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

General description

Developmental disorders with rickets particularly concern the physical state of the child’s growing body and mental state. Moreover, against the background of rickets, the risk of subsequent development of various diseases (infectious, etc.) also increases.

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

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

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

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

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

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

Rickets: reasons

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

• Prematurity. This factor is particularly relevant when considering rickets due to the fact that it is during the last months of pregnancy that phosphorus and calcium are supplied to the fetus with the greatest intensity.
• Improper feeding. For this reason, rickets can also develop; this occurs as a result of insufficient dietary intake of phosphorus and calcium. In addition, a certain irrationality of feeding is also taken into account here, if it is due to the fact that it occurs at the expense of someone else's milk, this, in turn, becomes the cause of ineffective absorption of calcium. Similarly, children whose diet includes monotonous foods are also at risk. protein food or lipid foods. This also includes artificial feeding of the child. And finally, this also includes insufficient intake of vitamin A, B and microelements.
• Impaired transport of calcium and phosphorus in the kidneys, gastrointestinal tract and bones. This is due to the immaturity of enzyme systems or the existing pathology relevant to the listed organs.
• Increased level mineral needs. This factor fully corresponds to the specifics of the disease, given the fact that rickets is a disease that develops during the process of intensive growth of the body.
• Features of ecology. Under adverse conditions environment with a current excess of chromium, iron, strontium, lead salts or a deficiency of magnesium, the corresponding basis for the development of rickets in a child is also determined.
• Specific Features body. It is known that boys are more predisposed to the development of rickets, in addition, they suffer it much more severely. It has also been noted that dark-skinned boys with blood group II experience the disease more severely than children with blood group I (in the latter case, the disease is diagnosed less frequently).
• Endogenous or exogenous vitamin D deficiency.
• Current disturbances in the functioning of the endocrine system (damage to the thyroid, parathyroid glands).
• Hereditary predisposition.

Rickets: classification

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

• Rickets, in terms of clinical variants, based on the characteristics of changes in the concentration of phosphorus and calcium in the blood serum, can be diagnosed in the following types of forms:
• calcium penic rickets;
• phosphopenic rickets;
• rickets, which manifests itself without particularly pronounced changes in the level of current indicators of phosphorus and calcium.
• Rickets, caused by specific features of its own course:
• Acute course of rickets. Accompanied by a predominance of neurological symptoms and osteomalacia. Osteomalacia is a systemic type of disease in which bone tissue is insufficiently mineralized, which is also associated with impaired metabolism of vitamin D or its deficiency, with a deficiency of microelements or macroelements, provoked by an increased degree of their filtration by the kidneys or a disturbance in the absorption processes (which is already relevant for intestines). The main phenomena accompanying osteomalacia include bone pain, muscle hypotonia (decreased muscle tone, combined with impaired muscle strength) and malnutrition (lack of body weight, accompanied by a decrease in thickness subcutaneous tissue), as well as deformation of skeletal bones and the appearance of pathological fractures.
• Subacute course of rickets. This form rickets is accompanied by a predominance of phenomena characteristic of osteoid hyperplasia. Osteoid hyperplasia is a condition in which osteoid tissue rapidly grows during rickets. In particular, this includes such phenomena as the appearance of parietal and frontal tubercles, thickening formed in the wrist area (which is defined as rachitic bracelets), as well as thickening in the areas of transition of the bone part to the cartilaginous part on the side of the ribs (defined as rachitic rosary) and thickening of the area interphalangeal joints on the fingers (accompanied by the formation of so-called strings of pearls).
• Undulating or recurrent course of rickets. The diagnosis of acute rickets, which is relevant for the child, in this case is combined with signs of various scales (laboratory, clinical, radiological), on the basis of which a picture is visible that accompanies the disease in the past. active form rickets.
• Rickets due to the severity of the manifestation:
• I degree of rickets – mild degree– features of the course correspond to the initial period of the disease;
• II degree of rickets - moderate severity - the course of the disease is characterized by moderate severity of changes affecting internal organs and the skeletal system;
• III degree rickets - severe degree - in this case, several parts of the skeletal system are affected simultaneously, severe damage to the nervous system also occurs and internal organs, there is a developmental delay (physical, mental), caused by compression of the skull due to its improper formation, and complications of the disease are identified.
• The cyclicity of the course of the disease, corresponding to this process passing through four successively manifested stages, and these are: the initial period of rickets, the period of the height of rickets, the period of reparation (convalescence) and the period characterized by residual effects of the disease.

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

• Relevance of malabsorption syndromes. Malabsorption literally means “poor absorption” from Latin. If we define this deviation more precisely, it implies the loss of those nutrients(in a single or multiple version), the receipt of which occurs in digestive tract at insufficient degree the intensity of their subsequent absorption through the small intestine.
• The presence of chronic diseases of the biliary tract or kidney diseases.
• The presence of diseases directly related to metabolism (cystinuria, tyrosinemia, etc.).
• Long-term use anticonvulsants(phenobarbital, diphenin), glucocorticoids, diuretics; parenteral nutrition.

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

Rickets: symptoms

Depending on the period of the disease, the characteristics of its symptoms are determined accordingly.

• Initial period of rickets

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

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

If an x-ray is taken within this period, it will reveal some rarefaction on the part of the bone tissue. Based on a biochemical blood test, either normal or completely increased calcium concentrations are revealed, while phosphate concentrations decrease.

• The height of rickets

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

Also, against the background of the development of a number of processes that are relevant in this case, the formation of a flat-rachitic narrowed pelvis occurs. Due to the fact that the ribs are subject to significant softening, a depression is formed along the line of the diaphragm (the so-called “Harrison groove”). Hyperplasia of osteoid tissues, which predominates in the subacute course of rickets, in this case manifests itself in the form of the formation of parietal and frontal tubercles of a hypertrophied type. In addition, there is an even greater thickening of the costochondral joints, wrists, and areas of the interphalangeal joints upper limbs(the previously discussed “bracelets”, “rosary beads”, “strands of pearls”).

• Period of convalescence of rickets

This period is characterized by an improvement in the child’s well-being and general condition. Static functions are subject to improvement or normalization. In the blood, normalization or some excess of phosphorus content is detected. Hypocalcemia may remain at a low level, and in some cases it may increase.

• Residual effects of rickets

During this period of the disease, blood test parameters (biochemistry) normalize, the symptoms of the active form of rickets disappear, which, accordingly, indicates the transition of the disease to an inactive stage, that is, to the stage of residual effects. Muscular hypotonia and residual forms of deformation, which the skeleton was subjected to against the background of rickets, throughout long period time can be preserved.

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

Symptoms of rickets: muscular system

A decrease in muscle tone in children leads to the appearance of a “frog belly”, which is accompanied by its increase due to changes in muscle tone (the abdominal muscles in particular are in a relaxed state in this case). The pliability of the joints, highlighted above, can also be defined as “looseness”, because of this the child begins to walk later, and it is also possible for him to be unable to maintain his body in an upright position.

Symptoms of rickets: internal organs

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

Sources of Vitamin D

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

A separate point concerns constant information, which has been heard especially often in recent years, indicating the harm from exposure to solar radiation, as well as the risk posed by ultraviolet rays affecting the skin, cancer being considered as the main one of these risks leather in its various variations. Based on this, within official medicine There are corresponding calls for the need to limit exposure to solar radiation on the skin, which especially concerns children. Based on this, it can be considered as the main source of vitamin D. dosage forms, through the use of which the prevention of rickets is ensured. You can learn about certain options for this type of drug from the pediatrician treating the child.

Diagnosis and treatment

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

Treatment of rickets is determined, again, on the basis of the period of its manifestation, as well as on the basis of the severity of the course. It is based on the use of specific drugs, which include vitamin D. An equally important role is given to the issue of rational nutrition, sufficient time spent in the air is recommended, therapeutic exercises, massage, salt, sun, pine baths, and ultraviolet radiation are indicated. In addition, vitamin therapy and the implementation of measures aimed at achieving a general strengthening effect are indicated. For hypocalcemia, calcium supplements may be prescribed, and a citrate mixture may be indicated to improve its absorption by the intestine.

The prognosis for rickets for children is generally favorable (if they have suffered from the classic form of the disease). If treatment is not carried out, then irreversible changes develop, such as, for example, deformation of bone structures. Prevention of rickets consists of measures implemented both before and after the birth of a child.

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

A general ailment of the body that occurs when there is a disorder associated with insufficient content vitamin D, mineral metabolism Ca (calcium) and P (phosphorus).

This disease is characterized primarily by changes in the nervous, and to a greater extent, skeletal systems, as well as impaired absorption and metabolism of the minerals calcium and phosphorus.

The significance of rickets, according to scientists, is determined by the fact that in severe cases it slows down growth and further growth and can lead to irreversible modification of bones.

With this disease, the percentage of diseases associated with long-term upper respiratory tract infections increases.

Causes of rickets in children?

The causes of rickets in children have been known for a long time; it is a disease of

a wasting body. Often found in areas where there is not enough sunlight, in large cities, less often in villages and villages.

The disease is seasonal, most often occurring when there is little ultraviolet rays, and this is in winter and spring, which indicates a lack of sunlight as a causative factor.

Rickets is more common in children artificial feeding, also with a monotonous and unbalanced diet, for example, they are fed only cow's milk. Vitamin D is produced only under the influence of ultraviolet rays, so a lack of ultraviolet rays can lead to rickets. Found in food products: milk, eggs, butter, vitamin D, together with the influence of sunlight, covers the needs of adults for this vitamin, however, in children with rapid body growth, this need is increased.

Rickets usually affects infants (3-24 months), but it can develop earlier. With very poor care, as well as with special condition metabolism, this disease can occur in older children.

Symptoms and degrees of rickets in children.

Doctor consultation

Characteristic changes in a blood test taken from a vein are always: a very small amount of phosphorus, slightly reduced calcium levels and high activity of alkaline phosphatase levels.

With 1st degree of rickets in children.

• At around age, parents notice that changes occur in the baby’s behavior, he becomes more restless and irritable or, on the contrary, lethargic, profuse sweating occurs, itching appears, so he rubs the back of his head on the pillow and a bald spot forms, then the bones of the skull become thin and soft, and so thus the skull becomes flat.
• Due to the increase and growth of bone tissue, the frontal parts of the skull increase, parietal bones become in the form of tubercles, the skull takes on a square shape.
• With rickets, there is a delay in the eruption of teeth, as well as their random appearance in the future.

With 2nd degree rickets in children.

• In the second degree, swelling begins to appear in the area of ​​the ribs, which is visible upon examination, and “rachitic rosaries” are also visible.
• Changes occur, the chest is deformed and becomes like a chicken breast, which is fraught with serious consequences, as it negatively affects breathing.
• The spinal column also changes: if the child begins to sit down very early, the formation of kyphosis (stoop) and scoliosis (curvature to the right or left) may begin; pressure of the spine on the pelvis leads to the formation narrow pelvis associated with rickets, which in girls will later appear serious problem during childbirth.
• Quite early, bone growths that look like bracelets form in the wrist and ankle area.
• Later, when the child is a child, a whole chain of changes occurs in the lower extremities, that is, the legs take on an X-shaped and O-shaped shape, and therefore fractures can occur.

With grade 3 rickets in children.

• The most severe degree. Serious deformation of the shape of the bones occurs. One cannot but agree that such a child, pale and with a large “frog” belly formed as a result of weak abdominal muscles, evokes a feeling of pity and pain not only among the medical staff, but also among those around him.
• However, rickets is not only a disease skeletal system, and there is also a weakening of muscles, ligaments and joints, constipation often appears, hemoglobin in the blood decreases, the liver and spleen enlarge, such children are predisposed to frequent relapses of protracted upper respiratory tract infections.
• IN advanced cases Severe bone deformities can cause disability in children in the future.

How to treat rickets.

To treat the causes of rickets in children, vitamin D3 is prescribed - an aqueous solution of "Aquadetrim" in drops, the dosage is selected by the doctor, the approximate therapeutic dose is 6-10 drops, the course can last up to two months, then the dosage is reduced to preventive, this is 1 - 2 drops daily until summer, bright sun. The dosage must be strictly followed as prescribed by the doctor. severe violations can occur with an overdose of vitamin D or even when prescribed usual doses, due to individual increased sensitivity.

If, after prescribing and taking vitamin D, the child begins to eat poorly or refuses to eat at all, vomiting appears, combined with constipation, growth arrest, it is necessary to inform the doctor about this in order to undergo an examination.

The leading biochemical shift in this case is hypercalcemia; when making a diagnosis, it is important to establish the presence elevated calcium c and the presence of calcium in the urine using the Sulkovich test. The most important thing in treatment is to immediately limit calcium intake.

The first mentions of the symptoms of rickets in children have reached our days from the works of the two hundred years of our era, but the first scientific interpretation of this pathology was given five centuries ago by the English orthopedist Gleason. Children with rickets exist all over the world, but children of the Negroid race are most predisposed to hypovitaminosis D, and therefore to the development of rickets.

Diagnosis of rickets in a child and causes of the development of the disease in children

The severe disease rickets, also known as “vitamin D deficiency,” develops in conditions of prolonged vitamin D deficiency. Since in recent decades civilization has reached a fairly high level of development, since intermediate level life has become quite high, children, as a rule, are provided with food, which contains all the necessary substances; it is extremely rare that we observe the so-called “blooming” rickets. Speaking about the symptoms and treatment of rickets in children, we usually mean individual manifestations of this disease, which arose not so much in connection with poor nutrition, how much due to impaired absorption of nutrients in the intestine due to impaired absorption of vitamin D.

The main cause of the development of rickets in children is vitamin D deficiency or prolonged hypovitaminosis D due to impaired metabolism of this important vitamin. When the body lacks vitamin D, the intestinal absorption of minerals such as calcium and phosphorus salts is impaired. The named salts are building materials for bone tissue, and in conditions of their deficiency, bone tissue begins to suffer - bones soften and become deformed quite quickly. Other systems of the body also suffer - nervous, cardiovascular, hematopoietic, respiratory, muscular. Vitamin D can be formed in small quantities in the skin under the influence of sunlight (ultraviolet part of the spectrum). And too infrequent exposure of a child to the sun is one of unfavorable factors, which can contribute to the development of rickets. Vitamin D deficiency in the body can also develop as a result of certain intestinal diseases accompanied by impaired absorption of vitamin D. Such diseases include enterocolitis, celiac disease, etc. In some diseases of the pancreas and liver, poor absorption of vitamin D in the body also occurs. rare reason the development of rickets in children is a violation of the process of reabsorption of phosphates in the kidneys (this pathology is inherited). If a mother did not eat properly during pregnancy, her baby may subsequently show signs of rickets. Other causes of rickets are protein deficiency and insufficient intake of calcium and phosphorus salts into the body.

How does rickets manifest in a child: signs of the disease in children

How does rickets manifest in a child, and what are the main symptoms characteristic of this disease? One or another manifestation of this serious illness can be detected in a baby already in the third or fourth months of life. A sick child is restless, irritable, whiny, and fearful. One of the manifestations of rickets in children is sleep disturbance. Characteristic excessive sweating child. The mother may notice that the baby sweats most intensely on the head; Every time she takes the baby out of the crib, she discovers a damp spot on the pillow.

Gradually (if treatment has not been started) general condition the child is getting heavier. The child eats poorly, his subcutaneous fat layer becomes thinner and disappears, and you can see through pale skin bluish strands of veins. Also signs of rickets in children are increased and frequent vomiting. Shortness of breath and tachycardia are noted.

As you can see in the photo, with rickets children develop characteristic changes in the skeletal system:

During the disease, the bones of the skull soften (craniotabes); osteoid tissue grows; the large fontanelle does not close by the time it should close; there is deformation of the bones of the head; head size increases; tubercles appear - frontal, parietal; the back of the head becomes flattened; malocclusion occurs; the bridge of the nose sinks (and at the same time exophthalmos develops); gradually gains irregular shape chest (as if compressed from the sides, with the sternum directed forward, it resembles a chicken breast, which is what it is called “chicken breast”); “rosary beads” are formed on the ribs, which are small thickenings.

In children suffering from rickets, the tubular bones of the lower extremities also suffer over time: When a child begins to walk, the legs bend under the influence of the body weight. If the bones bend outward, a 0-shaped curvature is visible; if the bones bend inwards, an X-shaped curvature develops.

Look at the photo - characteristic symptom Rickets in children is flat feet:

A rachitic child may experience bone fractures when falling (for healthy child early age fractures are uncommon). With rickets, the spine is bent - like kyphosis or lordosis. The bones of the wrists and ankles thicken. The pelvic bones become flatter.

A child suffering from rickets erupts teeth very late. The tone of the abdominal muscles and smooth muscles of the intestines with rickets is reduced, as a result of which the baby’s abdomen is enlarged in size; Such a belly of a rickets child is called “frog-like.” The baby's stool is abundant; there are frequent constipation or, conversely, diarrhea. The child may experience seizures. The body's resistance during rickets is significantly reduced; rachitic children are more likely than other children to develop pneumonia and tuberculosis.

Due to impaired tone of the respiratory muscles and due to deformation of the chest, the child’s ventilation of the lungs is impaired, and breathing suffers from this. Areas of atelectasis may form in the lungs. One of the complications of rickets in children is frequent pneumonia, and these diseases are very severe. A child suffering from rickets often exhibits anemia.

Treatment of children with rickets

For successful treatment rickets in children great value has the earliest possible diagnosis of the disease. If rickets has not yet developed strongly, it will be easier to cure. And, what is very important, when timely treatment Rickets in young children has fewer irreversible consequences. Treatment - long-term and complex - is prescribed by a doctor.

Features of treatment depend on etiopathogenetic factors and the severity of the disease. A sick child must be provided for good nutrition. Regular exposure of the baby to the sun is important, fresh air.

When a child is diagnosed with rickets, if the disease has developed as a result of hypo- and avitaminosis D, this vitamin is prescribed in therapeutic doses. In those cases where the cause of the disease is a malabsorption of vitamin D in the intestine, the diseases that led to the malabsorption are first treated.

Children who have developed rickets due to impaired reabsorption of phosphates in the kidneys are treated by introducing phosphates and vitamin D into the body.

Below are photos of symptoms and treatment of rickets in young children:

How to treat a child suffering from rickets using folk remedies

• take the child a decoction of the herb trifid; Preparation of the decoction: pour 1 tablespoon of dry herb with a glass of water, boil over low heat for no more than 15 minutes, then, wrapped in a towel, leave for 3-4 hours, strain; take 1 tablespoon 3 times a day;
• take equal quantities of white cabbage, carrots and beets, boil for about half an hour; child infancy take the decoction several times a day;
• take your child an infusion of walnut leaves; preparing the infusion: place 1 tablespoon of dry, crushed leaves in a preheated container, pour a glass of boiling water and, wrap it up, leave for about an hour, strain; take 1 teaspoon 3 times a day before meals;
• give the child general warm baths with decoction added to bath water oat straw; preparing the decoction: cut 1 kg of dry straw into smaller pieces and add a bucket of water, boil for at least half an hour, strain, pour the resulting decoction into the bath;
• give the child general warm baths with infusion added to the bath water pine needles; preparing the infusion: pour 50-100 g of dry pine needles into a bucket of water and leave for at least 8 hours, then strain and add to bath water; alternate with baths with the addition of other products;
• a child of the first year of life regularly takes general warm baths with the addition of a decoction prepared from the following mixture of plant materials: Scots pine needles - 1 part, hay dust - 1 part, oat straw - 1 part, walnut leaves - 1 part, rhizomes with the roots of calamus - 1 part; preparation of the decoction: 200-300 g of the dried mixture, crushed to a powder, pour 1-2 liters of boiling water and heat in a boiling water bath for at least 15 minutes, then leave the product in a sealed container at room temperature for about half an hour, strain through 1-2 layers of gauze, squeeze out the remaining raw materials, pour the finished broth into bath water, stir; take the procedure at a water temperature of 36-37.5 ° C; duration of the procedure - no more than 8 minutes; You can add table (iodized) salt to the water for a full bath with a decoction of this mixture in the amount of 50-80 g per 10 liters of water.

Prevention of rickets in young children

To avoid having to resort to treatment for rickets in children, disease prevention comes to the fore. Even during pregnancy (in the last few months of pregnancy), a woman is given vitamin D for prophylactic purposes. To prevent the development of rickets in an infant, a nursing mother should take this vitamin. If the mother takes vitamin D regularly (in doses agreed with the doctor), then the child receives the vitamin through breast milk and does not suffer from hypovitaminosis.

Children who are on mixed or artificial feeding are given vitamin D in the form of one of the preparations - and strictly in the dose calculated by the pediatrician. Vitamin D supplementation for preventive purposes is carried out continuously throughout the entire first year of the baby’s life.

The prevention of rickets in young children with fish oil is very effective. The latter contains vitamins A and D2 in fairly large quantities. Prevention of rickets with fish oil is carried out as follows: the child is given fish oil for a month, then a two-week break is taken, after which the administration of fish oil is resumed.

Regularly taken by the baby sunbathing will also help him avoid rickets. It is best to sunbathe in the morning and evening, when the spectrum of sunlight contains more ultraviolet rays and less infrared rays. It is impossible to sunbathe at home near a closed window because ultraviolet rays do not pass through the glass. In winter, the child can be irradiated with a quartz lamp. When walking with your baby during the cold season, you need to make sure that sunlight got on the baby's face. Exercise and massage are helpful.

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We are accustomed to considering rickets as a unique disease of its kind, caused by a significant lack of vitamin D in the body and, accordingly, a deficiency of its active derivatives. In fact, this is a group of diseases provoked by a violation of mineral metabolism, primarily reduced content calcium and phosphorus in blood plasma. And the reason for this condition is a deficiency of many substances coming from outside or synthesized in the body.

As a result of salt imbalance, the formation of bone tissue is disrupted and the functions of many internal organs are affected. Pathology occurs both in childhood, and in adulthood. But today we will talk about the classic form of rickets, which mainly affects children: almost half of children under the age of three experience single or multiple symptoms of the disease. Rare forms the diseases are hereditary in nature, are much less common, and doctors unanimously included them in the list of rickets-like diseases.

Classic rickets develops during a period of active human growth, which means that the most striking symptoms occur in infants and young children. Let's figure out why this happens, why the disease is dangerous, and how you can protect your little one from it.

The basis of bone tissue is calcium phosphate. It is formed as a result of complex physical and chemical processes. A regulates salt metabolism not only vitamin D, but also A, group B, C, E, thyroid hormones and parathyroid glands, the concentration of the minerals themselves, the rate of their elimination from the body, and the quantity and quality of transport proteins also play a role.

As a result of a breakdown at at least one of the stages, either a sufficient amount of calcium phosphate does not enter the bone or it is washed out into the blood to maintain internal homeostasis (for the functioning of more important structures). Bone tissue becomes loose and soft or, conversely, processes of perverted synthesis begin in it. The main symptoms of the disease are associated with this.

Causes of rickets and risk factors

Knowing the causes of the disease, you can determine the risk factors for the development of classic rickets.

Risk factors

During pregnancy:

• toxicosis, but more often;
• pathology of the formation and functioning of the placenta;
• renal or hepatic pathology, hypovitaminosis D in a pregnant woman;
• physical inactivity and insufficient insolation during the gravity period;
• short break between pregnancies;
• mother's age is too young.

After birth

• genetic predisposition;
• —prematurity—and low weight, accompanied by immaturity of enzymatic systems for processing vitamins;
• rapid growth in weight and size bone skeleton;
• exhausting chronic diseases, pathology of the respiratory tract leading to hypoxia;
• unbalanced diet;
• birth during the season of insufficient insolation (autumn, winter);
• drug deficiency, hypocalcemia and hypophosphatemia.

What are the signs of rickets in children

After you become familiar with clinical signs diseases, you will understand that many of them are familiar to you from your own children, nephews, neighbor kids... The disease is polysymptomatic, but a certain sequence of the appearance and progression of symptoms can still be traced.

The first signs of classic rickets appear in infants 2-3- one month old, and are characterized by changes in the function of the autonomic nervous system:

• anxiety;
• poor sleep;
• flinching;
• sweating of the skin on the back of the head (the child subconsciously wipes himself on the pillow, as a result of which this area becomes bald);
• sweating of the body skin, complicated by prickly heat, itching and increased skin sensitivity.

At the same time, signs of changes in bone tissue appear, with the rapidly growing parts of the skeleton being affected first:

• during the first 3 months of life, signs of damage to the skull become noticeable;
• from 3 months to six months, the chest and torso are involved in the process;
• as soon as the load appears on the legs, they also suffer (from 6 months).

The nature of bone damage depends on the course of the pathology:

• in the acute period, the phenomena of softening and, accordingly, deformation predominate;
• in subacute – excessive synthesis of non-calcified bone tissue.

And now directly about the signs of classic rickets in children under 1 year of age.

Head

During the period of intensive growth of the skull bones, the baby mainly lies down, and as the bone tissue softens, flattening forms in the corresponding places, leading to deformation and asymmetry of the head. The fontanelles heal slowly (up to 2 years), their edges soften and become pliable. In the subacute period, the frontal and parietal tubercles grow, giving the head a square shape.

At an older age, normal parameters of the head are restored, but late appearance teeth. Subsequently, such children are much more prone to caries than healthy ones.

Rib cage

In acute cases, as a result of increased softness, flattening is formed in those places where the load falls. Usually this is:

• lateral depressions of the ribs with protrusion of the sternum in the form of a keel and curvature of the clavicles (with frequent lying on the side);
• transverse depression along the anterior surface of the chest at the level of the attachment of the diaphragm, curvature of the spine backwards or to the sides (when sitting).

The growth of bone tissue is manifested by the so-called rosary - thickenings in the shape of large beads at the junction of the bone and cartilaginous parts of the ribs (along the lateral edges of the sternum).

Limbs

As a result of softening of the pelvic bones, the latter becomes flattened. When bone tissue is damaged, children who begin to stand or walk develop curvature of the legs with a bend in the knee area outward (in the shape of the letter O) or inward (letter X).

With excess synthesis, thickenings appear in different places:

• together wrist joint– “rachitic bracelets”;
• in the area of ​​the finger phalanges - “strings of pearls”;
• above the ankle joint.

All these signs of rickets in infants are clearly visible in the photos presented in any relevant literature.

Muscles and joints

Their defeat is also characteristic of pathology. The muscles become flabby and sluggish, and cannot keep the joints toned. Joint looseness appears, and the child can unnaturally straighten his limbs, bend his fingers, throw his leg behind his head (like a gutta-percha boy). Flabbiness of the abdominal press is manifested by a large “frog” belly and divergence of the rectus muscles.

Other signs

A severe course, in addition to damage to the central nervous system and bone skeleton, is characterized by enlargement of the liver, lymph nodes and spleen, disruption of the cardiovascular and digestive systems. Thoracic deformity and weakness diaphragmatic muscle gradually lead to impaired ventilation of the lungs, which increases the risk of development.

Why is rickets dangerous?

A mild course with mild changes in the nervous and skeletal systems does not pose a danger, except that babies later begin to roll over, sit, crawl, stand and walk, they erupt teeth later than usual and have a weakened immune system. But after moderate and severe forms, persistent residual effects can be observed for up to 2-3 years, in the worst case – lasting a lifetime:

• developmental delay;
• bone deformities;
• flat feet;
• myopia;
• liver enlargement;
• signs of immunodeficiency;
• caries;
• enlarged spleen.

What tests are needed to make a diagnosis?

1. An experienced pediatrician only needs to look at the child to make a diagnosis. But to treat pathology and monitor therapy, it is necessary to accurately know the level of minerals in plasma and urine, as well as the degree of damage to the skeletal system. To do this, a biochemical blood test is performed and X-ray examination. Blood is taken on an empty stomach, preferably in the morning. No specific preparation is required for x-rays.
2. If you suspect moderate and severe degree carry out a comprehensive examination, including ultrasound, to clarify the condition of internal organs and identify possible reason diseases.

How to treat rickets in a child

For pathologies of mild to moderate severity, it is not necessary to be treated in a hospital. The entire course can be completed on an outpatient basis. Severe damage requires constant medical supervision; it is treated under the control of calcium and phosphorus levels in the blood and urine, and, depending on the tests, the dosage of drugs is adjusted.

Regardless of the severity of the symptoms of rickets in children, doctors prescribe drug (specific) therapy and nonspecific treatment (daily routine and diet).

Nutrition and daily routine

1. Diet therapy consists of correcting the nutrition of the nursing mother, and after the introduction of complementary foods, of the child.
2. To stimulate the synthesis of vitamin D in the skin, frequent and long walks are recommended (only not under direct sun rays). They also contribute to better aeration of the lungs. And when the child learns to walk, even with outside help, he is prescribed an enhanced motor regimen.
3. Not earlier than 21 days from the start drug therapy full body massage and physical therapy are prescribed (passive for the smallest, i.e., active for older children).
4. They also resort to appointment medicinal baths(coniferous for easily excitable children and saline for passive ones).
5. Thermal procedures in the form of paraffin applications or warming with sand.

Drug treatment of rickets

Of course, these are vitamins, primarily D, and calcium supplements (in the acute stage), magnesium, and potassium. If there are signs of damage muscle tissue and parenchyma of internal organs, symptomatic therapy is indicated (ATP, antianemic drugs, etc.). The course of treatment lasts 1-1.5 months. The dosage of drugs for specific therapy depends on the severity of the pathology.

After completing the course, the child is given a citrate mixture for a month, although it can be prescribed in small doses simultaneously with vitamin D. The last stage of treatment is ultraviolet radiation, carried out in courses with a break of 1.5-2 months. If signs of relapse of the disease appear, a second course is possible no earlier than 3 months after the end of the first (not in summer).

Is it possible to get vaccinated for rickets?

Pathology mild degree severity is not a contraindication to vaccination. Moreover, one of its complications may be immunodeficiency. And when vaccines are administered, the child’s immunity begins to activate.

For moderate and severe cases, vaccinations are delayed until full recovery baby (3 months after the disappearance of active signs of the disease).

How to protect your child from rickets

Prevention of rickets in children begins in the prenatal period. Pregnant women are advised to eat a balanced diet, motor activity, fresh air. If there is a hereditary predisposition, vitamin D is prescribed after the 7th obstetric month or ultraviolet radiation in the autumn-winter season (up to 20 sessions).

After birth, it is recommended to breastfeed the baby or with adapted formulas, walk in the fresh air, do massage and do gymnastics. In the risk group they carry out specific prevention, prescribing vitamin D from one month of age. Older children are prescribed a diet that requires lactic acid products, butter and vegetable oils in their dishes, egg yolk, liver, sea ​​fish. These foods are rich in calcium and vitamin D.

Be a support and support for your child from the first days of life. Affectionate communication, maternal and paternal care will give him confidence. He will be less capricious, willingly eat and walk in the fresh air with his loved ones.

Video: drug prevention of rickets

From a short video you will learn the name of a specific drug, its time prophylactic use and contraindications for use.

In our country, children rarely develop severe forms of rickets. But we can see signs of a mild form all the time. That's why you were asked brief description pathology. If you know even more about it, share your knowledge in the comments.

Rickets is a disease associated with insufficient quantity vitamin D in the newborn's body. Alas, it still occurs in our kids. The disease is dangerous for the little man, since his calcium-phosphorus metabolism is disrupted. Noticing symptoms in time and starting treatment is the primary task of parents and doctors.

What is rickets in children under one year old? Stages of disease development

The formation of the baby’s bone tissue, which began in the womb, continues throughout the first year after birth. If there is a lack of vitamin D, a baby may develop rickets - a dangerous childhood disease accompanied by softening musculoskeletal tissue. As a result, the child’s bones become bent and the normal operation a number of internal organs.

Rickets can be recognized by a number of signs

1. This includes softening around the large fontanelle of bone tissue , enlargement of the frontal tubercles and thickening of the occiput. Subsequently, the bones begin to bend.
2. The functioning of the central nervous system begins to malfunction . The baby often cries, gets scared for no reason, and becomes lethargic.
3. The child develops unexplained sweating . The baby's head is often wet, usually after feeding or sleeping.
4. Weakening muscle tone , manifested in flabbiness of the muscular system;
   appearance skin itching and hair loss.
5. Slowing down of physical development.
6. Late teething.
7. Dense formations on the ribs baby (rickety rosary).

The first symptoms of the disease can appear as early as 2-3 months. Sometimes children are already born with initial signs of rickets.

The disease is divided into 3 stages

• Light form when minor changes are noticeable in the muscle tissue. The disease lasts from a week to a month, then moves into the next stage. With timely treatment, it goes away without consequences for the baby’s health.
• Average when deformation of the baby’s limbs and skull is clearly noticeable.
• Severe form manifested by softening and deformation of the bones not only of the limbs, but also of the chest. At the same time, it is difficult for the baby to breathe; he has a disorder in the functioning of all internal organs.

Why was the child diagnosed with rickets? Let's understand the reasons

Why in our time, when it is not difficult to replenish the body with missing vitamins and minerals, are children still diagnosed with rickets?

Certain categories of children are primarily at risk

• Premature babies in whom, due to the underdevelopment of a number of body functions, the absorption and assimilation of vitamin D is difficult.
• Big kids born with a large weight and requiring high content vitamins of group D in the body.
• Kids deprived breast milk and those receiving a diet that lacks phosphorus-calcium elements.
• Children who are breastfed by their mother , but at the same time she herself is not eating properly, which is why there is a lack of substances in the milk that ensure the healthy development of the baby.

It may happen that the diagnosis is made incorrectly, based on only one of the signs. To complete the picture, the doctor must prescribe a series of tests to determine the levels of calcium and phosphorus in the blood and the activity of alkaline phosphatase.

They allow you to clarify the diagnosis and x-ray and ultrasound data.

The signs by which a doctor diagnoses rickets may correspond to others that are no less dangerous. Therefore, in order to understand exactly what the little person is sick with, accurate diagnosis is so important.

What are the signs of rickets in a child under one year old?

The first symptoms of the disease appear already at

1. The child is often naughty , and sleeps little.
2. If you carefully examine the large fontanelle and feel its edges, you will notice noticeable thinning of bone tissue .
3. The child has increased sweating , which is accompanied by a sour smell, as well as itching, especially in the back of the head. The baby experiences discomfort and rubs his head on the pillow. At the same time, his hair wears out.
4. Rickets manifests itself slowing bone growth , especially the legs. The baby will experience growth retardation and distortion of body proportions.
5. Possible muscle hypotonia or loose joints, an increase in the size of the tummy.
6. Decreasing physical activity crumbs , the child becomes lethargic and phlegmatic, eats poorly.

Later manifestations of rickets include deformation of the limbs . The baby's legs are bent, forming the letters O or X. In the area of ​​the legs and forearms, rachitic bracelets are observed - thickenings on the bone tissue.

Children who have rickets, lying on their backs, easily pull their legs towards their heads and can even put their heels on their shoulders.

How to treat rickets in infants

If the diagnosis of the disease is confirmed, treatment should be started immediately.

You need to start with nonspecific forms of treatment - right balanced nutrition and regime

• The baby should walk in the fresh air at least 4 hours a day . In spring and summer, he needs to be in the sun more often.
• The best food for a baby is mother's milk , which contains the required amount of phosphorus and potassium. If breastfeeding is not possible, you need to use formulas adapted to the child’s body and containing a full range of vitamins and microelements necessary for the baby.
• A sick child needs to be given complementary foods on time. from one-component puree (broccoli, zucchini), gradually add butter and vegetable oil, fruits, juices, cereals, vegetables, cottage cheese and meat products to baby food.
• Daily baths with pine extract are beneficial for children or saline solution, calming the nervous system and supporting the immune system.
  Massage and hardening will help you cope with the disease faster.

Drug treatment is carried out as prescribed by a pediatrician and under his supervision. The baby is prescribed medications that contain vitamins D, calcium and phosphorus.

IN lately Doctors prefer to prescribe vitamin D in the form aqueous solution, since it is absorbed more quickly into the baby’s blood and does not lead to gastric disorders. (Aquadetrim). Oil solutions (Videhol, Vigantol or other drops) are prescribed to children if they are allergic to aqueous preparations.

These drugs regulate the exchange of phosphorus and calcium in the body and promote the formation of bones and teeth.

When treating a baby, it is important to strictly follow the dosage of the medicine that the attending physician prescribes, based on the stage of the disease. For each child, the dose is selected individually. This takes into account age, heredity, diet and other factors.

As a rule, the daily dose of the drug is from 2 to ten drops. Treatment is started with a minimum dose, gradually increasing it to a therapeutic norm that can produce a therapeutic effect.

If taking vitamin D does not lead to the desired result, it means that the baby is lacking not only this drug, but also other vitamins. In this case, he is prescribed multivitamins (Biovital gel, Multitabs and other children's vitamin preparations).

For comprehensive treatment of rickets, the baby is prescribed physical therapy and massage sessions, which are selected based on the child’s condition and the stage of the disease. Therapeutic massage activates metabolic processes in the skin. This helps the baby’s body produce vitamin D.

When carrying out therapeutic exercises, you need to remember that a sick baby gets tired quickly, so it is advisable to strictly dose the exercises.

Exercise therapy classes must include exercises that develop correct breathing. To do this, for very young children, lightly press on the chest, for a grown-up baby, pressure is combined with crossing the arms.

Since children with rickets become easily excitable, more stroking exercises are used during massage sessions, reducing or eliminating percussive and patting techniques.

Prevention of rickets in babies under one year old

Prevention of rickets should be done not from the first days of a child’s life, but while he is still in the womb. Then the likelihood of the disease occurring will be minimized. The exception is congenital rickets, when the mother’s pregnancy is very difficult, for example, with a prolonged period of toxicosis.

In other cases, if the mother walked a lot during pregnancy, did physical exercise, ate well and took multivitamin complexes, the baby’s body received everything necessary for its healthy development even before birth. Among such children, the incidence of rickets is significantly reduced.

Preventive measures to prevent rickets in infants are carried out from three weeks of age. At this time, the pediatrician prescribes 2 drops of Aquadetrim per day to the baby.

In addition, doctors recommend taking a urine test (Sulkovich test) once a month to determine the amount of calcium in it. This study should not be neglected, since with nonspecific prophylaxis there may be an overdose of vitamin D. This is also harmful for child's body as its disadvantage.

Dr. Komarovsky advises as preventive measures Children from 6 months of age should take baths with sea salt.

It is impossible to leave rickets without attention and treatment, since the consequences of this unsafe disease will persist in a person for life, making its own unpleasant and sometimes unsafe adjustments. Start taking care of your baby from the first days of pregnancy!

Proper nutrition for a pregnant woman, nursing mother and child is the key to the baby’s health and prevents the development of rickets.