Diseases associated with deficiency conditions are quite common in children. Not only infants, but also older children can get sick from them. Today we will talk about rickets in children over one year old.

What is it?

Rickets is a childhood pathology associated with a severe disturbance of calcium-phosphorus metabolism. This pathological condition is caused by various reasons that cause vitamin D deficiency or calciferol in the body. Normally, this biologically active substance participates in the internal metabolism of calcium and phosphorus, which ensures normal concentrations of these substances.

Typically, early unfavorable signs of rickets appear in a child in the first months and within 1 year after birth. However, the disease is also registered in children and at older ages.

According to statistics, children living in northern countries are more susceptible to this disease.

Boys get rickets as often as girls. Severe vitamin D deficiency in children’s bodies leads to disruption of the exchange between calcium and phosphorus. Both of these substances provide bone strength. When calcium-phosphorus metabolism is disturbed, the child develops various unfavorable symptoms associated with a severe deficiency of biologically active substances.

Usually, the first signs of rickets are detected by a pediatrician during regular examinations of the baby. Diagnosis of the disease does not cause significant difficulties for medical specialists.

Various reasons lead to the development of the disease in children, which contribute to a decrease in calciferol levels. In some cases, the impact of causes may be combined. Understanding exactly what causative factors caused the baby’s illness is very important. Only eliminating the cause of the disease will lead to a complete recovery of the child.

The peak incidence of rickets occurs in infancy. Typically, the first manifestation of rickets occurs during the first three months after the birth of the child. In some cases, with a mild course of the disease, clinical signs are not visible, which greatly complicates diagnosis. In such a situation, the diagnosis, as a rule, is established only by the age of 2-3 years.

The most common causes leading to calciferol deficiency in children include:

• Insufficient intake of vitamin D from food. In babies under one year of age, this is caused by rapid cessation of breastfeeding. In older children, the cause of exogenous deficiency of calciferol intake is unbalanced and inadequate nutrition. A lack of animal products and a vegetarian diet can cause rickets in a baby.
• Accommodation in the northern regions. The lack of solar insolation leads to the fact that an insufficient amount of endogenous (internal) vitamin D is synthesized in the child’s body. Exposure of the skin to ultraviolet rays causes a cascade of biological reactions in the baby that trigger the synthesis of calciferol.

Children who live in countries with long winters and short daylight hours, according to statistics, have a higher chance of developing rickets than their peers living in the south.

• Chronic diseases of the digestive system. The leading role is given to intestinal pathologies. Chronic enteritis, accompanied by severe malabsorption of various substances from food, often leads to the formation of various deficiency conditions in children. In this case, the unfavorable symptoms of rickets cannot be dealt with without treating the underlying disease.
• Prematurity and congenital pathologies. The birth of a baby earlier than planned is often the trigger for the development of rickets. This can be explained by the fact that the formation of many internal organs in a premature baby is not complete. Disorders of intrauterine development often cause various health problems in the future.

Symptoms

The development of the disease undergoes several successive stages. The initial period of the disease is accompanied mainly by the appearance of vegetative disorders. This is manifested by disturbances in the baby’s behavior and mood. The child becomes nervous and easily irritated by small things. Children lose interest in their favorite games and try to limit active movements. Usually the initial stage lasts about a month.

This period of the disease is also characterized by the appearance of a characteristic symptom - the child’s sweating increases. Its smell also changes. The sweat becomes acrid and sour. Its abundant secretion on the skin contributes to the development of irritation and prickly heat. Children often scratch the affected areas of the skin. The change in the smell of sweat is explained by a change in its chemical composition and its constituent electrolytes due to impaired metabolism.

After the initial stage, the disease enters its peak period. This is a more unpleasant time, characterized by the appearance of numerous symptoms. The baby develops the first deformations of bone tissue. Basically, all tubular and flat bones that are actively growing are involved in the process. Diagnosis of the disease at this time is not difficult and does not pose a problem for the doctor.

The severity of clinical symptoms may vary.

Severe disease in children older than one year is quite rare.

The child has a characteristic curvature of the spine - scoliosis. The density and thickness of the collarbones changes. They come forward a little. The architecture of the chest structure is also disrupted.

The ribs are somewhat flattened, the intercostal spaces change. Some children develop characteristic signs of rickets: depression or bulging of the lower third of the sternum. Since ancient times, characteristic names for these conditions have been used - "shoemaker's breast" and "chicken breast". The child's appearance changes greatly. Typically, these signs appear in babies who are diagnosed too late.

The child's lower limbs change shape. They become O- or X-shaped. Typically, this symptom appears in children with severe rickets by the age of five. In order to identify this symptom, you should look at the baby from different angles. Usually the curvature of the lower extremities is clearly visible from the side.

Also during the height of the disease Muscle hypotonicity appears and various neuromuscular pathological conditions occur. In a horizontal position in sick babies it is clearly visible "frog belly". Upon examination, the child’s tummy becomes flattened and hangs somewhat to the side surfaces of the body. This symptom is due to the presence of pronounced hypotonicity of the muscles that make up the anterior abdominal wall.

Bone deformations of the skeleton also lead to disturbances in the functioning of internal organs. Pathologies of the chest contribute to a decrease in the ventilation capacity of the lungs, which leads to the development of emphysema and other pathological conditions. Impaired breathing affects hemodynamics and vascular tone. Such combined conditions lead to the baby developing problems in the functioning of the heart muscle and blood vessels.

Hypotonicity of the abdominal wall muscles and pronounced curvature of the spine contribute to compression of the internal organs. In some cases, this leads to disturbances in the functioning of the liver and spleen. Pathologies of bone tissue contribute to the development of numerous orthopedic diseases in the baby, which require appropriate treatment. On average, the peak period lasts several months.

Timely treatment helps normalize the child’s condition and improve his appearance.

The period of convalescence or recovery can range from 2 to 4 months. In some cases it lasts up to six months. If a child has suffered severe rickets, then residual symptoms of the disease may persist for a couple of years from the moment of convalescence. Usually they disappear completely after a course of rehabilitation measures.

Diagnostics

Signs of rickets in children should be detected as early as possible. Timely diagnosis will avoid the development of long-term complications in the child and will help return the baby to an active life. A doctor can identify the very first signs of the disease and suspect rickets during regular examinations. After a clinical examination of the child, the doctor prescribes additional tests to clarify the severity of the disorders and confirm the established diagnosis.

The following studies are used to identify the disease:

• Measurement of calcium and phosphorus in the blood. Normally, the calcium level should be 2.5-2.7 mmol/l, and phosphorus - 1.3-2.3 mmol/l. A decrease in these indicators in a child below the age norm indicates the presence of signs of calcium-phosphorus metabolism disorders.
• Determination of alkaline phosphatase. This enzyme is actively involved in the exchange between calcium and phosphorus. Normally it is up to 200 U/l. An increase in this indicator indicates the presence of metabolic disorders in calcium-phosphorus metabolism.
• Radiography. Allows you to clarify the presence of bone deformations and disruption of skeletal architecture caused by the disease. Using bone radiography, it is possible to identify specific signs characteristic of rickets: “rickets bracelets”, pathological curvatures of the spinal column, “rickets rosaries”, pathologies of the chest, bone compactions in the tubular bones. This method can only be used according to strict indications.
• Computed tomography. It is carried out for the same reasons as radiography of bone tissue. This method has a higher resolution and allows you to obtain the most accurate results. The use of computed tomography allows doctors to assess the level of damage and the degree of functional impairment.

Consequences

The prognosis of the disease in children is greatly influenced by timely diagnosis and treatment. If rickets is detected in a child in the earliest stages, then, as a rule, negative complications of the disease do not occur. If the diagnosis is delayed, the baby may experience various long-term consequences of the disease, which require mandatory rehabilitation measures. Common consequences of rickets suffered in childhood include: a moderate decrease in muscle tone, slight curvature of the lower extremities, malocclusion, and others.

To eliminate the adverse symptoms of the disease, several therapeutic methods are prescribed. The effectiveness of prescribed therapy is monitored with mandatory determination of calcium levels in the blood. During the treatment, the clinical condition of the child is also assessed. When therapy is prescribed, the baby should feel better and become more active.

To treat rickets in children, the following treatment principles are used:

• Regular walks in the fresh air. Sunlight insolation is necessary for a baby suffering from rickets. Ultraviolet rays have a pronounced therapeutic effect on the child’s body, increasing the internal synthesis of calciferol. Your baby should take walks in the fresh air every day. Only regularity and systematicity will allow you to achieve good and lasting results.
• Prescription of medications, containing vitamin D. Many doctors prefer water-soluble forms. The dosage of the drug should be determined by the attending physician individually for each child.

Independent selection of a therapeutic dose is unacceptable! Such self-medication can contribute to the development of a very dangerous condition in the baby - an overdose of vitamin D.

• Complete nutrition. Your baby's daily diet must include foods rich in calciferol. These include: meat, chicken, fish, eggs, milk and dairy products, cottage cheese, cheese. The baby must eat a variety of dishes that contain vitamin D. If the child receives medications with calciferol, then the diet must be discussed with the attending physician in order to avoid an overdose of this vitamin in the child’s body.
• Carrying out physiotherapy. A course of UFO (ultraviolet irradiation) helps children suffering from rickets improve their overall well-being and increases bone density. Usually it consists of 12-15 procedures. Their duration can vary: from 2 to 10 minutes. Physiotherapy has a number of contraindications and is prescribed by the attending physician.

To learn about what rickets is in children and how to treat it, see the following video.

Quite often, during the next visit to the pediatrician with a 3-4 month old child, parents may hear from the doctor a diagnosis of “rickets.” Many parents have a very vague and superficial understanding of this disease; they do not know the main symptoms of the disease and cannot imagine possible treatment. So what is rickets and why is it dangerous when detected in children?

Rickets is a disorder of the exchange of phosphorus and calcium in the body, resulting from a lack of vitamins of group D. First of all, the absorption of calcium ions from the intestine deteriorates, and as a result of its lack, demineralization and curvature of the bones occurs.

What is vitamin D for?

Vitamin D is produced in the skin under the influence of sunlight and only a small part of it enters the body through food.

• Promotes the transport of calcium through the intestinal wall.
• Enhances the retention of calcium and phosphorus ions in the renal tubules, which prevents their excessive loss in the body.
• Promotes accelerated absorption of bone tissue with minerals, that is, strengthens bones.
• It is an immunomodulator (regulates the state of the immune system).
• It has a positive effect on the metabolism of tricarboxylic acids, as a result of which a lot of energy is released in the body, necessary for the synthesis of various substances.

Vitamin D (90%) is produced in the skin under the influence of ultraviolet rays, and only 10% of it enters the body with food. Thanks to it, calcium is absorbed in the intestines, which the body needs for the normal formation of bone tissue, the full functioning of the nervous system and other organs.

With a long-term lack of vitamin D in children, processes of bone tissue demineralization begin. This is followed by osteomalacia (softening of long bones) and osteoporosis (loss of bone tissue), which lead to gradual curvature of the bones.

Most often, children aged from 2-3 months to 2-3 years suffer from rickets, but children under 1 year of age are most vulnerable.

Causes of the disease

If there is only one cause of rickets - a deficiency of vitamin D in the child’s body, and as a result - a decrease in calcium levels, then there are a lot of factors that provoke the disease. Conventionally, they can be divided into several groups:

1. Insufficient insolation due to the baby’s infrequent exposure to fresh air, and the associated decrease in the formation of vitamin D in the skin.

1. Errors in nutrition:

• artificial feeding with formulas that do not contain vitamin D, or the calcium-phosphorus ratio is disturbed, which makes the absorption of these elements difficult;
• late and incorrect introduction of complementary foods;
• foreign breast milk often causes poor calcium absorption;
• the predominance of monotonous protein or fatty foods in the diet;
• malnutrition of a pregnant woman and mother feeding her baby with breast milk;
• introduction of predominantly vegetarian complementary foods (cereals, vegetables) without a sufficient amount of animal protein in the baby’s diet (egg yolk, cottage cheese, fish, meat), as well as fats (vegetable and animal oils);
• a state of polyhypovitaminosis, a particularly noticeable lack of vitamins B, A and some microelements.

1. Prematurity and large fetus:

• prematurity is one of the leading causes of rickets in a baby, since phosphorus and calcium begin to flow intensively to the fetus only after the 30th week (at 8 and 9 months of pregnancy), so premature babies are born with insufficient bone mass;
• It should also be taken into account that due to the relatively rapid growth of premature babies in relation to babies born at term, they need a diet rich in calcium and phosphorus;
• Large babies require much more vitamin D than their peers.

1. Endogenous causes:

• malabsorption syndromes (impaired absorption of nutrients in the intestine) accompanying a number of diseases, for example, celiac disease;
• dysbacteriosis, due to which absorption and metabolic processes are disrupted, including vitamin D;
• weak activity of the lactase enzyme, which is responsible for the breakdown of milk sugar contained in dairy products.

1. Hereditary factors and predisposition to the disease:

• abnormalities of phosphorus-calcium metabolism and synthesis of active forms of vitamin D;
• hereditary metabolic abnormalities in the body (tyrosinemia, cystinuria).

1. Other reasons:

• maternal illnesses during pregnancy;
• environmental factor: pollution of the environment - soil, and then water and food - with salts of heavy metals (strontium, lead, etc.) leads to the fact that they begin to replace calcium in bone tissue;
• colds increase the need for vitamins, including group D, but at the same time impair their absorption; Also, during illness, the number and duration of walks with the baby are reduced, which leads to insufficient insolation;
• hypodynamia (decreased motor activity), which can be caused by both a disorder of the nervous system and a lack of physical education in the family (exercise, massage, gymnastics).

Changes in the body due to vitamin D deficiency

A deficiency of vitamin D in the body leads to changes in many organs and systems.

• The formation of a specific protein that binds calcium ions and promotes their passage through the intestinal wall is reduced.
• Due to the reduced level of calcium in the blood, the parathyroid glands begin to actively produce parathyroid hormone, which is necessary to ensure a constant level of calcium in the blood. As a result of this process, calcium begins to be washed out of the bone tissue, and the reabsorption of phosphorus ions in the renal tubules decreases.
• Disruptions in oxidative processes begin, demineralization of bones continues, they become soft and gradually begin to bend.
• In the zone of active bone growth, defective bone tissue is formed.
• Acidosis develops (a shift in the body's acid-base balance to the acidic side), and then functional failures occur in the central nervous system and many internal organs.
• Immunity decreases, the child begins to get sick often, and the course of the disease is longer and more severe.

Groups of children most susceptible to rickets

• Babies with the second blood group, mostly boys.
• Overweight children, large babies.
• Premature babies.
• Children living in large industrial cities, as well as in the northern climate zone and high mountain areas, where there is often fog and rain and few clear sunny days.
• There is a genetic predisposition due to the characteristics of the enzymatic system in the Negroid race.
• Frequently and long-term ill children.
• Babies born in autumn or winter.
• Children who are bottle-fed.

Classification of rickets

Currently, several classifications of the disease are accepted.

There are primary and secondary forms of the disease. The primary form is based on a lack of intake of the vitamin from food or the synthesis of its active forms. The secondary form of rickets develops as a result of a variety of pathological processes:

• calcium absorption disorders – malabsorption syndromes;
• fermentopathy;
• long-term use of medications by the child, in particular anticonvulsants, diuretics and glucocorticoids;
• parenteral nutrition.

Depending on the type of metabolic disorders, the following are distinguished:

• rickets with calcium deficiency (calcipenic);
• rickets with phosphorus deficiency (phosphopenic);
• without changes in the level of calcium and phosphorus in the body.

According to the nature of the disease:

• acute form, in which softening of bone tissue occurs (osteomalacia) and symptoms of nervous system disorders are expressed;
• subacute form, which is characterized by a predominance of processes of bone tissue growth over its rarefaction;
• recurrent (wavy) rickets, in which frequent relapses are observed after an acute form.

By severity:

• 1st degree (mild), its symptoms are characteristic of the initial period of the disease;
• 2nd degree (moderate) – changes in internal organs and the skeletal system are moderate;
• 3rd degree (severe course) – severe disorders of the internal organs, nervous and skeletal systems, pronounced retardation of the child in psychomotor development, frequent occurrence of complications.

In relation to vitamin D, rickets is divided into two types:

• vitamin D dependent (there are types I and II);
• vitamin D resistant (resistant) - phosphate diabetes, de Toni-Debreu-Fanconi syndrome, hypophosphatasia, renal tubular acidosis.

Symptoms of the disease

Rickets is clinically divided into several periods of its course, which are characterized by certain symptoms.

1. Initial period.

It occurs at the age of 2-3 months and lasts from 1.5 weeks to a month. At this time, parents begin to notice the appearance of the first symptoms:

• changes in the child’s usual behavior: anxiety, fearfulness, flinching at sharp and unexpected sounds, increased excitability;
• decreased appetite;
• the appearance of frequent regurgitation and vomiting;
• the child sleeps restlessly, waking up frequently;
• the face and scalp often sweat, this is especially noticeable during feeding and sleep; sweat with an unpleasant sour odor, constantly irritates the skin, thereby causing itching and prickly heat;
• due to constant itching, the baby rubs his head on the pillow, rolling hair and characteristic baldness of the back of the head and temples appear;
• there is a decrease in muscle tone and weakening of the ligamentous apparatus;
• intestinal cramps, constipation or diarrhea;
• anemia develops;
• possible seizures caused by a lack of calcium in the body;
• stridor - noisy, wheezing breathing;
• The pediatrician, when feeling the seams and edges of the large fontanel, notes their softness and pliability;
• thickenings appear on the ribs, resembling a rosary.

There are no pathologies from the internal organs and systems.

1. The peak period of the disease

Usually occurs at 6-7 months of a child’s life. The disease continues to attack in several directions at once. At the same time, a number of new symptoms appear.

Bone deformation:

• the process of softening of the bones is clearly pronounced, this is especially noticeable if you feel the seams and the large fontanelle;
• a slanted, flat back of the head (craniotabes) appears;
• dolichocephaly – elongation of the skull bones;
• asymmetrical head shape, which may resemble a square;
• saddle nose;
• change in the shape of the chest - “chicken breast” or “keeled” (protrusion forward), or “shoemaker’s chest” (indentation in the area of ​​the xiphoid process);
• there is curvature of the collarbones, flattening of the chest with simultaneous expansion downwards;
• curvature of the legs - O-shaped or X-shaped (less common) bone deformation;
• flat feet appear;
• the pelvic bones flatten, the pelvis becomes narrow, “flat-rachitic”;
• protruding parietal and frontal bumps may appear on the head (“Olympic” forehead), which develop due to excessive growth of non-calcified bone tissue, but over time they disappear;
• “rachitic rosary” on the ribs, thickening in the wrist area (“rachitic bracelets”), thickening of the phalanges of the fingers (“strings of pearls”) - this is all the growth of bone tissue where it turns into cartilage;
• when palpated, there is pain in the leg bones, sometimes thickening of the knee joints occurs;
• a retraction appears at the level of the diaphragm - Harrison's groove;
• the large fontanelle closes with delay - at 1.5-2 years;
• Late and inconsistent teething, malocclusion, deformation of the hard palate and jaw arches, and tooth enamel defects are noted.
• Children rarely experience pathological fractures or household injuries;
• dwarfism

Decreased muscle tone and ligamentous weakness:

• the baby has difficulty turning over onto his stomach and back, does it reluctantly and sluggishly;
• does not want to sit down, even if he is supported by the arms;
• due to the weakness of the abdominal wall in children when lying down, a symptom such as a “frog belly” is noted, and the abdominal muscles can often diverge;
• curvature of the spine - rachitic kyphosis;
• joint hypermobility is noted.

Children with rickets begin to hold their heads up, sit and walk late. The gait of children is uncertain and unstable, their knees collide while walking, and their step width is sharply narrowed. The child often complains of fatigue and pain in the legs after walking.

From the nervous system, symptoms worsen:

• excitability and irritability increase;
• the child gurgles less often, there is no babbling at all;
• restless, intermittent sleep;
• children learn poorly, sometimes even lose acquired skills;
• pronounced red dermographism appears on the skin - a change in skin color after mechanical irritation.

From the digestive tract:

• complete lack of appetite, and neither long intervals between feedings nor small portions of food contribute to its arousal;
• oxygen starvation resulting from anemia leads to a decrease in the production of many enzymes necessary for normal digestion.

On the part of the blood, severe iron deficiency anemia is observed:

• increased fatigue;
• pale skin;
• drowsiness and lethargy.

The immune system malfunctions - children get sick more often and more severely.

With severe rickets, almost all organs and systems are affected. Curvature of the chest and weakness of the respiratory muscles leads to insufficient ventilation of the lungs and frequent pneumonia. There is an enlargement of the spleen and lymph nodes. There are disturbances in protein and fat metabolism, there is a lack of vitamins A, B, C and E, as well as micro- and macroelements, especially copper, zinc and magnesium.

It is the severe degree of the disease that most often leads to complications:

• heart failure;
• laryngospasm;
• frequent convulsions, tetany;
• hypocalcemia.

1. Recovery period

It occurs by the age of 3 and is characterized by an improvement in the child’s general condition, the disappearance of neurological disorders and excessive growth of bone tissue. The child becomes active, easily turns over from back to stomach and back, sits or walks better (depending on age). The pain in the legs goes away.

Unfortunately, muscle weakness and skeletal deformity disappear very slowly.

For some time, the level of calcium in the blood may still be reduced, but phosphorus, on the contrary, will be normal or even increased. Biochemical blood parameters confirm the transition of the disease into the inactive phase and the final period.

1. Period of residual effects

This stage of the disease is most often absent now, since rickets almost always occurs in a mild form.

Prognosis and consequences of rickets

At the height of rickets, the child develops bone deformations, in particular, an o-shaped or x-shaped curvature of the legs.

With early diagnosis and timely treatment, the prognosis of the disease is favorable. And only with severe rickets are some irreversible changes in the body possible:

• short stature;
• curvature of tubular bones;
• poor posture – kyphosis;
• uneven teeth, malocclusion;
• defects of tooth enamel, caries;
• underdevelopment of skeletal muscles;
• fermentopathy;
• narrowing of the pelvis in girls, which can lead to complications during childbirth.

Diagnosis of the disease

Most often, the diagnosis of rickets is based on a thorough history and examination of the child, as well as clinical symptoms. But sometimes, to determine the severity and period of the disease, additional diagnostic measures may be prescribed:

• a clinical blood test shows the degree of anemia;
• a biochemical blood test determines the level of calcium, phosphorus, magnesium, creatinine and alkaline phosphatase activity;
• radiography of the lower leg and forearm with the wrist;
• level of vitamin D metabolites in the blood.

Treatment of rickets

Treatment of the disease depends on the severity and period, and is primarily aimed at eliminating the causes. It must be long and complex.

Currently, specific and nonspecific treatment is used.

Nonspecific treatment includes a number of activities aimed at improving the general condition of the body:

• proper, nutritious nutrition, breastfeeding or adapted formulas, timely introduction of complementary foods, and it is best to give the first such children vegetable puree from zucchini or broccoli;
• correct the mother’s diet if the child is breastfed;
• observing the child’s daily routine according to his age;
• long walks in the fresh air with sufficient insolation, avoiding direct sunlight;
• regular ventilation of the room and maximum natural light;
• mandatory daily therapeutic exercises and a massage course;
• air baths;
• daily bathing in pine or herbal baths to calm the nervous system.

Specific therapy for rickets consists of prescribing vitamin D, as well as drugs containing calcium and phosphorus. Currently, there are many medications containing vitamin D. But, in any case, they are prescribed only by a doctor, based on the child’s condition. Doses are selected individually, taking into account the severity of the disease. Usually 2000-5000 IU (international units) are prescribed per day, the course is 30-45 days.

The most common drugs:

• Aquadetrim is an aqueous solution of vitamin D3. It is well absorbed, does not accumulate in the body and is easily excreted by the kidneys. Suitable for both treatment and prevention of rickets.
• Videin, Vigantol, Devisol are oil solutions of vitamin D. They are hypoallergenic and suitable for children with allergies to Aquadetrim. But they should not be given to babies suffering from dysbiosis or having problems with absorption.

After completing specific treatment, the doctor may prescribe vitamin D preparations for prevention, but in much smaller doses. Usually 400-500 IU per day is enough, which is given to the baby for two years and in the third year of life in the autumn-winter period.

Prevention of rickets

Breastfeeding plays an important role in the prevention of rickets.

Prevention of rickets should begin long before the birth of the child, even during pregnancy. Therefore, all preventive measures are divided into two groups - before and after the birth of the baby.

During pregnancy, a woman must follow these rules:

• complete fortified diet;
• prolonged exposure to fresh air;
• moderate physical activity: special exercises for pregnant women with the permission of the supervising doctor;
• taking complex vitamin preparations throughout pregnancy, especially in the last trimester;
• regular monitoring by doctors to prevent complications during and after childbirth.

Prevention of rickets in a child:

• mandatory preventive intake of vitamin D if the child was born in autumn or winter (the dose and medication are prescribed by the doctor); duration of the course of prophylaxis – 3-5 months;
• proper nutrition, optimally breastfeeding;
• strict adherence to the daily routine;
• long walks in the fresh air, avoiding direct sunlight on children's skin;
• air baths;
• daily bathing;
• gymnastics classes;
• conducting massage courses;
• complete nutrition for a nursing mother, rich in vitamins; with the permission of the doctor, take multivitamin complexes.

Summary for parents

Rickets, like many other diseases, is much easier to prevent than to cure. Pay attention to your pediatrician's prescriptions and don't forget to give healthy the child is prescribed long-term “drops” - vitamin D preparations. These “drops” will preserve the health of your baby and save him from the onset of rickets - a rather serious disease, as you have seen.

Which doctor should I contact?

Treatment and prevention of rickets is carried out by a pediatrician. In case of severe disorders of the musculoskeletal system, consultation with an orthopedist is indicated; in case of development of iron deficiency anemia, consultation with a hematologist. If vitamin D deficiency is associated with intestinal diseases, you should consult a gastroenterologist. Violation of the formation of jaws and teeth can be corrected by a dentist.

Dr. Eleonora Kapitonova talks about rickets and its prevention:

Rickets - what to expect from it and how to prevent it

In order for a baby to grow healthy and physically strong, he must spend a lot of time in the fresh air and eat well. The healing effects of sunlight stimulate the formation of vitamin D in the skin, which is necessary for bone development. Rickets most often affects babies born in winter, when the weather is cloudy, as well as those living in the northern regions. It is necessary to prevent rickets in children. It is important not only to carry out hardening and massage, but also to ensure that the child’s body replenishes the lack of vitamin D, calcium and phosphorus.

• Description of the disease
• Forms of the disease
• Severity

Causes of rickets

• Vitamin deficiency during pregnancy
• After birth
• Other reasons

Symptoms and signs of rickets Diagnosis of rickets Treatment

• Specific therapy
• Nonspecific therapy
• Auxiliary treatment with folk remedies

Prevention of rickets in children

Description of the disease

Rickets is a pathology of bone tissue development associated with a lack of vitamin D in the body. This substance promotes the absorption of calcium and maintains the balance of calcium and phosphorus that make up the bones. Rickets affects mainly children under 2 years of age, but it also occurs in adults. This disease is not life-threatening, but its consequences can be very serious. There is deformation of the skeleton (skull, ribs, limbs, spine), disruption of the functioning of internal organs, and retardation in mental and physical development. In girls, the pelvic bones form incorrectly (the so-called flat-rachitic pelvis appears). Subsequently, this significantly complicates the course of labor and makes it impossible to give birth to a child in a natural way.

Forms of the disease

The following forms of rickets are distinguished:

1. Spicy. The disease occurs in babies in the first months of life (especially premature babies) who have not received additional vitamin D in the form of special preparations. Sometimes rickets occurs in this form in obese children who are fed mainly foods high in carbohydrates (cereals, pasta, sweets). Manifestations of rickets in this case (bone pain, weak muscle tone, deformation of skeletal bones, the occurrence of fractures) are pronounced and rapidly progressing.
2. Subacute. “Osteoid hyperplasia” occurs - the formation of frontal and parietal tubercles, thickening of the wrists, abnormal development of the ribs, joints of the fingers and toes. This course is observed in babies older than 6 months, if prevention or treatment at the appearance of the first symptoms was insufficient.
3. Recurrent (wavy) form. Signs of rickets appear against the background of already existing manifestations of a previous disease.

Severity

Pathology occurs with varying degrees of severity.

1st degree (mild). The beginning of changes, the appearance of the first symptoms.

2nd degree (moderate). Moderate changes appear in the skeletal system and internal organs.

3rd degree (severe). Damage occurs to bones, internal organs, the nervous system, and improper formation of the skull.

There are several types of diseases similar to rickets that can develop in older children. These include, for example, “phosphate diabetes” - a lack of phosphorus in the bones. With this disease, a person has short stature, curvature of bones, despite the fact that he has a strong physique.

There is also pseudo-deficiency rickets, which occurs due to the body's inability to absorb vitamin D.

Video: Causes of rickets

Causes of rickets

The causes of rickets in a baby are:

• lack of vitamin D in the mother’s body during pregnancy;
• insufficient intake of nutrients into the body after birth;
• impaired absorption of vitamin D by the child’s digestive system.

Vitamin deficiency during pregnancy

A deficiency of vitamin D in a pregnant woman’s body occurs as a result of poor nutrition and insufficient consumption of foods containing this vitamin, as well as calcium and phosphorus. They form the basis of bone tissue and are necessary for the proper formation of the skeleton and muscles of the unborn baby. Difficult pregnancy, exposure to a harmful environmental environment, smoking - these factors contribute to the occurrence of vitamin deficiency and vitamin D deficiency.

If the pregnancy proceeded normally, the woman’s nutrition was adequate, then the newborn has a supply of these useful substances in the body for up to 1-2 months. Subsequently, it is required to be supplied with breast milk or in the form of additives to infant formula. If the birth was premature, then the beneficial substances do not have time to accumulate, and a deficiency occurs from the moment of birth.

After birth

Factors that provoke the occurrence of rickets in infants are:

1. Lack of vitamin D in breast milk due to poor nutrition of the mother.
2. Feeding the baby with formulas low in components necessary for the formation of bone and muscle tissue.
3. Swaddling too tight, restricting the baby's movements.
4. Use of anticonvulsants.
5. Feeding the baby with cow's milk, which is poorly absorbed by his digestive system.
6. Late introduction of complementary foods. After 6 months, it is necessary to gradually include vegetable, fruit, and meat purees in the diet, since breast milk alone is no longer enough to replenish the supply of vitamins and minerals. The formation of their deficiency is facilitated by the predominance of cereals in complementary feeding (semolina, for example). Their consumption promotes the removal of vitamin D from the intestines along with feces.
7. In older children, the cause of rickets may be a lack of animal products in the diet, or a predominance of plant foods, from which vitamin D absorption is poorer.
8. Insufficient exposure of the baby to the sun. Vitamin D is formed in the skin under the influence of ultraviolet radiation.

Premature babies are at risk of developing rickets.

Other reasons

If the child’s birth weight was high, then his body’s need for nutrients is higher than that of children with normal weight, so a balanced diet is of particular importance for him. The risk of rickets is increased in twins and twins. A lack of vitamin D, calcium and phosphorus occurs during the period of intrauterine development, and, as a rule, such children are born prematurely.

Rickets is caused by congenital underdevelopment of the organs of the digestive system, which impairs the absorption of beneficial food components. Calcium absorption is impaired in the presence of thyroid disease. In dark-skinned children, rickets occurs more often than in light-skinned children, since their production of vitamin D under ultraviolet rays is weaker.

Children living in large cities with polluted air that does not transmit ultraviolet rays are more susceptible to rickets.

Note: Rickets occurs more often in boys than in girls, and the manifestations are usually more severe. In some families there is a hereditary predisposition to rickets.

Symptoms and signs of rickets

In children, an uncomplicated disease goes through 4 developmental periods: initial, peak period, reparation and recovery.

At the onset of the disease, symptoms such as baldness of the back of the head, poor sleep, increased irritability, and softness of the bones around the fontanel are observed. This period lasts from 2 weeks to 2 months.

During the height of the disease, curvature of the bones, muscle weakness, poor teething, and impaired psychomotor development are observed. The period lasts 3-6 months.

Reparation occurs as a result of properly administered treatment. Pathological changes in bones stop, muscles become stronger, signs of nervous system disorders disappear, after which recovery occurs.

The first signs by which a mother can notice the development of rickets in a 1-2 month old baby is a decrease in his appetite (the feeding process becomes short). The baby does not sleep well, flinches at the slightest sound, and sweats profusely in his sleep. The back of his head is going bald. Digestion is impaired (diarrhea gives way to constipation).

It is necessary to draw the attention of the pediatrician to the appearance of such signs.

Symptoms of rickets in children appear over the next few months if the pathology begins to progress. The following happens:

• muscle tone weakens, the baby becomes lethargic and inactive, cannot hold his head up, sits poorly, falls to the side, cannot roll over onto his stomach;
• the child’s teething is delayed, the fontanelle closes up late, it is difficult for him to rise to his feet, he begins to walk late;
• bloating occurs;
• the deformation of the skull gradually progresses: the back of the head becomes flat, the head elongates in length, and frontal tubercles appear;
• the legs become crooked, the pelvis does not develop, the chest is not formed correctly;
• the functioning of internal organs deteriorates, signs of difficulty breathing, heart rhythm disturbances appear, and the liver enlarges;
• mental development lags and mental disorders occur.

During the height of the disease, trembling of the hands and chin becomes noticeable in the child.

Diagnosis of rickets

Signs of rickets, as a rule, do not raise doubts among the doctor. However, to confirm the diagnosis, determine the period of development of the disease and the degree of calcium deficiency in the body, a urine test, the so-called “Sulkovich test,” is performed. Urine is collected in the morning before the first feeding. If necessary, urine excreted during the day is analyzed for calcium and phosphorus content.

By biochemical analysis, the concentration of calcium, phosphorus and vitamin D in the blood is determined, and the content of the enzyme necessary for the absorption of phosphorus (“alkaline phosphatase”) is determined.

The degree of bone deformation and disturbances in the condition of internal organs is determined using ultrasound and x-rays.

Treatment

To eliminate and alleviate the manifestations of rickets, specific and nonspecific therapy is carried out. They must be started immediately after diagnosis.

Specific therapy

Treatment with vitamin D preparations is carried out in a dose corresponding to the period of development of the disease and the nature of the symptoms. A Sulkovich test is performed once every 7-10 days to monitor the progress of treatment and adjust the dosage. If a noticeable effect appears, then after 1-1.5 months the dose is reduced.

To prevent relapses, the drug is taken in a reduced dose until the age of 2, and then until the age of 3 - only in winter.

There are vitamin D preparations dissolved in water and preparations in the form of oil solutions. Water-soluble vitamin D is absorbed better by the body and remains in the liver longer, showing its activity. Oil preparations (devisol, viden) are more often prescribed in cases where the baby has a tendency to constipation.

The main drug in the treatment of rickets in children is Aquadetrim. The dose is selected individually for each child to avoid side effects.

A course of ultraviolet irradiation is carried out with a gradual increase in dose. This stimulates the body’s own vitamin D production and improves its absorption.

Video: The first signs of rickets

Nonspecific therapy

It is carried out to improve the absorption of calcium in the child’s body by restoring the acid-base balance. For this purpose, a citrate mixture (an aqueous solution of sodium citrate) and dimephosphone are used. Potassium orotate is given to improve metabolism.

If the level of calcium in the blood is low, calcium gluconate and other calcium preparations are prescribed. To strengthen the body, therapy with vitamins C and B is carried out. In the presence of anemia, iron supplements (maltofer, tardiferon) are prescribed.

Medicinal baths are used. Special massage and therapeutic exercises are performed.

It is recommended to increase the duration of walks in the fresh air, as well as make adjustments to the child’s diet, including egg yolks, cottage cheese and other foods with a high content of calcium and phosphorus in the diet. When treating infants, it is recommended to reduce the consumption of cereals, introduce complementary foods, accustoming the baby to vegetable and meat purees.

Auxiliary treatment with folk remedies

When the first signs of rickets develop in a baby, it is useful to bathe him in salt water or with the addition of pine decoction. Pine baths are used to calm the child’s nervous system. To prepare it, pour pine extract into warm water (1 teaspoon per 1 liter of water). The child is placed in the bath for 10-15 minutes.

Bathing in salt water is carried out if the child is lethargic. Use table or sea salt at the rate of 2 tbsp. l. for 10 liters of water. After the bath, you need to wash off the salt by pouring clean water over your baby.

To replenish calcium deficiency, you can prepare a mixture of finely crushed eggshells, ¼ cup of lemon juice and 1 cup of water. Give medicine after meals.

Prevention of rickets in children

Preventing the development of rickets in a child must be taken care of even before birth. During pregnancy, women should take vitamins (for example, gendevit) to compensate for the deficiency of useful elements, which inevitably arises due to the increased need associated with fetal growth. It is important to take vitamin D tablets in the last 2 months before giving birth, especially if the woman lives in areas where the summer is short or the baby is due to be born in the autumn-winter period. The drug is taken strictly in doses prescribed by the doctor, since excess vitamin D is just as harmful to the unborn child as its deficiency.

A pregnant woman should eat well, spend a lot of time outdoors under the influence of ultraviolet radiation emitted by the sun, avoid infectious diseases and colds, and regularly undergo the necessary tests.

After the birth of a child, it is necessary to strive to maintain the possibility of feeding him with full-fledged breast milk for at least 5-8 months. From 6 months it is necessary to begin complementary feeding, gradually introducing into the diet fortified foods rich in calcium and phosphorus (egg yolks, liver, meat, butter).

If necessary, the pediatrician prescribes prophylactic intake of fish oil or vitamin D supplements for children at risk.

Video: Doctors' recommendations for detecting and treating rickets

The diagnosis of rickets in children is quite common in pediatric practice. Its incidence depends on the socio-economic and cultural level of the population, hygienic living conditions, child feeding, and genetic predisposition. What is the essence of pathology? How long does it last and how dangerous is it for the child’s health? And what needs to be done to avoid this disease? Let's figure it out in order.

Pathogenesis

As a result of disturbances in mineral metabolism, primarily phosphorus-calcium, the correct formation of the skeleton is disrupted and the function of internal organs and entire systems changes.

Many people know that a lack of vitamin D plays a decisive role in the pathogenesis of rickets. But not everyone is aware that it is not a deficiency of calciferol in food, but a disruption in the synthesis of vitamin D metabolites in the epidermis and capillaries of the skin that leads to the development of a disease such as rickets.

It is the active metabolites that promote better absorption of calcium and phosphorus in the digestive tract, block the excessive excretion of these elements in the urine, and catalyze the synthesis of calcium-binding protein. And most importantly, they stimulate the “incorporation” of calcium into bone tissue.

But other vitamins are also necessary for normal development of bone tissue. Thus, a lack of vitamins A and B1 leads to the development of osteoporosis. Vitamin C promotes better absorption of calciferol and enhances its effect. Therefore, the cause of rickets is actually polyhypovitaminosis.

The same applies to microelements. Not only calcium and phosphorus deficiency leads to disease, although it is a leading pathogenetic factor. Children develop rickets with a concomitant deficiency of zinc, iron, cobalt, copper and magnesium.

The essence of the disease

• Lack of calcium directly in the bones leads to their softening. As a result, the bones become deformed from the load. This situation is generally not dangerous for the life of the body. But other organs and systems also suffer from a lack of microelements in the blood: cardiovascular, nervous.
• Against the background of mineral imbalance, bacterial and fungal infections occur. Therefore, the body tries to equalize the level of calcium and phosphorus in the blood and, through increased function of the parathyroid glands, flushes them out of the bones. This further aggravates the condition of the bone tissue.

Ultimately, hypovitaminosis D leads to disruption of other types of metabolism: protein, carbohydrate and fat.

Causes and ricketogenic factors

The development of the disease is promoted by insufficient synthesis of vitamin D and its metabolites, as well as a deficiency of exogenous calcium and its excessive release.

• Vitamin D is synthesized under the influence of ultraviolet light, therefore, insufficient insolation can lead to its deficiency in the body. This mainly concerns children living in areas with insufficient insolation. Pathology can also develop in children who are contraindicated to be in the sun. Although 10 minutes of exposure to the sun, even with clothes on, is enough to synthesize vitamin D in the amount of daily requirement.
• Insufficient intake of calcium from the outside is associated with poor nutrition of both the pregnant woman and the child. Intensive calcification of bone tissue occurs in the last months of pregnancy. Therefore, premature newborns are at greater risk of developing rickets. In full-term infants, during the first two months of life, calcium from the mother’s blood is used to build bones. Then, due to intensive growth, its reserves are depleted. Unbalanced artificial or cow's milk feeding, late complementary feedings contribute to a deficiency of exogenous calcium.
• Malabsorption in the digestive tract is caused by the immaturity of the enzyme system, perverted binding with phytic or oxalic acid into stable compounds, diseases of the stomach, intestines, liver, and obstruction of the bile ducts.
• Massive release of calcium through the gastrointestinal tract occurs with steatorrhea (“fatty” stools), through the kidneys – with nephrological diseases and the same lack of vitamin D.

Diagnostics

The leading role in the diagnostic search is played by the symptoms of rickets, x-ray examination of long bones, blood and urine tests for microelements and enzymes, and the Sulkovich test in children (determining the level of calcium in the urine).

Clinical and laboratory studies are necessary to exclude diseases with similar changes in the skeleton: tuberculous spondylitis, congenital hip dysplasia, chondrodystrophy, hypothyroidism, congenital syphilis, Down's disease.

Symptoms of the disease

The appearance and intensity of symptoms depends on the period of rickets, the severity of the process and the nature of the course. In this regard, there are 3 working classifications of the disease.

By periods:

• convalescence;
• residual phenomena.

By severity:

• light (I)– mild changes in the nervous and skeletal systems;
• medium (II)– moderate signs of damage to the nervous, muscular and skeletal systems, enlargement of the liver and spleen;
• heavy (III)– a vivid clinical picture with bone deformation, loose joints, muscle hypotonia, enlarged liver and spleen, involvement of the cardiovascular, respiratory and digestive systems in the process.

According to the nature of the flow:

• acute(the phenomena of softening and deformation of bone tissue predominate - signs of rickets in infants);
• subacute(characterized by bone hyperplasia with the formation of tubercles and nodes);
• relapsing course(periodic change of acute and subacute course).

From two months of a child’s life, when calcium reserves are depleted, the initial period of rickets is diagnosed. First, changes appear in the autonomic nervous system: anxiety, poor sleep, increased sweating (especially of the head), excessive vasomotor sensitivity of the skin.

After about a month, changes in bone tissue appear, which indicates the beginning of the height of the disease.

Important! With rickets, the entire skeleton is affected, but primarily those bones that grow most rapidly during a given age period. Therefore, bone deformations can be used to judge the time of onset of the disease. Typically, all bone symptoms of rickets in children have time to develop before one year.

Deformation of the skull bones occurs in the first 3 months of life, the trunk and chest - from the third to the sixth, and the limbs - in the second half of the year.

• With rickets in infants, the posterior fontanel softens, and the edges of the anterior one become soft.
• The flat bones of the skull also soften, which can bend under pressure and then return to their previous position (craniotabes). As a result of uneven distribution of pressure on the head (with constant lying on the back or side), a deformation of the skull develops - a flat back of the head, asymmetry of the head. To balance intracranial pressure, the frontal and parietal cusps are enlarged, giving the head a square shape.

Photo: craniota without rickets in children Changes in the chest during the acute period are characterized by softening of the ribs with the appearance of lateral depressions and a transverse depression corresponding to the attachment of the diaphragm. In this case, the sternum protrudes forward in the form of a keel, and the xiphoid process is depressed. These are quite common symptoms of rickets in infants. In the future, kyphosis or scoliosis is possible. In the subacute period, thickenings—rosaries—appear in the area of ​​the sternocostal joints.

The bones of the limbs and pelvis are the last to be involved in the process. The acute course is characterized by curvature of long bones, mainly the legs (O-shaped or X-shaped deformities), as well as the pelvis (flat rachitic pelvis). In the subacute period, “rachitic bracelets” (or “strands of pearls”) are formed in the area of ​​the epiphyses.

Simultaneously with the damage to the bone skeleton, muscle hypotonia develops, which leads to loosening of the joints, an increase in the range of motion in them, and a flattened abdomen (“frog belly”).

During the period of convalescence, the main symptoms subside: The functioning of the nervous system is restored, bones are compacted, their deformation is reduced, metabolic processes are normalized.

With timely and adequate treatment, signs of rickets in children disappear after a year. After moderate or severe rickets, bone deformations and an enlarged liver and spleen may remain.

Rare forms

• Congenital rickets develops in utero. It is caused by poor nutrition, hypovitaminosis, and pathology of the endocrine or skeletal system of a pregnant woman. Especially if these problems arose in the third trimester. A child is born with all the clinical manifestations of rickets.
• Late rickets– essentially a progression or exacerbation of the process in children 5 years old. It manifests itself as a decrease in appetite, increased sweating, deformation and pain in the legs, which is accompanied by anemia.

Did you know? On average, rickets most often affects children under one year of age, less often - up to 2 years of age, and very rarely - at 3-4 years of age.

Treatment

Nonspecific treatment includes:

• diet therapy (nutrition correction, freshly squeezed juices, boiled vegetables 1 month ahead of schedule, liver, meat, yolk);
• active motor mode, air baths;
• massage and physical therapy;
• medicinal baths (salt, pine needles);
• thermal procedures (paraffin baths, warming with sand).

Specific treatment is based on the administration of vitamin D under the control of calcium levels in the blood and urine. Only a doctor knows how to treat rickets with medication, who individually selects the dosage of medications depending on the clinical picture of rickets. In addition to ergocalciferol, other vitamins are prescribed, as well as ATP and Dibazol. Calcium supplements are indicated only in the acute period.

After the end of specific therapy, a citrate mixture is prescribed for a month, and then 2 courses of ultraviolet irradiation at intervals of a month.

Prevention

Similar to treatment, the prevention of childhood rickets consists of nonspecific and specific methods.

• In the antenatal period it is– rational, nutritious nutrition of a pregnant woman, her physical activity and stay in the fresh air. Specific methods include ultraviolet irradiation and artificial fortification in the last trimester.
• In the postnatal period– massage and gymnastics, air baths, breastfeeding or feeding with adapted formulas, timely and adequate (by age) complementary feeding. As a specific prevention, premature babies are prescribed a course of ergocalciferol 2 weeks after birth, then a citrate mixture, and finally ultraviolet irradiation. In full-term babies, such specific measures begin 1 month after birth. If the mixtures are rich in vitamins, the dose of ergocalciferol is reduced by half.

Video about proper massage

One of the important methods of treating rickets is general body massage. But you need to know the sequence of massage movements and their strength. The video will tell you about all the intricacies of therapeutic massage for children.

If you follow the regime of routine pediatric examinations, the doctor will identify symptoms of rickets in children and prescribe appropriate treatment. Don’t ignore going to the clinic - and everything will be fine! Have you encountered the problem of rickets in your family? Have you carried out antenatal prevention of hypovitaminosis D? We will be very interested to hear about this from your comments.

Rickets in a child: forewarned is forearmed!

What is rickets?

Children's health is a close focus of parents' attention. In order for a growing body to form correctly, it needs a whole complex of vitamins and minerals. The child receives most of them through breastfeeding or feeding with an adapted formula. But the need for vitamin D is not always met even if these rules are followed, so many mothers know firsthand what rickets is.

Rickets is a metabolic disease that occurs when there is a deficiency of vitamin D (calciferol) in the body, which affects the child’s musculoskeletal system, internal organs, nervous and endocrine systems.

Causes of rickets in children

According to various sources, symptoms of this disease are observed in approximately 40 percent of children under one year of age. In those countries where there is a shortage of sunlight, this figure is higher.

Most often, rickets in children under one year of age occurs because, while still pregnant, the woman did not pay due attention to her lifestyle and health. For example, if the expectant mother had a hard time with the last months of pregnancy, she had late toxicosis, or she was too keen on diets and limited the consumption of foods containing animal proteins.

In the postnatal period, premature babies, babies born in the cold season, artificial babies and babies living in unfavorable conditions are at risk of developing rickets. Rickets in infants can provoke an unhealthy diet for the mother: if, for fear of gaining excess weight, she eats too little, prefers low-calorie foods, and limits the consumption of milk, meat and fish.

In addition, there are the following causes of rickets:

1. insufficient exposure of the child to the fresh air in general and the sun in particular;
2. tight swaddling and limited motor activity of the child;
3. lack of breastfeeding, early transition to mixed or artificial feeding (mothers who use unadapted formula are especially at risk);
4. gastrointestinal tract disorders, congenital pathologies (celiac disease, lactase deficiency, dysbacteriosis);
5. tendency to frequent illnesses;
6. taking anticonvulsants;
7. rapid weight gain in a child (at the same time the need for calcium increases).

How to determine rickets in a baby - SYMPTOMS

The disease manifests itself gradually.

The first symptoms of rickets can be detected at 4-8 weeks of a baby’s life:

• the child does not eat well: his appetite decreases, his usual portion is not fed, and the feeding process itself takes less time than usual;
• the baby becomes restless: shudders for no reason, often tosses and turns during sleep, becomes more capricious and fearful;
• sleep disorders: the baby does not fall asleep well, often wakes up for no reason, shudders or cries loudly in his sleep, the sleep itself is short and superficial;
• sweating increases: even in cool weather, the child gets wet, wakes up in wet clothes, sweat has a specific sour smell and taste, diaper rash and prickly heat appear again after healing;
• the hairs on the back of the head fall off. ;
• stool disorders are noted: Despite the usual diet, diarrhea and constipation may occur.

If this is ignored, after a few weeks infants develop the following signs of rickets:

• The muscles are in low tone;
• The baby does not hold his head well, is in no hurry to roll over on his stomach, crawl, or walk;
• Later teeth erupt;
• Later the fontanel closes;
• The shape of the skull may change: the head becomes elongated, the back of the head becomes flat, frontal tubercles appear;
• Bloating;
• The chest is deformed, the pelvis becomes narrow, and the legs become bent.

Severe forms of rickets affect the physical condition and psyche of the child: a noticeable lag in development. Severe deformations of the chest, skull bones, and limbs occur.

In some particularly advanced cases, children cannot sit and stand up on their own. From the cardiovascular system, difficulty breathing and tachycardia are observed. The liver increases in size.

It is possible to cure rickets - TREATMENT

It is easier to cure any disease if you start doing it at an early stage, so if you suspect rickets, you should consult a pediatrician. It is he who will make the final diagnosis and tell you how to treat rickets.

Even if this disease has reached a severe stage, doctors rarely resort to hospitalization. They usually prescribe procedures that can be done at home, designed to eliminate the lack of vitamin D and correct disorders that have occurred in the body.

Treatment of rickets is based on a set of procedures for correcting the daily routine, physical activity (walking) and diet of mother and child.

It is necessary to take your baby for walks in the fresh air more often. If the weather cooperates, you can take air baths. Sunbathing MOST effective, but in hot weather overheating must be avoided ().

The child’s diet should contain a sufficient amount of protein and minerals (calcium and phosphorus are especially important), and vitamins.

Massage

Physical therapy and massage have a positive effect on health. Such a complex should include breathing exercises, stroking the legs, arms, feet, abdomen, chest and back. To strengthen the baby's muscles, you need to turn him from his back to his tummy, strengthen the walking and crawling reflexes (supporting the baby, giving him the desired position). Rocking on a fitball or in your arms will help calm your child’s nervous system.

Video

To overcome tearfulness, lethargy, irritability, and normalize the child’s mental state, you should protect him from excessive impressions and external stimuli (noise, bright light).

Bathing

If the baby is hyperexcitable, baths with the addition of pine needle extract (1 teaspoon per 10 liters of water at room temperature) can have a good therapeutic effect. They are indicated for excitable children. If the baby’s muscle tone is reduced, he or she experiences lethargy, baths containing sea salt can help. To prepare the solution, you need to add 2 tablespoons of salt to 10 liters of warm water. 10–12 procedures are enough to ensure a positive effect.

Note to moms!

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Medicines for rickets - VITAMINS

Take all medications only as prescribed by your doctor!

Medicines:

• Aquadetrim- aqueous solution of vitamin D3 (colecalciferol)
• Devisol, Vigantol, Videin- Oil solutions of vitamin D3

Among the medications taken for rickets, vitamin D solution is considered the most effective.

But here, too, there are nuances: vitamin D3 is more effective than vitamin D2, and an aqueous solution has a longer lasting effect and is absorbed by the body better than an alcohol or oil solution.

In any case, vitamins for rickets should be prescribed by a pediatrician, who will select the type of drug, its dosage, and determine the timing of treatment.

Often, a therapeutic dose of vitamin D (it is 2000–5000 IU) should be taken for 30–45 days, and then a maintenance (preventive) dose of 400 to 500 IU should be taken daily. One drop of vitamin D3 oil solution contains approximately 420 IU of cholecalciferol.

Taking vitamin D should be accompanied by constant monitoring of urine analysis to avoid overdose, because large doses can have a toxic effect on the body. An overdose of this drug can cause loss of appetite, nausea, vomiting, urinary retention, constipation, and even limb cramps.

If anemia occurs due to rickets, it is treated with iron supplements in the form of syrup or drops.

By following all the requirements, you can very quickly improve the child’s condition.

Preventing rickets is easier than treating it - PREVENTION

The health of the child must be taken care of long before his birth - during planning, as well as during pregnancy. At approximately 28 weeks of intrauterine development, the child’s body begins to actively store vitamins. Vitamin D accumulates in the liver, fat and muscle tissue of the fetus. During this period, a pregnant woman should pay special attention to her lifestyle:

• regularly visit a antenatal clinic doctor;
• eat regularly and nutritiously;
• spend more time in the fresh air;
• protect yourself from colds and infectious diseases;
• walk a lot.

Prevention of rickets is carried out from the birth of a child and is especially necessary for premature babies, with insufficient weight, in the first months of life, as well as for those born in the autumn-winter and even spring periods. It is enough to follow the regime, take long walks in the fresh air, get a lot of sun, strengthen and physically develop the child.

Prevention of rickets video:

Breast-feeding– the best protection against many diseases, but only if your menu contains the required amount of nutrients. A nursing mother needs to streamline her diet: consume more dairy and fermented milk products, take multivitamins (). If your baby is “artificial,” you need to choose an adapted milk formula that closely resembles the composition of human milk. ()

In the future, when introducing complementary foods, you should take into account that vitamin D is found exclusively in products of animal origin (meat, liver, butter, egg yolk) and systematically offer them to your baby. You should not overuse semolina porridge. In addition to the fact that it can cause allergic reactions, it also interferes with the absorption of calcium in the small intestine.

Fish oil

Children from the “risk group” are recommended to undergo drug prevention of rickets. One of the most popular remedies is fortified fish oil. It can be given to children starting at four weeks of age, gradually increasing the dose.

It should be remembered that prevention is carried out under the supervision of a local pediatrician.

For the purpose of prevention, medications (vitamin D, fish oil) must be given for a certain period.

There is a so-called “r” rule - take vitamins in those months of the year that have the letter “r” in their names. May and the summer months are usually sunny, so there is no need for drug prevention.

Rickets cannot be left to chance - CONSEQUENCES

Consequence of rickets

Most often, rickets does not pose a threat to the child’s life. But if you do nothing, the symptoms go away, but the consequences of rickets remain. Often children who have had this disease suffer from caries of milk and permanent teeth. Curvature of the legs. There may be developmental delays.

Due to changes in the skeleton, scoliosis, flat feet, and pelvic deformity may occur. In schoolchildren, the effects of rickets manifest themselves in the form of myopia, anemia, reduced immunity and pain (frequent bronchitis and pneumonia).

Older adults may develop osteoporosis.

It is not entirely correct to say that signs of rickets in children under 1 year of age develop due to a lack of calcitriol (vitamin D) or short exposure to sunlight. A number of modern surveys indicate a high prevalence of hypocalcemia in children with pathology of fat metabolism.

Symptoms of calcium-phosphorus metabolism disorders depend on individual characteristics and the speed of clinical development. It is impossible to standardize the manifestations of the disease, therefore a morphological classification of the disease has been developed that takes into account vitamin D-resistant forms of the nosology.

The first symptoms of vitamin D deficiency

The initial manifestations of rickets in a child occur at the age of 2-3 months, when damage to the nervous system is actively expressed. Behavioral disorders in children under 1 year of age are the first negative indicator of changes in calcium-phosphorus metabolism. Minerals are necessary for muscle function, the transformation of cartilage tissue into bone, cardiac activity, and maintaining microelectrolyte balance.

Neurological signs of the disease in children under one year of age:

1. Shyness;
2. Strong excitability;
3. Muscle twitching due to sudden external sounds;
4. Trembling when exposed to bright light;
5. Poor sleep;
6. Tearfulness.

Parents identify neurological disorders in a child under 1 year of age by the “wet pillow” syndrome. The symptom develops due to strong nervous stimulation of areas with irritation of receptors. The baby has such an area - the occipital region, which comes into contact with the pillow.

The flattening of the back of the head usually forms after one year. Initially, redness and peeling of the skin can be seen on the back of the skull. In the area of ​​contact, hair falls out and inflammation forms. The process results in a “wet spot” appearing on the pillow. Increased sweating appears all over the body. The sign of rickets is especially active during physical activity of the child.

A laboratory examination reveals an acidic reaction. The liquid provides irritation to the nerve receptors of the skin. To reduce itching, the baby constantly rubs against the pillow or bed. Frequent transverse movements of the back of the head lead to baldness of the area.

The second symptom of rickets in children under 1 year of age is a violation of muscle innervation.

Lack of calcium leads to weakness and hypotension. The condition causes difficulty in standing up and sitting. If you compare the timing of the formation of muscle reflexes with peers using special tables, they will appear later - in some cases even later than the 2nd year of life.

Rickets is a childhood disease caused by metabolic disorders. The disease affects young children (up to 2 years). Although this disease has been known since ancient times and is well studied, it is still widespread today.

The disease is not fatal, but it causes numerous disorders in the baby’s body, which in some cases can have negative consequences for life. Therefore, treatment of rickets in a child should be started when its first signs appear.

This disease is diagnosed to one degree or another in every fifth small resident of Russia. More often the disease occurs in children in large northern cities. The likelihood of rickets in children born in the cold season is higher than in those born in spring and summer.

For example, at the beginning of the 20th century, the disease was diagnosed in 50% of children in England, while in sunny Bulgaria this figure was only 20%.

Rickets primarily affects the nervous system and bone apparatus. The disease is based on a metabolic disorder caused by a deficiency of vitamin D, which enters the human body with certain foods (dairy products, egg yolk, fish oil, vegetable oil, nuts, etc.).

In addition, vitamin D is produced by the body under the influence of ultraviolet rays. Two forms of this vitamin are important for humans: ergocalciferol and cholecalciferol. It is they, by participating in metabolic processes, that allow the baby to form the dense bone mass he needs during the period of active growth and development.

Rickets is a general disease of the human body, which is caused by a discrepancy between the high need of the child’s body for calcium and phosphorus and the improper functioning of the systems that deliver these substances.

Rickets has negative consequences. Children who have been diagnosed with the disease are more likely than other peers to suffer from respiratory diseases. This is due to the fact that the disease provokes dysfunction of the child’s immune system.

Severe disease can lead to osteoporosis, poor posture, caries, and anemia. Under the influence of a lack of calcium, phosphorus, and magnesium, gastrointestinal motility disorders develop. The disease, suffered in early childhood, can leave consequences for life.

Causes of the disease

The rapid growth and active development of the baby in the first 3 years of life determine the high need of his body for building material. A baby at this age needs much more calcium and phosphorus than older children, and even more so adults.

Insufficient levels of these substances in the blood can occur due to both limited intake from food and impaired absorption in the intestine due to a lack of vitamin D.

As soon as a deficiency of these microelements in the blood begins, they are washed out of the bones. Therefore, it would be correct to say that the main cause of rickets is a lack of vitamin D, calcium and phosphorus compounds in the body.

Due to the fact that the disease still occurs, every mother should know why rickets appears and how to cure it.

The disease can be provoked by the following factors:

• prematurity;
• high birth weight of babies;
• early artificial feeding with unadapted infant formula or cow's milk;
• lack of ultraviolet radiation;
• restriction of the baby’s motor activity (tight swaddling);
• abuse of complementary foods rich in carbohydrates (semolina);
• strict vegetarian diet;
• gastrointestinal diseases or immaturity of enzymes that impair the absorption of calcium and phosphorus in the intestines;
• dark skin of the baby, in this case vitamin D is poorly produced in the skin;
• hereditary metabolic disorders;
• congenital abnormalities of the liver and kidneys;
• taking certain anticonvulsants or glucocorticoids.

When calling the main cause of rickets a deficiency of vitamin D in the baby’s body, it is necessary to take into account that there is no clearly defined daily requirement, the use of which can clearly guarantee protection against the disease.

The dosage of vitamin D varies depending on the child’s age, living conditions, nutrition and, importantly, skin color. The lighter the baby's skin, the more vitamin D it can produce. This is one of the reasons for the prevalence of rickets in African countries.

Vitamin D is best produced under the influence of ultraviolet radiation in red-haired children with fair skin. For such a child, a 10-minute daily stay in the shade in clear weather is enough for the required amount of this vitamin to be synthesized in the skin.

Symptoms and diagnosis of rickets in children

The number of children suffering from rickets has decreased significantly over the past half century in developed countries.

This was achieved thanks to factors such as:

• improving the standard of living and, accordingly, enriching the diet of pregnant and lactating women;
• breastfeeding promotion;
• enrichment of infant formula with vitamin D.

Signs of rickets include:

• softening and thinning of the bones of the child’s skull;
• decreased muscle tone;
• an increase in the size of the frontal and parietal tubercles of the skull;
• delay in the appearance of teeth, the enamel of the teeth is fragile, prone to darkening and destruction;
• rachitic rosary beads appear on the ribs - compactions;
• deformation of the chest (depressed “shoemaker’s chest” or protruding “chicken” chest);
• the baby’s growth rate slows down, his development parameters lag significantly behind those accepted by WHO;
• With the further development of the disease, bone fragility appears, due to which frequent fractures of the legs are possible.

It is common to unfoundedly attribute certain symptoms to rickets that are not actually such:

• increased child sweating;
• lack of hair on the back of the head;
• loss of appetite;
• increased excitability;
• curvature of limbs,
• "frog" belly.

Most of these so-called “symptoms” occur in many children much more often without rickets than with it. For example, a child’s head sweats for various reasons - overheating, after illness, vaccination, intense crying, etc. And the hair on the back of the head is wiped off and does not grow for some time in most babies, because they constantly lie on their back.

It is necessary to understand that the above signs may be symptoms of other diseases. Based on them, it is impossible to independently diagnose rickets in a baby. Only a pediatrician can establish the disease through a visual examination confirmed by x-ray and laboratory tests.

Degrees of rickets

Degree of disease	Manifestations	Changes in the body
I (light)	Minor changes in some bones (slight deformation of the skull, curvature of the arms and legs)	Hypotension, but psychomotor development remains normal, decreased calcium levels in the blood
II (medium)	Severe bone deformation	Lesions in the nervous system, lag in motor skills, dysfunction of internal organs
III (severe)	Multiple severe bone deformities	Developmental delays in the child, severe anemia, disorders of the digestive, nervous, cardiovascular, and respiratory systems.

The main diagnostic method for determining rickets in the laboratory is an analysis of calcium levels in plasma. The Sulkowicz test for determining the level of calcium in urine is currently considered an outdated method for determining rickets.

Modern diagnostics involves studying blood for:

• calcium, phosphorus, magnesium, alkaline phosphate and creatinine content;
• levels of vitamin D metabolites.

In addition to a blood test to establish a diagnosis, an x-ray of the lower leg and forearm is prescribed, which allows us to determine a decrease in bone density and other changes characteristic of rickets.

Treatment of rickets

It is now well known why the disease occurs and how to treat rickets in a child.

The main direction of treatment for this disease is the normalization of the baby’s lifestyle and diet, which includes:

• Daily walks lasting at least 4 hours. In the spring-summer period, it is important to provide the baby with the necessary amount of ultraviolet radiation, so he should be taken for a walk as undressed as possible.
• Long-term breastfeeding (at least up to 1 year). If breast milk is not available to the baby for any reason, it is necessary to use adapted milk formulas.
• In case of rickets, earlier introduction of complementary foods is recommended. Since vitamin D is fat-soluble, it is necessary to monitor the balance of fats in your baby's diet. For a child under 1 year old, butter can be added to the menu.
• Taking pine and salt baths daily, which helps strengthen the child’s immune system and nervous system.
• The use of medications containing vitamin D. This is the main method; without it, all other measures will not be effective enough. The most preferred are aqueous solutions of vitamin D3.

Vitamin D in the treatment of rickets

The most common drug containing an aqueous solution of vitamin D is Aquadetrim. It does not accumulate in the body and is well excreted by the kidneys, which minimizes the risk of overdose. Aquadetrim is not only a medicine, but also a prophylactic agent.

The amount of medicine required for the child is selected by the doctor individually depending on the age, weight and condition of the baby.

But Aquadetrim, like any drug, can cause allergic reactions or individual intolerance to its components. What to do in this case?

Is it possible to cure rickets in a child without this remedy? If the use of Aquadetrim is not possible, then as an alternative, the modern pharmaceutical industry offers oil solutions of vitamin D3.

Treatment of rickets with Vigantol, Videin, Devisol is preferable for children with allergic reactions. Oil solutions are much less likely to provoke allergies, but are not recommended for children with dysbacteriosis and certain intestinal disorders.

They are convenient to use for the prevention of rickets, but the therapeutic dosage is quite difficult to calculate. Any drug containing vitamin D, regardless of whether it is an oil solution or a water solution, must be taken in strict accordance with the doctor’s recommendations.

Parents should remember that an overdose of vitamin D will cause no less harm to the baby than its deficiency. . Therefore, you need to entrust the treatment of the disease to a pediatrician, do not self-medicate and do not wait for the disease to go away on its own!

If anyone has a question whether rickets is treated with drugs other than those containing vitamin D, the answer will be clear. Today, all other drugs are only an auxiliary means.

The dietary supplement Calcid, which is used as a prophylaxis for rickets, has proven itself well. The drug contains calcium and vitamin D for better absorption. But treatment of rickets with Calcide will not be effective at an advanced stage of the disease; it is better to use it as a prophylactic agent.

The use of calcium supplements is recommended as a necessary supplement if a child is advised to take a large dose of vitamin D once. In this case, an increased amount can lead to a sharp decrease in calcium in the blood, which can provoke seizures.

Rickets in children

Rickets is a word familiar to many parents. Rickets is a widespread disease of children in the first two years of life. Rickets has been known for a very long time, mentioned in the works of Soranus of Ephesus (9-138 AD) and Galen (131-211 AD). A clinical and pathological-anatomical description of rickets was given by the English orthopedist F. Glisson in 1650. The English name rickets comes from the Old English wrikken, which means “to bend,” and Glisson changed it to the Greek rhachitis (spine), since this is the first area affected by rickets.

Rickets is a metabolic disease that primarily affects bones. Children suffer from rickets mainly in the first two years of life. The first symptoms usually appear at the age of 1–2 months; a detailed clinical picture of rickets is observed, as a rule, at 3–6 months of age. Rickets occurs in all countries, but is especially common among those northern peoples where there is a lack of sunlight. It is relatively rare in hot countries. Children born in autumn and winter suffer from rickets more often and more severely. The incidence of rickets in Russia among young children ranges from 20 to 56 percent.

Answers parents' questions Nina Alekseevna KOROVINA- Professor, Doctor of Medical Sciences, Head of the Department of Pediatrics of the Russian Medical Academy of Postgraduate Education.

- Is it true that only children from low-income families suffer from rickets?

No, that's not entirely true. And, although rickets was previously called a disease of the slums, children from rich families also suffered from it. If a child does not walk in the fresh air, does not eat properly (eats semolina porridge several times a day), and does not receive egg yolk and meat from the age of 6–7 months, the risk of developing rickets is quite high.

- What are the main causes of rickets?

There are many of them, but the main cause of rickets is insufficient intake of vitamin D from food or its formation in the skin under the influence of ultraviolet rays. But they predispose the mother to the development of rickets during pregnancy and breastfeeding:

The child is predisposed to the development of rickets:

- Why is phosphorus-calcium metabolism disrupted during rickets?

Vitamin D3 (cholecalciferol) is formed in the skin under the influence of ultraviolet rays. Vitamin D enters the gastrointestinal tract in the form of cholecalciferol (D3) from animal products or ergocalciferol (D2) in the form of medications. In the body, through complex transformations in the liver and kidneys, these forms of vitamin D are converted into more active ones, capable of regulating the absorption of calcium and phosphorus salts in the small intestine and deposition in the bones. As a result of disturbances in the metabolism of calcium, phosphorus and deficiency of the active metabolite vitamin D, disorders of the central nervous system, bone tissue, and many internal organs are observed.

- What are the first clinical signs of rickets?

Attentive parents can notice the initial clinical signs of the disease from 1–2 months of age. There is anxiety, increased excitability, shuddering, and the skin becomes covered with red spots. The child’s sleep may deteriorate, he begins to turn his head, and “balding” of the back of the head is noted. There is increased sweating with a characteristic sour odor. A persistent heat rash appears on the skin. Characteristic is decreased muscle tone and constipation. Bone changes are usually absent during this period.

- It is believed that for patients with rickets, O- or X-shaped curvatures of the lower extremities, deformation of the skull, chest (“chicken breast”, “shoemaker’s chest”), and skull are obligatory.

Such pronounced bone deformations do not always occur and are characteristic only of advanced, severe forms, which have not been common in recent years. Mild forms of rickets occur in 60 percent of children of the first life. This is characterized by flattening of the back of the head, usually one-sided, on the side on which the child often sleeps, some “pliability” of the edges of the large fontanelle, thickening in the wrist (“bracelets”), on the phalanges of the fingers (“strings of pearls”), on the ribs, in places of transition of bone tissue into cartilaginous tissue (“rachitic rosary”). Rickets is characterized by late closure of the fontanelles and sutures of the skull, irregular and untimely teething. In more severe cases, in the absence of treatment, deformation of the chest appears with protrusion (“chicken breast”) or, conversely, depression (“shoemaker’s chest”). The most severe course of rickets is observed in children who do not spend enough time in the fresh air, are on a carbohydrate diet, gain weight well, and do not receive preventive or therapeutic doses of vitamin D.

- My baby is 2 years old, he often suffers from ARVI. The doctor believes that rickets is to blame. Is this true?

Yes, it's possible. With rickets, not only metabolic disorders are noted, but also functional changes in the respiratory system. Decreased tone of the respiratory muscles and deformation of the chest can lead to breathing problems. In addition, with rickets, immunity decreases. All this predisposes to more frequent inflammatory diseases of the upper and lower respiratory tract.

- My child had normal, regular bowel movements, but after a month constipation appeared. What could this be connected with?

One of the possible causes of constipation at this age may be rickets.

- Some people believe that rickets need not be treated, since it “goes away” on its own by the age of 4. Is this true?

No, if rickets is not treated, persistent bone deformations of the skeleton remain, scoliosis (curvature of the spine), and flat feet occur. Deformation of the pelvic bones may develop; caries of milk and then permanent teeth often develops. In severe cases, spontaneous fractures of the hands and growth retardation are possible. A frequent companion to rickets is anemia (anemia). At school age myopia may appear.

- How to properly treat rickets?

Treatment of rickets is usually comprehensive and involves the elimination of all factors predisposing to impaired calcium and phosphorus metabolism, as well as the use of vitamin D. It is necessary to organize the correct daily routine with sufficient rest in accordance with the child’s age and the elimination of various irritants (bright light, noise, etc.) . Sufficient exposure to fresh air and regular ventilation of the room are recommended. Importance is given to physical therapy, massage courses, hygienic baths and rubdowns.

If the child is breastfed, attention must be paid to the mother's nutrition. Her food should be varied, containing sufficient amounts of complete proteins, fats and carbohydrates, as well as vitamins, mineral salts and microelements.

If the child is bottle-fed, it is necessary to select an adapted milk formula that is as close as possible to human milk.

The use of vitamin D is mandatory for rickets.

- How long should you take vitamin D?

To determine the timing of treatment, you need to show the child to a pediatrician. Typically, using 2000–5000 IU of vitamin D per day for 30–45 days gives a good therapeutic effect. Usually after this they switch to a maintenance dose - prophylactic, from 400 to 500 IU, which the child should receive daily for two years and in the winter in the third year of life.

- Why is vitamin D3 better to take than D2?

The advantages of vitamin D3 over D2 are:

- In the pharmacy you can find vitamin D in oil, alcohol and water. How are they different from each other?

An aqueous solution of vitamin D3 has significant advantages over an oil solution:

In recent years, an alcohol solution of vitamin D is practically not produced due to the high dose (about 4000 IU in 1 drop) and possible overdose due to the evaporation of alcohol and an increase in the concentration of the solution.

Currently, a new drug has appeared in Russia for the prevention and treatment of rickets - VITAMIN D3 - CHOLECALCIFEROL (AQUEOUS SOLUTION). Vitamin D3 aqueous solution was developed and introduced by the Polish company TERPOL, specializing in the production of pediatric medications. Available in 10 ml bottles with a special pipette. The drug is convenient to dose; one drop of solution contains about 420 IU of cholecalciferol.

- What methods exist for preventing rickets?

You need to think about preventing rickets even before the baby is born. A pregnant woman should eat properly (consume at least 0.5 liters of dairy or fermented milk products, 150 grams of cottage cheese, 30 grams of cheese, 100 grams of fish); walk more in the fresh air, especially in the second half of pregnancy.

In order for the baby to grow up healthy, it is necessary to use all methods of preventing rickets in a timely manner, and if the disease has developed, carry out treatment until the child fully recovers. Particular attention should be paid to the physical development of the child and his hardening. In addition to walks in the fresh air and water treatments, therapeutic exercises and massage are of great importance for rickets, which should be carried out systematically, regularly, for a long time, with a gradual and uniform increase in load. The best food for a child is breast milk, but if the mother does not have milk, it is necessary to use modern adapted human milk substitutes. To prevent rickets in healthy full-term infants, it is good to use water-soluble vitamin D3 (cholecalciferol) 1 drop (420 IU) daily during the autumn-winter period. The dose for premature babies and those at risk for rickets (receiving anticonvulsant therapy, those who are often ill, with pathologies of the gastrointestinal tract, and so on) is determined individually by the doctor.