Is it necessary to prevent rickets? Ways of getting vitamin D into the body
Treatment rickets should be complex and should be carried out against the background of non-specific measures aimed at normalizing metabolic processes in the child's body and increasing its resistance
Of paramount importance is the correction of nutrition, all other medical measures will be effective only against the background of rational feeding. It is rational to provide the child with breastfeeding. The first complementary foods must be necessarily vegetable, it is introduced 1 month earlier than usual. For the second feeding, buckwheat or oatmeal cooked on a vegetable broth. Earlier than usual, yolk and cottage cheese are introduced. The diet should contain a sufficient amount of complete proteins, in this regard, earlier, from 5 months, it includes mashed liver and meat. Instead of drinking, they give vegetable and fruit decoctions, juices. Besides non-specific treatment includes:
saline - lethargic, adynamic (not earlier than from 6 months). Prepare for 10 liters of water 2 tbsp. sea spoon or table salt. Water temperature 36º→35ºС, duration from 2-3 minutes to 5 minutes, course 8-10 procedures
coniferous baths are used for easily excitable children from 6 months. Water temperature 37→36°С, duration - 5→10 minutes, course 10-15 procedures. (for 10 liters of water - 2 teaspoons of coniferous extract)
Sufficient stay of the child fresh air, air baths, motor mode, massage, gymnastics.
Therapeutic baths:
For specific treatment rickets, vitamin D is used. It is prescribed daily for 30-45 days at a daily dose of 2000-5000 IU. After achieving a therapeutic effect, the therapeutic dose of vitamin D is replaced by a prophylactic dose - 500 IU, which. The child receives daily during the first two years and in winter period at the 3rd year of life. Vitamin D is prescribed in dosage forms: videhol (vitamin Dz) or an aqueous solution of cholecalciferol, in the form of a 0.125% oil solution (in 1 ml - 25,000 IU, in 1 drop - 500 IU); ergocalciferol (vitamin D2), etc.
Vitamin D treatment should be combined with calcium and phosphorus supplements. (glycerophosphate schgi calcium gluconate), magnesium-containing drugs ("Asparkam", "Panangin"). The complex therapy of rickets includes vitamins of group B, C, citrate mixture or lemon juice,
Clinical examination of children with rickets carried out quarterly Assign anti-relapse treatment 3 months after the end of the main course. Anti-relapse treatment with vitamin D is carried out in the same doses (2000-5000 IU per day) for 3-4 weeks. Subsequently, secondary prevention is carried out.
Prevention of rickets
Prevention includes non-specific and specific activities and is divided into antenatal (antenatal) and postnatal (postpartum).
Antental non-specific - walks in the fresh air, active motor mode, rational nutrition, prevention and treatment of diseases, preeclampsia and miscarriage, daily intake of multivitamin preparations. "Undevit", "Aerovit", etc.
Specific - prophylaxis with vitamin D. Healthy women are given from the 28th-32nd week of pregnancy at a dose of 500 IU per day. For this, it is applied oil solution ergocalciferol (vitamin D 2) in capsules or in the form of dragees for 6-8 weeks, excluding the summer months of the year In winter and spring, instead of vitamin D preparations, pregnant women can have 15-20 sessions ultraviolet irradiation. As a multivitamin preparation, including vitamin D, you can use the Gendvit, Materna, Pregnavit complex, created specifically for pregnant women.
Postnatal non-specific prevention - begins from the first days of a child's life and includes: proper care for a child; rational nutrition of a breastfeeding woman daily intake multivitamin preparations; breast-feeding; timely introduction of corrective additives and complementary foods; the correct organization of mixed and artificial feeding with insufficient or no breast milk, hardening procedures, gymnastics, massage, active motor mode.
Specific prophylaxis in full-term children, it is carried out from 3 to 4 weeks of age. Vitamin D is prescribed in a daily dose of 500 IU during the 1st and 2nd year of life in the autumn, winter and spring periods. Due to sufficient insolation from June to September, specific prophylaxis with vitamin D is not carried out. If the child was born in May or summer, prophylaxis in the 1st year of life begins in autumn in September and continues until the summer period. When feeding with adapted milk formulas containing vitamin D, the prophylactic dose is prescribed taking into account the amount of vitamin D , in milk formula, up to a total dose of 400-500 IU per day.
For children at risk (premature, often ill, suffering from allergic diathesis, chronic liver diseases, receiving anticonvulsant therapy, etc.), the dose of vitamin D is selected individually.
For specific prophylaxis, general ultraviolet irradiation of the skin can be used as a more physiological method. In autumn and winter time two courses of irradiation of 10-15 sessions are carried out. Vitamin D is used between UVI courses.
Health status small child largely depends on what parents feed him, how long they walk with him on the street and how accurately they follow the recommendations of the pediatrician. If the baby is constantly at home, does not receive mother's milk, if complementary foods are not introduced into his diet in a timely manner, and all nutrition is limited to cow's milk or milk mixtures that are unbalanced in composition, he may develop rickets.
Rickets is a disease associated with a deficiency and violation mineral metabolism in organism. Children of the first year of life suffer from rickets, and among the sick most of all are premature babies and "artificial" (children who eat milk mixtures).
For the life of a child, rickets does not pose a danger, but in the absence of adequate treatment, this disease can leave a trace for life - noticeable deformations of the skeleton, malocclusion, flat feet and other similar violations.
Causes and mechanisms of development of rickets
It is known that in order to form a complete bone tissue calcium, phosphorus and vitamin D are needed, which ensures the absorption of the first two substances in the intestine. All these compounds enter the child's body with food (breast milk, yolk, vegetable oil, fish, vegetables, etc.), and vitamin D is also synthesized in the skin under the influence of sunlight.
Newborn babies are born already with a supply of calcium, phosphorus, vitamin D (these substances are especially actively accumulated in the body of the fetus in the last weeks of intrauterine life, but only on condition that the mother eats properly and walks regularly on the street), so up to 1-2 months, their bone tissue develops normally. Subsequently, both because of the depletion of reserves, and because of active growth children's body starts to need more and more more"building" material. If this need is not met, calcium and phosphorus are washed out of the bones. Because of this, the bone tissue becomes less dense and easily deformed. Hence all the unpleasant manifestations of rickets from the side of the skeleton.
In addition to the effect on bone tissue, the violation of phosphorus-calcium metabolism negatively affects the condition of the muscles and nervous system of the child. Patients have a delay in psychomotor development, muscle hypotension and other pathological symptoms.
Thus, the main cause of rickets is a deficiency of vitamin D, and a lack of calcium and phosphorus also plays a certain role in the development of the disease. There is such scarce state in the following cases:
- If the child does not receive all the substances he needs with food. For example, when parents replace breast milk with unbalanced formulas or cow's milk when complementary foods are introduced late (after 6-8 months), when cereals, especially semolina, dominate in the baby's diet.
- If the child's skin is not exposed to sunlight for a long time.
- If the processes of digestion and absorption of food are disturbed in the intestines useful substances(if the child has a disease gastrointestinal tract, even the most good nutrition will not reduce the risk of developing rickets).
Risk factors for rickets
Apart from obvious reasons For rickets, a number of risk factors can be identified:
- Prematurity (children born prematurely do not have time to make “reserves” of useful substances - this is, firstly, secondly, they have problems with the intestines and, in general, with the digestive system as a whole much more often).
- The large weight of the newborn (the larger the baby, the more nutrients and vitamins he needs).
- Multiple pregnancy. Babies born from such a pregnancy, as a rule, begin to feel a lack of calcium and phosphorus even in utero. In addition, these babies are more likely to be born prematurely.
- Congenital disorders of the digestive system.
- Dark skin color (in dark children, the skin produces less vitamin D).
The first signs of rickets, which parents should definitely pay attention to:
- Increased sweating of the baby (mother should be alerted that even when it is cool, the baby sweats on the forehead and nose during feeding, that his arms and legs sweat a lot, etc.).
- Poor sleep, causeless anxiety, startle.
- Baldness of the neck.
- Constipation (with rickets, hypotension of the muscles develops, including the intestinal wall, so peristalsis weakens, which leads to a delay in feces).
These symptoms may appear as early as 3-4 months of a child's life. If the disease is detected at this stage (it is called the initial stage) and treated, no negative consequences for the health of the baby will not remain. If this moment is missed, the disease will progress (go into the stage of peak), and the child will have more severe symptoms pathologies:
- Deformities of the skull, limbs and torso. An indicative sign is a flattened occiput, big forehead, O- or X-shaped change of legs, etc.
- strong muscle weakness, due to which another indicative symptom appears - “frog belly”.
- Lagging behind in motor development (the child does not begin to hold his head, roll over, sit, although his peers are already doing all this, etc.).
- Late teething.
- Various violations by internal organs(primarily the gastrointestinal tract).
Gradually, the child's condition, of course, improves (the stage of recovery begins about 6-7 months after the onset of the disease), but the formed bone deformities do not disappear completely, with many of them children remain for life. This and narrow pelvis, and large frontal tubercles, and malocclusion, and a deformed chest (compressed laterally and protruding forward), and flat feet.
Diagnostics
An experienced doctor can make a diagnosis of "Rickets", as they say, by eye, but to confirm the diagnosis, you still need to go through one simple study -. This is a qualitative test for calcium in the urine taken from the baby before the first morning feeding. For the analysis, you should prepare (purchase a urinal to make it more convenient to collect the child's urine, make some dietary restrictions, etc.).
In severe cases, when doctors need to find out the degree of violation of phosphorus-calcium metabolism and the depth of bone tissue damage, the patient undergoes a more extensive examination, including:
- Blood tests for electrolytes (calcium and phosphorus), activity alkaline phosphatase(an indicator of bone destruction), as well as vitamin D metabolites.
- Determination of calcium and phosphorus content in daily urine.
- Ultrasound of the bones of the forearm.
- X-ray (in Lately rarely used).
Treatment of rickets
It is necessary to treat children with rickets in a complex way, using specific and not specific methods(be sure to take into account the cause of the disease).
Non-specific methods are nutrition, and the correct daily routine of the child, and various restorative procedures (massage, gymnastics, herbal, salt and coniferous baths, etc.). Specific methods include the appointment of vitamin D, calcium and phosphorus preparations, artificial skin irradiation with ultraviolet radiation (recently used less and less and mainly in premature babies).
Nutrition and daily routine
The nutrition of children with rickets should be aimed at providing the body with all essential substances. For babies up to a year the best food is breast milk. If it is not possible to breastfeed a child, you should choose adapted milk formulas, cow and goat milk not suitable for this.
It is also important to introduce complementary foods in a timely manner, since the needs of the child are growing every month, and the amount of nutrients in women's milk, on the contrary, decreases every month. Therefore, pediatricians do not recommend exclusive breastfeeding after 6 months of age.
For a child with rickets, the first complementary foods can be introduced as early as 4 months, and it is better if it is a vegetable puree, to which over time it is necessary to add natural sources vitamin D - vegetable oil, egg yolk, and after 7-8 months - fish and meat. In addition, a sick baby needs fruit purees and juices, as well as cottage cheese and sour-milk products. But with cereals, especially manna, it is better to wait a little.
As for the daily routine, it should be organized in such a way that the child is outside for at least 2 hours a day. Moreover, it is not necessary to expose the baby to direct sunlight (this is even harmful), the light breaking through the greenery of the trees will be sufficient.
In addition, you should do exercises with your child, take him for a massage (or do it yourself after consulting a specialist). Also, children with rickets are shown saline, herbal, coniferous baths(which one to choose, the doctor will tell). After such procedures, the child will eat and sleep better.
Medical treatment of rickets
The basis given treatment- this is taking vitamin D, and what drug to use and the dose should be prescribed only by a pediatrician, since with rickets it is dangerous as small dose medicines (there will be no effect), and overestimated (there will be hypervitaminosis).
In addition to vitamin D, I can prescribe calcium and phosphorus preparations to the baby (it is not advisable to take them without vitamin D). Premature babies are often recommended complex medications, in which, in addition to vitamin D, there are other vitamins, as well as all the necessary minerals.
Rickets is one of the diseases, the development of which is very easy to prevent with the help of a number of preventive measures. These measures include:
In addition, the prerequisites for a healthy future mother can give her child during pregnancy. To do this, a woman needs to eat a balanced diet, walk more in the air and take vitamin and mineral complexes, if they are prescribed by a doctor.
Prevention of rickets is carried out in a complex manner. It should begin even before birth (antenatal) and continue after the birth of the child for 2 years. Preventive measures can be specific and non-specific. In the first case, admission is required certain drugs, and in the second - a change in lifestyle.
Prenatal Prevention
Antenatal prevention of rickets begins during pregnancy. The fetus satisfies its phosphorus-calcium needs at the expense of the resources of the mother's body. Therefore, these reserves should be significant, as well as regularly replenished with calcium and phosphorus contained in food. To avoid micronutrient deficiencies pregnant women are advised to adhere to the following rules (non-specific prophylaxis rickets):
- sufficient rest and sleep;
- walks in the fresh air (daily from 2 to 4 hours);
- a balanced diet with sufficient intake of vitamin D, calcium and phosphorus. Therefore, the amount of dairy products in the diet is increased.
The best option is not whole milk, and specialized milk drinks for pregnant and lactating women (for example, Bellakt-MAMA). They have a complex effect on the body of a woman and a fetus.
- reception of specialized vitamin complexes enriched with minerals;
- giving up passive and active smoking, as well as other bad habits.
Specific prevention of rickets during pregnancy should begin 2 months before delivery. For this purpose, the use of vitamin D is recommended. It is prescribed in a daily dose of 500 IU. If the date of birth falls in autumn or winter, when solar activity is minimal, then the dose of vitamin D is increased by 2 times, i.e. 1000 IU.
If a woman is at risk, then the treatment and prevention of rickets is carried out from the 28th week for a duration of 8 weeks. Not only the duration of the course intake increases, but also the daily dose, which ranges from 1000 IU to 1500 IU. The risk group includes women suffering from the following diseases:
- diabetes;
- arterial hypertension;
- preeclampsia;
- rheumatism;
- obesity, etc.
In more early dates and in patients over the age of 32, taking vitamin D can lead to calcium deposition in the placenta and other complications:
- fetal hypoxia;
- violation of the configuration of the head during childbirth;
- atherosclerosis in the mother;
- early closure of fontanelles in a child, etc.
Therefore, the question of prescribing vitamin D to pregnant women is decided only by a doctor. This takes into account many circumstances that increase the risk of negative consequences for the child and mother.
The use of artificial ultraviolet (solarium) by women in order to prevent rickets in children is prohibited. This increases the risk oncological diseases, damages the placenta and leads to excessive deposition of calcium in the internal organs.
Postpartum prevention
Postpartum prevention of rickets in children is shown to everyone without exception. Experimental studies It has been proven that already 6 hours after birth, the level of calcium drops critically and reaches a minimum by the end of the first day of life. Therefore, prophylactic intake of vitamin D is carried out almost immediately after childbirth, preventing a critical decrease in the calcium-phosphorus balance in the child's body.
For the prevention of rickets, both non-specific and specific methods are used. The first include (they are carried out in a lactating woman):
- a rational combination of rest and activity, sufficient sleep;
- proper nutrition with the inclusion of special dairy products;
- to give up smoking.
For a child non-specific activities are:
- Be sure to continue breastfeeding for the first six months.
Human milk has a balanced mineral and protein composition, as well as the optimal fat content (by quantitative and qualitative composition). It also contains parathormone, which is involved in calcium metabolism.
- When using artificial mixtures, it is worth giving preference only to those that are enriched with vitamin D.
However, the use of vitamin D-enriched mixtures does not exclude the need for prophylactic use of this vitamin. This naturally increases the risk of developing rickets.
- In children early age the timely introduction of complementary foods from vegetables and fruits, which are rich in ascorbic acid. It helps in the absorption of minerals necessary for normal development child
- Introduction adapted fermented milk products. They must be approved for use by children of a certain age.
- Daily exposure of the child to the fresh air. However, you should not abuse this rule, and walk during the hours of maximum solar activity. This may cause burns.
- Regular ventilation of the room in which the baby is located.
Specific prevention of rickets in children under one year of age and older involves taking vitamin D. For these purposes, both a water-soluble and a fat-soluble form of cholecalciferol can be used. For newborns and older children, the following rules should be followed:
- Reception begins from the first month in healthy children born at term. Treatment continues for 2 years, and sometimes up to 3 years of age. The minimum recommended dose of vitamin per day is 400 - 500 IU. Reception is necessary in autumn, spring and winter. In summer, with sufficient insolation, it can be stopped.
- Prevention of rickets in preterm infants should begin at 2 weeks of age and continue for 2 years.
- Newborns at risk during the first month of vitamin D are prescribed 1000 IU, followed by a transition to daily intake at 500 IU.
- Accounting daily dose vitamin D, which is part of the artificial mixture, if the child is fed with it. However, such mixtures do not exclude the additional appointment of specific anti-rachitic prophylaxis.
- In some cases, you may need to take calcium supplements. They can be given alone or in combination with vitamin D.
- In the presence of pathology digestive system her treatment is required, tk. prophylactic drugs will not be adequately absorbed.
The expectant mother should spend a lot of time outdoors, observe the regime of work and rest, monitor the nature of the diet (take more vegetables, fruits, protein). In the last 3-4 months of pregnancy, it is recommended to take multivitamin preparations(daily requirement of a pregnant woman in vitamin D - 400 IU).
Breast-feeding
The best prevention of rickets for a newborn is breastfeeding. You should walk daily with your child, take the stroller out into the sun. Be sure to give your baby a massage, gymnastics, temper it.
Specific prevention of rickets begins at 3-4 weeks of age and lasts up to 1-1.5 years. It consists of taking 500 IU of vitamin D (in oil or aqueous solution) every other day, excluding summer period. Vitamin D intake can be alternated with courses of ultraviolet irradiation for 15-20 sessions twice a year. After the end of the course of ultraviolet irradiation, it is not recommended to take vitamin D for 3-4 weeks.
Possible consequences of an overdose
Under adverse conditions and premature infants, the dose of vitamin D can be increased to 600-800 IU per day. By the way, vitamin D should be given to a child very carefully, since an overdose leads to poisoning of the child. Signs of poisoning can be a sharp decrease in appetite, nausea and vomiting, less often - a decrease in urination and constipation. In order to prevent an overdose of vitamin D (when taking high doses of the drug), it is recommended to conduct a Sulkovich test once every 2-3 weeks. When positive result Vitamin D samples are cancelled.
After the child is transferred to adult food, it is imperative to include foods rich in vitamin D in his diet. This vitamin is found mainly in animal products such as fish liver, milk, eggs, caviar, and fatty fish.
Vitamin D in breast milk
There are several polar opinions regarding the content of vitamin D in breast milk and the need for prophylactic intake of this vitamin by children who are on breastfeeding.
Currently, the position that full-term breastfed babies who are normally gaining weight and not having initial signs rickets, do not need to take vitamin D. At the same time, a number of domestic experts believe that vitamin D is not enough in breast milk and prophylactic intake of this vitamin is necessary.
Mixes
As for artificial breast milk substitutes, although they are enriched with vitamin D (on average 40-45 IU per 100 ml), they do not cover daily requirement in this vitamin. By the age of 6 months, a child receiving artificial feeding is provided with an amount of vitamin D corresponding to no more than 15-20% of the need for it. The relatively low digestibility of the vitamin leads to the fact that, in essence, this amount is two times lower. Therefore, it must be remembered that even the most the best blends are not a sufficient source of vitamin D.
For the treatment of rickets prescribed therapeutic doses vitamin D, however, it should be noted that due to an excess of this drug, a child can also have serious complications ( e.g. kidney dysfunction, allergic attacks, liver problems). To avoid such consequences, before giving a child vitamin D, you should carefully read the doctor's instructions and, if necessary, directly consult with a specialist.
What are the degrees of severity of rickets?
There are the following degrees of severity of rickets:
- first degree ( light);
- second degree ( moderate);
- third degree ( heavy).
| The severity of rickets | Clinical manifestations |
| First degree (light) | Amazed nervous system, as well as minor changes bone structure. The manifestations of the first degree of severity of rickets are:
|
| Second degree (moderate) | It is characterized by a more pronounced lesion of the bone, muscle and nervous systems. With the second degree of severity of rickets in a child, the following manifestations are observed:
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| Third degree (heavy) | Long tubular bones, and there is an aggravation of all the above symptoms. With the third degree of rickets, the following pathological changes are formed:
|
Depending on the severity of rickets, therapeutic doses of vitamin D2 are prescribed in the following order:
- with rickets of the first degree of severity assigned two to four thousand international units per day for four to six weeks; the course dose is 120 - 180 thousand international units;
- with rickets of the second degree of severity assigned four to six thousand international units per day for four to six weeks; the course dose is 180 - 270 thousand international units;
- with rickets of the third degree of severity eight to twelve thousand international units are assigned per day for six to eight weeks; the course dose is 400 - 700 thousand international units.
What are the types of rickets?
Exist the following types rickets:
- vitamin D-deficient ( classical) rickets;
- secondary rickets;
- vitamin D-dependent rickets;
- vitamin D-resistant rickets.
| Types of rickets | Description |
| Vitamin
D-deficient (classical)rickets | This type of rickets most often occurs in the first years of a child's life. The period of development of children from two months to two years is considered the most dynamic, while the growing body's need for phosphorus and calcium increases. Vitamin D-deficient rickets occurs when the child's body does not receive the necessary resources due to insufficient intake of vitamin D from food or due to a violation of the system that ensures the delivery of phosphorus and calcium. The occurrence of classic rickets is accompanied by such predisposing factors as:
|
| Secondary rickets | This type of rickets develops against the background primary disease or an existing pathological process in the body. There are the following factors contributing to the development of secondary rickets:
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| Vitamin D dependent rickets | This type rickets is a genetic pathology with an autosomal recessive mode of inheritance. In this disease, both parents are carriers of the defective gene. There are two types of vitamin D dependent rickets:
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| Vitamin D-resistant rickets | The development of this type of rickets is facilitated by such background diseases How:
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What are the first signs of rickets?
Most often, the development of rickets occurs in children aged three to four months. With a lack of vitamin D, first of all, the nervous system of the child suffers. A child with rickets, as a rule, is restless, irritable, tearful, does not sleep well and shudders in his sleep. Also noted excessive sweating, which occurs most often during feeding and sleep of the child. Due to a violation of metabolic processes, the child's sweat, like urine, acquires an acidic character and a corresponding sharp sour smell. Due to sweating and friction of the head on the pillow, the child has baldness at the back of the head. "Acid" urine, in turn, irritates the baby's skin, causing diaper rash. also in initial stage rickets, the child loses his skills acquired by three to four months. The baby stops walking, rolls over. There is a delay in the psychomotor development of the child. Subsequently, such children begin to stand, walk late and, as a rule, their first teeth thin out later.
If time does not attach importance to the first manifestations of rickets, then subsequently the development this disease may lead to more serious violations from the skeletal and muscular systems.
Apart from clinical symptoms The diagnosis of rickets is confirmed by biochemical laboratory research. These tests determine the amount of phosphorus and calcium in the child's blood. With rickets, the above indicators ( phosphorus and calcium) are reduced.
When the first signs of rickets appear, it is strongly recommended:
- immediately consult a doctor;
- refrain from self-medication;
- make sure that the child receives the dose of vitamin D strictly prescribed by the doctor;
- regularly walk with the child in the fresh air;
- monitor the child's nutrition, it should be regular and rational ( increase intake of foods rich in vitamin D);
- regularly do massage and gymnastics to the baby;
- comply with the regime of work and rest.
Which vitamin deficiency leads to rickets?
Rickets is considered to be a "classic" disease childhood, in which in a young organism there is a metabolic disorder - calcium and phosphorus. This disease is especially dangerous in the first year of a baby's life, when there is an active formation of bone tissue. Rapidly developing, this disease usually leads to serious changes in the bone structure of the child, affecting also his nervous and muscular system. These pathological changes occur due to a lack of vitamin D, which, in turn, is a regulator of metabolism in the human body.
Vitamin D is considered universal. This is the only existing vitamin that can enter the human body in two ways - through the skin under the influence of ultraviolet rays, as well as through the mouth, entering the body with food containing this vitamin in its composition.
The following foods are rich in vitamin D:
- fish fat;
- fish caviar;
- butter, margarine;
- vegetable oil;
- sour cream, cottage cheese, cheese;
- egg yolk;
- liver ( beef, pork, chicken).
That is why vitamin D is prescribed in the last trimester of pregnancy, since during this period of time a woman prepares her body not only for birth, but also for further feeding of the child.
A prophylactic dose of vitamin D is also given to the child immediately after birth. It is accepted from October to May, that is, in those months when sunlight not enough. From May to October, vitamin D is usually not prescribed, but regular walks with the child in the fresh air are strongly recommended.
Prescribing an individual dose of vitamin D will depend on the following factors:
- the age of the child;
- features of genetics;
- type of feeding the child;
- severity of rickets;
- presence of other pathological processes in organism;
- season ( the weather of the area where the child lives).
For any pathology, the daily intake of vitamin D is prescribed by a doctor.
It should be noted that an overdose of vitamin D can lead to serious consequences. Therefore, in order to avoid this complication, the child is recommended to conduct a Sulkovich test every two to three weeks. This test consists in determining the presence and level of calcium in the test urine.
Urine for this sample is collected in the morning, before meals.
The results of the study are determined depending on the degree of turbidity of the urine:
- minus is negative result, in which the child may experience a lack of vitamin D;
- one or two pluses count normal indicators;
- three or four pluses indicate increased secretion calcium.
What care is needed for a child with rickets?
Childcare is important aspect rickets treatment. At the same time, high-quality child care should be carried out both in the hospital and at home. Caring for a child with rickets, medical staff should do the following:
- monitor the behavior of the child;
- perform inspection and palpation of fontanelles ( big and small);
- to check the fusion of cranial sutures;
- to make a thorough examination of the chest of children four to six months old in order to determine the pathological thickening of the costal-sternal joints;
- to monitor the thickening of the epiphyses of the bones of the lower leg and forearm, as well as the curvature of the bones in children older than six months;
- determine motor activity child, as well as the state of muscle tone;
- make adjustments to the child's nutrition;
- teach the rules of care for the parents of the baby.
- therapeutic doses of vitamin D are prescribed;
- a child in the third or fourth month of life, who is on breastfeeding, juices, fruit decoctions, vegetable purees, yolk and cottage cheese are introduced into the diet ( children on artificial and mixed feeding, the first complementary foods are introduced one month earlier);
- Enzymes are given with food e.g. pancreatin, pepsin) And hydrochloric acid, which are necessary for the child to improve the processes of digestion;
- also, in order to reduce the degree of acidosis, vitamins of group B are prescribed along with nutrition ( B1, B2, B6), vitamin C and citrate blend ( a tool that contains lemon acid, sodium citrate and distilled water);
- nurse monitors the calcium content in the urine ( using the Sulkovich test);
- calcium is prescribed in the form of a five percent solution, which is given to children orally ( in the mouth) at the first signs of bone softening;
- held regularly physiotherapy and massage;
- coniferous and saline are assigned therapeutic baths (the course includes ten to fifteen baths);
- a course ( consisting of 20 - 25 sessions) ultraviolet irradiation at home, in winter.
- Daily walks with the child in the fresh air. At the same time, the total time spent on the street should be at least five hours in the summer period and about two to three hours in the winter period ( temperature dependent). When walking with a child, it is necessary to ensure that his face is open.
- Regular exercise. It is recommended to perform flexion and extension movements of the child's arms and legs, as well as to perform adduction and abduction of the baby's limbs.
- Regular hardening child. It is necessary to harden the baby gradually. For example, while swimming warm water, at the end, it is recommended to rinse the child with water one degree lower. Then, as you get used to it, during subsequent bathing, the degree of water can be reduced below.
- Proper organization daily routine for a child.
- Monitor the regularity and rationality of nutrition. Complementary foods that are introduced should be appropriate for the age of the child. You also need to increase your intake of foods rich in vitamin D ( e.g. liver, fish, egg yolk, butter, cottage cheese).
- Accurate implementation of actions prescribed by the doctor.
Can rickets be cured?
You can completely cure rickets, but for this you will need to do the following:
- It is very important to detect the first symptoms of this disease in a timely manner, since the treatment of rickets on early stage promotes speedy recovery child. The first manifestations of rickets are usually excessive sweating, mainly observed at night and after feeding the baby, anxiety and irritability, tearfulness, sleep disturbance, manifested by frequent shudders, pruritus, as well as baldness of the back of the head.
- If you suspect rickets, you should immediately consult a pediatrician. Self-treatment in this case is strictly contraindicated. The doctor, in turn, can immediately diagnose rickets based on clinical manifestations of this disease or prescribe certain diagnostic procedures to detect pathology. After confirmation of rickets, the child will be prescribed appropriate treatment.
- The treatment of rickets includes the rational feeding of the baby, the organization moving image life, vitamin therapy, regular walks in the fresh air, as well as the elimination of the causes of the disease. At the same time, all stages of treatment should be carried out strictly according to the doctor's prescription.
The child's food must be complete. It should contain all the necessary nutrients. Especially with rickets, food rich in vitamins and trace elements is useful. The best food in this case is the mother's breast milk, which is rich in vitamins, amino acids, enzymes and immune bodies. The composition of breast milk is optimal for the child, as it best meets his nutritional needs. In the event of a forced transfer of the baby to a mixed and artificial feeding it would be more rational to use adapted milk formulas, the nutritional composition of which is as close as possible to nutritional composition breast milk.
Examples of adapted milk formulas include: trade marks How:
- "Detolact";
- "Baby";
- "Vitalakt".
Organization of a mobile lifestyle
This includes massage, as well as the use of various gymnastic exercises ( for example, adduction and abduction of the arms, as well as flexion exercises of the upper and lower extremities). These procedures have a positive effect on metabolic processes in the skin, thereby increasing the productivity of vitamin D. Massage is usually done two to three times a day for eight to ten minutes.
Regular outdoor walks
Walking with the child should be at least two to three hours daily, especially in sunny days. This procedure contributes to the formation of vitamin D in a child, which is synthesized in the skin under the influence of ultraviolet rays.
vitamin therapy
The main treatment for rickets is therapeutic use vitamin D. When using this tool it is necessary to strictly follow the recommendations of the doctor, since due to an overdose of vitamin D, intoxication of the body may occur.
What head changes are observed in rickets?
At the onset of the disease, no major changes head does not occur. The child during this period has increased sweating especially in the area of the scalp ( in 90% of children). In this regard, during sleep, friction of the back of the head against the pillow is created, and the baby develops areas of baldness with a clearly visible venous network due to hair loss. With the subsequent progression of the disease, there is some softening of the edges of the large fontanel, as well as bones at the site of the passage of the sagittal ( located between the parietal bones) and occipital sutures.
The height of the disease is characterized by thinning and softening of the bones of the skull ( craniotabes). These pathological changes in the bones are especially pronounced in the region of the large and small fontanelles, as well as in the area where the sutures of the skull pass. In this regard, a large fontanel in a child closes quite late, by two to three years. Also, the baby shows alignment of the parietal and occipital bones.
From the side of the bones facial department the following changes are observed:
- jaw misalignment ( top and bottom);
- malocclusion;
- narrowing of the arch of the sky;
- possible narrowing of the nasal passages.
It should also be noted that with the progression of the disease, an increase in the frontal and parietal tubercles occurs, due to which the head increases in size and externally takes on a square shape.
Data development pathological changes on the part of the head largely depends on:
- the age of the child;
- the severity of the disease;
- individual characteristics baby's body.
Is it necessary to take calcium for rickets?
Calcium plays an indispensable role in the growth of a child. Thanks to calcium, the bone skeleton becomes strong, able to withstand heavy loads. In addition, the participation of calcium is indispensable in the processes of blood coagulation, as well as in the functioning of the nervous system. The need for calcium supplementation occurs when a child has hypocalcemia ( decrease in certain levels of calcium in the blood plasma). With rickets given state may occur with active bone mineralization, as well as in premature or low birth weight children.
It should also be noted that calcium preparations for rickets can be prescribed if the child has various changes skeletal system.
Rachitic changes in the skeletal system can occur due to:
- slow bone formation hypogenesis);
- excessive formation of osteoid tissue ( osteoid hyperplasia);
- bone softening ( osteomalacia).
Examples of calcium preparations include Calcium gluconate and Complivit. For complete absorption, calcium preparations are usually prescribed in combination with vitamin D.
Calcium-rich foods include:
- processed cheese;
- cottage cheese;
- sour cream;
- cheese;
- beans;
- peas;
- almond;
- pistachios.
