for the development of rickets includes children with an unfavorable perinatal history. Unfavorable factors on the part of the mother are gestosis in pregnant women; physical inactivity during pregnancy; operative, induced or rapid labor; mother's age is younger than 18 and older than 36 years; extragenital pathology.

On the part of the child, a certain role in the development of rickets can be played by a large weight (more than 4 kg) at birth, excessive weight gain or malnutrition; 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 long-term immobilization for hip dysplasia), taking certain medications (phenobarbital, glucocorticoids, heparin, etc.). The role of gender and hereditary factors has been proven: thus, boys, children with dark skin, blood group II (A) are more predisposed to the development of rickets; Rickets is less common among children with blood group I (0).

Classification of rickets

The etiological classification involves the identification of the following forms of rickets and rickets-like diseases:

1. Vitamin D deficiencyrickets(calciumpenic, phosphopenic variant)
2. Vitamin D dependent(pseudo-deficiency) 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).
3. Vitamin D-resistant rickets(congenital hypophosphatemic rickets, Debre de Toni-Fanconi disease, hypophosphatasia, renal tubular acidosis).
4. Secondary rickets for diseases of the gastrointestinal tract, kidneys, metabolism or induced by drugs.

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

Symptoms of rickets

The initial period of rickets occurs in the 2-3rd month of life, and in premature infants 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, shallow, anxious sleep, frequent startles in sleep. The child's sweating increases, especially in the scalp and back of the head. Sticky, sour-smelling sweat irritates the skin, causing persistent diaper rash. Rubbing your head against a pillow leads to the formation of bald spots on the back of your head. The musculoskeletal system is characterized by the appearance of muscle hypotonia (instead of physiological muscle hypertonicity), compliance of the cranial sutures and edges of the fontanel, thickenings on the ribs (“rachitic rosary”). The duration of the initial period of rickets is 1–3 months.

During the height of rickets, which usually occurs in the 5-6th month of life, the process of osteomalacia progresses. The consequence of the acute course of rickets can be softening of the cranial bones (craniotabes) and unilateral flattening of the back of the head; deformation 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 enlarged liver and spleen, severe anemia, muscle hypotonia (“frog” belly), and loose joints.

In the subacute course of rickets, hypertrophy of the frontal and parietal tubercles, thickening of the interphalangeal joints of the fingers (“strings of pearls”) and wrists (“bracelets”), and costochondral joints (“rachitic rosaries”) occur.

Changes in the internal organs during rickets are caused by acidosis, hypophosphatemia, microcirculation disorders and may include shortness of breath, tachycardia, loss of appetite, unstable stool (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 skeletal deformation and muscle hypotonia.

In many children, rickets occurs in a mild form and is not diagnosed in childhood. Children suffering from rickets often suffer from acute respiratory viral infections, pneumonia, bronchitis, urinary tract infections, and atopic dermatitis. There is a close connection between rickets and spasmophilia (infantile tetany). Subsequently, children who have suffered from rickets often experience a violation of the timing and sequence of teething, malocclusion, and 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 disturbance of mineral metabolism, a biochemical study of blood and urine is performed. The most important laboratory signs that allow us to think about rickets are hypocalcemia and hypophosphatemia; increased alkaline phosphatase activity; decreased levels of citric acid, calcidiol and calcitriol. A blood CBS test reveals acidosis. Changes in urine tests are characterized by hyperaminoaciduria, hyperphosphaturia, hypocalciuria. Sulkovich's test for rickets is negative.

X-rays of tubular bones reveal changes characteristic of rickets: goblet-shaped expansion of the metaphyses, unclear boundaries between the metaphysis and the epiphysis, thinning of the cortical layer of the diaphysis, unclear visualization of the ossification nuclei, osteoporosis. Therapeutic mud can also be used to assess the condition of bone tissue.

Prognosis and prevention

The initial stages of rickets respond well to treatment; after adequate therapy, long-term consequences do not develop. Severe forms of rickets can cause severe skeletal deformations and slow down the physical and neuropsychic development of the child. Monitoring of children who have suffered rickets is carried out quarterly for at least 3 years. Rickets is not a contraindication for preventive vaccination of children: vaccinations are possible within 2-3 weeks after the start of specific therapy.

Prevention of rickets is divided into antenatal and postnatal. Prenatal prevention includes taking the pregnant woman special micronutrient complexes, sufficient exposure to fresh air, and nutritious nutrition. After childbirth, it is necessary to continue taking vitamins and minerals, breastfeeding, adhere to a clear daily routine, and give the child preventive massage. During daily walks, the child's face should be left exposed to 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 ultraviolet radiation.

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

What it is?

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

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

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

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

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

Various reasons lead to the development of the disease in children, which contribute to a decrease in calciferol levels. In some cases, the impact of causes may be combined. Understanding exactly what causative factors caused the baby’s illness is very important. Only eliminating the cause of the disease will lead to a complete recovery of the child.

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

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

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

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

• Chronic diseases of the digestive system. The leading role is given to intestinal pathologies. Chronic enteritis, accompanied by severe malabsorption of various substances from food, often leads to the formation of various deficiency conditions in children. In this case, the unfavorable symptoms of rickets cannot be dealt with without treating the underlying disease.
• Prematurity and congenital pathologies. The birth of a baby earlier than planned is often the trigger for the development of rickets. This can be explained by the fact that in a premature baby, the formation of many internal organs has not been completed. Disorders 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 disturbances in the baby’s behavior and mood. The child becomes nervous and easily irritated by small things. Children lose interest in their favorite games and try to limit active movements. Usually the initial stage lasts about a month.

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

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

The severity of clinical symptoms may vary.

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

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

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

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

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

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

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

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

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

Diagnostics

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

The following studies are used to identify the disease:

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

Consequences

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

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

To treat rickets in children, the following treatment principles are used:

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

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

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

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

Quite often, during the next visit to the pediatrician with a 3-4 month old child, parents may hear from the doctor a diagnosis of “rickets.” Many parents have a very vague and superficial understanding of this disease; they do not know the main symptoms of the disease and cannot imagine possible treatment. So what is rickets and why is it dangerous when detected in children?

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

What is vitamin D for?

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

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

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

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

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

Causes of the disease

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

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

1. Errors in nutrition:

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

1. Prematurity and large fetus:

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

1. Endogenous causes:

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

1. Hereditary factors and predisposition to the disease:

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

1. Other reasons:

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

Changes in the body due to vitamin D deficiency

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

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

Groups of children most susceptible to rickets

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

Classification of rickets

Currently, several classifications of the disease are accepted.

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

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

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

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

According to the nature of the disease:

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

By severity:

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

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

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

Symptoms of the disease

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

1. Initial period.

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

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

There are no pathologies from the internal organs and systems.

1. The peak period of the disease

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

Bone deformation:

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

Decreased muscle tone and ligamentous weakness:

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

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

From the nervous system, symptoms worsen:

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

From the digestive tract:

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

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

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

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

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

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

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

1. Recovery period

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

Unfortunately, muscle weakness and skeletal deformity disappear very slowly.

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

1. Period of residual effects

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

Prognosis and consequences of rickets

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

With early diagnosis and timely treatment, the prognosis of the disease is favorable. And only with severe rickets are some irreversible changes in the body possible:

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

Diagnosis of the disease

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

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

Treatment of rickets

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

Currently, specific and nonspecific treatment is used.

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

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

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

The most common drugs:

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

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

Prevention of rickets

Breastfeeding plays an important role in the prevention of rickets.

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

During pregnancy, a woman must follow these rules:

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

Prevention of rickets in a child:

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

Summary for parents

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

Which doctor should I contact?

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

Dr. Eleonora Kapitonova talks about rickets and its prevention:

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

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

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

Causes of rickets

• Vitamin deficiency during pregnancy
• After birth
• Other reasons

Symptoms and signs of rickets Diagnosis of rickets Treatment

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

Prevention of rickets in children

Description of the disease

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

Forms of the disease

The following forms of rickets are distinguished:

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

Severity

Pathology occurs with varying degrees of severity.

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

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

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

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

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

Video: Causes of rickets

Causes of rickets

The causes of rickets in a baby are:

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

Vitamin deficiency during pregnancy

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

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

After birth

Factors that provoke the occurrence of rickets in infants are:

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

Premature babies are at risk of developing rickets.

Other reasons

If the child’s birth weight was high, then his body’s need for nutrients is higher than that of children with normal weight, so a balanced diet is of particular importance for him. The risk of rickets is increased in twins and twins. A lack of vitamin D, calcium and phosphorus occurs during the period of intrauterine development, and, as a rule, such children are born prematurely.

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

Children living in large cities with polluted air that does not transmit ultraviolet rays are more susceptible to rickets.

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

Symptoms and signs of rickets

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

At the onset of the disease, symptoms such as baldness of the back of the head, poor sleep, increased irritability, and softness of the bones around the fontanel are observed. This period lasts from 2 weeks to 2 months.

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

Reparation occurs as a result of properly administered treatment. Pathological changes in bones stop, muscles become stronger, signs of nervous system disorders disappear, after which recovery occurs.

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

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

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

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

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

Diagnosis of rickets

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

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

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

Treatment

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

Specific therapy

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

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

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

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

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

Video: The first signs of rickets

Nonspecific therapy

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

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

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

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

Auxiliary treatment with folk remedies

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

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

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

Prevention of rickets in children

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

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

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

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

Video: Doctors' recommendations for detecting and treating rickets

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

Pathogenesis

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

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

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

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

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

The essence of the disease

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

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

Causes and ricketogenic factors

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

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

Diagnostics

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

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

Symptoms of the disease

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

By periods:

• convalescence;
• residual phenomena.

By severity:

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

According to the nature of the flow:

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

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

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

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

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

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

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

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

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

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

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

Rare forms

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

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

Treatment

Nonspecific treatment includes:

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

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

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

Prevention

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

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

Video about proper massage

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

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

During the period of active growth of children, a terrible “beast” lies in wait - rickets. Every parent should know the signs of rickets in children, as this insidious disease has unpleasant consequences. The earlier the disease is diagnosed, the more successful its treatment will be, in most cases without complications or consequences. Rickets has been known since ancient times; for many years it has been studied and tried to overcome. Today doctors know how to diagnose this disease, why it occurs, how to treat it, and most importantly, how to prevent it.

What is rickets?

Rickets is a disease that affects young children. When it occurs, calcium-phosphorus metabolism is disrupted, the functions of internal organs and the nervous system are disorganized, and the processes of bone mineralization and bone formation are destabilized. The occurrence of this disease is associated with a deficiency of vitamins D in the body. These vitamins are necessary for the normal absorption of calcium and its proper distribution.

Vitamin D is a group of substances. The main ones are vitamin D 2 and vitamin D 3. Vitamin D 2 is found in vegetable fat, and vitamin D 3 is found in animal fat. However, nutrition alone cannot ensure proper absorption of these vitamins by the body. Only their precursors are supplied with food, which are then converted into vitamins D under the influence of ultraviolet radiation.

The name of the disease comes from the Greek word "rachis", which means spine or spine. This is due to one of the consequences of rickets - a hump. It is also called active growth disease because rickets most often occurs in children under one year of age. The classic boundaries of this disease are from 2 months to 2 years. Another common name for rickets - “English disease” - was formed in the 17th century, as it manifested itself in children who lived in factory areas with constant smog, lack of sunlight and ultraviolet radiation.

Rickets in children under one year of age varies in severity of the disease and the nature of its course. Rickets happens:

• 1st degree (mild);
• 2 degrees (medium);
• 3 degrees (severe).

According to the nature of the course:

• Spicy;
• Subacute;
• Recurrent.

The disease is also divided into periods:

• Elementary;
• The height of the illness;
• Convalescence (recovery);
• Residual effects.

Symptoms and signs of rickets

Many parents are concerned about the question: how to determine rickets in a child. Some signs of this disease are visible to the naked eye, while others are confirmed through special studies. Symptoms of rickets in infants vary depending on the period of its occurrence. The initial period of the disease in babies under one year of age is characterized by changes in the functioning of the nervous and muscular systems:

• children show anxiety and irritability;
• the baby flinches when turning on bright lights and loud sounds;
• the child becomes sweaty, especially in the head area, sweat is characterized by an unpleasant odor;
• bald patches appear on the back of the head;
• Muscle tone decreases instead of the usual hypertonicity for this age.

During the height of the disease, the initial symptoms, characteristic of changes in the muscular and nervous systems, progress. They are accompanied by a lag in children's psychomotor development. Bone changes become especially noticeable:

• asymmetrical head shape resembling a square;
• saddle nose;
• malocclusion;
• "Olympic" forehead;
• late and inconsistent teething.
• scoliosis;
• sunken chest;
• thickenings on the ribs, called “rosaries” and others.

To diagnose rickets in children and then prescribe the correct treatment, you should pay attention to the following signs:

• changes in the skeletal system (head, spine, chest, limbs);
• clinic (iron deficiency anemia, weakness, frequent respiratory diseases, tachycardia, etc.);
• Ultrasound signs;
• X-ray signs;
• Biochemical signs (based on blood and urine tests).

If a child has symptoms of the initial stage of rickets, he is assigned grade 1. If changes affect the systems of internal organs and bones, the disease is graded 2. When children show signs of psychomotor and physical retardation, severe damage to internal organs, nervous system and bones, the disease is assigned grade 3.

Causes and consequences of rickets

For a long time, the causes of rickets were unknown. Scientists put forward hypotheses: sometimes successful, sometimes not. In 1919, Guldchinsky made the assumption that one of the reasons for the development of rickets is insufficient exposure of the child to sunlight. After some time, other causes of this disease were formulated:

• endogenous;
• prematurity;
• improper feeding.

Endogenous causes should be understood as those that arise as a result of internal diseases. These may be disorders that cause normal absorption of vitamin D from the gastrointestinal tract, liver disease, kidney disease, and others. Rickets is most often observed in premature babies, since the “lion’s share” of calcium is deposited in the skeleton at the 9th month of pregnancy. Due to the early birth, the child’s body does not have time to accumulate a substance so important for development.

In infants, rickets practically does not occur, provided proper, properly organized feeding. To fulfill this condition, the nursing mother must not have any health problems. A child who is bottle-fed or mixed-fed may develop rickets if his diet is based on unadapted formulas (for example, cow's or goat's milk). The disease can also be provoked by insufficient nutrition or incorrectly selected infant formula.

If treatment for rickets is not started in time, it can cause serious consequences:

• disorders in the skeletal system (for example, square head, sunken chest, “wheel” legs, etc.);
• malocclusion;
• prone to infections;
• Iron-deficiency anemia.

In severe rickets (grade 3), the following complications are possible:

• heart failure;
• convulsions;
• laryngospasm;
• hypocalcemia and others.

Treatment of rickets in children under one year of age can be divided into specific and nonspecific. Specific treatment is carried out by a doctor and includes the prescription of vitamins D, calcium and phosphorus. Doses and the need to take certain vitamins and microelements are determined only by the children's doctor after conducting the necessary tests. Upon completion of successful treatment, the child is prescribed a preventive course of vitamin D.

Today, the ultraviolet irradiation method is not used for children under one year of age. It is believed that the younger the baby, the more careful you need to be with ultraviolet radiation. Additional intake of calcium and phosphorus is also not a completely resolved issue. If the child's diet is balanced, then additional calcium intake along with vitamin D can cause hypercalcemia.

Nonspecific methods of treating rickets are aimed at strengthening the body of a child up to one year old and include:

• natural feeding (or deliberate choice of formula);
• adherence to daily routine;
• walks in any weather with sufficient (but not excessive!) sun exposure;
• massage;
• gymnastics;
• hardening;
• medicinal baths (after 1.5 years): salt, pine or herbal;
• treatment of diseases associated with rickets.

Today, doctors attach greater importance to how to treat children with nonspecific methods. Walking, gymnastics and massage play an important role in this.

Prevention of rickets should be carried out both during pregnancy and after the birth of the baby. Before birth it includes:

• good nutrition;
• taking multivitamins;
• walks;
• physical exercise.

Prevention after birth includes the following measures:

• adherence to daily routine;
• competent feeding;
• massage;
• gymnastics;
• hardening;
• daily walks;
• mother and/or child taking multivitamins (as directed by the doctor);
• taking small doses of vitamin D in the autumn-winter period of the year (as directed by a doctor).

Breastfeeding (at least until 4-6 months) and correct and timely introduction of complementary foods play a particularly important role in the prevention of rickets. Massage, gymnastics and walks are also important.

Doctors say: “Prevention is better than cure.” Therefore, the prevention of rickets should be taken seriously and carried out during pregnancy. After the baby is born, monitor his health, strengthen him, massage and breastfeed for as long as possible. Grow up healthy!

Rickets is a general disease of the whole body with metabolic disorders, mainly calcium and phosphorus metabolism. Mostly children in the first 2-3 years of life suffer from rickets, but it can also occur at a later age, especially during periods of increased child growth. The main cause of rickets is a lack of vitamin D. Even mild forms of rickets reduce the child’s body’s resistance and lead to frequent colds. Pneumonia in children with rickets has a protracted course. Rickets is often accompanied by dystrophy and anemia.

Symptoms of rickets.

In the early stages of the disease, the child becomes irritable and capricious. Sweating appears, especially during feeding and sleep. The sweat is sticky and has an unpleasant odor. The child rubs his head on the pillow, and the hair on the back of his head falls out. As the disease progresses, the bones of the skull soften and the head takes on a square shape; teething slows down, bite is disturbed; The bones of the chest become soft, the chest becomes deformed. In severe cases, a hump may appear.

Traditional methods of treating rickets.

Vitamin D, ultraviolet irradiation, therapeutic massage, and therapeutic exercises are prescribed. Much attention is paid to the child’s nutrition and daily routine.

ATTENTION: Rickets!

Be on your guard - rickets often begins in the third month of a child’s life. The first signs of rickets: the child becomes restless, fearful, flinches when there is a sharp knock, especially when falling asleep. He begins to sweat, beads of sweat appear on his face during feeding, and at night his head sweats so much that by morning there is a damp spot on the pillow. He keeps rubbing his head against the pillow, causing the hairs on the back of his head to fall out. You may also notice that the urine has acquired an unusually pungent odor - the amount of ammonia in it has increased.

The likelihood of developing rickets is higher in children:

those born prematurely, full-term with low weight (less than 3 kg), signs of immaturity, indicating trouble at the end of intrauterine life. And that's why. The main “supply” of building materials - calcium and phosphorus - from mother to fetus and their “laying” in bone tissue under the guidance of vitamin D occurs in the last months of pregnancy. A child born before the 30th week is born with osteopenia - a reduced content of minerals in the bones. In fact, this is already a symptom of rickets. The same can happen with a full-term baby if at the end of pregnancy the mother had toxicosis or other health problems, or out of fear of “overweight” she went on a diet without consulting a doctor;

artificial formula: although the composition of infant formula is as close as possible to breastfeeding and they are richer in vitamin D (therefore, “artificial formula”, as a rule, does not need to take it prophylactically), calcium and phosphorus from such food are absorbed approximately 2 times worse than from breast milk . And a deficiency of mineral “building blocks” for building bones leads to rickets;

those suffering from atonic diathesis, food allergies, exudative enteropathy, diseases of the liver and biliary tract - all these conditions complicate the absorption of calcium, phosphorus and vitamin D in the gastrointestinal tract;

receiving certain medications. A course of anticonvulsant therapy in the first week of life, in particular, diphenin and phenobarbital (it is also prescribed for neonatal jaundice), reduces the activity of cytochrome P-450 reductase, an enzyme involved in the formation of the active form of vitamin D in the liver. With its deficiency, calcium levels in the liver decrease. blood, due to which convulsions and even fractures are possible, and by the end of the month, if the child continues to take the drug, the first symptoms of “medicinal” rickets. Its mechanism can be triggered by vitamin D antagonists - glucocorticosteroid hormones, heparin (in children it is more often used in the treatment of kidney diseases), furosemide, aluminum-containing antacids (drugs that reduce the acidity of gastric juice), sodium bicarbonate, replacement blood transfusion;

deprived of the ability to actively move, for example, due to immobilization due to hip dysplasia. “Movement is life!” - the motto of infancy. With muscle activity, the blood supply to the bones increases, which means that the “building” of the skeleton is better maintained, which rickets tends to disrupt.

If the baby is at risk, parents need to be very attentive to his condition so as not to miss the slightest manifestations of rickets, and at the very first visit to the pediatrician, find out how to more reliably protect the child from this growth disease.

Signs of congenital rickets

1. The dimensions of a large fontanel exceed 2.8 x 3 cm.

2. The small and lateral fontanelles are open.

3. The seams between the bones of the skull diverge (gape).

4. The level of calcium and phosphorus in the blood serum is reduced.

5. Ultrasound examination reveals low bone mineralization.

Cause of rickets- vitamin D deficiency. So far, little of it comes from food, and the need for it during intensive growth is very high: after all, this vitamin is involved in the formation of the skeletal system and bone mineralization. True, nature has prudently provided the body with its own laboratory for the production of vitamin D - it is formed in the skin under the influence of ultraviolet solar radiation.

But our environmental troubles have affected us here too: through the veil of industrial emissions that hangs over the cities, rays with an antirachitic effect are difficult to penetrate. How many of them will a city child get, especially one born in autumn or winter, when only his face remains exposed during a walk?

Rickets develops quickly, and within a couple of weeks after the first signs appear, it enters a stage called the full stage, or blooming rickets. At this time, the doctor can already feel softening along the edges of the fontanelles and cranial sutures, thickening on the ribs (“rachitic rosary”), and detect other disorders of the skeletal system.

Rickets “reshapes” the skull in its own way, increasing the frontal and occipital protuberances, which is why the head becomes square or, as experts say, “buttock-shaped.” Years later, as in infancy, the diagnosis will be “written on the forehead”, excessively steep and high - it is called “Olympic”. A “notch” in the form of a saddle will remain on the nose, the bite will be disrupted, and the teeth will erupt later and not in the sequence determined by nature, moreover, they will turn out to be an easy target for caries.

By 5-6 months, the child will lag behind in psychomotor development, and the disease will make changes - alas, irreversible - to the structure of the skeleton, not for the better.

Have you ever met a child with “wheel” legs, curved in the shape of the letter “O”? This is the result of untreated rickets. A rickety child is often also characterized by anemia, reduced general body resistance, and a tendency to infections. I believe you won’t allow any of this! Moreover, the treatment of rickets is relatively simple and quite affordable - just don’t be late!

If you notice the first signs of rickets, immediately contact your local pediatrician. He may have already prescribed you prophylactic doses of vitamin D, but since they did not work, now, apparently, they will have to be increased. An important warning regarding infants receiving formula milk: most formulas are fortified with vitamin D, and this will need to be taken into account as An overdose of vitamin D is dangerous.

Vitamin D is given to the baby in a spoonful of breast milk or a formula containing it. You cannot drip into a spoon directly over the edge of the bottle; be sure to use a pipette, and hold it strictly vertically - if it is tilted, a drop that is too large will form, which may contain extra units of vitamin.

It is useful to replace bathing with a therapeutic bath.

Conifers will help excitable children relax. For 10 liters of warm (36°) water, take a teaspoon of natural liquid pine extract or a standard strip of briquette. For the first time, 5 minutes is enough, and then gradually increase the procedure time to 10 minutes. The course of treatment is 12-15 baths, daily or every other day.

Toning baths are useful for those who are sluggish, “loose” and sedentary. Dissolve 2 tablespoons of sea or table salt in 10 liters of water (35-36°). The first bath is 3 minutes, then no longer than 5 minutes. Limit yourself to 8-10 procedures every other day.

For children with manifestations of exudative diathesis, baths from decoctions of medicinal herbs are recommended. Plantain leaves, calamus root, oak bark, string grass and chamomile should be mixed in equal quantities and brewed at the rate of a tablespoon of the mixture per liter of water. Bath your baby in a healing decoction every day for 5-10 minutes until his skin is cleansed.

You should worry about preventing rickets even before the baby is born, by planning your pregnancy, firstly, during a favorable period for the family and, secondly, with the expectation that the child will be born in the spring or summer. Then he will have time to “intercept” his “portion” of ultraviolet radiation before the onset of cold weather, under the influence of which a supply of vitamin D is formed in the skin.

From the first days of pregnancy, drink 2 glasses of milk daily (if you tolerate it well) or yogurt, kefir, eat a few slices of cheese and 100-150 g of cottage cheese. In this way, you will create a “reserve” of calcium in your body - those irreplaceable 30 g that the baby will certainly “demand” in the last 3 months before birth.

Make it a rule to spend several hours every day in the fresh air, in the summer - not under the scorching rays, but in the through shade of trees. The diet includes fish, eggs, butter and vegetable oil. All this will help to some extent compensate for the need for vitamin D, which has increased 10 times since you decided to become a mother.

If pregnancy occurred during the cold season, the doctor may prescribe a preventive course of vitamin D or irradiation with a quartz lamp. But on your own initiative, do not do anything and do not sunbathe at home under a source of ultraviolet light: otherwise, hypervitaminosis is possible, which upsets metabolic processes in the same way as a lack of vitamin D.

After your baby is born, do everything in your power to breastfeed him for at least 3-4 months, and preferably up to 1-1.5 years.

Take the baby for a walk three times a day, at least for 1.5-2 hours. In hot weather, the stroller should be in the shade - diffused light is enough for vitamin D to form in the baby's body.

Forget about tight swaddling! From the first days, equip the baby in onesies so that he can freely move his arms and legs when he is awake - this way the bones will get stronger faster and will not succumb to rickets. Do not neglect daily massage and gymnastics for your baby. And if there is an opportunity to teach him to swim in the pool at the clinic, take advantage of it!

In each specific case, the doctor will prescribe you a massage, restorative, general developmental and breathing exercises for the prevention and treatment of rickets.

Folk remedies for treating rickets

Herbs and herbs for rickets

Pour 2 tablespoons of string herb with 2 cups of boiling water, leave for 30 minutes, strain. Give the child 0.5 cups for rickets 2-3 times a day.

Pour 1 tablespoon of burdock root with 2 cups of boiling water, leave for 2 hours, strain. Take the infusion for rickets hot, up to 0.3 cups 3-4 times a day.

Pour 15 g of peppermint herb into 100 ml of alcohol, leave, strain. Take 15-20 drops 3 times a day as a folk remedy for rickets.

Therapeutic baths for rickets

Mix 200 g of elecampane root and burdock root and pour 10 liters of boiling water over the mixture. Place on low heat and heat for 15 minutes, leave for 1.5 hours, strain. Pour the broth into the bath and bathe the child.

Mix 150 g of calamus root and nettle root, pour 10 liters of boiling water over the mixture, heat over low heat for 10 minutes, leave for 50 minutes, strain and use for baths.

Take 400 g of tripartite herb and 100 g of common yarrow flowers, brew the mixture with 10 liters of boiling water. Place on low heat and heat for 5 minutes. Leave for 50 minutes, strain. Prepare warm water in the bath, mix it with the broth and bathe the child.

Be outdoors as much as possible.

Sunbathing.

Give your child fish oil every day for 1 month. After a 15-day break, repeat the course. The diet of a child with rickets should include milk, egg yolks, pureed liver, and fish (especially tuna and salmon).

An approximate set of exercises for the prevention of rickets.

With rickets, a child often has trouble holding his head up. Therefore, at first the exercises are carried out in a horizontal position, and they should be given 10-15 minutes several times a day. It is very important to train the muscles of the back, abdomen and chest. You should start and end classes with a light, short (1-3 minutes) massage of the body, arms and legs - stroking and rubbing. Do a massage between exercises, repeat each of them 2-4 times, depending on the child’s well-being and mood. So, let's start.

On the back

1. Hold the baby’s shins and encourage him to get the toy that lies first on one side and then on the other side of him: “Take the rattle.”

2. Make the previous exercise more difficult. Holding the child by the shins, encourage him to take a toy that lies further away - 40-50 cm or located above him. You can simultaneously support him from behind by the shoulders and head, helping to lift it and strain the anterior muscle groups of the neck, shoulder girdle, and abdomen.

3. Place your baby with his legs facing you. Holding them with one hand and holding his hand with the other, help him turn on his side and stomach (the same in the opposite direction, holding the baby by the other hand).

On the stomach

4. With one hand, support the child under the chest, showing the toy lying in front, and with the palm of the other hand touch his soles - the baby will push off from it. Encourage him to reach for the toy, thereby encouraging him to crawl.

5. Move the baby's legs towards you. Hold him by the shins with one hand, and with the other show the toy to the left, then to the right, then in front of him (it must be in his field of vision at all times). This is how the baby learns to raise his head and turn it.

6. The child lies first on his back, then on his stomach and pushes off with his legs from the ball or your hand.

Gradually, as the baby’s condition improves, you can put him on his feet and “practice” stepping, and then walking. Walking helps strengthen and develop the muscles of the legs (this prevents their curvature). Only in one case - with a significant decrease in muscle tone - should a doctor give the go-ahead for exercises related to walking.

It is very useful to place the baby on a hard mattress or board 8-10 times a day (before meals or 40 minutes after). In this position, the natural curves of the spine are formed and strengthened, some deformities of the chest and spine are prevented and corrected, and the corresponding muscles are strengthened. Children who do not raise their head and shoulders when lying on their stomach are considered weakened. A flannelette diaper placed under the chest, folded several times, or a roll of baby oilcloth, half filled with sand and covered with a diaper, will help. In this position, it is easier for the child to raise his head and shoulders.

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