How to get rid of rickets. Rickets

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. Severe vitamin D deficiency in children’s bodies 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 bone tissue development. 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 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.

In this article:

This disease has been known to doctors for several centuries. Many parents, if they haven’t encountered it, have definitely heard of it. So what is called rickets? It turns out that this is not one disease, but a whole group associated with metabolic disorders. According to statistics, this pathology affects from 20 to 60% of children, especially those living in northern regions or environmentally unfavorable ones.

Signs of childhood rickets arise due to rapid age-related changes in bone tissue and imperfect regulation of metabolic processes.

Causes

Vitamins, minerals and salts play a major role in these processes. Calcium is involved in the important process of formation of bones and teeth, and is a valuable component of organs and muscle tissue. The second essential component of teeth and bones is phosphorus. With its participation and its derivatives, most processes in the body occur. Magnesium is responsible for the transfer and favorable absorption of all necessary substances. Sodium is actively involved in the functioning of nervous and muscle tissue, digestion. Manganese is needed to strengthen connective and bone tissue, and iron is needed to produce hemoglobin. The formation of bones and tooth enamel is impossible without fluoride. These and a number of other vitamins take an important part in metabolic processes and their deficiency can lead to rickets.

But the main factor in the onset of the disease is considered to be insufficient production or absorption of vitamin D by the body. Its deficiency occurs for several reasons:

1. Lack of enough ultraviolet radiation, especially in the cold season. Children who get little exposure to the sun and even outside in the fall and winter get sick with rickets.
2. It can also be caused by taking certain medications, hormones and antibiotics.
3. Insufficient intake of vitamin D from food.
4. Diseases of the kidneys and liver, in which the vitamin D in them does not enter its active stage and is not absorbed by the body.

There are a number of factors that predispose to the development of the disease:

• The child grows faster in the first years of life, when the need for vitamin D increases.
• Early artificial feeding. With natural breastfeeding, 70% of calcium is absorbed from mother's milk, and with artificial breastfeeding from cow's milk and formula - only 20%.
• Poor nutrition: for example, semolina porridge several times a day.
• Insufficiency of vitamins A.E.C, K, group B and minerals calcium, phosphorus, silicon, magnesium, iron and manganese.
• Acute and other diseases of the child, in which vitamin D is intensively consumed.
• Lack of adequate motor activity of the baby, gymnastics and massage, tight swaddling, immobility due to damage to the central nervous system or congenital dislocation of the hip.
• Poor living conditions for the child, lack of adequate care and preventive measures to prevent vitamin D deficiency.
• Vitamin deficiency during the prenatal period. If in the last trimester of pregnancy there are not enough of them, then the bones of the born child will be poorly mineralized. And in the first year of life, the need for them is quite great, and at a time when there is insufficient bone mineralization, it is problematic to talk about normal development.

Intrauterine deficiency can lead to:

1. pregnancy in autumn and winter, insufficient exposure to ultraviolet radiation (there is little exposure to the sun), living in the northern regions;
2. poor and monotonous diet of a pregnant woman (lots of flour and cereals, few vegetables and fruits;
3. complications of pregnancy (toxicosis, threatened miscarriages, hypoxia, illnesses suffered during pregnancy);
4. twins, large fetus, prematurity.

Rickets can affect children in infancy (3-4 weeks), but most often the disease affects children aged 1 to 2 years. Today, doctors consider rickets as a systemic disease with disruption of mineral metabolism, ossification and changes in the functioning of various organs and systems.

Mineral metabolism primarily refers to phosphorus-calcium metabolism. In addition, changes in the process of protein metabolism, macro- and microelements iron, fluorine, zinc, copper, manganese and oxidative degradation of lipids are of no small importance. The incidence of the disease is directly related to the lack of natural sunlight. Children born in winter and autumn suffer from rickets much more often and in more severe forms.

The causes of rickets in children are due to anatomical and physiological characteristics:

• intensive growth, requiring a large amount of plastic material;
• emphatic (fast) metabolism;
• structural features of bone tissue;
• imperfection of the processes of osteogenesis and calcium and phosphorus metabolism;
• lack of acceptable static-dynamic load on bone tissue.

There are several causes of rickets, the main of which is a lack of vitamin D. As a rule, it is associated with exogenous (insufficient dietary intake) and endogenous (weak production by the body in the absence of sunlight) causes. Under the influence of ultraviolet radiation, vitamin D is formed in the skin from 7-dehydrocholesterol, and with food it comes in the form of vitamin D2 (ergocalciferol) and D3 (cholecalciferol). Therefore, two active forms are distinguished.

Why is vitamin D needed?

Vitamin D is very important for a child's body. It is both a hormone and a fat-soluble vitamin. It is a protohormone for the formation of active metabolites in the liver and kidneys. In its active form, vitamin D is manifested by the production of metabolites, the action of which is aimed at three types of tissues:

• the mucous membrane of the small intestine, where calcium is absorbed into the intestine;
• bone tissue, in which resorption and remodeling occur under its influence;
• proximal tubules of the kidneys, where the effect of vitamin D increases the reabsorption of phosphorus.

Recent studies have also shown that calciferol produces interferon, affecting the immune system.

Functions of vitamin D:

1. Impact on the skeletal system. The main function of the vitamin is the absorption of calcium and magnesium, which are necessary for the development of bones and teeth. It also promotes the absorption of calcium in the intestines and kidneys, regulating the level of phosphorus and calcium in the blood. Vitamin D plays a major role in the hormonal regulation of phosphorus and calcium.
2. Activation of cell growth. Vitamin D takes an active part in the development and growth of cells. The hormone calcitriol is an effective protection against cancer of the skin, breast and colon, as well as a prophylactic agent for prostate, ovarian, breast, skin, and brain cancer. Externally, vitamin D3 is used in the treatment of psoriasis.
3. Impact on immune processes. The quantitative composition of vitamin D in the body can influence the area of ​​the brain responsible for the production of immune system cells. By regulating the synthesis of monocytes, it improves immunity.
4. Hormonal system. Vitamin D directly affects blood glucose levels.
5. Regulation of the nervous system: thanks to vitamin D, an optimal level of calcium is maintained in the blood, which is responsible for the transmission of nerve impulses and muscle contraction.

The causes of rickets in children may also be increased production of parathyroid hormone by the parathyroid glands. This biologically active hormonal substance regulates the level of calcium and phosphorus in the blood. Its main task is to increase the concentration of calcium and decrease the concentration of phosphorus in the blood serum. This occurs due to increased absorption of calcium in the intestine and its active absorption by the cells of the body.

The level of the hormone depends on the level of calcium ions in the blood - the lower it is, the more active the parathyroid glands secrete the hormone. Its main function in the body is:

• preventing calcium loss in urine;
• increased excretion of phosphorus in urine;
• in case of deficiency of phosphorus and calcium in the body, its extraction from bone tissue;
• if there is an excess of calcium in the body, it is transported to the bone tissue.

If the release of parathyroid hormone is impaired, phosphorus-calcium metabolism suffers: impaired absorption by the intestines, loss of calcium by the kidneys and leaching of it from the bones. When the hormone is released excessively, the formation of bone tissue slows down, and already formed bone beams can actively dissolve, which leads to their softening. Bone density and strength decrease, calcium under the level of the hormone is washed out into the plasma and its content in the blood will be increased. Due to the increase in phosphorus salts, the kidneys suffer, blood circulation in the vessels is disrupted, and calcification occurs in them.

The antagonist of parathyroid hormone in phosphorus-calcium metabolism is thyrocalcitonin. This hormone is produced by the thymus, thyroid and parathyroid glands. Its main role is to maintain the balance between osteoblasts and osteoclasts. Thyroid calcitonin lowers the level of calcium and phosphorus in the blood and helps new bone cells (osteoblasts) actively take it up. Thus, it helps the formation of inert tissue, that is, the activity and proliferation of osteoblasts, and the enhancement of mineralization processes. And at the same time, a sufficient level of the hormone inhibits the action of osteoclasts, which contribute to the destruction of bone tissue. In the intestines and kidneys, thyrocalcitonin enhances the absorption of phosphates and reduces the resorption of calcium.

Signs of rickets in children

The initial clinical signs of rickets in a child appear at the age of 2-3 months and are associated with damage to the nervous system. The child becomes fearful, flinches at sharp sounds or bright light, often gets irritated, cries, sleeps poorly (as a rule, sleep is superficial and short). A characteristic sign of rickets in a one-year-old child is sweating at the back of the head after sleep, which can be noticed by the wet pillow around the head. This occurs due to increased sweating of the body and an acidic reaction of sweat, as a result of which the skin becomes irritated, the baby becomes restless and rubs its head on the pillow. Characteristic patches of baldness may appear.

The manifestation of rickets in children during this period is weakness of muscles and ligaments, loose joints. Because of this, the first teeth appear later, children begin to sit, stand and walk later. Symptoms of rickets in children can also be observed in the form of deformation of the spine and chest, and weakness of the abdominal muscles leads to a “frog belly” and constipation.

The initial period lasts from 2 weeks to a month, then the height of the disease is observed, during which changes in bone tissue rapidly progress. The bones of the skull soften, the edges of the large fontanelle become pliable, and the back of the head flattens. Osteoid tissue actively grows in areas of bone growth. Sick children are characterized by late closure of the fontanelles, late teething and subsequently caries.

As rickets develops in children, characteristic bone deformities appear:

• when the child begins to walk, due to softening of the bones, the legs become O-shaped and X-shaped;
• muscular hypotonia contributes to the curvature of the spine and “rickets kyphosis” occurs;
• the shape of the head becomes square, the parietal and frontal tubercles clearly protrude, and an “Olympic forehead” is formed;
• due to softening of the bones of the chest and muscle weakness, the sternum sinks or protrudes, “chicken breast” or “shoemaker’s breast” appears;
• on the ribs at the places where the inert tissue transitions into cartilaginous tissue, seals are formed - “rachitic rosaries”;
• there is thickening of the epiphyses of the bones of the forearm - “rachitic bracelets”, and thickening in the growth zones on the fingers - “pearl bracelets”;
• the pelvic bones are deformed, it becomes flat, which subsequently makes childbirth difficult for girls;
• there is a delay in the growth of tubular bones in length, which causes “short legs”.

Treatment of rickets

As a rule, treatment of the disease is long-term and is carried out in the following areas:

• elimination of hypovitaminosis D;
• normalization of phosphorus and calcium metabolism;
• restoration of the functions of muscle tissue, other organs and systems.

Adequate nutrition and adherence to a daily routine are prescribed. Specific treatment is carried out by a pediatrician, taking into account the time of year, the period of growth and the specific course of the disease and includes UV irradiation or taking vitamin D along with calcium supplements. These two types of treatment cannot be combined, because excess vitamin D can cause serious complications.

Nonspecific treatment includes bathing:

• salty (10g sea salt per 10 liters of water);
• conifers (10-15 g of coniferous extract per 10 liters of water);
• herbal (a glass of chamomile decoction, calamus root or oak bark, plantain per 10 liters of water).

Bath temperature is 32-36 degrees, duration is 10-15 minutes, after which it is necessary to rinse with fresh, clean water. The course of treatment is 10-15 baths.

Prevention of rickets

It is important to take preventive measures already during pregnancy. The expectant mother needs to eat a rational and balanced diet, adhere to a sleep and rest schedule, and spend enough time in the sun.

Specific prevention is carried out for healthy children under 1 year of age and includes:

1. 10-15 sessions of UV irradiation in spring and autumn;
2. Take vitamin D daily from October to March in a daily dose of 400-500 IU.

Nonspecific prevention of rickets includes:

• full child care;
• strict sleep and rest schedule;
• sufficient daily exposure to the street during daylight hours;
• regular air and air-light baths;
• timely bathing and massage after it;
• daily gymnastics for at least 30 minutes;
• breast-feeding;
• timely and adequate introduction of complementary foods, especially of animal origin.

With adequate and timely treatment during the recovery period, the signs of rickets decrease and then do not appear at all. However, if time is lost, bone deformities can remain for life.

Useful video about rickets in children

The disease called “rickets” is heard by many people. However, not everyone knows what exactly it is. From childhood I remember that thin and weak children were figuratively called “rickets,” but no one remembers why.

Of course, these days it is enough for the pediatrician who is observing the baby to have knowledge about the symptoms and treatment of rickets in children. But it is also useful for parents to familiarize themselves with information about this, because the disease overtakes children at a very early age, starting from the first months of a baby’s life.

Rickets is a disease that is caused by a lack of vitamin D in the body, leading to disruption of calcium-phosphorus metabolism, which in turn leads to changes in the process of bone formation and disorders of other vital functions of the body.

In our country, the diagnosis of “rickets” is often made, but in the vast majority of cases, when physiotherapy and vitamin D (calciferol) are prescribed as treatment, this is enough to eliminate any suspicion of the development of the disease.

Causes of rickets in children

Rickets affects children from 2 months to 3 years. But the main danger is age under one year.

Vitamin D is formed in the human body under the influence of UV rays. This radiation can be obtained while under the open sun. A small part of the radiation is also received in cloudy weather, if a person is outdoors. This type of radiation does not penetrate through glass.

The causes of rickets are different, but there is a risk group. This:

• severe pregnancy: toxicosis, concomitant diseases, difficult childbirth;
• black children;
• overweight children;
• children with low immunity, who are often sick;
• children born in winter and autumn. The fact is that babies receive calciferol in the mother’s stomach, in the last stages of pregnancy. And if a pregnant woman has not been in the sun much, then both she and the baby will experience a deficiency of bone formation elements. If the baby is also not exposed to the sun in the first months of life, then the vitamin simply has nowhere to come from;
• premature babies. They do not have time to receive an important vitamin from their mother through the placenta.

Once born, babies begin to quickly gain weight and grow, so they quickly encounter a shortage of cellular building materials.

The main reasons for the development of the disease

1. A rare stay in the open air. A high-tech urban environment implies some difficulties with walking in the fresh air, because there is dust, exhaust fumes, wind, dirt, etc. all around. Therefore, parents of a newborn often hide it in a stroller during walks so that light does not penetrate there. As a result, it turns out that the baby went for a walk, but did not receive ultraviolet radiation.
2. Poor nutrition. If the baby switches to complementary feeding, you need to monitor the variety of his diet, be sure to include fish, seafood, eggs, milk, and cheese. If the baby is still small, but for some reason the mother cannot breastfeed him, you should take a responsible approach to choosing the formula so that it contains everything necessary for the diet.
3. Metabolic disease. If a child has a problem with mineral metabolism or, for example, a pathology of the kidneys or liver, then vitamin D may simply not be absorbed by the body, no matter how much you walk the baby outside.

Signs and symptoms of rickets in a child by form of the disease

There are primary and secondary forms of rickets. They differ in the method of origin of the disease.

Primary rickets appears as an independent disease; it is the most common form of the disease, especially in infants. Secondary rickets will be considered separately.

Secondary rickets

Appears against the background of a precursor disease, which leads to disruption of metabolic processes in the body, and, as a consequence, a lack of vitamin D and disturbances in calcium and phosphorus metabolism in the patient’s body.

Among the causes of secondary rickets, diseases such as hepatic rickets, phosphate deficiency, renal tubular acidosis may be observed; the cause may be treatment for seizures, since seizures accompany the process of massive intake of calcium into the bones. With long-term use of anticonvulsants, the work of vitamin D is blocked, provoking the production of a protein that transports calcium to the bones.

With hypophosphatization, changes in the structure of the skeleton are pronounced, the patient's legs remain short and crooked.

Hepatic rickets is characterized by the fact that vitamin D is no longer absorbed by the body.

Changes in the body due to vitamin D deficiency

Changes in the body are characterized by a pronounced cumulative effect. The disease first manifests itself with minor symptoms in a latent form, although the body at this time is already in a critical condition.

At the stage when the softening of the bones and the removal of calcium and potassium ions from their composition becomes obvious, the disease has already developed so much that it is almost impossible to stop it without any consequences. This happens because treatment also has a cumulative nature. You cannot solve the problem by giving your baby a shock dose of vitamin D. This can lead to serious consequences for the body.

Only 10% of this important vitamin enters the body through food. The rest must be produced in the skin independently. This means that therapy should include a whole range of measures, the sum of which will allow the child’s body to overcome the disease and recover.

Symptoms of rickets in infants

In infants, the first symptoms of rickets may not be recognized by either parents or pediatricians. Typically, the onset of the disease is between 3 and 4 months of age.

These are usually behavioral signs rather than clinical symptoms.

The baby begins to behave poorly, becomes restless, and all day and night routines are disrupted. The child eats little, but often asks to eat, has problems with bowel movements, sleeps poorly, often wakes up and falls asleep.

The baby behaves restlessly, including during sleep. He tosses and turns, sweats, and the smell of sweat is sour. Because of all this, the hair on the back of the baby’s head begins to roll off, and the back of the head becomes bald.

Symptoms of rickets in children aged 1 to 2 years

Most often, rickets, which is found in children after one year, is a subacute form and lasts from infancy; it’s just that the severity of the clinical symptoms was not enough to carry out tests and make a diagnosis. Symptoms of rickets in children 2 years old can be attributed to character traits, childhood experiences, and age-related changes.

Therefore, often the main factors in detecting the disease are changes in the bone structure: scoliosis, gait disturbance, and curvature of the legs.

The acute course of the disease in children over one year of age is rarely observed, since children in this age period hardly gain weight, and the growth functions of the body are aimed at stretching the skeleton, and not at increasing body weight. Due to this, the body's needs for nutrients are not critical.

Main symptoms:

• scoliosis;
• muscle weakness;
• change in the structure of the chest (indentation);
• protruding, bloated belly;
• curvature of limbs;
• nervous abnormalities.

These symptoms are accompanied by frequent respiratory tract diseases, limb fractures, pathologies of the heart, liver, and spleen.

Changes in the bone apparatus

1. The appearance on the skull of areas with softened bone cover. Because of this, the shape of the head changes: the frontal bone and temporal lobes protrude, and the back of the head, on the contrary, becomes flat because the child constantly lies on it.
2. Decreased muscle tone and the entire body. The baby gets tired quickly and moves little. Does not begin to roll over, sit or crawl with peers.
3. Due to the fact that the bones become soft, deformation of the chest begins, it seems to be pressed inward, while the abdomen increases in size and looks very swollen.
4. Bone thickenings are observed in the wrist area.
5. Nodules appear on the ribs, which can be seen upon external examination. They are called rachitic rosaries.
6. Curvature of the spine and scoliosis are observed.
7. The large bones of the legs begin to bend under the weight of the body, the legs take on the appearance of two symmetrical arches. The deformity when the legs form a circle shape is called varus, the reverse deformity, in the shape of the letter X, is called valgus.
8. The eruption of teeth may slow down, they may begin to grow in the wrong order, in the future the teeth will be fragile and painful, and problems with orthopedic teeth are possible.

With proper treatment, most symptoms, such as crooked leg bones, can be eliminated, but spinal problems will remain forever.

Tissues and internal organs

Often, against the background of changes in the skeletal system, there is a decrease in immunity, diseases of the lymphatic system, and an enlargement of the liver and spleen.

There is a decrease in muscle tone and general lethargy of the body. The child lags behind his peers in psychomotor development.

Your baby may develop a fear of bright lights or sounds. At the same time, he is generally nervous and irritable, and cannot fully relax and spend time fully and actively.

At a late stage of the disease, severe damage to the central nervous system is observed.

In modern conditions, the disorder can be brought to such a degree only with the complete connivance of the parents; usually the disease is detected and treatment begins at an earlier stage. In everyday practice, there is a tendency towards reinsurance of medical personnel. This is expressed by the fact that vitamin D preparations are prescribed to children at the slightest suspicion of the development of rickets. Even if the diagnosis is not correct, prevention does not affect their health in any way.

Classification of rickets

Rickets is classified according to a number of parameters. Depending on the degree of damage to the body, mild, moderate and severe stages are distinguished. According to the phases of the course of rickets, there are the initial stage, the acute stage, the recovery stage and the period of observation of residual effects.

According to the nature of development, the disease is divided into acute, subacute and chronic. The acute form is typical for children of the first year of life. This is due to the fact that at this age children gain weight up to 2 kg per month. In the first months of life, the baby’s body weight increases monthly by almost one and a half times. Therefore, all life support systems operate in emergency mode. Any malfunction in the body can lead to a deficiency of vitamins, including a bone formation stimulator.

The subacute form is expressed in slow development, protracted processes, which increases the risk of late detection of the disease, which complicates therapy.

A chronic disease is characterized by relapses. This is possible when therapy is not followed in full, or when preventive measures are not followed, that is, when conditions for the occurrence of rickets are repeatedly created. With secondary rickets, relapses can occur if the disease - the causative agent - cannot be completely cured.

Algorithm for the development of rickets in children

As the disease progresses, changes in the body begin in the following order:

• nervous and skeletal system: irritability and fearfulness, sleep and rest disturbances, proliferation and softening of bone tissue, growth disturbance.
• disturbances in the functioning of the muscular and cardiovascular systems, pathology of the respiratory system, and gastrointestinal tract are added
• severe complications of all of the listed symptoms of rickets in children

Treatment of rickets in children consists of complex therapy, which includes:

• taking vitamins
• treatment of concomitant diseases;
• to eliminate muscle hypotonicity;
• compliance with the baby’s diet and daily routine;
• physiological procedures.

If a child has been diagnosed with rickets, it is not enough to simply stop the symptoms. Further actions should prevent consequences and relapses as much as possible.

Therapy takes on the same cumulative nature, the rehabilitation period takes months and years, but even after the crisis has passed and there are no visible consequences, all preventive measures should be strictly observed.

Which doctor should I contact?

If you suspect the development of rickets in your baby, make an appointment with your pediatrician. The general practitioner will examine the patient and either prescribe treatment or refer you to an endocrinologist. This doctor will also conduct an examination. To confirm the diagnosis, a biochemical blood test is prescribed. In severe cases, patients are sent for skeletal x-rays to properly assess the damage to the body. Further treatment is carried out under the supervision of an endocrinologist.

Vitamin therapy

Treatment involves taking vitamin D in medicinal form according to a strict regimen. The severity of the symptoms of rickets in young and older children does not affect the dosage, since an overdose is dangerous due to intoxication of the body.

Doctors often prescribe water-based calciferol preparations without additives because it is easier to control the dose. One drop contains the daily requirement of the vitamin.

For children under one year of age, the drug is diluted in a few drops of water or milk to ensure that the required amount enters the body. Children of any age are given medicine from a spoon, and not directly from the bottle, to avoid an overdose.

Massage

Massage is part of general restorative therapy, which is prescribed to eliminate muscle hypotonicity. When the muscles return to normal, they tighten the bones and joints and help normalize their condition. To align the bones, the mechanisms of their support are developed and trained.

Nutrition

The correct diet for children includes fish, eggs, dairy products, and greens. A balanced diet does not create unnecessary stress on the gastrointestinal tract. Don't forget about water balance; it is important for children to get enough fluid in proportion to their expenses.

Pregnant women and nursing mothers should be no less careful about their health, which affects the child.

Prevention

Prevention means:

1. Maintaining a daily routine. This will ensure rest and correct metabolic processes.
2. Walking in the fresh air is an effective preventive measure for the full production of calciferol. According to Dr. Komarovsky, five to ten minutes in the sun is enough, even if only the baby’s face and hands are exposed, to get a dose of vitamin D for two to three days.

In this article:

Rickets in children develops due to a lack of vitamin D in the body. The changes primarily affect the skeletal and nervous systems. The disease has been known since the 2nd century BC. Ancient portraits depicted children who had smoothed occipital bones, brow ridges in the form of overhanging ridges, curved arms and legs, and a flattened belly.

Today, the pathology is widespread: more than 20% of children, and in some countries this figure reaches 60%, have an established diagnosis. At risk are children living in northern regions where there are not enough sunny days a year, and large cities with developed industry, because there is a high level of air pollution from exhaust gases and other waste.

Classification

There are several systematizations of such a disease as rickets in children, each of which indicates the characteristics of the course, stage and etiology of the disease.

In relation to vitamin D, vitamin-deficient and vitamin-resistant forms are distinguished. The first group includes those patients whose pathology is caused by a deficiency of this substance, and to eliminate the disorders, it is enough to take medications containing vitamin D in a therapeutic dosage.

The second group includes children for whom taking standard dosages has no effect, and recovery is possible only by consuming the vitamin in an amount several times higher.

The classification of rickets in children by stages includes:

• period of onset of illness;
• the height of the disease;
• recovery;
• stage of residual manifestations.

Degrees of rickets in children according to severity:

1. Lightweight– symptoms are mild, minor disorders of the musculoskeletal system and nervous system are noted.
2. Average– pronounced disorders of the skeleton and innervation of the extremities, deviations in the functioning of the cardiovascular and respiratory systems, and disruptions in the functioning of the gastrointestinal tract are observed.
3. Heavy– a high degree of pathological changes in all systems and organs that ensure normal life.

According to the nature of its course, rickets can be:

• sharp;
• subacute;
• recurrent.

Causes

Rickets in newborns and children under 1 year of age V occurs due to insufficient synthesis of calciferol in the body. Vitamin D can be absorbed from food and breast milk, and can also be formed in skin cells under the influence of sunlight or ultraviolet rays. If the supply of the substance is disrupted, the disease develops. Vitamin deficiency disrupts calcium-phosphorus metabolism, which negatively affects the condition of the skeletal system.

The causes of rickets include the following:

• low nutritional value of foods that contain low amounts of calciferol;
• lack of ultraviolet rays (living in the north, rare walks);
• pathological processes in the intestines, due to which the absorption of vitamins is impaired;
• endogenous causes, including liver and kidney diseases that interfere with the absorption of calciferol;
• feeding a newborn with unadapted formulas where the correct ratio of beneficial elements is not observed;
• constant use of anticonvulsant medications.

Rickets is often diagnosed in children born, because the formation and formation of the bone skeleton occurs during the period of intrauterine development.

Symptoms

Rickets usually occurs in both young children under one year and after one year. The first changes are detected at the age of 1-2 months after birth.

First of all, changes affect the nervous system:

• sleep is disturbed, wakefulness and night rest patterns change;
• irritability and tearfulness occur;
• the baby does not eat well, refuses or does not eat the prescribed amount, and the feeding process extends for a long time;
• stool disturbances occur, diarrhea or diarrhea appears for no apparent reason;
• increased sweating is noted;
• Baldness develops on the back of the head.

The last two symptoms are closely interrelated. During night sleep, the child sweats excessively, causing a wet patch to form on the pillow (wet spot syndrome). The baby often turns his head, as sweat leads to unpleasant sensations and itchy skin, which causes the hair on the back of the head to be wiped off.

After a couple of weeks, others will join the listed symptoms. A clear sign of rickets in children is decreased muscle tone, as well as a “frog” stomach - as if it was crushed by something heavy, which is why it took this shape. Symptoms of the disease include delayed teething, delayed overgrowth of fontanelles, deformation of the legs and arms, and changes in the shape of the head.

Diagnostics

It is often not difficult to determine the presence of rickets in children, since the pathology has characteristic external manifestations. In the first stages, neurological disorders appear, after which disturbances occur in the skeletal apparatus. It is at this time that most mothers turn to the pediatrician.

In order to reliably establish a diagnosis and determine the degree of calciferol deficiency, it is necessary to take tests for the content of calcium, phosphorus and vitamin D in the body.

The following indicators are considered the norm for these substances:

1. Calcium - 2.5-2.7 mmol, if the value drops below two, then in this case they speak of the presence of rickets.
2. Phosphorus is the normal value of a microelement in the blood - from 1.3 to 2.6. In severe forms of the disease, this indicator can decrease to 0.6 mmol.

Another reliable way to determine the presence of rickets in a child aged 1-3 years is an x-ray. It shows skeletal deformations and the level of bone mineralization. Developing disorders can be more accurately examined using computed tomography.

Why is rickets dangerous?

If the disease is not treated promptly, then signs of advanced rickets can be observed even in children 5 years of age and older. The pathology disrupts the shape of the skull, spine, limbs, and chest.

Disorders of the skeletal system appear at older ages:

1. Rachitic rosary - areas of thickening at the ends of the ribs.
2. “Olympic” forehead - the frontal and parietal tubercles increase in size, which is why the head takes on the shape of a cube.
3. Deformed pelvic bones in girls will cause problems during pregnancy and childbirth.
4. The depressed lower third of the sternum interferes with full breathing.
5. Crooked legs in the shape of the Latin letter “X” disrupt gait and create additional stress on the hip joints.

Treatment

Treatment of rickets in early childhood consists of specific and nonspecific methods. The first group includes taking calcium and vitamin D supplements. The dosage of medications is determined individually, depending on the degree of deficiency of substances and the level of demineralization of the bone skeleton according to laboratory tests. Even after calciferol concentrations rise, vitamin D must be taken for preventive purposes for several more months.

Nonspecific therapy is as follows:

• establishing breastfeeding or selecting a high-quality adapted formula for feeding;
• regular walks in the fresh air;
• gymnastic exercises;
• sunbathing;
• massage;
• hardening procedures;
• treatment of concomitant diseases.

Rickets of the legs is most common in children. This disorder does not allow the child to move fully, and in advanced conditions does not even allow him to walk. This is why it is so important to undergo appropriate treatment in the early stages. It is possible to correct the curvature of the legs due to rickets in a child up to 4 years of age, after which attempts may not bring the desired result.

Complications

In the absence of therapeutic correction of calciferol content in the body, the disease further worsens. In this case, violations affect internal organs and cause disruptions in their functioning.

The following symptoms occur:

• abdominal pain;
• frequent vomiting and regurgitation after eating;
• pale skin;
• hepatomegaly;
• stool disorders.

Rickets is a common reason that a baby cannot hold his head up on his own and begins to sit and move around much later than his peers. If rickets appears in a child at 1 or 2 years of age, then there is a risk that such a child may not learn to walk. This is why vitamin deficiency should be treated in a timely manner, because the severe consequences of the disease will last a lifetime. Rickets in a child, which appears after 4 years of age, leads to flat feet and scoliosis, and sometimes even causes myopia.

Consequences

How dangerous is rickets in a child? Untimely detection and treatment of the disease has a negative impact on the development of the baby and his health in the future.

The child is threatened:

• violation of the jaw relationship;
• frequent tendency to infectious diseases;
• convulsive syndrome due to lack of calcium and magnesium;
• spasm of the larynx;
• osteoporosis.

Prevention

A set of preventive measures aimed at preventing a childhood disease such as rickets consists of activities carried out during pregnancy and after the birth of a child.

Intrauterine prophylaxis:

• comprehensive balanced diet;
• use of vitamin preparations;
• walks in the fresh air under the sun's rays;
• gymnastics for pregnant women.

After the baby is born, you should:

• organize proper feeding;
• give vitamin D drops;
• maintain a daily routine;
• organize daily sleep or walks outside;
• massage and exercise.

The most important place in the prevention of rickets is feeding the baby with mother's milk at least until the age of six months. Rickets is one of those pathologies that are easier to prevent than to subsequently correct problems in the functioning of the body.

Useful video about what rickets is

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!