Spasmophilia is observed in older children. Spasmophilia in children: symptoms and treatment

Spasmophilia in children

Smasmophilia is a pathological condition characterized by increased nervous muscle excitability and frequent clonic seizures. The disease can appear in a child between the ages of three months and two years. According to statistics, boys are more likely to get sick. After a year, the disease manifests itself in the form of spasms of individual muscle groups. More often they occur in spring or late winter. The cause is a disturbance in the metabolism of phosphorus and calcium, which results in a decrease in the level of calcium in the blood. Keeping your baby exposed to sunlight for a long time may also be one of the reasons. Disruption parathyroid glands leads to a decrease in calcium and its active excretion in the urine, which also leads to spasmophilia. Negative factor is also a decrease in the content of sodium, magnesium, chlorides, vitamins B6 and B1.

Spasmophilia can occur in latent, overt form, or hidden form. The latent form becomes overt when the baby develops rickets due to vitamin D deficiency. The latent form is expressed by anxious sleep, excessive sweating, fearfulness and anxiety.

Symptoms of the disease are: laryngospasm, tetany and eclamptic convulsions. With laryngospasm, a sharp spasm of the glottis occurs, similar to the crow of a cock. Then shortness of breath and stenotic breathing appear. Respiratory cessation may occur if there is sudden pallor, cyanosis of the lips, or freezing with the head thrown back. At the end of the attack, the child takes two to four shallow wheezing breaths, and then breathing returns to normal. It happens that an attack leads to death. Tetany manifests itself as a spasm from three hours to several days. Cramps cause severe pain. The feet may swell. Eclamptic seizures are manifested by twitching of the facial muscles, as well as the muscles of the neck, leg or arm. The child may lose consciousness, his face turns red, tachycardia appears, and his breathing quickens. Vomiting may occur involuntary urination, defecation, foaming from the mouth.

Used to diagnose the disease various techniques- Trousseau, Lyusta, Khvostek, Maslova. They are based on identifying the degree of nervous excitability.

If a child loses consciousness during an attack, urgent resuscitation measures are necessary. Lung inhalation is carried out, artificial respiration. Anticonvulsant drugs are administered. A fence is also used cerebrospinal fluid. In most cases of timely treatment of the disease, the prognosis is favorable. In case of severe pathology, it is very important not only to treat, but also to prevent subsequent attacks. When the baby turns three years old, to eliminate pathological process carry out measures to stabilize phosphorus and calcium in the blood.

If a baby suffers from spasmophilia, then after six months it is necessary to introduce fruit and vegetable dishes into the diet. The baby is on artificial feeding you need to reduce the amount of milk, replacing it with vegetables and fruits. The baby should be in a calm environment and walk in the fresh air more often.

Spasmophilia in adults

Spasmophilia is less common in adults than in children. In some cases, the nature of the disease remains unknown. A number of symptoms can be observed in both children and adults. This is chilliness, goosebumps. Most often this happens while falling asleep. According to studies by French scientists, it has been established that spasmophilia is more common in women who are deficient in calcium. The main provoking factors include:

period of pregnancy and lactation;
presence of infectious diseases;
nervous tension

The disease can be caused by:

surgical removal of the parathyroid glands;
tumors;
hemorrhages.

Spasmophilia form

Depending on the clinical picture, a hidden (latent) and overt (manifest) form is distinguished. The transition of a hidden form to an explicit one is not excluded. The latent form is revealed only by carrying out special examination using skin and mechanical tests. The manifest form occurs as laryngospasm, attacks of eclampsia or cardodedal spasm.

Hidden spasmophilia

Flow latent spasmophilia is always accompanied by an obvious form and can last several months. Signs include sweating, increased fatigue, tachycardia, hand dysfunction gastrointestinal tract. The form is characterized by certain symptoms:

Chvostek's sign. When tapping the zygomatic arch with a hammer, twitching of the corner of the mouth or eye is observed.
Ebra's sign. When the median nerve of the elbow is irritated by current, the fingers bend.
Lust's sign. Tapping the area with a hammer tibia leads to the fact that the foot is retracted to the side and the sole of the leg is bent.
Trousseau's sign. When the brachial nerve bundle is compressed, the muscles of the hand contract.
The Maslov phenomenon. The injection may cause breathing to stop.

Explicit spasmophilia

One of the manifestations of obvious spasmophilia is laryngospasm. In severe cases, this can lead to loss of consciousness. Another manifestation is a tonic spasm of the hands and feet, which can last for a day. This can lead to swelling of the dorsum of the feet and hands. Possible occurrence eye spasms, turning into strabismus. Spasms of the respiratory muscles pose a risk of cardiac arrest. The most severe manifestation is clonic-tonic convulsions. The attack is accompanied by impaired breathing and consciousness.

Spasmophilia symptoms

The main symptoms of the disease are:

convulsions, including those of the whole body with loss of consciousness;
muscle twitching in the arms and legs;
spasms of the feet and hands;
laryngospasm;
excessive nervous excitability;
increased nervous excitability and sweating;
rapid heartbeat.

Causes of spasmophilia

The main cause of the disease is a lack of vitamin D, especially in the autumn, when it is found in abundance in skin. This leads to deterioration in the functioning of the parathyroid glands. The level of calcium in the blood decreases, most of it is found in the bones. This leads to muscle tension and cramps. Another reason is prolonged exposure to the sun.

Spasmophilia diagnosis

Diagnosis of the disease includes a Sulkovich laboratory test, studies of calcium and phosphorus levels in the blood. An alkalosis study (ASA) is being carried out to establish acid-base balance, and also do an electrocardiogram for hypocalcemia and radiography. At the first suspicion of illness, you should consult a doctor.

Spasmophilia emergency care

Emergency treatment for convulsive attacks, laryngospasm, and fainting is the elimination of hypoxia. For this purpose, artificial respiration, oxygen inhalation and administration are performed. medicines. Convulsive attack It can be removed from a child at home. The child needs to stick out his tongue and irritate the wall of the pharynx and the root of the tongue. Before the first breath, do artificial respiration, spray on the skin cold water, pat your buttocks. Provide fresh air. During the activities, the level of calcium in the blood is determined and, if necessary, a 10% solution of gluconate or sodium chloride is used

Treatment of spasmophilia

Diseases must be started in a timely manner, since identified disorders can remain for life. Treatment includes several main areas:

activities during a seizure;
preventive measures to reduce excitability and seizures.

IN home medicine cabinet There should always be chloral hydrate. It can be used as an enema as a 2% solution. You can also use a 10% urethane solution. Solutions at a temperature of 36° C are injected into the rectum. The action begins in about thirty minutes. To relieve cramps, a 10% solution of magnesia is also used, which is administered intramuscularly at the rate of one milliliter per kilogram of weight. In the intervals between attacks, treatment against rickets is carried out. Repeated attacks can occur against the background of infectious diseases, high body temperature and gastrointestinal disorders. At high temperature antipyretic drugs are prescribed and cool wraps are used. A reliable remedy is taken in large doses, which are gradually reduced. Special significance has proper diet. It should consist largely of dairy products, as well as fruits and vegetables.

Spasmophilia care

Caring for a patient with spasmophilia requires strict adherence to the daily routine. Massage sessions and gymnastics are required. The home environment should be calm and balanced, without stress and anxiety. Frequent exposure to fresh air calms the nervous system.

Prevention of spasmophilia

Prevention of spasmophilia in newborns is breastfeeding. Compliance hygiene standards in child care and maintenance of living quarters is an important condition. WITH early years it is necessary to carry out measures to harden the body and take care of colds. It is necessary to monitor the level of calcium in the blood, take prophylactic drugs within six months after the attack. The main provisions of prevention include preventive measures for the treatment of rickets. Fish oil is prescribed from half a teaspoon per day from two months. Vitamin D is used from four to five weeks in an amount of 1500 to 2000 units.

Special painful condition children early age(from 2 months to 2 years, more often from 3 to 9 months), associated with a violation mineral metabolism(calcium and phosphorus) and parathyroid hormone deficiency, expressed in increased neuromuscular excitability with a tendency to general or limited (local) tonic or clonic convulsions. It is observed more often in February - April, often in premature babies. With spasmophilia, serum calcium is reduced (less than 9 mg%). In particular, the content has been reduced ionized calcium. Serum phosphorus is usually increased, sometimes decreased. The level of alkaline phosphatase is sharply increased.

There are two forms of spasmophilia:

hidden (latent);

Symptoms of hidden spasmophilia

Symptom facial nerve(Khvostek) - repeated rapid contraction of the facial muscles with short spring blows to the area of the facial nerve in the middle of the cheek. Trousseau's symptom is the rapid appearance of tonic convulsive contraction of the fingers in the form of an obstetrician's hand with moderate compression of the child's shoulder with the palm of the hand or an elastic bandage, as well as plantar flexion of the foot with compression of the calf muscle. Erb's symptom is a sharply increased galvanic neuromuscular excitability. Tested on median nerve in the elbow bend (when opening the cathode, bend the fingers). Proofable at current levels below 5 mA. Changes in the child’s psyche - tearfulness, fearfulness, anxiety, worsening sleep and appetite.

Provoking moments: dyspepsia, improper feeding (excessive amount of cow's milk), infectious diseases, agitation, hot baths, mustard wraps as factors that irritate the autonomic nervous system, create a predisposition to alkalosis, contribute to the mobilization of phosphorus, a decrease in serum calcium and the transition of latent spasmophilia to overt.

Symptoms of obvious spasmophilia

Laryngospasm (twitch of the glottis). Initial forms laryngospasm manifests itself in the form of a loud inhalation or inhalation with a choking sound with any excitement of the child, increased nervous excitability, timidity, or rolling up. Attacks of laryngospasm are characterized by:

a loud, sonorous groaning inhalation or an inhalation with a croaking tinge with a sudden stop in breathing after unsuccessful attempts to inhale;

sharp pallor with blue lips, a frightened look;

sharp motor restlessness child or freezing with head thrown back; sometimes the child’s whole body is tense;

tension of the large fontanelle in infants;

signs of the end of the attack: the appearance of several shallow breaths with a whistling tint (air penetration through a still narrowed glottis) and the establishment of normal breathing.

The number and intensity of seizures vary from single ones at large intervals to frequent - 20 or more per day. After severe seizures, the child becomes lethargic, drowsy, and sometimes an attack of laryngospasm can turn into general convulsions.

Less commonly observed are so-called carpopedal spasms - tonic spasms of the muscles of the hands and feet, lasting for hours and sometimes several days.

Bronchotetany is a particularly life-threatening spastic contraction of the bronchial muscles. Sometimes bronchoetania occurs as the first appearance of spasmophilia. It is observed mainly at 3-6 months of age. Its symptoms:

at normal temperature or with existing minor catarrhal symptoms of the upper respiratory tract sudden appearance shortness of breath with flaring of the wings of the nose;

spasmodic ringing cough;

difficult exhalation with groaning, cyanosis;

acute swelling of the lungs; hard breathing, areas with bronchial breathing and wheezing.

The most severe manifestations of overt spasmophilia are eclampsia - general clonic convulsions with loss of consciousness.

Differential diagnosis

Laryngospasm must be differentiated from congenital stridor, aspiration foreign body and respiratory affective convulsions(see relevant sections).

Treatment

Emergency aid algorithm:

application of external irritations - spray with cold water, bring a cotton swab moistened with ammonia to the nose;

spatula or index finger push the tongue forward or pull it out;

in case of a severe attack:

artificial respiration (with oxygen therapy),

intravenous slow administration of 3-5 ml of 10% calcium gluconate solution or 10% calcium chloride solution,

if ineffective, intracardiac injection of 2-4 ml of 10% calcium gluconate solution, indirect massage hearts,

tracheotomy with controlled breathing as a last resort;

with repeated attacks of an enema with chloral hydrate, luminal in suppositories or in powders;

after the end of the attack of laryngospasm, the administration of calcium preparations orally is indicated: 10% calcium chloride solution, one dessert spoon, 6-8 times on the 1st day, with a dose reduction in subsequent days.

A diet with a sharp restriction of cow's milk in the first days. After saturating the body with calcium, prescribing a course of vitamin D2 ( alcohol solution) with continued use of calcium supplements.

Primary diffuse pulmonary fibrosis (Gamman-Rich syndrome)

The primary process of scarring of lung tissue, which initially occurs in the interalveolar septa with a secondary change in the entire connective tissue framework of the lungs, resulting in alveolar capillary blockade with hypoxemia and hypoxia.

Symptoms:

attacks of shortness of breath lasting from an hour to a day with the transition later to severe respiratory and cardiovascular failure;

cough, predominantly dry, whooping cough with sputum, sometimes containing streaks of blood, suffocating, accompanied by pain in the chest and throat;

cyanosis, persistent after several attacks;

increase in temperature;

headache;

hemoptysis;

physical data:

in the lungs there is a box-like tint of percussion sound, scattered dry and fine-bubbling wet rales, sometimes pleural friction noise,

decrease in cardiac dullness (relative and absolute), second tone on pulmonary artery strengthened,

sometimes slight hepatosplenomegaly;

X-ray findings: reticular pattern of pulmonary fields, “honeycomb” appearance, dilated roots, emphysema.

Differentiation with diseases of the reticular tissue of the lung (sarcoidosis, Christian-Schüller disease, collagenosis, miliary tuberculosis, idiopathic hemosiderosis, pneumoconiosis).

Treatment is often ineffective: inhalation of a 1-2% trypsin solution; corticosteroids in high doses; oxygen therapy (40-50% oxygen mixed with air); antibiotic therapy for the prevention of intercurrent diseases.

Idiopathic pulmonary hemosiderosis

In the lung tissue, hemosiderin is deposited and fibrosis develops. The vascular bed of the lesser circle narrows, forming hypertension and cor pulmonale.

Symptoms:

periodic crises with attacks of shortness of breath, severe pallor, often with icterus and increased temperature;

cough, hemoptysis;

pain in the chest, stomach;

severe anemia after crises with thrombocytosis, normal blood clotting, indirect bilirubinemia;

the presence of macrophages with hemosiderin in the sputum;

X-ray examinations, unstable multiple large and small lesions(a consequence of massive hemorrhages), later compacted roots or fibrous changes;

progressive fibrosis in the lungs and symptoms of cardiovascular failure.

Treatment

Early recognition is necessary for timely active therapy: desensitizing therapy with corticosteroids - cortisone or prednisolone, initially large doses; calcium supplements, vitamins C, P, B complex; antianemic treatment.

Congenital stridor

Congenital stridor is detected from the first days of life, gradually weakening by 6 months or ½-2, less often by 3 years. Its causes are anomalies in the development of the structure of the larynx (its deformation, the softness of the epiglottis, folded into a tube, causing the aryepiglottic folds to come together, when inhaling, they stick to the larynx and produce side effects of sound). Perhaps this underdevelopment of the larynx is associated with a delay in the development of innervation.

Symptoms:

a characteristic breath, accompanied by special sounds reminiscent of the clucking of a chicken, the purring of a cat or the cooing of a dove;

decreased stridor during sleep, increased when the child is excited, screaming, crying;

the general condition is not disturbed.

In acute respiratory disease congenital stridor may intensify and breathing becomes more difficult.

The diagnosis is established based on the main features: congenital inspiratory noise, decreasing during sleep, increasing when the child is excited, with a normal voice and wellness are saved. Recognition may be difficult if congenital stridor is layered with inflammatory phenomena larynx and trachea. Interviewing parents helps to establish the presence of stridor from the first days of life.

Congenital stridor must be differentiated:

with laryngospasm during spasmophilia, when respiratory arrest is noted. The phenomena of spasmophilia begin not at birth, but after 3 months. Outside of an attack, no adverse breathing sounds are observed;

with enlargement of the thymus gland. In this case, breathing is difficult, accompanied by collateral noise during inhalation and exhalation. When the head is tilted back, the noise intensifies. Percussion reveals dullness in the upper part of the sternum;

with tumor-like tuberculosis of the bronchial lymph nodes, which is characterized by expiratory shortness of breath worsening during sleep, as well as a constant bitonic or whooping cough.

Treatment congenital stridor not required.

Shortness of breath in severe rickets

Severe form of rickets with deformation chest, kyphoscoliosis, softness, pliability of the ribs, hypotonia of the respiratory muscles and abdominal muscles, flatulence, highly elevated diaphragm causes:

disruption of normal gas exchange in the lungs with the surface, improper breathing and the appearance of poorly ventilated areas of the lungs, blockage of bronchioles with mucus with the appearance of atelectatic areas;

difficulty in blood circulation in the pulmonary circle with stagnation in the lungs;

frequent prolonged bronchitis, pre-pneumonic condition;

constant shortness of breath of an expiratory nature (“ chronic asthma rickets").

creation of proper hygiene regime;

correct mode nutrition, vitamins C and B complex;

antirachitic therapy ( ultraviolet irradiation) or a course of vitamin D2 with a prescription later fish oil, calcium supplements);

massage, therapeutic exercises.

Shortness of breath of a neurotic nature (a manifestation of obsessive syndrome)

Complaints of shortness of breath with a feeling of “lack” of air “heavy sighs” are observed at school age, less often in children 5-6 years old who have suffered from any acute respiratory or cardiovascular disease with unstable symptoms of respiratory failure. None pathological abnormalities it is not detected in children from the lungs and heart. This obsessive syndrome with shortness of breath is observed in children with an unstable autonomic nervous system and is associated with easy education conditioned reflexes at this age, especially if the parents behave incorrectly.

the main thing is not to pay too much attention to these manifestations;

physical education (exercise, sports);

ingestion of a solution of glucose with sodium bromide, ascorbic acid and vitamin B.

Respiratory affective convulsions

Reflex inspiratory suspension of breathing is observed during respiratory affective convulsions. They are accompanied by asphyxia, anoxemia of the brain, sometimes with the addition of general convulsions. They occur in early childhood (from 6 months to 3-4 years). The reason is usually various emotional moments: anger, fear, force-feeding, unexpected joyful excitement.

Symptoms:

the child “goes crazy” from screaming;

initial cyanosis gives way to sudden pallor;

loss of consciousness with cessation of breathing and adynamia, sometimes short-term (up to V2 minutes) epileptiform general convulsions;

end of seizure take a deep breath with the return of consciousness (sometimes after severe attacks the child falls asleep);

different frequency of seizures (several times a day or repetition at long intervals);

The target setting of seizures is often revealed. This is how children achieve their desires and whims.

Differential diagnosis:

with foreign body aspiration. The main difference between Decnupa toral affective seizures is the recurrence of seizures;

with laryngospasm.

It should be noted that laryngospasm affects younger children. There are always signs of spasmophilia. Laryngospasm begins with a characteristic loud (sometimes groaning) inhalation. But if seizures of respiratory affective convulsions last more than 1 minute and not each of them is associated with affect, then another etiology of convulsions is likely: tracheal anomalies, compression of the trachea by an enlarged thymus gland or large blood vessels if their location is abnormal.

Treatment

If the child is still conscious, unpleasant external irritations are used (sprayed with cold water, allowed to smell ammonia). In case of loss of consciousness, artificial respiration should be used. For prevention, children suffering from affective respiratory convulsions are advised to take the correct regimen of calcium, bromine, and vitamin B supplements.

Spasmophilia is a disease of early childhood, which with timely treatment has a favorable prognosis. The disease rapidly develops as a result of hypocalcemia (lack of Ca in the body), while the content of vitamin D in the blood increases.

The rapid development of spasmophilia in children is facilitated by disorders of the parathyroid glands, decreased level of calcium absorption in the intestine or increased level excretion of Ca along with urine. Frequent seizures provoked by a lack of levels of Mg, Na, chlorides, B vitamins in the blood. When identifying the slightest symptoms of spasmophilia, it is necessary urgently contact a pediatric neurologist. On early stage drug therapy allows you to eliminate symptoms and protect your baby from negative consequences in the future. Unfortunately, late detection of spasmophilia provokes serious complications for the whole body and deterioration in the child’s quality of life. Treatment of spasmophilia involves urgent hospitalization of the patient.

Reasons

The main causes of spasmophilia are the following factors:

excess vitamin D (due to an overdose of the drug during treatment or as a result of prolonged exposure to the sun);
poor nutrition;
breastfeeding replacement artificial mixtures;
feeding infant cow's milk;
various kidney disease, which cause problems in mineral processing associated with large deposits of calcium in the urine;
premature birth(from 33 weeks of pregnancy);
unfavorable sanitary and hygienic living conditions.

Seizure attacks with spasmophilia, as a rule, can be triggered by stress, loud sounds, bright light, etc.

Classification

Spasmophilia can occur in two forms: latent (hidden) and obvious.

Latent form suggests the absence of significant symptoms. The first signs of spasmophilia can only be noticeable with careful diagnosis by an experienced neurologist. The disease becomes obvious when exposed to associated factors, including stress, overexertion, infectious lesion organs and systems of the body. Average duration spasmophilia in latent form – from 2 to 6 months. In the absence of diagnosis and treatment, the disease becomes obvious.

At explicit form spasmophilia, spasticity of the glottis is observed, against which the child’s voice becomes rougher, he has difficulty pronouncing sounds, the process of humming is disrupted, and there is a delay speech development. Also often spasms occur, hands and feet are in a flattened, tucked form, arms are brought to the chest. The spasms may last for several minutes or hours. Also with this form there is rapid breathing and heartbeat, sometimes long delays in breathing (apnea). In severe cases of spasmophilia, seizures accompanied by eclampsia and loss of consciousness. Sometimes the child falls asleep immediately after a seizure, but muscle spasms persist. In such cases it is necessary urgent hospitalization with subsequent observation by a neurologist.

Symptoms

The main signs of the disease are:

muscle spasms of various groups;
curled toes downwards;
“twisting” of the brushes;
twitching of limbs;
improper formation of the hand and fingers;
hoarse voice, rapid breathing;
increased sweating;
in children;
increased neuromuscular excitability;
decreased concentration;
skeletal disorders (curvature of the spine, pronounced frontal lobes, O-shaped or X-shaped legs, curved chest);
disruption of the digestive process;
poor sleep;
twitching of facial muscles;
general cyanosis;
increased pain sensitivity.

Diagnostics

To diagnose the disease, the following manipulations are performed:

examination by a neurologist;
examination by a pediatrician;
galvanic skin tests;
biochemical blood test;
general blood test;
general urinalysis;
mechanical tests.

Diagnosis of spasmophilia must be carried out by specialists in the field of pediatrics and neurology. Based on the research results, optimal therapy and prevention of recurrent seizures can be recommended.

Treatment

In children, spasmophilia should be treated exclusively under the supervision of a doctor. In most cases, treatment in a hospital setting with consistent monitoring of the patient is appropriate.

Basic methods of conservative therapy:

intravenous administration of magnesium and calcium solutions;
taking sedatives;
diet therapy(infants are prescribed a “tea diet” for 6-12 hours, during which they are given weak tea in limited quantities, then breast milk is introduced, fermented milk products; adult children are prescribed fruits and vegetables in the form of purees, vitamins);
administration of a solution of chloral hydrate (intramuscularly or through an enema).

After completing the course, they are assigned preventive measures against, including massage, gymnastics and frequent walks in the fresh air.

Urgent assistance in the event of a seizure attack involves:

placing the child on a flat, hard horizontal surface (floor, couch, table);
freeing the chest from clothing;
providing a direct supply of fresh air;
insertion of a breathing tube into the throat;
wetting the face with cold water;
indirect cardiac massage;
urgent administration of anticonvulsant drugs.

Prevention of disease

Prevention of spasmophilia includes a number of measures. First of all, it is necessary to have a comprehensive regular meals, including drinking milk, fermented milk products, cottage cheese, vegetables, meat while maintaining breastfeeding. If this is not possible, mixtures with the optimal content of calcium, magnesium, and phosphorus are prescribed. Also, children with spasmophilia are shown preventive taking vitamin D in the first year of life (1 drop per day), while in the summer and spring it is recommended to stop taking this vitamin to avoid an overdose. Constantly necessary monitor blood calcium levels, take calcium supplements in a timely manner. Good effect They also provide frequent walks in the fresh air and therapeutic and preventive massage. To prevent spasmophilia, children in the first year of life should undergo monthly examinations by a pediatrician; at least once a quarter - with a neurologist.

Forecast

If the child has been promptly diagnosed and given comprehensive treatment, then the prognosis for spasmophilia positive. It is very important to provide timely assistance when convulsive syndrome, correct electrolyte disturbances in the body, establish proper and regular nutrition. In the absence of help, especially during seizures, the child may die as a result of cardiac arrest or asphyxia. Treatment of spasmophilia should be prescribed exclusively by an experienced neurologist, as well as prevention of this disease after recovery.

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Spasmophilia is a serious pathology characterized by increased neuromuscular excitability and a predisposition to clonic convulsions. This disease develops in babies between three and twenty-four months of age. According to statistics, there are more boys than girls among the patients.

Experts say that spasmophilia in children develops against the background of rickets. The attacks are most often spontaneous and are often provoked by the baby’s fear. If a child is diagnosed with rickets, then parents need to know how spasmophilia occurs, what its signs and symptoms are, and how to help the child before the arrival of doctors to prevent respiratory arrest.

Nowadays, about four percent of children with clear signs rickets. This relatively small percentage indicates that in recent years the number of manifestations of severe forms rickets.

What is spasmophilia?

Spasmophilia is the result of a violation of phosphorus-calcium metabolism, which reduces the calcium level in the blood. There are two forms of this disease:

latent;
explicit.

The latent form becomes overt if the child has a deficiency of vitamin D in the body, which causes rickets to develop. Spasmophilia in children in a latent form is manifested by motor restlessness and fearfulness. Anxious sleep and increased sweating are also observed.

Causes of spasmophilia in children

Spasmophilia manifests itself due to acutely developed hypocalcemia in combination with electrolyte imbalance and alkalosis. The amount of vitamin D, an active metabolite, rapidly increases in the blood. In addition, hypocalcemia can be caused by disruption of the parathyroid glands, a significant decrease in calcium absorption in the intestine, or increased excretion in the urine.

Convulsions during spasmophilia in children are caused by a decrease in the level of vitamins B6 and B1, sodium, chlorides, and magnesium in the blood. The main causes of the disease are:

Failure of calcium-phosphorus metabolism, causing a decrease in the saturation of ionized and total calcium in the blood, which is combined with hyperphosphatemia and alkalosis.
An increase in inorganic phosphorus due to feeding the baby with cow's milk. As a result, excess phosphorus is excreted.
Overdose of vitamin D2 and D3.
Absorption of ultraviolet rays in spring in large quantities.

Due to the metabolite of vitamin D, the following occurs:

deterioration of the parathyroid glands;
a change in the alkaline reserve in the blood; in a more severe form, alkalosis may develop;
reabsorption of amino acids in the renal tubules;
accumulation of excess calcium in bone tissue, while its level in the blood decreases and the amount of potassium increases.

In addition, ultra-high muscular-nervous activity and convulsive readiness can be caused by a decrease in the blood level of vitamins B6 and B1, and chlorides. In this case, any, even minimal unfavorable factor- screaming, fear, viral disease, crying, temperature rise, vomiting - can provoke a convulsive attack.

Young mothers should know that breastfed babies practically do not suffer from spasmophilia. The risk group includes artificial babies and premature babies.

Symptoms of the disease

Symptoms of spasmophilia in children are clearly manifested:

Eclamptic convulsions.
Carpopedal spasm.
Laryngospasm.

Characteristic signs of spasmophilia in children are eclamptic convulsions, which are expressed by twitching of the muscles of the face, then the neck, legs and arms. Then convulsions begin to shake the child’s entire body. The baby loses consciousness, his face turns purple, tachycardia appears, frequent intermittent breathing, possible involuntary bowel movements, urination, foaming from the mouth.

Due to increased during an attack intracranial pressure The tension of the large fontanelle is recorded. With tetany characteristic feature spasmophilia in children - carpopedal spasm. It can last from two to three hours to several days. Such convulsive contractions cause severe pain. Due to their duration, swelling may appear on the baby’s feet.

Laryngospasm

This is a severe spasm of the glottis. Symptoms of spasmophilia in children in the stage of laryngospasm first manifest themselves as a “cock” cry. Then stenotic breathing appears, retraction yielding places sternum, inspiratory dyspnea. Stopping breathing may be sudden. Although the following symptoms indicate an approaching attack of spasmophilia in children:

cyanosis (blue discoloration) of the lips;
pale skin;
freezing of a child with his head thrown back.

The attack ends with the baby taking two to four whistling shallow breaths. They are accompanied by this whistling sound as the air passes through a very narrow gap. Then breathing returns to normal. Unfortunately, each such attack can result in death.

Diagnostics

To install accurate diagnosis, the child is examined by checking Trousseau's, Lust and Chvostek's symptoms, which indicate high mechanical excitability with positive result. Short twitching in the corner of the mouth, wings of the nose or eyelids when tapping with a finger in the area between the corner of the mouth and the zygomatic arch (fossae caninae) - this is how Chvostek’s symptom manifests itself (positive).

Positive Trousseau's symptom - characterized by convulsive contraction of the hands ("obstetrician's hand") when the shoulder is compressed. Compression in the area of the head of the fibula n. peronaeus reveal Lust's symptom. In this case, involuntary slight flexion of the foot may occur.

When diagnosing spasmophilia in children, the task is to identify increased neuromuscular galvanic excitability. To identify Erb's symptom, area n. Medianus is irritated by direct current: when the cathode is opened, in a healthy child, contractions of the forearm muscles occur at a current strength of about 5 mA; in a child with spasmophilia, this will require only 2-3 mA.

The famous researcher Maslov drew attention to the increased pain sensitivity in children with this disease. In such children, a shot in the leg usually causes a short-term cessation of breathing. A healthy child reacts to this procedure with rapid breathing. This is checked using a pneumogram.

Spasmophilia in children: symptoms and treatment

For tonic convulsions, loss of consciousness, laryngospasm and respiratory arrest, the child needs urgent measures resuscitation. First of all, he needs artificial respiration. Mask inhalation of 100% oxygen helps combat hypoxia. In addition, injections of anticonvulsants are given.

The most effective is a 0.5% solution of Seduxen. It is administered both intravenously and intramuscularly. The required dose of the drug is:

at three months - from 0.3 to 0.5 ml;
from six months to a year - from 0.5 to 1.0 ml;
up to three years - from 1.0 to 1.5 ml.

After the injection, the effect is noticeable immediately. But its effect lasts only thirty minutes: during this time doctors spend necessary research to determine the cause of the seizures.

A solution of gamma-hydroxybutyric acid (20%) has the same effect. It is administered intramuscularly, rectally, intravenously. The dose is increased when reintroduction. The drug, administered intramuscularly, begins to act within five minutes, and its effect lasts from thirty minutes to two hours. If your child's seizures persist long time, then he can receive from four to six injections per day.

Other remedies for spasmophilia

Sometimes enemas are used from a two percent solution of chloral hydrate, preheated to a temperature of 40 ° C, and a solution (25%) of magnesium sulfate intramuscularly. While anticonvulsants are in effect, doctors urgently determine the level of calcium in the blood and administer a ten percent solution of gluconate or calcium chloride intravenously. Dosage is:

for children up to six months - 0.05 ml;
from six to twelve months - 0.5-1.0 ml;
from twelve to thirty-six months - 2 ml.

Then a solution of calcium chloride (10%) is given to the child orally three times a day, one teaspoon (teaspoon) after meals. The drug should be taken with milk. The course of treatment lasts from a week to ten days. In addition, a spinal tap is performed in some cases for diagnosis and treatment.

Urgent help during an attack

Parents of a child diagnosed with spasmophilia need to be prepared to provide emergency assistance when the first symptoms indicating laryngospasm appear. To do this you need:

place the child on a hard flat horizontal surface (couch, table, floor);
free the chest from clothing;
provide a flow of fresh air;
wet the child's face with cold water;
urgently administer anticonvulsants.

When an attack begins, parents need to call ambulance. To stop it, doctors will inject calcium gluconate into a vein. This is carried out under constant monitoring of heart rate. In cases where first aid does not give the desired result, tracheal intubation is performed to ensure normal breathing. The most severe complication, which can cause spasmophilia - cardiac arrest. In this case, it is necessary to urgently perform a cardiac massage.

Possible complications

Without highly qualified and timely treatment, the child will experience:

respiratory dysfunction;
convulsions.

This condition over a long period of time leads to disruption of activity nervous system. In addition, mental retardation and even death may occur.

Forecast

With proper treatment, the disease usually ends favorably. When the child reaches two or three years of age, the pathology disappears, as the proportions of phosphorus and calcium in the blood stabilize.

In especially severe cases, it is necessary not only correct treatment spasmophilia in children, but also compliance with long preventive period. Fatal outcome fortunately, it is observed quite rarely - due to suffocation during prolonged laryngospasm, respiratory or cardiac arrest.

At long period eclampsia, deviations in mental development child. To prevent such serious problems, it is very important to provide for the baby essential microelements, monitor his condition, behavior, reactions and the slightest sign diseases, seek help from a pediatric neurologist and pediatrician. And once again I would like to remind young mothers of the importance of breastfeeding, which in the vast majority of cases prevents the development of the disease.

Spasmophilia in adults

The disease is much less common in adults than in children. Until now, the exact reason for the progression of this condition in adult patients is unknown. More often women suffer from this disease. Risk factors include:

presence of infectious diseases;
nervous tension;
pregnancy and lactation;
the presence of malignant and benign neoplasms;
extraction of the parathyroid glands.

Prevention

All doctors are well aware of the truth: it is much easier to prevent a disease than to treat it. You can significantly reduce the risk of developing spasmophilia by following the following recommendations:

babies who are bottle-fed should regularly include donor milk in their diet;
it is necessary to maintain the exact dosage of vitamin D;
baby needs good nutrition, the baby’s diet should include: meat, cottage cheese, carrots, milk, cabbage, etc.

Primary prevention involves prevention, timely diagnosis and treatment of rickets. Diagnosis and treatment of a latent form of the disease is secondary prevention. In addition, a long-term (six to twelve months) anticonvulsant therapy barbiturates. Parents need to monitor their child's blood counts.

Khlebovets N.I. - Associate Professor, Candidate of Sciences honey. sciences

Spasmophilia (Greek spasmos - spasm, convulsion and philia - predisposition, tendency; synonym: infantile tetany, rachitic tetany) is a disease of predominantly young children, characterized by a tendency to tonic and tonic-clonic convulsions, other manifestations of increased neuromuscular excitability due to a decrease in the level of ionized calcium in the extracellular fluid, usually against the background of alkalosis.

Pathogenesis

The connection between spasmophilia and rickets was noticed long ago, but was proven only in the 70s, when it was discovered low level 25-hydrocholecalciferol (25-OH-D 3) in the blood of all examined children with spasmophilia. In the spring, against the background of the formation of small amounts of vitamin D under the influence of sunlight, the deposition of calcium in the bones increases, while its absorption in the intestines is low. Alkalosis caused by spontaneous or iatrogenic hyperventilation, prolonged vomiting, or overdose of alkalis when correcting acidosis can be a provoking factor in the development of an attack of spasmophilia.

Clinical picture

It is necessary to distinguish between hidden (latent) and overt spasmophilia, which differ in the degree of severity of the same pathological process. The disease is most often observed in the spring in children aged 6 to 18 months.

With the latent form, children are practically healthy in appearance, often well-fed, psychomotor development is within normal limits; they almost always have symptoms of rickets, most often during the recovery period.

Most frequent symptoms are the facial phenomenon of Khvostek (when tapping in front of the ear in the area of distribution of the branches of the facial nerve, lightning-fast contractions of the facial muscles appear in the mouth, nose, lower, and sometimes upper eyelid); Erb's symptom (increased galvanic excitability of nerves - muscle contraction when the cathode of the cattle is opened at a current strength below 5 Ma); Trousseau phenomenon (when the shoulder is compressed with an elastic tourniquet, a convulsive contraction of the fingers occurs in the form of an obstetrician’s hand); Maslov's symptom (with a slight prick of the skin in a child with spasmophilia, breathing stops at the height of inspiration; in a healthy child, such irritation causes increased and deepening of respiratory movements; this phenomenon is clearly revealed on the pneumogram); Peroneus phenomenon (rapid abduction of the foot upon impact below the head of the fibula in the area of the n. fibularis superficialis - Lust phenomenon).

With obvious spasmophilia in a child, most often when crying or frightened, laryngospasm occurs - a spasm of the glottis, manifested by a sonorous or hoarse breath when crying and screaming and breathing stops for a few seconds: at this moment the child first turns pale, then he develops cyanosis, loss of consciousness, sometimes clonic convulsions occur. The attack ends with a deep, sonorous breath, after which the child almost always cries, but after a few minutes the child almost returns to normal and often falls asleep. In the most severe cases, death may occur as a result sudden stop heart (tetany of the heart), and swelling of the dorsum of the hands often appears. Less commonly, breathing stops not on inhalation, but on exhalation (bronchus).

Carpopedal spasm is a spasm of the distal muscles of the hand and foot, taking a characteristic position: the hand is in the “obstetrician’s hand” position, the foot is in the pes equinus position, the fingers, especially the big ones, are in plantar flexion. This condition of the hands and feet can be short-lived, but can persist for a long time - for several hours or even days; with spasm m. orbicularis oris the lips take the position of a “fish mouth”.

In the most severe cases, attacks of eclampsia are observed - clonic convulsions that occur with loss of consciousness. They occur after short-term tonic convulsions. Eclamptic convulsions may drag on or be interrupted for a short time, completely stopping. Sometimes clonic convulsions are associated with an attack of laryngospasm.

Children prone to spasmophilia usually experience increased nervous excitability (hyperreflexia, paresthesia, etc.).

Diagnosis and differential diagnosis

Diagnosis, as a rule, does not present significant difficulties. Presence in a child aged 6–18 months. clinical, biochemical and radiographic evidence of rickets and symptoms of increased neuromuscular excitability makes it mild. A typical attack of laryngospasm almost always allows us to consider it indisputable. ECG data indicate hypocalcemia (increased QT complex more than 0.2 s).

All patients have a decrease in the concentration of ionized calcium in the blood serum (below 0.9 mmol/l with a norm of 1.1–1.4 mmol/l) in combination with alkalosis (respiratory, less often metabolic). A reduced concentration of total calcium in the blood serum (less than 1.75 mmol/l when the norm is 2.5–2.7 mmol/l) is less common than a low level of ionized calcium.

Spasmophilia is differentiated from diseases that can cause tetany, an attack of convulsions.

Hypoparathyroidism, which practically does not occur in infants, is characterized by severe hypocalcemia and hyperphosphatemia.

In renal osteodystrophy, a decrease in serum calcium occurs against the background of acidosis, hyperphosphatemia, azotemia and other manifestations of chronic renal failure.

Transfusion in hospital large quantity blood stabilized by citrate can lead to the binding of calcium in the blood, which, against the background of hyperkalemia, explains the attack of seizures.

The eclamptic form must be distinguished from epilepsy, attacks of which can occur in children of any age. History data, clinical picture and age of the child and EEG facilitate diagnosis.

Prevention

Basically the same as with rickets. It is necessary to strive to preserve breastfeeding as much as possible. In spring, when symptoms appear latent spasmophilia calcium supplements must be prescribed.

Treatment

With laryngospasm (“birthmark”), a dominant focus of excitation is created in the brain by irritating the nasal mucosa (blowing into the nose, tickling, bringing ammonia), skin (injection, patting and pouring cold water on the face), vestibular analyzer (“shaking” the child) , changes in body position.

For convulsions, seduxen (diazepam) 0.1 ml 0.5% solution/kg body weight or magnesium sulfate 0.2 ml/kg 25% solution, GHB (sodium hydroxybutyrate) 0.5 ml/ kg (80–100 mg/kg) 20% solution and, at the same time, slowly intravenously calcium chloride 0.2 ml/kg 10% solution or calcium gluconate 0.2 ml/kg 10% solution. Calcium preparations are pre-diluted 2 times with a 10% glucose solution and administered intravenously slowly, because Rapid administration of calcium supplements can cause bradycardia and even cardiac arrest.

The child is hospitalized in the hospital after the seizures disappear.

It is advisable to transfer a bottle-fed baby to feeding with expressed milk from a donor or mother. If this is not possible, it is necessary to limit the content of cow's milk in the diet as much as possible (due to the large amount of phosphates) and increase the amount of vegetable complementary foods.

In the post-attack period, calcium supplements are prescribed orally. 5–10% solution of calcium chloride or calcium gluconate at the rate of 0.1–0.15 g/kg (1 ml/kg) per day; Calcium carbonate is better absorbed in combination with a citrate mixture (lemon acid 2.1 g, sodium citrate 3.5 g, distilled water up to 100 ml) 5 ml 3 times a day. You can prescribe calcium - D3 Nycomed (calcium carbonate 1250 mg - equivalent to 500 mg), vitamin D3200ME) 1 tablet per day.

3-4 days after the attack, patients with obvious spasmophilia should be prescribed vitamin D2 4000-8000 IU 2 times a day. The method of choice may be oral administration of 0.1% dihydrotachysterol solution at 0.05–0.1 mg/day (1–2 drops 2 times a day). Although the drug has a positive effect on hypocalcemia, it does not have vitamin D activity.

To create acidosis, a 10% ammonium chloride solution is prescribed (1 teaspoon 3 times a day).

Calcium therapy and restriction of cow's milk must be continued until the symptoms of latent spasmophilia completely disappear. It is necessary to limit as much as possible or perform with extreme caution all procedures that are unpleasant for the child (examination of the pharynx, injections, etc.), which can cause a severe attack of laryngospasm.

Forecast

Favorable. Very rarely severe attack laryngospasm, if not provided urgent Care, ends fatally. A very prolonged eclamptic state can negatively affect the central nervous system - in the future there may be a delay in mental development.

Chronic eating disorders in young children

Volkova M.P. – Associate Professor, Candidate of Sciences honey. sciences

State normal nutrition– normotrophy, eutrophy (A. M. Tour) – characterized by physiological height and weight indicators, clean velvety skin, properly developed skeleton, moderate appetite, normal in frequency and quality physiological functions, pink mucous membranes, absence pathological disorders from the outside internal organs, good resistance to infection, correct neuropsychic development, positive emotional attitude.

Eating disorders are pathological conditions that develop as a result of insufficient or excessive intake and/or absorption of nutrients. Eating disorders are characterized by disturbances physical development, metabolism, immunity, morphofunctional state of internal organs and body systems.

In ICD 10, nutritional deficiency is referred to as protein-energy malnutrition (PEM).

According to ICD-10, the group of eating disorders includes the following categories:

E40–46 – protein-energy deficiency. (hypotrophy: prenatal, postnatal).

E50–64 – other nutritional deficiencies (insufficient vitamins and microelements).

E65–68 – obesity and other types of excess nutrition.