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Rickets in babies develops due to a lack of vitamin D in the body. Primarily changes affect the bone and nervous systems. The disease has been known since the 2nd century BC. Ancient portraits depicted children with smoothed occipital bones, superciliary arches in the form of overhanging rollers, twisted arms and legs, and a flattened stomach.

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

Classification

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

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

The second group includes babies for whom taking standard dosages does not give an effect, and recovery is possible only with the use of a vitamin in an amount several times greater than it.

In the classification of rickets in children, the stages are:

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

The degree of rickets in children according to the severity of the course:

1. Light- the symptoms are mild, there are minor violations of the musculoskeletal system and nervous system.
2. Medium- pronounced disorders of the skeleton and innervation of the limbs, there are deviations in the functioning of the cardiovascular and respiratory systems, malfunctions in the gastrointestinal tract.
3. heavy- a high degree of pathological changes in all systems and organs that ensure normal life.

By the nature of the course, rickets happens:

• sharp;
• subacute;
• recurrent.

The reasons

Rickets in newborns and children under 1 year in It occurs due to insufficient synthesis of calciferol in the body. Vitamin D can be absorbed from food and mother's milk, and can also be formed in skin cells when exposed to sunlight or ultraviolet rays. If the intake of the substance is disturbed, a disease develops. Vitamin deficiency disrupts calcium-phosphorus metabolism, which negatively affects the state of the skeletal system.

The causes of rickets include the following:

• low the nutritional value foods that contain a small amount of calciferol;
• lack of ultraviolet rays (living in the north, rare walks);
• pathological processes in the intestine, due to which there is a violation of the absorption of vitamins;
• endogenous causes, including liver and kidney diseases that disrupt the absorption of calciferol;
• feeding a newborn with unadapted mixtures, where the correct ratio of useful elements is not observed;
• chronic use of anticonvulsants.

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

Symptoms

Rickets is usually found in young children up to a year, so after a year. The first changes are found at the age of 1-2 months after birth.

First of all, changes affect the nervous system:

• sleep is disturbed, the mode of wakefulness and night rest changes;
• there is irritability, tearfulness;
• the baby does not eat well, refuses or does not eat the prescribed norm, and the feeding process stretches for a long time;
• stool disorders occur, diarrhea appears for no apparent reason or;
• there is increased sweating;
• baldness develops on the back of the head.

The last two symptoms are closely related. During nighttime sleep, the child sweats excessively, which causes a wet spot on the pillow (wet spot syndrome). The baby often turns his head, as sweat leads to discomfort and skin itching, because of which the hair on the back of the head is wiped.

After a couple of weeks, other symptoms join the listed symptoms. A striking sign of rickets in babies is a reduced muscle tone, as well as a "frog" belly - it is as if pressed down by something heavy, which is why it took such a shape. The symptoms of the disease include delayed teething, delayed overgrowth of fontanelles, deformity of the legs and arms, and a change in the shape of the head.

Diagnostics

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

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

The following indicators are considered the norm of these substances:

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

Another reliable way to determine the presence of rickets in a child at 1-3 years old is an x-ray. It shows skeletal deformities and the level of bone mineralization. More accurately, developing disorders can be examined using computed tomography.

Why is rickets dangerous?

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

Disorders of the skeletal system manifest themselves at an older age:

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

Treatment

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

Nonspecific therapy is as follows:

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

The most common rickets of the legs in children. Such a violation does not allow the child to fully move, and in advanced conditions does not even allow him to walk. Therefore, it is so important to undergo appropriate treatment at an early stage. It is possible to correct the curvature of the legs with rickets in a child up to 4 years of age, after which attempts may not bring the desired result.

Complications

In the absence of therapeutic correction of the content of calciferol in the body, further aggravation of the disease occurs. At the same time, violations affect the internal organs and cause malfunctions in their functioning.

The following symptoms occur:

• pain in the abdominal cavity;
• increased vomiting and regurgitation after eating;
• pallor of the skin;
• hepatomegaly;
• stool disorders.

Rickets is common cause The fact that the baby cannot hold his head on his own, much later than his peers, he begins to sit and move around. If rickets appears in a child at 1 or 2 years old, then there is a risk that such a baby may not learn to walk. That is why you should deal with the timely treatment of vitamin deficiency, because the severe consequences of the disease will remain for life. Rickets in a child, appearing after 4 years, leads to flat feet and scoliosis, and sometimes even causes myopia.

Effects

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

The child is threatened:

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

Prevention

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

Intrauterine prophylaxis:

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

After the baby is born,:

• organize proper feeding;
• give vitamin D drops;
• observe the daily routine;
• organize daily sleep or walks on the street;
• massage and exercise.

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

Useful video about what is rickets

It's spring in the yard .. calendar, but still the sun began to appear more and more often. It would seem that there is no time for such a disease as rickets! However, the lack of vitamin D accumulated during the autumn and winter months can make itself felt right now! How to prevent rickets, what are the symptoms and signs of rickets in children, how to treat rickets, what are the consequences of rickets - you will learn all this from this article.

Rickets in children

Starting from the maternity hospital, doctors tell every mother that for the prevention of rickets it is necessary to eat foods rich in vitamin D, and give the baby vitamin D in the form of drops. However, not all parents take these recommendations responsibly and seriously, skipping medication from time to time. But this can cause serious changes in the body!

Rickets(from the Greek rháchis - backbone, spine), hypo- and beriberi D, impaired mineralization of the growing bone, a disease of infants and young children (usually from 2 months to 1 year), caused by vitamin D deficiency in the body and proceeding with metabolic disorders substances (mainly mineral) and leading to impaired skeletal formation in early childhood.

Causes of rickets

Usually, rickets develops when a child does not take enough vitamin D with food, insufficient ultraviolet radiation (anactinosis) or when the natural formation of this vitamin in the body is disturbed due to lack of sun, malabsorption syndrome (malabsorption syndrome).

Vitamin D deficiency leads to a decrease in the amount of phosphorus and calcium, the activity of alkaline phosphatase (an enzyme involved in the exchange of phosphoric acid) increases, the amount of citrates (salts and esters of citric acid) in tissues, blood plasma and urine decreases, the amount of amino acids in the urine is growing. Hypocalcemia - a decrease in the content of ionized calcium in the blood serum - leads to an increase in the function of the parathyroid glands (four small endocrine glands located near the thyroid gland). As a result of these changes, calcium exchange between blood and bone tissue is disrupted.

In addition, rickets can be a consequence of:
- therapy with anticonvulsants - anticonvulsant drugs (increased metabolism of vitamin D due to induction of liver enzyme systems);
- lack of production of 1,25-dihydroxycholecalciferol (with vitamin D-dependent form of the disease, with renal failure)
Deficiency of minerals such as calcium, phosphorus, magnesium and copper, together with insufficient amounts of vitamin D in recent times particular importance is attached, although an isolated deficiency of each of them separately can also lead to the development of mineral-deficient forms of rickets; sufficiency);
– increased loss of phosphorus;
– absence of alkaline phosphatase in hypophosphatasia – hereditary disease skeletal system due to insufficient activity of alkaline phosphatase (occurs rarely).

Children at risk for rickets are:

• premature;
• with signs of morphofunctional immaturity;
• with malabsorption syndrome (celiac disease, exudative enteropathy, etc.);
• receiving anticonvulsants;
• with reduced motor activity (paresis and paralysis);
• with chronic pathology of the liver, biliary tract;
• frequently ill with SARS, bronchitis, etc.;
• receiving non-adapted milk mixtures;
• monthly gaining weight more than the norm (for example, 1 kg per month).
• twins or children born from repeated births with small gaps between them.

Most often, rickets occurs in the winter season in children who are bottle-fed, premature, often ill. Premature infants are particularly prone to rickets due to increased relative growth rates with greater mineral requirements.

Rickets classification

There are vitamin-deficient rickets and vitamin-resistant (usual doses of vitamin D in these cases are ineffective, therapeutic effect can only be achieved at dosages many times higher than usual).

Rickets is usually divided into:

1. Periods:

• elementary;
• outbreak of illness,
• recon-valescence,
• residual effects.

2. Disease severity

• I - mild (mild symptoms, mainly from the nervous and skeletal systems);
• II - moderate (disorders of the nervous and skeletal systems, pathological changes in the muscular and hematopoietic systems, secondary changes in the respiratory system, cardiovascular system, as well as gastrointestinal tract);
• III - severe (pronounced changes in all of the previously listed organs and systems).

3. The nature of the flow:

• acute current,
• subacute,
• recurrent.

Signs of rickets in children

In the winter season, it is necessary to give the baby vitamin D, vitamin D is prescribed for premature babies from 2 weeks of age.

Remember, it is easier to prevent a disease than to guard against its consequences later. In the case of rickets, such consequences include scoliosis, deformity of the chest, pelvis, curvature of the legs, an increased tendency to caries of the teeth - they can remain for life.

Treatment of rickets

The two most important forms of vitamin D are vitamin D3 (cholecalciferol) and vitamin D2 (ergocalciferol). Unlike vitamin D3, the human body does not produce vitamin D2, which it obtains from fortified foods or supplements. An aqueous solution of vitamin D3, unlike oily D2, is absorbed several times faster and the clinical effect occurs within 5-7 days after the start of administration (10-14 days when taking D2). Also, an aqueous solution of D3 has a longer effect - it remains in the body for up to 3 months (up to 4-6 weeks for D2).

Children at risk require special doses of vitamin D (they are determined by the doctor, but usually not less than 1000 IU) for two years, excluding the summer period.

The prophylactic course dose of vitamin D is 200,000-400,000 IU, the therapeutic dose is from 600,000 to 1,000,000 IU. The drug is dosed depending on the number of units contained in one drop of an alcohol or oil solution of vitamin D2. Usually 400 IU of vitamin D is prescribed per day.

There are many vitamin D regimens available.

The most commonly used therapeutic regimen, in which 2000-5000 IU of ergocalciferol is given to the child daily for 4-8 weeks. Immediately after the end of the therapeutic course, ergocalciferol is prescribed in a prophylactic dose - 400 IU / day for two years, and in the third year of life - only in winter.

The so-called stoss therapy, or "jogging" therapy, consists in prescribing 400,000-600,000 IU for oral administration in one or more doses (up to 6) within 24 hours. In the absence of a noticeable clinical effect, the treatment is repeated after 10-30 days. If after another 3-4 weeks there is no complete cure (based on biochemical blood tests), then the disease is not vitamin D-deficient rickets.

When conducting both standard and stoss therapy, hypocalcemia may develop. It can be prevented by prescribing lactate or calcium gluconate at an age dosage during the first 2 weeks of treatment. If hypocalcemia is detected prior to treatment, the patient should be hospitalized.

In the treatment of rickets, nutrition should be aimed at normalizing disturbed metabolic processes. It is important to ensure sufficient intake of proteins and fats, as well as a complete amino acid composition of proteins. With rickets, there are often violations of vitamin metabolism (in addition to vitamin D), especially pronounced in relation to B vitamins and ascorbic acid.

The first of the described methods is more physiological, and therefore preferable.

Dose of vitamin D (D2- ergocalciferol and D3 - cholecalciferol):
Prevention

• Premature babies - 10-20 mcg / day (400-800 IU / day);
• Infants - 10 mcg / day (400 IU / day)
• Adolescents - 2.5 mcg/day (100 IU/day)

Treatment

• Daily intake - 100 mcg / day (4000 IU / day) for 4 weeks, then daily - prophylactic dose
• The course of "one dose" (stoss therapy) - 10 mg (400,000 IU) orally once. If there is no clinical effect, repeat after 1 month

Physiological needs correspond to a long-term intake of 400-1000 IU of vitamin D daily from the end of the neonatal period (premature babies are prescribed from two weeks of age).

The most common vitamin D3 preparations are Aquadetrim and Vigantol.

There is also: Videhol; Vitamin D3; Vitamin D3 BON; Vitamin D3; Colecalciferol; Osteokea; Cholecalciferocaps; Cholecalciferol. Which of the drugs to choose, your pediatrician will tell you.

Important!! It is necessary to strictly follow all recommendations for taking vitamin D! Under no circumstances should you give this drug without consulting your doctor. In the treatment of rickets, vitamin D is prescribed strictly individually in combination with other drugs. The duration of therapy and the magnitude of the therapeutic dose are determined only by the doctor!

Uncontrolled intake of vitamin D leads to the risk of developing vitamin D intoxication (nephrocalcinosis).
But fortunately, one drop of a modern solution contains about 500 IU, that is, a prophylactic dose. And the course of treatment is a maximum of 10 drops per day. With this treatment, accidental overdose is not possible. However, there are cases of overdose.

Vitamin D overdose

When an excessive amount of vitamin D enters the child's body, calcium salts accumulate in the blood, and poisoning of the body occurs. suffer the cardiovascular system, liver, kidneys and gastrointestinal tract. This usually occurs if the dose is exceeded by 200-1000 times. However, there are babies who are hypersensitive to vitamin D. Therefore, before starting treatment, it is necessary to determine individual sensitivity to this vitamin.

Symptoms of intoxication: sudden loss of appetite, sleep, persistent vomiting, dyspepsia, thirst, polyuria, dry tongue, inelastic skin. Constipation alternates with diarrhea, the child loses weight dramatically, he has subfebrile temperature (an increase in body temperature for a long time in the range of 37.5–38 ° C), convulsions, difficulty breathing, enlargement of the liver and spleen, slowing of the pulse are possible.

To alleviate the condition of intoxication, you just need to stop taking vitamin D.

In this article, we examined the most important points regarding such a disease as rickets.
If, along with recommendations for taking vitamin D in medical institutions, they also gave a memo with all the information described in this article, according to MameNaZametku, the percentage of children with rickets would decrease significantly.
Let this disease bypass your family! Health to you and your children!

Rickets is a disease characterized by a violation of phosphorus-calcium metabolism. Usually this diagnosis is determined in children at an early age against the background of an insufficient amount of vitamin D in the body - calciferol. Chronic deficiency of this microelement leads to disruption of the supply of phosphorus and calcium to bone and cartilage tissue. As a result of this, irreversible changes occur in the formation and mineralization of bones, which causes rickets in children.

Most people consider this diagnosis a relic of years, so rickets is often called not a medical, but a social problem, since it is associated with a violation of the conditions for caring for a child. Undoubtedly, modern level life of the population and the improvement of the general socio-economic situation in the country should contribute to making this disease a thing of the past.

But despite this, rickets still poses a threat to the health of children in the first years of life.

Rickets is a disease that affects musculoskeletal system. Most clearly, the signs of pathology are manifested in infants and young children - a few months after birth and up to 5 years. Rarely, a similar situation develops in an adult, but in this case we are talking about osteomalacia - a pathological softening of the bones.

Changes in bone tissue against the background of rickets are caused by a chronic lack of phosphorus and calcium.

Usually, these trace elements are found in sufficient quantities in food, but in order for them to be fully absorbed by the body, vitamin D or calciferol is needed - a substance that helps phosphorus and calcium penetrate into bone and muscle tissue, into nerve fibers, pre-preparing them.

Vitamin D enters the body of children from food and special pharmacy supplements. Also, calciferol is independently formed in the skin of a child under the influence of direct ultraviolet rays from products of cholesterol derivatives (which is why any restrictions on baby food are prohibited).

The main causes of rickets are:

• malnutrition;
• insufficient exposure to open sunlight;
• disorders of vitamin D and cholesterol metabolism.

Also, experts identify a whole list of predisposing factors contributing to the development of rickets:

• the weight of the child is more than 4 kg at birth;
• refusal to breastfeed;
• the use of non-adapted mixtures for artificial feeding;
• difficult childbirth;
• restriction of motor activity of the child;
• rare walks;
• disruption of the digestive tract;
• frequent infectious and viral diseases;
• treatment with anticonvulsants;
• rapid growth and weight gain in a child requiring an increased amount of calcium in the body.

Usually, children born prematurely as a result of the disease are affected. They may develop symptoms of rickets as early as the second week after birth. This is due to the general weakness of their body and unwillingness to digestive system it is normal to take and assimilate food against the background of physiological immaturity.

The exception is the congenital form of rickets, the causes of which are the unsatisfactory condition of the placenta and the meager diet of the mother during pregnancy.

In rare cases, doctors are faced with rickets, independent of the presence of vitamin D in the body. With this disease, both calciferol, and phosphorus, and calcium are in the child's body within the normal range, but due to the existing pathologies in the liver and kidneys, as well as when taking certain medications (corticosteroids, barbiturates, etc.), calcium and phosphorus are not can be converted into an accessible form for full assimilation by the body.

Symptoms and Diagnosis

The first signs of rickets in children appear imperceptibly and most parents do not pay due attention to them, attributing everything to the whims and behavior of the child.

So, we list the main symptoms of the disease:

• problems with falling asleep, violation of the biological rhythm of sleep and wakefulness;
• sudden fearfulness of the child, unexplained anxious behavior;
• sluggish inhibited state, lack of interest in the surrounding reality;
• severe irritability, constant whims for no apparent reason;
• excessive sweating, especially during feeding, while the sweat has an unpleasant sour smell;
• irritation and itching of the skin;
• lack of hair in the occipital region due to the fact that the child rubs against the pillow during sleep;
• constant ammonia smell from the genitals, diaper rash and irritation on the genitals due to contact with urine;
• convulsive syndrome, especially during sleep;
• persistent digestive problems - diarrhea or constipation.

These signs of rickets usually develop a few months after the birth of a child. The onset of the disease usually occurs in the cold season - late autumn or winter-spring period.

The first symptoms of rickets affect the behavior of the child to a greater extent: he becomes extremely capricious and demanding, nervousness is associated with excessive sweating, itching and irritation of the skin, characteristic baldness of the occipital part of the head.

If you leave these symptoms without due attention, then by six months the child will already have a complete picture of the disease.

Following the first symptoms of the disease, a delay in physical development appears: the baby begins to raise and hold his head later, sit down and walk, he later has milk teeth, and the fontanel remains open longer than the due date.

Both the pediatrician and parents should definitely pay attention to all this and conduct a biochemical blood test in a timely manner: changes in the analysis will indicate a low concentration of phosphorus and an increased activity of phosphatase.

Signs of rickets that appear in a later period are already an independent irreversible pathology. The danger lies in serious developmental disorders, which later becomes the cause of disability.

Children's rickets affects cartilage and bone tissue, immune system and internal organs. Children suffering from rickets from the first months of life are more likely to develop infectious and viral diseases.

The following symptoms indicate the complications of rickets:

• pathological enlargement of the spleen and liver;
• chronic anemia;
• abnormal joint mobility;
• hypotension of muscles, for example, the abdomen - it becomes flat and shapeless when the child lies on his back;
• unnatural curvature of the legs with the letters O or X (appears from the moment the child begins to walk);
• retraction or protrusion of the chest;
• rachiocampsis;
• rachitic growths on the ribs, visible to the naked eye;
• softening of the bones of the skull;
• bone growths along the superciliary arches, parietal and frontal protrusions;
• a noticeable increase in head volume;
• thickening of the ankles and wrists - rachitic "bracelets".

If treatment is delayed, the consequences can be catastrophic. In the future, a hump forms in the child against the background of a curvature of the spine, specific bone thickenings appear on it. Anatomically underdeveloped pelvis and pathological formation of cartilage and bone tissue lead to the development of hip dysplasia.

Also, the list of complications can be supplemented with flat feet, asymmetry of the skull and disability of the child. Residual symptoms of rickets remain with a person throughout his subsequent life. We are talking about a stable deformation of the skeleton.

The diagnosis is made on the basis of examination and laboratory and instrumental research methods. If rickets is suspected, the pediatrician sends a small patient for consultations to a pediatric surgeon and orthopedist, who know how to identify rickets at an early stage.

Specialists may prescribe the following additional studies:

• biochemical analyzes of urine and blood to determine the amount of phosphorus, calcium and calciferol;
• computed tomography and X-ray examination, which allows to examine the lesions of cartilage and bone tissue in the body.

Based on the diagnostic examination, the doctor selects the appropriate treatment or prescribes preventive measures.

Treatment

The primary task in the treatment of rickets is the biochemical normalization of the amount of missing trace elements in the body. In this case, specific medications with vitamin D.

They are available in the form of tablets and drops and are used depending on the age of the child. With a therapeutic and prophylactic purpose, the following drugs are prescribed: Aquadetrim, Vigantol, Devisol and many others. Medicine and the dosage of the drug should be selected by the doctor according to an individual scheme.

Improving the child's condition against the background of conservative treatment occurs quickly, this can be seen from radiographic and biochemical changes. After the start of taking the drug with calciferol, within one week, the concentration of phosphorus increases significantly, the activity of alkaline phosphatase decreases, and the level of calcium in the blood temporarily decreases.

Positive changes also appear on the radiograph: the ossification nuclei become more visible, the bone tissues become stronger, and new epiphyseal lines are found.

The second point in the treatment of rickets is physiotherapy.

With its help, it is possible to accelerate the development of the child and the assimilation of trace elements by his body. Children suffering from rickets should move more, develop muscles and joints. Physiotherapy can be carried out as soon as the child is 6 months old.

Usually, the complex of treatment includes massage, balneotherapy, electrophoresis using phosphorus and calcium ions, ultraviolet baths and physiotherapy.

Rickets is a disease in which there is a violation of the musculoskeletal system against the background of a lack of vitamin D. Rickets, the symptoms of which are also caused by a violation of the metabolism of phosphorus and calcium, is accompanied, in addition, by a violation of bone growth. Despite the fact that this disease is not fatal, it, meanwhile, provokes the development of irreversible deformation that the skeleton of a sick child undergoes (namely, rickets is a "childhood" disease), and also contributes to a significant inhibition of a number of processes associated with its development. .

general description

Developmental disorders in rickets in particular relate to the physical condition of the growing body of the child and the mental state. Moreover, against the background of rickets, the risk of subsequent development is also increased. various diseases(infectious, etc.).

In general, when considering rickets, it can be distinguished that this disease in children in the first year of life manifests itself quite often. It is not possible to determine the exact figures for the prevalence of rickets, and, nevertheless, in many young patients one or another type of residual effects are detected that are directly related to its transfer. Such phenomena include various anomalies in the growth of teeth and occlusion, deformities lower extremities, chest, skull, etc. Considering that rickets creates certain conditions for the subsequent predisposition of children to infectious and other diseases, children suffering from rickets often get sick.

Rickets usually refers to one disease, but this is not entirely true. The fact is that in reality rickets is a group of diseases and disorders directly related to metabolic processes, due to the characteristics of which one was determined for them. common feature. As such a sign, a decrease in the level of calcium in the bone tissue is considered (this determines such a pathology as osteopenia). This can be provoked not only by vitamin D deficiency, but also by certain internal or external factors. Given this, the first signs of rickets do not necessarily require treatment using the specified vitamin - to begin with, this issue determines the need to highlight the specific causes that caused these signs. Moreover, in certain situations, vitamin D is generally contraindicated for use, which should also be considered when warning signs and symptoms appear.

The disease we are considering is also commonly defined as an active growth disease, which is explained by the specifics of its manifestation. Rickets develops, as we have already identified, only in young children and only at the stage in which their skeleton actively grows, during which a temporary imbalance is formed between the incoming vitamin D and calcium and between their consumption by the body itself.

In the CIS countries, signs indicating a lack of vitamin D are detected in more than half of the cases among full-term babies and in 80% of cases in premature babies. The causes of rickets (and, in fact, a lack of vitamin D, which is also defined as hypovitaminosis D) are the insufficiency of the formation of vitamin D in the skin due to the effect that contributes to this. sun rays. It is the sun's rays, as the reader probably knows, that are the main source of obtaining this vitamin.

The solar spectrum determines the relevance of the vitamin-forming effect only due to exposure to ultraviolet radiation. Vitamin D, formed in this way, begins to accumulate in the form of "reserves" in the skin and adipose tissue, as well as in the liver muscles. Due to these reserves, it is subsequently possible to prevent the development of toxic effects on its own side, in addition, the supply of vitamin D makes it available to the body in the cold season, when less time is spent under the sun and, in general, the skin is hidden from exposure. its rays.

The need for vitamin D is dictated by age in each case. The largest amount of this vitamin is required, as is already clear, for children, in particular during the first months and years of their life - this will ensure an adequate process of formation of their bone tissue. Within the specified age period, the need for this vitamin is 55 mg per 1 kilogram of weight. Gradually, as the child's skeleton develops in the future, the need for the vitamin in question decreases. As for the question of the need for vitamin D in adults, here it is 8 mg per 1 kilogram of weight, which, apparently, is several times less than the amount that is mandatory for children.

Rickets: causes

Based on the above features, as well as other additional factors that determine the development of such a disease as rickets in a child, the following number of reasons leading to the development of this disease can be distinguished:

• Prematurity. This factor is particularly relevant when considering rickets due to the fact that it is during the last months of pregnancy that phosphorus and calcium enter the fetus with the greatest intensity.
• Improper feeding. For this reason, rickets can also develop, this happens as a result of insufficient intake of phosphorus and calcium with food. In addition, a certain irrationality of feeding is also taken into account here, if it is due to the fact that it occurs at the expense of someone else's milk, this, in turn, becomes the cause of inefficient absorption of calcium. Similarly, children whose diet includes monotonous protein foods or lipid foods also fall into the risk group. This also applies to artificial feeding of the child. And finally, this also includes insufficient intake of vitamin A, B and trace elements.
• Violation of the transport of calcium and phosphorus in the kidneys, gastrointestinal tract and bones. This is due to the immaturity of the enzyme systems or the existing pathology that is relevant for the listed organs.
• Increased need for minerals. This factor is fully consistent with the specifics of the disease, given the fact that rickets is a disease that develops in the process of intensive growth of the body.
• Features of ecology. Under adverse conditions environment with an actual excess of chromium, iron, strontium, lead salts in it, or with a deficiency of magnesium, the appropriate basis for the development of rickets in a child is also determined.
• specific features of the body. It is known that boys are more predisposed to the development of rickets, in addition, they also endure it much harder. It has also been noted that dark-skinned boys with II blood group suffer the disease more severely than children with I blood group (in the latter case, the disease is diagnosed less often).
• Endogenous or exogenous vitamin D deficiency.
• Actual disturbances in the work of the endocrine system (lesion of the thyroid, parathyroid gland).
• hereditary predisposition.

Rickets: classification

Classic variant of rickets (or classic rickets) with vitamin D deficiency, it can be isolated into a specific form, which is determined for it depending on the specifics clinical manifestations, features of the course, severity of the disease and its specific periods.

• Rickets in terms of clinical variants, based on the characteristics of changes in the concentration of phosphorus and calcium in the blood serum, can be diagnosed in the following types of forms:
• calcium penic rickets;
• phosphopenic rickets;
• rickets, manifested without particularly pronounced changes in the level of actual indicators of phosphorus and calcium.
• Rickets, caused by specific features of its own course:
• Acute course of rickets. It is accompanied by a predominance of neurological symptoms and osteomalacia. Osteomalacia is a systemic disease in which the bone tissue is not sufficiently mineralized, which is also associated with a violation of the metabolism of vitamin D or its lack, with a deficiency of microelements or macroelements, provoked by an increased degree of their filtration by the kidneys or a violation in the absorption processes (which is already relevant for intestines). As the main phenomena accompanying osteomalacia, one can single out bone pain, muscle hypotonia (low muscle tone, combined with a violation of muscle strength) and malnutrition (lack of body weight, accompanied by a decrease in the thickness subcutaneous tissue), as well as deformation of the bones of the skeleton and the appearance of pathological fractures.
• Subacute course of rickets. This form of rickets is accompanied by a predominance of phenomena characteristic of osteoid hyperplasia. Osteoid hyperplasia is a condition in which rickets overgrow osteoid tissue. In particular, this includes such phenomena as the appearance of parietal and frontal tubercles, a thickening formed in the wrist area (which is defined as rickety bracelets), as well as a thickening in the areas of transition of the bone part to the cartilaginous part from the ribs (defined as rickety beads) and thickening of the area interphalangeal joints on the fingers (accompanied by the formation of the so-called strings of pearls).
• Undulating or relapsing course of rickets. The diagnosis of acute rickets relevant for the child in this case is combined with signs of various scales (laboratory, clinical, radiological), on the basis of which a picture is visible that accompanies the transfer of an active form of rickets in the past.
• Rickets, due to the peculiarities of the severity of the manifestation:
• I degree of rickets - mild degree- features of the course correspond to the initial period of the disease;
• II degree of rickets - the degree of moderate severity - the course of the disease is characterized by moderate severity of changes affecting the internal organs and the skeletal system;
• III degree of rickets - a severe degree - in this case, several departments in the skeletal system are subject to damage at the same time, severe damage to the nervous system and internal organs also occurs, developmental delay (physical, mental) is noted, caused by compression of the skull due to its incorrect formation, disease complications.
• The cyclicity of the course of the disease, corresponding to this process passing through four successively manifested stages, and these are: the initial period of rickets, the peak period of rickets, the period of reparation (reconvalescence) and the period characterized by residual effects of the disease.

Rickets can also be secondary (respectively, secondary rickets), often it develops against the background of the following factors:

• The relevance of malabsorption syndromes. Malabsorption literally means "bad absorption" in Latin. If we define this deviation more precisely, then it implies the loss of those nutrients(single or multiple), the entry of which occurs in the digestive tract with an insufficient degree of intensity of their absorption in the future through the small intestine.
• Availability chronic diseases biliary tract or kidney disease.
• The presence of diseases directly related to metabolism (cystinuria, tyrosinemia, etc.).
• Long-term use of anticonvulsants (phenobarbital, difenin), glucocorticoids, diuretics; parenteral nutrition.

Vitamin D-dependent can manifest itself in two types: type I and type II. Vitamin D-resistant rickets develops against the background of such diseases as renal tubular acidosis, phosphate diabetes, hypophosphatasia, de Toni-Debré-Fanconi syndrome.

Rickets: symptoms

Depending on the period of the disease, the features of its symptoms are determined, respectively.

• The initial period of rickets

The first symptoms of rickets, as a rule, are noted from the first or third months of a child's life (in premature babies, they may appear even a little earlier). They consist in altered behavior, in which fearfulness, increased anxiety and excitability can be traced, when exposed to external stimuli (flash of light, noise), a child's shudder is noted. Changes also apply to sleep - anxiety and its general superficiality are also noted here.

Sweating increases, especially on the face and scalp. Sweat has a sour odor that irritates the skin, which in turn causes itching. Because of this, you can notice that the child begins to rub his head against the pillow, for the same reason, areas of baldness subsequently appear in the back of the head. The hypertonicity of the muscles that is relevant for this age against the background of the disease is converted into muscle hypotension (which we discussed above). The edges of the large fontanel and the sutures of the skull become pliable, characteristic thickenings are noted from the side of the ribs, in particular, they are concentrated in the area of ​​the costal-cartilaginous joints, as a result of which the so-called "rachitic rosary" already identified by us is formed.

If an x-ray is taken within this period, then some rarefaction from the side of the bone tissue is revealed on it. On the basis of a biochemical blood test, either a normal or even an increased concentration of calcium is detected while reducing the concentration of phosphates.

• The peak period of rickets

This period falls mainly on the period of completion of the first half of the child's age, disorders of the musculoskeletal system and the nervous system here become even more significant in terms of the nature of the manifestation. Due to the processes of osteomalacia (which are especially intense in the manifestation within the acute course of the disease), the flat bones of the skull are subject to softening, then often a unilateral thickening of the occiput develops. The bridge of the nose can also sink in, which can form a saddle nose. In comparison with the body, it seems that the head is too large. The chest becomes pliable, deformed, and an impression of the sternum from the side of its lower third also develops (which determines the name “cobbler’s chest” for such a pathology), in other cases, on the contrary, its bulging (“keeled”, “chicken” chest) may develop. Long tubular bones are bent in an O-shaped (somewhat less often X-shaped) type.

Also, against the background of the development of a number of relevant processes in this case, the formation of a flat-rachitic narrowed pelvis occurs. Due to the fact that the ribs are subject to significant softening, a recess is formed along the line of the diaphragm (the so-called "Harrison's furrow"). The hyperplasia of osteoid tissues prevailing within the subacute course of rickets, in this case, manifests itself in the form of the formation of parietal and frontal tubercles of a hypertrophied type. In addition, there is an even greater thickening of the costal-cartilaginous joints, wrists, areas of interphalangeal joints upper limbs(the previously considered "bracelets", "rosary", "strings of pearls").

• The period of convalescence of rickets

This period is characterized by an improvement in the well-being of the child and his general condition. Static functions are subject to improvement or normalization. Normalization or some excess of indicators on the content of phosphorus in it is found in the blood. Hypocalcemia may persist at a low level, in some cases, it increases.

• Residual effects of rickets

Within this period of the disease, blood test indicators (biochemistry) normalize, the symptoms of the active form of rickets disappear, which indicates, accordingly, the transition of the disease to an inactive stage, that is, to the stage of residual effects. Muscular hypotension and residual forms of deformation, which the skeleton has undergone against the background of rickets, can persist for a long period of time.

We examined the course of the disease in general terms, highlight additional points associated with it.

Rickets symptoms: muscular system

A decrease in muscle tone in children leads to the appearance of a "frog belly", which is accompanied by its increase due to changes in muscle tone (the abdominal muscles, in particular, are in this case in a relaxed state). The suppleness of the joints, highlighted above, can also be defined as "looseness", because of this, the child begins to walk later, it is also possible that he cannot keep his body in an upright position.

Symptoms of rickets: internal organs

Due to the lack of calcium and vitamin D in the body, the functioning of internal organs (digestive tract, spleen, liver) is disrupted. Quite often, children with rickets have symptoms such as anemia, jaundice and constipation. Again, due to compression of the lungs against the background of an altered state of the chest frame, the normal development and growth of internal organs is subject to disruption. With compression of the lungs, colds often develop, deformation of the heart causes the development of heart failure. The fontanelles close later, teething occurs with a delay, an abnormal bite develops. The weakness of the ligamentous apparatus determines the child's ability to perform the most unusual movements with the joints. Children with rickets begin to sit, walk and hold their heads later than their peers.

Sources of Vitamin D

As already clear, the main percentage of vitamin D received by our body occurs through exposure to ultraviolet radiation from sunlight (about 90%). It is slightly common in other natural resources, for this reason, obtaining vitamin D through food occurs only approximately 10% of the volume required by the body. In particular, fish oil (the largest amount of possible consumption), egg yolks, margarine and vegetable oil. In the West, foods rich in vitamin D are especially in demand, but even if such foods are consumed, there is no guarantee that the body will receive the required amount of it.

A separate point concerns constant information, which is especially often heard in recent years, indicating harm from exposure to solar radiation, as well as the risk posed by exposure to the skin ultra-violet rays, in particular, skin cancer in its various variations is considered as the main of these risks. Based on this, within the framework of official medicine, there are corresponding calls for the need to limit the effects of solar radiation on the skin, which is especially true for children. Based on this, it can be considered as the main source of vitamin D. dosage forms, due to the reception of which the prevention of rickets is ensured. You can learn about certain options for this type of drug from the pediatrician treating the child.

Diagnosis and treatment

The diagnosis of rickets is established on the basis of blood tests (biochemical analysis), on the basis of the dynamics and the general ratio of the concentrations of calcium, phosphorus and phosphatase, it is determined which period corresponds to the course of the disease. Also, the diagnosis is based on a visual examination of patients.

Treatment of rickets is determined, again, based on the period of its manifestation, as well as on the basis of the severity of the course. It is based on the use of specific preparations, which include vitamin D. An equally important role is given to the issue of rational nutrition, sufficient exposure to air is recommended, therapeutic exercises, massage, salt, sun, coniferous baths, UVI are shown. In addition, vitamin therapy and the implementation of measures aimed at achieving a general strengthening effect are shown. With hypocalcemia, calcium preparations can be prescribed, a citrate mixture can be shown to improve its absorption by the intestines.

The prognosis for rickets for children is mostly favorable (if they endure the classic form of the disease). If treatment is not performed, then changes that are irreversible in nature develop, such as, for example, deformation of bone structures. Prevention of rickets is based on measures implemented both before the birth of the child and after it.

If symptoms appear that indicate a possible rickets in a child, you should contact your pediatrician.

During the period of active growth, babies are lured by a terrible “beast” - rickets. Every parent should know the signs of rickets in children, as this insidious disease has unpleasant consequences. The earlier the disease is diagnosed, the more successfully it will be treated, in most cases without complications and consequences. Rickets has been known since ancient times, years it was explored and tried to win. Today, doctors know how to diagnose this disease, why it occurs, how to treat it, and most importantly, how to prevent it.

What is rickets?

Rickets is a disease that affects young children. With it, calcium-phosphorus metabolism is disturbed, the functions of internal organs and the nervous system are disorganized, and the processes of bone mineralization and bone formation are destabilized. emergence this disease due to vitamin D deficiency in the body. These vitamins are necessary for the normal absorption of calcium and its proper distribution.

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

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

Rickets in children under one year old differs in the severity of the disease and the nature of the course. There is rickets:

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

By the nature of the flow:

• Spicy;
• Subacute;
• Recurrent.

Also, the disease is divided into periods:

• Elementary;
• The height of the disease;
• Reconvalescence (recovery);
• Residual events.

Symptoms and signs of rickets

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

• children show anxiety, irritability;
• the baby shudders when bright lights are turned on and from loud sounds;
• the child becomes sweaty, especially in the head area, sweat is characterized by an unpleasant odor;
• bald patches appear on the back of the head;
• muscle tone decreases instead of the usual hypertonicity for a given age.

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

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

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

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

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

Causes and consequences of rickets

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

• endogenous;
• prematurity;
• improper feeding.

Endogenous causes should be understood as those that arise as a result of internal diseases. These can be disorders that cause normal absorption of vitamin D from the gastrointestinal tract, diseases of the liver, kidneys, and others. Rickets is most often observed in premature babies, since the "lion's share" of calcium is laid in the skeleton at 9 months of pregnancy. Due to the early birth, the child's body does not have time to accumulate such an important substance for development.

In infants, rickets practically does not occur, provided that the feeding is properly organized. To fulfill this condition, there should be no health problems in a nursing mother. A child who is formula-fed or mixed-fed may develop rickets if his diet is based on unadapted mixtures (for example, cow or goat milk). Also, malnutrition or improperly selected milk mixtures can provoke the disease.

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

• violation in the skeletal system (for example, a square head, sunken chest, legs with a "wheel" and others);
• malocclusion;
• tendency to infections;
• Iron-deficiency anemia.

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

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

Treatment of rickets in children under one year old can be divided into specific and nonspecific. Specific treatment is performed by a doctor and includes the appointment of vitamins of group D, calcium and phosphorus. Doses and the need to take certain vitamins and microelements are determined only by a children's doctor after conducting the necessary tests. At the end of successful treatment, the child is prescribed a prophylactic course of taking vitamin D.

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

Non-specific methods of treating rickets are aimed at strengthening the body of a child up to a year old and include:

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

Today, doctors attach more importance to how to treat children with non-specific methods. Walking, gymnastics and massage play an important role in this.

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

• complete nutrition;
• taking multivitamins;
• walks;
• physical exercises.

Prevention after birth includes the following measures:

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

plays an important role in the prevention of rickets breast-feeding(at least up to 4-6 months), the correct and timely introduction of complementary foods. Massage, gymnastics and walks are also important.

Doctors say: "Prevention is better than cure." Therefore, the prevention of rickets should be taken seriously and carried out even during pregnancy. After the birth of the baby, monitor his health, harden, massage and breastfeed as long as possible. Grow healthy!