Children with rickets. Rickets is sweating, bald head, crooked legs, square head, inverted ribs

Despite significant advances in medicine, rickets remains a disease that, to one degree or another, affects almost every second or third child at the very initial stage of its development, namely in the first year of life. What measures should parents take to protect their baby from this disease?

Rickets (from the Greek rhachis - spine, spine) is a disease of infants and young children (usually from 2 months to 1 year), caused by a deficiency of vitamin D in the body and occurring with metabolic disorders (mainly mineral). It was first described in the mid-17th century by the English physician Glisson. One of the main symptoms of the disease was then considered to be curvature of the spine, the so-called “rachitic hump,” which determined the name of the disease. Rickets develops when a child insufficiently consumes vitamin D from food or when the natural formation of this vitamin in the body is disrupted, namely in the skin (insufficient ultraviolet radiation). It occurs more easily in the winter season in children who are bottle-fed, premature, and often ill.

Rickets suffered at an early age can lead to poor posture, persistent deformities of the chest, legs, pelvis, contribute to the formation of malocclusion and flat feet, and cause delayed psychomotor development.

Manifestations of rickets

Mechanism of development of rickets

As is known, vitamin D enters the human body with food products of both vegetable (vegetable oil, wheat germ, nuts, etc.) and animal (dairy products, fish oil, butter, egg yolk, etc.) origin, as well as produced in the skin under the influence of ultraviolet rays.

The most significant forms of vitamin D are ergocalciferol (vitamin D 2) and cholecalciferol (vitamin D 3). However, research by scientists has established that vitamins D 2 and D 3 have very little biological activity in the human body. The main effect on organs (intestines, bones, kidneys) is exerted by their metabolic products, which are formed in the liver and kidneys as a result of certain biological transformations. It is they (i.e. active metabolites) that determine the main function of vitamin D in the body - maintaining phosphorus-calcium metabolism at the required level. This happens through the influence of vitamin D on the absorption of calcium and phosphorus in the intestines, on their reabsorption (reabsorption) in the kidneys and deposition in the bones.

The needs for calcium and phosphorus in young children (in the first three years of life) are several times higher than in older children and especially adults. The rapid growth rate of the baby during this period requires the intake of a sufficient amount of building material into the body. When calcium and phosphorus in the blood decrease (hypocalcemia and hypophosphatemia) as a result of insufficient intake from food or impaired absorption in the intestine, minerals are “washed out” from the bones. Therefore, it has recently been accepted that the development of rickets is largely determined not so much by a deficiency of vitamin D, but by a deficiency of phosphorus and calcium compounds in the body.

Risk factors

Prematurity (the fetus creates the largest reserves of calcium and phosphorus in the last weeks of pregnancy), the birth of children from multiple pregnancies, as well as children with a high birth weight can contribute to the occurrence of deficiency of phosphorus and calcium compounds.

Insufficient intake of minerals from food (early feeding with unadapted products (whole cow's milk), late introduction of complementary foods (later 6 months), introduction of carbohydrate-rich foods (semolina porridge) as complementary foods, adherence to strict vegetarianism (complete exclusion of meat products from the diet), violation absorption of calcium and phosphorus in the intestine due to disease of the gastrointestinal tract or immaturity of enzymes can also contribute to the development of rickets.In addition, individual characteristics of the child are possible, such as dark skin color (these children have reduced production of vitamin D in the skin), hereditary characteristics of vitamin D metabolism, congenital dysfunctions of the intestines, liver and kidneys, predisposing to disturbances in the metabolism of calcium, phosphorus and vitamin D in the baby’s body.

Diagnosis of rickets

The minimum research program includes the collection and analysis of genealogical and clinical history, examination data and a Sulkowicz urine sample.

The Sulkowicz test is a qualitative reaction to determine the concentration of calcium in the urine. 2-3 days before the test, it is necessary to exclude kefir and other foods rich in calcium from the diet. Collect urine in the morning and strictly on an empty stomach. In healthy children, the calcium content corresponds to 2+. A negative Sulkovich test is characteristic of the height of rickets. The test is also used to monitor the treatment of rickets. When its values ​​increase to 3-4, the therapeutic dose of vitamin D is reduced to a preventive dose or canceled.

The maximum research program is carried out when severe forms of rickets are identified or when treatment is ineffective. It includes determining the level of calcium and phosphorus in the blood plasma, determining the activity of alkaline phosphatase, daily excretion of calcium and phosphorus in the urine, x-ray or ultrasound examination of the tubular bones of the forearm, determining the level of vitamin D metabolites in the blood plasma, and determining the acid-base status.

Treatment of rickets

Treatment of children with manifestations of rickets should be comprehensive, taking into account the reasons that led to the development of the disease. And it is necessary to start treatment when the first symptoms of the disease appear and carry it out for a long time, achieving a complete cure for the child. Treatment of rickets is prescribed by a pediatrician. It is customary to distinguish specific and nonspecific methods of treating rickets.

Among nonspecific methods aimed at general strengthening of the body, the following are of great importance:

• a properly organized daily routine with sufficient time for the child to spend time in the fresh air;
• nutrition aimed at normalizing disrupted metabolic processes in the baby’s body;
• regular exercise, massage, swimming.

Children should be outdoors for at least 2-3 hours every day. It should be remembered that children's skin, due to its characteristics (reduced ability to produce melanin pigment), is very sensitive to ultraviolet rays. In this regard, in the summer, direct sunlight is contraindicated for children of the first year of life. In order for the baby’s skin to produce a sufficient amount of vitamin D, walking in the so-called “lace” shade of trees, and not in the open sun, is quite enough.

Breastfeeding is optimal for a child in the first year of life. If the baby is forced to receive artificial feeding, it is necessary to give preference to a milk formula that is as close (adapted) in composition to human milk as possible. Since children with manifestations of rickets have a lack of phosphorus-calcium and vitamin (not only vitamin D, but also vitamins A, C, group B) metabolism, it is important to promptly introduce vegetable and fruit purees, juices, cereals, meat, and cottage cheese into the diet. As the first complementary food for children suffering from rickets, vegetable puree is recommended (from 4-6 months of life), followed by the addition of egg yolk to it at 7-8 months, rich in calcium, phosphorus, vitamins and microelements. Adding porridge, cottage cheese, and meat to the diet will help ensure a sufficient supply of complete proteins to the child’s body. But excess consumption of bread, flour products, and fat should be avoided, as they impair the absorption of calcium in the intestines.

When treating rickets, it is mandatory to prescribe vitamin D supplements, as well as calcium and phosphorus supplements, in other words, specific treatment.

The prescription of vitamin D, calculation of the therapeutic dose and duration of treatment is determined only by the pediatrician, taking into account the severity of rickets in a particular child, as well as the presence of concomitant conditions, such as prematurity, anemia (decreased hemoglobin in the blood), dysbacteriosis, skin and liver diseases , kidneys, etc.

It should be noted that medications may contain vitamin D in the form of D2 (ergocalciferol) or D3 (cholecalciferol), in the form of an oily, aqueous or alcoholic solution. Vitamin D content is measured in international units (IU). Before starting to give vitamin D to a child, parents should pay attention to its content in one drop of solution, which must be noted on the bottle: 1 drop of oil solution contains approximately 650 IU of vitamin D; in 1 drop of aqueous solution - 500 ME; in 1 drop of alcohol solution - about 4000 ME.

Recently, doctors have given preference to prescribing vitamin D 3 preparations (Vigantol, Videhol, Aquadetrim) and mainly its water-soluble forms (Aquadetrim). They are better absorbed in the baby’s intestines and have a longer lasting effect in the body compared to oil solutions.

An alcohol solution of vitamin D is practically not used due to the large doses of vitamin it contains. In addition, due to the evaporation of alcohol (if the bottle is not tightly closed) and an increase in the concentration of the solution, an overdose of vitamin D is possible. Fish oil preparations are rarely used now, since they have a specific taste and smell, which, when taken orally, sometimes causes a negative reaction in the child .

An important point in the treatment of rickets is the correct calculation of the therapeutic dose of vitamin D. Recently, doctors have been wary of prescribing both excessively high doses and impact methods of treating rickets (a method in which the child receives very high doses of vitamin one time, equal to doses calculated for the entire course treatment), as this can lead to the development of a serious disease - hypervitaminosis D. An overdose of vitamin D causes weakness, loss of appetite, nausea, vomiting, diarrhea, weight loss, severe pain in the joints, convulsions, fever, slow pulse, difficulty breathing. In addition, a child’s individual hypersensitivity to vitamin D is possible. Therefore, if after several days of taking vitamin D the baby begins to refuse to eat, or develops nausea or vomiting, it is necessary to urgently consult a doctor; perhaps the listed signs are a consequence of an overdose of the drug.

If, after several days of taking vitamin D, your baby begins to refuse to eat, or develops nausea or vomiting, you should immediately consult a doctor.

At the same time, don’t worry if mom accidentally drops two drops instead of one. In this case, the next time the drug should be given not the next day, but every other day. Cases of overdose are more common if the baby is given an alcohol solution instead of an oil or water solution every day - by mistake. Therefore, you need to be extremely careful when purchasing the drug and strictly follow the doctor’s prescriptions.

At the end of the treatment course of vitamin D, they switch to long-term use of a prophylactic dose of the vitamin - 400 IU per day, which continues throughout the year, with the exception of the warm months (from May to September).

Sometimes taking a therapeutic dose of vitamin D may not be so effective, and this is often due to a deficiency of a number of vitamins in the child’s body (hypovitaminosis), especially a deficiency of vitamins C and B2, which are directly involved in the formation of active metabolites of vitamin D. In this regard, treatment rickets include multivitamin preparations (Polivit baby, Biovital gel, Multitabs and others), including vitamin D in a moderate dose.

Previously, artificial ultraviolet irradiation (UVR) of the skin was actively prescribed in the treatment of rickets. However, given the possible carcinogenic effect - the likelihood of developing cancer, this treatment method has not been used in children recently. Calcium and phosphorus preparations have no independent value in the treatment of rickets. However, in some groups of children (premature infants, children with severe softening of the skull bones, decreased calcium in the blood), their administration is still required for 2-3 weeks. Massage and therapeutic exercises are useful. Children over 6 months of age are prescribed medicinal baths - salty, pine.

For lethargic and inactive children, salt baths are recommended (2 tablespoons of sea salt per 10 liters of water, temperature 35-36°C). The first baths should be taken no more than 3 minutes, the subsequent ones no more than 5. Baths are carried out every other day, the course is 10 procedures. Pine baths (1 teaspoon of liquid or 1 strip of briquette of pine extract per 10 liters of water, temperature - 36°C) are indicated for children with increased nervous excitability. They begin to take baths lasting 5 minutes, gradually increasing the time to 10 minutes, for a course of 10-15 baths every other day.

Rickets is not a contraindication to the appointment of preventive vaccinations, however, they can be carried out in children no earlier than 2-3 weeks after the start of treatment, since after this time the baby’s body adapts to the treatment started.

Prevention of rickets should begin from the first days of a child’s life (so-called postnatal prevention). It includes:

• maintaining a proper daily routine with daily walks in the fresh air;
• rational nutrition of the child in accordance with his age needs. It is optimal to maintain breastfeeding and timely introduction of complementary foods (no later than 4-6 months of life). If a baby suffers from allergies in the first year of life and is forced to receive a less varied diet, the doctor may recommend courses of taking multivitamin preparations for infants. It should be noted that the vitamin complexes that a nursing mother takes provide only her needs, and despite the mother taking these medications, the baby should receive preventive doses of vitamin D, and regular gymnastics and massage with a gradual and uniform increase in load are also necessary.

Taking into account the state of health, the area where the baby lives, as well as the time of year, the pediatrician will definitely help resolve the issue of prophylactic administration of vitamin D. Healthy full-term children in the first year of life, in order to prevent rickets, receive vitamin D in a dose of no more than 400 IU per day, starting from 4-5 weeks of life throughout the entire autumn-winter-spring period. As already mentioned, one drop of an aqueous solution contains 500 IU, to give the baby 400 IU, you need to drop a drop of the drug on a spoon, give the baby the medicine from a spoon - we can assume that the remaining drug contains 100 IU of vitamin D. However, in the summer when there is an insufficient number of sunny days (cloudy, rainy summers), especially in the northern regions of Russia, as well as when feeding children with whole milk, it is advisable to prescribe vitamin D in a prophylactic dose.

Vegetable puree is recommended as the first complementary food for children suffering from rickets.

A special place is given to premature babies, in whom rickets is prevented from the 2-3rd week of life throughout the first 2 years, excluding the summer months. In this case, the prophylactic dose of the vitamin may be higher than for full-term infants, and only a pediatrician can decide this. For full-term newborns, prophylactic doses of vitamin D are usually prescribed after one month.

Children with a small fontanel also need to be prevented from rickets in the first year of life, however, in order to avoid early closure of the fontanel, they are recommended to take vitamin D after 3-4 months of life.

Discussion

Useful article. Everyone has heard something about rickets, especially about crooked legs, but they are not very aware of the risk factors. In addition, important information about multivitamins and, most importantly, about the symptoms of vitamin D overdose

Rickets is a disorder of phosphorus-calcium metabolism due to vitamin D deficiency, which leads to deformation of the skeletal system. At about the age of 3–4 months, rickets is most often diagnosed in infants; the symptoms of the disease at the initial stage are: hypotonicity and softening of bone tissue in the area of ​​the fontanel, cranial sutures, and chest. An accurate diagnosis can only be established after additional examinations.

Is rickets really that bad? Yes, indeed, this is a dangerous disease that has a number of complications and irreversible consequences. Is rickets common? Although rickets is often suspected, this disease is very rare. Bone tissue is actively formed in the first year of life. Therefore, it is in infancy that this disease is detected. Childhood rickets is an ancient disease that was described back in the second century BC. e. Children of medieval Europe often suffered from it, and even at the beginning of the twentieth century, infants died en masse from rickets in civilized England. In modern medicine, treatment of rickets in children under one year of age is effective through the use of vitamin D solutions.

About vitamin D and its deficiency

Vitamin D is required for the absorption of calcium and phosphorus, which are the main building materials of the skeleton. Its deficiency leads to the development of rickets, difficulty breathing, and convulsions. You can get this valuable vitamin in only two ways:

• Staying in the sun. Under the influence of ultraviolet rays, vitamin D is synthesized in the skin, which is why it is also called “sun vitamin”.
• Food. Vitamin D is found in fatty fish, seafood, liver, butter and vegetable oil, fermented milk products, and yolks. Vegetarian diets are low in vitamin D.

If it is not possible to obtain sufficient vitamin D, it can be used in its pure form as a preventive measure and treatment.

Which children are at risk

It cannot be said that there is a single norm for vitamin D intake for all children. It is necessary to take into account the individual characteristics of the body, climatic conditions, place of residence, diet, lifestyle, skin color, and body weight. If all these conditions are violated comprehensively, then we can talk about a high risk and prerequisites for the development of rickets.

We also cannot exclude a genetic predisposition to poor absorption of vitamin D. There is a hypothesis that children with blood group II suffer from rickets more often. This disease also affects boys more often than girls.

Real symptoms of rickets

It is important that the doctor evaluates the child’s condition comprehensively. Single signs of rickets in children under one year old cannot be considered a direct indication of the development of the disease.

• Deformation of the jaw arches and hard palate.
• Teeth are cut late, with damaged, thin enamel.
• The bones of the skull soften and become thinner.
• The parietal and frontal tubercles increase, the head becomes elongated.
• Dense formations on the ribs (“rachitic rosary”).
• Deformation of the chest with a transverse depression (“Harrison’s groove”).
• Deformation of other skeletal bones.
• Formations on the wrist and ankle joints (“rachitic bracelets”).
• Thickenings on the fingers (“strings of pearls”).
• Bone pain, sensitivity.
• Frequent fractures.
• Decreased muscle tone, or hypotonicity.
• Slow physical development.

It is impossible to diagnose “rickets” offhand, relying only on external signs. It must be confirmed after additional examination: X-ray diagnostics and blood tests for hormones, calcium, phosphorus, vitamin D. To avoid large radiation exposure, X-rays are usually taken in the area of ​​the wrist or knee joint.

Possible symptoms of incipient rickets

The first symptoms may appear as early as 2 months. Sometimes children are born with signs of rickets if the disorders began during intrauterine development. It happens that the first symptoms of rickets in infants are observed at 6 months. Only hypotonicity and initial softening of bones in the area of ​​the fontanel, cranial sutures, and chest can signal problems with the absorption of calcium and phosphorus, vitamin D deficiency. Most modern pediatricians question all other symptoms.

• Excessive sweating. If a baby sweats a lot (especially the head) during sleep, feeding, or active play, this may indicate individual characteristics of the body. Thermoregulation in infants has not yet been formed; babies overheat very quickly. It is impossible to judge the onset of rickets by this criterion.
• Dry hair on the back of the head. Bald spots on the back of the head may appear due to the fact that the child often sleeps on his back in the first months of life. Hair is dried mechanically, and not because there is not enough vitamin D.
• Loss of appetite . There can be many reasons for refusing to eat.
• Moody, restlessness. If a child has an increased reaction to external noise (when household appliances are turned on, screams, sharp sounds), this does not always indicate neurological disorders, much less the initial stage of rickets. It is necessary to consult a neurologist.

What diseases can occur due to vitamin D deficiency?

Rickets-like diseases in children are various changes in bone tissue (often irreversible) caused by a lack of vitamin D. These include:

• renal tubular acidosis;
• de Toni-Debreu-Fanconi syndrome (glucose-phosphate-amine diabetes);
• 1α-hydroxylase deficiency;
• Dent's syndrome;
• 25-hydroxylase defect;
• cystinosis;
• tyrosinemia.

The listed diseases are rare and severe hereditary pathologies with metabolic disorders. The most characteristic signs of all rickets-like diseases are retarded growth and development, convulsions, damage to the kidneys and eyes, and bone deformation. They can develop regardless of the prevention of rickets.

How to treat the disease

To treat rickets in infants, aqueous solutions of vitamin D are more often used. In this form, it is absorbed faster, does not accumulate in the body, and is excreted well by the kidneys. What medications can the doctor prescribe?

• Aqueous solution "Aquadetrim". This drug is based on vitamin D3, or colecalciferol, which regulates the metabolism of calcium and phosphorus. Dosage form - drops. The dose for treatment is set individually and depends on the weight, place of residence, time of year, dietary habits and daily routine of the infant, and the stage of rickets. The treatment course lasts 1–1.5 months. Possible dosage is from 6 to 10 drops with gradual increase. For preventive purposes, 1 to 4 drops of colecalciferol are prescribed (1 drop = 500 IU). Children often have allergic reactions to Aquadetrim.
• Oil solution "Devisol Drops". Recommended for children without signs of dysbacteriosis or disorders of the gastrointestinal tract, otherwise the vitamin in oil form will not be absorbed. Preventive dose of "Devisol Dropsa" - 5 drops. The drug is effective in the prevention of rickets in newborns. Drug analogues: “Vigantol”, “Videin”.
• "Ergocalciferol". This drug is based on vitamin D2. Usually prescribed only for prevention.
• Multivitamin complex. Since rickets affects the general metabolism, the doctor may prescribe a course of vitamins. It is taken into account that they also contain a preventive dose of vitamin D.
• Supplemental calcium gluconate. Prescribed in the first two weeks of taking vitamin D. This is due to the fact that vitamin D can reduce calcium levels. The drug is often prescribed to low birth weight, premature babies.

Under no circumstances should you exceed the dose prescribed by your doctor. For precise dosage, dispensers are provided on the solution bottles.

Side effects sometimes occur when taking aqueous solutions of vitamin D. The child may be capricious, cry, not sleep, refuse to eat, allergic rashes, vomiting, diarrhea or constipation, respiratory failure, and convulsions may also appear. All these symptoms may indicate an overdose of the drug. If such signs occur, you should stop taking it and consult a doctor. The doctor may prescribe a different medicine or reduce the dose.

If rickets is detected after a year

Rickets cannot be neglected. Because this disease has serious consequences, primarily related to the musculoskeletal system. With advanced forms of rickets, the baby lags behind in development: later he begins to hold his head, sit, crawl, and walk. In severe forms, the child cannot walk at all. Flat feet, pelvic deformation, X-shaped, O-shaped legs, scoliosis, myopia, malocclusion - these are not all the consequences of rickets suffered in early childhood. Maybe that’s why pediatricians in our country prefer to play it safe, so that later it won’t be too late.

Treatment of rickets in children after one year consists not only in the use of therapeutic doses of vitamin D. You need to undergo a full course of examination and register with an orthopedist. In addition to drug treatment, restorative therapy is carried out: massage courses, physiotherapy, physical therapy, and a diet enriched with calcium. Balneotherapy - medicinal baths - is also used.

A child diagnosed with rickets has been observed by specialists for 3 years. With parental persistence and proper therapy, the disease can resolve without consequences. Over time, if the child plays sports and eats right, his legs and posture will straighten out, and the shape of his head and chest will also return to normal.

Preventive measures: 6 important points

Prevention of rickets in infants begins from the first days of life. What does it include?

1. Breast-feeding. If possible, it should be preserved for at least six months. Breast milk provides the optimal balance of minerals and vitamin D.
2. Balanced nutrition for a nursing mother. A woman should receive vitamin D from food, sun exposure, or prophylactically in a multivitamin complex.
3. Sunbathing. Children develop rickets with a lack of sunlight. Ultraviolet rays are beneficial for both mother and baby. However, we must also remember about their harm. You shouldn't fry under the scorching sun to accumulate vitamin D. It has been proven that staying in the sparse shade of trees where sunlight filters in is as beneficial and effective as being in direct sunlight. It is believed that it is enough for a child to spend 10 minutes in the sun three times a week to receive the required weekly dose of vitamin D. At the same time, the skin should be 50% open. If protective products with SPF filters are used, vitamin D is poorly synthesized. This once again confirms the idea: in the summer it is better to walk before 10 a.m. and after 4 p.m., without using protective creams.
4. Complete complementary foods. After 6 months, complementary feeding begins. It is important that the diet be varied. Butter and vegetable oils, dairy products, fish and meat dishes are gradually introduced into the diet.
5. Preventive vitamin D supplementation. It is prescribed to most infants in the autumn-winter period. The preventive dose is usually 1–2 drops of an oil solution of vitamin D. The daily preventive dose for babies under one year of age is 400 IU, for children after one year - 500–600 IU. In spring, the need for this drug is significantly reduced.
6. Fish fat . Many mothers have questions: is it worth giving fish oil instead of vitamin D and when can this be done? Fish oil is allowed for children after one year. Doctors do not recommend using it because it has many side effects, it has a negative effect on the pancreas, and its effectiveness is much lower than that of vitamin D solutions.

Safety measures: if a child spends a lot of time outside in the summer, there is no need to take additional vitamin D. Typically, pediatricians cancel it in the summer season in those climatic zones where there is a lot of sun. When such nuances are not taken into account, complaints of nervousness, restlessness, and poor sleep often arise - clear signs of an overdose. To find out whether there is excess vitamin D in the body, a Sulkovich urine test is prescribed. If it shows excess calcium, it means there is a lot of vitamin D.

How to treat rickets in a child? Fortunately, in most cases, it is not treatment that is required, but prevention of this disease. The best preventative measures are safe sun exposure, good nutrition, and vitamin D oil solutions.

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With rickets, the baby's nervous system is the first to suffer. Children become irritable, often cry, flinch at sounds, and have interrupted sleep.

A bald head is an early sign of rickets

Excessive sweating is one of the early signs of rickets. The child's head sweats so much that the pillow becomes wet, sticky sweat irritates the skin, the child turns his head restlessly, the hair is wiped off and bald patches appear.

Click on pictures to enlarge.

Drawing. A bald nape in a child is a sign of rickets.

The child is going bald. She was born hairy, and then her hair began to fall out. Yesterday I literally went bald in one day. You run it over your head, and the hair stays right on your fingers. You take off your cap, and there’s hair on it. Bald patches on the sides and back of the head. I am terrified!?! Elya

Rickets is an unattractive head shape

With rickets, the soft bones of the skull are easily deformed, and lying in bed makes the back of the head flat. The parietal and frontal tubercles grow, an “Olympic” forehead appears, and the head appears square or saddle-shaped. The child has a disproportionately large brain part of the head - rachitic hydrocephalus. The large fontanelle closes late.

Severe rickets disfigures the face - the upper jaw protrudes forward over the lower jaw, the bite is open, the arch of the palate is high and narrow, sound pronunciation is impaired.

With rickets, milk teeth erupt at a later date, often in the wrong order. Teeth have enamel defects and are easily destroyed.

Drawing. Flat occiput or rachitic brachycephaly in a child (1, 2). Large square head with an “Olympic” forehead with rickets (3).

At one month old, we noticed that the baby’s head was flattened on his “favorite” side. The back of my husband’s head is also a little flat - it lay there in infancy. Olesya

Rachitic chest and crooked legs

With rickets, the growth of bones in length is slowed down. From 5-6 months of age, children are stunted in growth. There is an increased growth of osteoid tissue in the metaphyses of long bones, thickenings are formed - rachitic “bracelets” on the wrists and shins, “strings of pearls” on the phalanges of the fingers, rachitic “rosaries” on the ribs.

Drawing. Rachitic “bracelets” on the wrists (1, 2). Rachitic “rosary” at the border of the bone and cartilaginous parts of the ribs.

With rickets, due to the softness of the ribs, a depression in the form of a belt appears at the place of attachment of the diaphragm, the lower ribs spread out to the sides under the pressure of the abdominal organs, and the upper ones are pulled inward, the lower part of the chest is expanded, and the upper is narrowed. In very severe cases, a “chicken” breast is formed - the sternum is protruded forward, or a “cobbler’s chest” - the lower part of the sternum is depressed.

Drawing.“Chicken” breast (1) and “shoemaker’s” breast (2, 3) with rickets in a child.

My son is 1 year and 2 months old. Runs around the house without a T-shirt. Every time I pay attention to his ribs - the ribs themselves are sunken, but the lower ones seem to be turned out from below. Maria

In infants, the tone of the flexor muscles predominates. Children usually lie on their backs with their legs bent, tucking them inward, softening the bones to form O-shaped legs. The deformation intensifies under the weight of the body when the child begins to stand and walk. In children who are already on their feet and walking, the tone of the extensor muscles predominates. If softening of the bones of the lower extremities occurs at this age, X-shaped legs are formed. If muscle tone is significantly reduced, then even with severe forms of rickets and significant softening of the bones, curvature of the legs does not occur.

Drawing. O-shaped curvature of the legs in children with rickets.

Drawing. X-shaped curvature of the legs in children is a consequence of rickets.

At the age of 10 months, my daughter’s legs curved like the letter “O”. The diagnosis in the chart is: Post-strachitic O-shaped deformity of the lower extremities. The orthopedist said it will improve by two years. To believe or not to believe? Kate

Flat rachitic pelvis

In children with severe forms of rickets, the pelvic bones are deformed - a flat rachitic pelvis. Rachitic deformation of the pelvis in girls can cause pathology during childbirth.

Muscles suffer from rickets

Low muscle tone (muscle hypotonia) and loose joints are a constant companion to rickets. Due to flabby muscles and loose joints, a child lying on his back can easily pull his foot towards his face and even throw it behind his head. The patient's posture is typical - he sits with his legs crossed and supports his torso with his hands, with a rachitic hump behind him. With rickets, the child later begins to hold his head up, roll over, sit, stand and walk. After treatment, muscle hypotension persists for a long time.

Rickets heart

With rickets, the border of cardiac dullness can be expanded, since due to the high position of the diaphragm, the position of the heart is transverse. In severe rickets, breathing is shallow - shallow inhalation and short exhalation. During inspiration, the negative pressure in the chest is insufficient, venous return to the heart decreases, and blood stagnation occurs in the lungs and veins of the systemic circle.

The digestive organs suffer from rickets

With rickets, the “varnished” mucous membrane of the oral cavity shines bright red, and bare areas can be seen on the tongue - the “geographical” tongue. People with rickets have a large « frog's belly, a hernia of the white line is often found.

People need your experience - “the son of difficult mistakes.” I ask everyone, send recipes, don’t be sorry for advice, they are a ray of light for a patient!

Take care of yourself, Your Diagnosticer!

Rickets is a typical childhood disease; it occurs only during a period of very active growth, up to two years. At older ages, rickets does not occur. This disease occurs as a result of a lack of vitamin D in the diet, due to which the bones become stronger and the skeleton actively grows.

Rickets especially often occurs in the first year of life, when the body is actively growing and requires a lot of nutrients and vitamins. Vitamin D will be especially important, as it helps calcium to actively penetrate and be deposited in the bones. Due to this, the bones of the skeleton actively grow, metabolism is normalized, and the child feels good.

For the most part, rickets occurs in children born in the autumn-spring period, when there is little sunlight and insufficient vitamin D is formed in the skin. Also, children born prematurely, twins, or if there is little vitamin D in the diet (in infants or children fed unadapted formulas) more often suffer from rickets. The initial stage of rickets in infants can appear as early as two or three months, but often the first symptoms of rickets are mistaken for other diseases or a normal variant. Gradually, due to vitamin D deficiency, metabolism is disrupted and calcium levels in the bones change. This leads to more pronounced changes - the skeleton suffers, the shape of the head and chest changes, the functioning of the nervous system and digestion suffer.

Based on the severity of symptoms and course, rickets in infants can be divided into three degrees of severity. With rickets of the 1st degree, the infant exhibits minor disturbances in the nervous system, muscle tone changes, but there are no pronounced changes in the skeleton, which may subsequently remain for life. If you look at a photo of a baby with stage 1 rickets, there will be no serious changes in appearance. The back of the head flattens slightly and the hairs on it may roll up, forming bald patches, and the muscles will be somewhat weakened.

With grade 2 rickets, a baby may exhibit quite noticeable changes in the skull, which will smooth out as the child grows. The chest and limbs may also become deformed, and quite noticeable changes occur in the growth of the skeleton, the functioning of the muscular system and hematopoiesis. The nervous system and digestion suffer, internal organs do not work properly, the liver and spleen may become enlarged.

With rickets of the 3rd degree, all changes are strongly expressed, pronounced changes in the skeleton occur, which remain for later life, and internal organs suffer greatly. The shape of the head is sharply changed, the chest can be deformed so that the breathing process is disrupted. The legs are severely curved, which interferes with normal walking. Fortunately, such rickets practically does not occur today.

Sometimes even a photo can show what rickets looks like in infants. Such children are excitable, cry a lot, are frightened by sharp sounds and shudder violently. They are irritable and have trouble sleeping. The skin of such babies may have a “marbled” appearance with red spots easily remaining at the slightest pressure. Such children sweat a lot with the slightest effort - sucking, screaming, and especially at night, while sleeping. At the same time, sweat is sticky with a sour taste and a special smell; it can cause the skin to itch and irritate. Due to sweating and itching, a bald patch forms on the back of the child’s head due to friction between the back of the head and the pillow. The back of the head itself may become flat due to deformation of the less dense bones of the skull. If you look at a photo of the head with rickets in infants, you can note an increase in the pubic and parietal bones, which is why the head can become “square”. In this case, the forehead protrudes strongly, the hairline rises to the back of the head.

As rickets progresses, the entire skeleton may suffer. In the photo of infants with rickets, changes in the chest can be identified. It seems to bulge out in the sternum area, and becomes narrower on the sides (chicken breast). With severe rickets, the baby’s legs may take on the shape of the letter “o” or “x”.

But what else is dangerous about rickets in infants? In addition to the fact that the skeleton changes, the growth of teeth suffers; they erupt much later than usual. The functioning of the heart or lungs is impaired, and there may be constipation. Because of all this, children lag behind in development, both physical and mental, immunity suffers - children can often get sick for a long time.

Diseases of bone tissue and the nervous system are often found in children in the first year of life. The first place in popularity is occupied by rickets in infants; all parents know the symptoms of the disease. They are very afraid of him. How dangerous is rickets? Is there a high risk of developing the disease? How to stop the course of the disease? All parents are looking for answers to these questions.

Rickets is a disease of the musculoskeletal system caused by a significant lack of vitamin D. This substance enters the body from the outside in various ways. The vitamin is found in some foods and is actively produced by the body itself under the influence of sunlight. For this reason, children born in hot southern countries are much less likely to develop rickets than children from the north, where there are not enough sunny days a year.

To replenish vitamin D reserves, you can take it in pharmacy form. This substance is water soluble. Oil solutions of the vitamin will not be effective. Many vitamin-mineral complexes include this component, but its concentration is insufficient. Domestic pediatricians recommend giving vitamin D in the form of an aqueous solution to children of the first year of life daily for preventive purposes. This medicine is produced by Russian pharmaceutical companies, but it often causes skin rashes in children. European-made products act more delicately. Parents praise vitamin D from Germany, but getting it is problematic. It is extremely important to identify the manifestations of rickets at the initial stage of development of the disease, so that the disease does not yet lead to irreversible consequences for the body.

Rickets in infants affects not only bone tissue, but also the nervous system. This disease is developing rapidly. There is an opinion that the disease affects children only in the first year of life, but this is wrong. Many are surprised to learn that the disease can develop even in adults. Medical practice shows that children under three years of age are at risk. the greatest negative consequences occur if the disease began to develop at 2-3 months, but was not detected for a long time.

To understand how rickets develops and what the danger of the disease is, it is necessary to consider the functions of vitamin D in the body:

1. Activates the processes of absorption of calcium, which comes from outside, in the small intestine;
2. Accelerates the processes of bone tissue formation;
3. Enhances the excretion of phosphorus from the kidneys.

Knowing the main purpose of an important vitamin, imagine what happens in the body when there is a deficiency of this substance.

Calcium, which enters the body in sufficient quantities, is simply not absorbed by it. It is excreted naturally. There will be no benefit from eating foods rich in this microelement. The parathyroid gland controls calcium levels in the blood. When it detects a lack of a mineral, the process of washing it out of the bone tissue begins. The balance in the blood is restored, but the body begins to suffer greatly. Bones become brittle, which is very dangerous during periods of active growth.

Significant harm is also caused to the functioning of the nervous system. Due to a lack of calcium and phosphorus, muscles lose tone, and the baby’s physical development slows down significantly. These symptoms should not go unnoticed.

Causes of the disease

The reasons for the development of rickets in
Children of the first year of life include not only a lack of vitamin D in the body, but also the inability to absorb it. With this course of the disease, complex treatment is required. We need to find out why nutrients are not absorbed. Having solved this problem, it will be easier to restore all the functions of the growing body.

The main prerequisites for the development of rickets in infants include:

• Poor nutrition of the mother during pregnancy;
• Bad habits - smoking, addiction to alcohol, when carrying a baby;
• Refusal of breastfeeding;
• Rare exposure to the sun;
• Ignoring the recommendations of a neonatologist and pediatrician.

It largely depends on the parents whether pathological changes in tissues will develop, but there are also factors that adults cannot influence. Doctors say that premature babies born with low weight are always at risk, and vice versa, babies who were born weighing more than 4 kg. In such cases, parents should monitor the development and health of the baby even more closely. At an early stage of the development of a disease, it is always possible to prevent it and prevent negative consequences.

Knowing the reasons for the development of rickets in an infant, you will be able to promptly notice the symptoms of the disease, draw the attention of your doctor to them, undergo diagnostic measures and begin treatment immediately.

Signs of rickets in children vary depending on the stage of development of the disease.

The first manifestations are noticeable at 2-3 months:

1. Tearfulness;
2. Poor sleep;
3. Breast refusal;
4. Excessive sweating (wet pillow syndrome);
5. Increased size of the fontanel;
6. Baldness of the occipital part of the head.

The problem of diagnosis during this period is that the manifestations of rickets are similar to the symptoms of a host of other diseases.

Many parents associate poor sleep and frequent crying of the baby with individual character traits. Alopecia of the back of the head also occurs in 90% of healthy children. Babies spend most of their time lying on their backs. With constant contact of hair and bed linen, the back of the head “rolls out”. The presence of this symptom often plays a cruel joke on parents. Young mothers, having read on the Internet that baldness at this age is a sign of rickets, begin to panic, make diagnoses on their own and annoy the attending physician. Here it is important to observe a fine line between unbridled panic and a responsible attitude towards children's health.

The large size of the fontanel is
a symptom that should really bother you. To pay attention to it, adults must compare the tops of several babies. Young parents of their first child do not have such experience. It is for this reason that in the first year of life it is necessary to make preventive visits to the pediatrician once a month.

A specialist will be able to assess the structure of the baby’s skull. He will be the first to see the slightest deviations from the norm, ask about your health and other symptoms, and offer to undergo an examination.

Manifestations of the disease in older children

If at first the symptoms of rickets are associated more with the poor health of the baby, then over time obvious manifestations appear that cannot be ignored:

• The head takes on a flattened cubic shape;
• The “frog belly” syndrome appears - all the muscles in the body are flabby and soft;
• Seals on the ribs, visible to the naked eye (the so-called “rachitic rosary”);
• Knots on the wrists;
• Curvature of the spine;
• Curvature of the legs.

If no measures are taken at this stage, the little patient will remain disabled forever. In addition to bone tissue, internal organs suffer, their work is disrupted, and their structure changes. Over time, disorders of the digestive, cardiovascular, and central nervous systems may develop. Under no circumstances should such problems be ignored.

In the modern world, where the level of development of medicine is constantly growing, there are fewer and fewer cases of detection of rickets at a late stage of development in children, but in dysfunctional families and infant homes such cases occur quite often.

As you prepare to become parents, you need to pay attention to your own education. You are taking on a huge responsibility. To avoid serious health problems, you need to know the main symptoms of diseases such as rickets.

Diagnostic measures

Only a doctor can diagnose rickets in a baby in the first year of life. Self-medication is strictly contraindicated. Be sure to contact your pediatrician. An experienced doctor will prescribe the necessary additional studies. Biochemical blood tests are required. The development of rickets is indicated by increased alkaline phosphatase, and the levels of calcium and phosphorus are markedly reduced.

If changes in bone tissue are noticeable visually, then an x-ray examination is prescribed. It allows you to change structural changes in areas of active growth. With rickets, these places become noticeably thicker. Even before all diagnostic measures are completed, therapy is prescribed. All examinations conducted help determine the stage of development of the disease and the degree of damage to internal organs and systems.

Treatment methods

Treatment of rickets in children of the first year of life includes many activities. To achieve a positive result, all therapeutic measures must be comprehensive. The doctor prescribes calcium and phosphorus supplements, as well as vitamin D in an easily digestible form. Its dosage is selected with special care. An excess of vitamin in a child’s body is fraught with no less negative consequences, like hypercalcemia.

Concomitant therapy methods used in the treatment of rickets in infants:

1. Massage;
2. Infant swimming lessons with an instructor.

Walks in the open air
Massage

With a comprehensive approach to the treatment of rickets in children, the symptoms of the disease will quickly subside, the consequences will be minimized, and the structure of the bone tissue will be restored. After completing the full course of therapy, detailed blood tests are taken again to assess the dynamics of the process.

Health implications

If treatment for rickets is not started in a timely manner, structural changes in bone, connective and soft tissues will negatively affect the structure of the body and body functions. Severe curvature of the spine, the formation of a “rickets hump,” protrusion of the chest, severe curvature of the legs – these are not all the consequences of the disease. As an adult, the patient loses the ability to move independently and experiences constant pain in the damaged joints. Teeth suffer greatly. Their complete loss at an early age is possible. Sometimes the rudiments of molars do not appear at all.

The disease also affects the psycho-emotional development of the child. Delayed physical and mental development is a common consequence of the disease. Knowing all these factors, parents of young children understand how important it is to promptly identify the problem and begin to deal with it. Self-medication is strictly forbidden. Only professional help from experienced pediatricians will help with this. Be sure to listen to all their advice.

Preventive actions

To prevent the development of rickets in infants and children 2-3 years old, it is necessary to use a set of preventive measures. These actions begin during pregnancy. Following the doctor's recommendations, undergoing all required tests, proper nutrition, an active lifestyle, absence of stress and anxiety - all this has a beneficial effect on the intrauterine development of the child. The fetus develops a certain supply of vitamin D, which it uses in the first months of life. Then this stock is replenished from outside.

Children must be given vitamin D in water-soluble form. The source of easily digestible vitamin is high-quality fish oil and omega-3 polyunsaturated fatty acids. The pharmaceutical industry produces fish oil in capsules, a solution with a pleasant fruity taste. Parents will not have any problems giving their child medicine.

Frequent walks in the fresh air, sunbathing, active physical development of children in the first year of life are an effective and enjoyable prevention of rickets. If you use such banal remedies, you can reduce the likelihood of illness by 80-90%.

Some parents are sure
that rickets develops only up to a year. At this age, it is especially dangerous because bone tissue is destroyed during the active growth of the baby. But the disease can also develop in older children. You should always monitor a balanced diet, organize private walks for your baby, and take care of your immune system. Then rickets will not be scary for infants and children 2-3 years old.