Rickets 1st degree subacute course. Rickets in infants

Rickets is a disease characteristic of young children, which manifests itself when there is insufficient intake of vitamins belonging to group D into the growing children's body. These vitamins are very necessary for children, since they help maintain the norm of calcium and phosphorus. The latter are an integral element of the full functioning of the nervous system and the development of bone tissue.

Rickets occurs in babies who lack vitamin D

Causes of rickets

The causes of rickets are:

Not sufficient quantity sun (ultraviolet rays help produce vitamin D) - for example, in autumn - winter, especially in the city, there is little sun, which is why few D vitamins are formed;
- maternal illness during pregnancy (for example, gestosis);
- difficult childbirth;
- artificial feeding, excessive amounts of cereals (slow down the absorption of calcium by the intestines);
— insufficient motor activity (reduces blood supply to the legs);
- other diseases of the child (for example, an abnormality of the kidneys, when they secrete an excessive amount of phosphate into the urine, which leads to its decrease in the body. The lack of phosphates leads to weakening of the bones, or gastrointestinal diseases, when the absorption of calcium and phosphorus is difficult);
- dark skin of the child (reduced production of vitamin D by the body).

Remember that rickets is not congenital; it always develops against the background of an illness. Regardless of the causes, the signs of rickets in children are the same, and the symptoms of rickets in children appear extremely early, already in the first year of life. The manifestation of symptoms of rickets depends on the stage of development of rickets.

Stages of disease development

There are several stages in the development of rickets in children:

1. Elementary
2. High period
3. Convalescence stage
4. Residual effects

At 2-4 months, children usually experience the initial stage of rickets. Signs of rickets at 4 months are:

- decreased activity;
- increased excitability;
- baby's anxiety;
- loss of appetite;
- bad sleep;
- the baby rubs his head on the pillow - this is how bald spots appear;
- increased sweating;
- urine and sweat are characterized by a sour odor.

Signs of rickets in premature infants appear as early as 2-3 weeks of age. In this case, the symptoms of rickets are also caused by disorders of the central nervous system and autonomic changes. The following signs of rickets appear in premature infants:

Babies with rickets develop bald patches

- restlessness, moodiness;
- with loud sounds - flinching;
- increased irritation from bright light;
- sleep disturbance;
- sweating (especially of the head);
- bald patches on the back of the head;
— after a few weeks, the bones of the skull soften and muscle tone decreases.

The initial period of rickets in infants lasts up to a month, and then progresses to its height.

The peak period is characterized by changes in skeletal systems e, which are enhanced compared to initial stage rickets. Signs of rickets in infants during this period are bone deformations, namely:

Deformation of the skull (asymmetry of the head shape, flattening of the occiput, enlargement frontal bone);
- deformation of the chest (it bulges or is pressed in, the places where the bone tissue transitions into cartilaginous tissue become denser);
- deformation lower limbs(if the child stands and walks, then curvature of the leg bones is possible);
- curvature of the spine.

The convalescence period is a period of gradual recovery. There is an improvement general condition in children - work normalizes cardiovascular system, respiratory system, pass neurological, autonomic disorders, phosphorus levels are normalized, alkaline phosphatase, there is uneven compaction of bones in their growth zones.

Residual effects are the consequences of rickets in children under one year of age, which remain virtually for life and are noticeable in adults.

Degrees of rickets

There are also three degrees of severity of rickets, which manifests itself in children:

• 1st degree – the severity of the disease is mild;
• 2nd degree – moderate severity;
• Stage 3 is the most severe degree of the disease.

Rickets of the first degree. Rickets of the 1st degree at 2-3 or 3-4 months of a child’s life is characterized by symptoms of rickets from the head, at 4-6 months - from the chest, and after 6 months - deformation of the limbs and spine.

At 3-4 months, children with 1st degree of rickets experience a symptom called “craniotabes” - this is a symptom of rickets caused by thinning of the internal surfaces of the bones, and also the symptoms of rickets in infants become softening of the parietal, occipital bones, and sometimes the frontal, parietal tubercles. At 4-6 months, children with 1st degree of rickets experience changes in the chest:

- “rib rosary” (look like thickenings in the places of transition from bone tissue to cartilaginous tissue, squeezing from the sides of a child’s chest);
- “Harrison's groove” (appears from the fact that the chest is retracted at the site of attachment of the diaphragm).

Rickets of the 1st degree is characterized by severe muscle hypotonia and the absence of disturbances in psychomotor development.

Rickets of the second degree. Average severity of rickets (grade 2) is characterized by:

Rickets causes severe skeletal deformities in children

Diagnostics

Diagnosis of rickets disease in children is carried out by using laboratory methods studies that determine the content of calcium, phosphorus, vitamin D metabolites in the body, and the activity of alkaline phosphatase in the blood. X-ray studies examine the epiphyses tubular bones. In addition, diagnosis is also based on medical history, symptoms of damage to the muscular, nervous, and skeletal systems of the body, and the state of psychomotor development.

Treatment of rickets

Remember that if you suspect the first signs of rickets, you should immediately consult a doctor, whose prescribed treatment will help avoid worsening the development of the disease.

Drug treatment the occurrence of rickets in children includes the use of vitamin D preparations and its metabolites. Doses of medications are prescribed exclusively by a pediatrician, who takes into account the severity and course of rickets in a particular child. Sometimes, in in some cases(for example, frequently ill children) undergo specific treatment for rickets - these are anti-relapse courses prescribed 3 months after the end of the main course.

Medicines prescribed for rickets: capsules 500 mg, dragees 500 IU, aqueous solution vitamin D, or tablets 50 mcg, oil solution 0.25%. In addition to vitamin D, vitamins B2, A, B6, E, a citrate mixture, magnesium preparations, Asparkam, and preparations with phosphorus are also prescribed. Also required therapeutic massage, sea salt baths or pine extract, exercise therapy.

When treating rickets in children, massage is of great importance.

Massage is very important for rickets, as it activates metabolic processes, improves tissue trophism, and strengthens the muscular and skeletal systems. The massage must be carried out in a gentle manner, since with this disease the bones are softened and brittle.

A child with rickets is prescribed a regimen appropriate for his age, which takes into account maximum exposure to fresh air. When walking, the child's face must be open so that ultraviolet rays promote the production of vitamin D3 in the skin.

To prevent the occurrence of bone deformities, the child should be placed on a hard and flat playpen (for example, on a sheet of plywood suitable for the size of the crib). Such activities are especially important when children are awake. You need to encourage your child to motor activity, toys are used for this, for example.

Prevention of bone deformities also requires limiting prolonged sitting or standing for children (if such skills already exist). There is also no need to sit the child down or put him on his feet if he does not know how to do this.

Diet for rickets

Children suffering from rickets are prescribed special diets. The best option is breastfeeding. To reduce acidosis, children are prescribed a diet in which vegetable and fruit dishes predominate. For example, children already 5 months old can cook porridge with vegetable broth (rice, oatmeal, buckwheat). You can use porridges rich in iron, microelements, and vitamins that do not require cooking.

Vegetable purees are also prepared, where the use of zucchini, cabbage, cauliflower, carrots, pumpkin, turnips, and some potatoes is recommended. It is important to give children the proteins they need, which can come, for example, from meat, cottage cheese, yolk, fish, green peas). Yolks should be given to children from 5 to 7 months (half a mashed yolk). A child with rickets begins to be fed minced meat one and a half months earlier than a healthy one. If the child is artificially fed, use modern adapted formulas.

Prevention

Although no one dies from rickets, the prospect of leaving a child, in case of untimely treatment of rickets, disabled for life, is far from better. So parents need to take the prevention of rickets in infants seriously. Start preventing the disease even if there are no signs of it - this way you will protect your baby from possible illness.

It is necessary to begin the prevention of rickets during pregnancy

It is necessary to start preventing rickets even before the baby is born - for example, especially in the third trimester, a pregnant woman must receive a sufficient amount of vitamins, and most importantly, vitamin D. Then the child will have time to stock up on enough of this substance, which after birth will help him develop normally.

Vitamin D expectant mother will be obtained by walking in sunny weather, as well as by eating right. From 32 weeks of pregnancy, it is recommended to take 500 IU of vitamin D daily. This should not be done before the 32nd week, because an excess of the vitamin will harm the placenta (therefore, modern multivitamin preparations should also be taken in the third trimester).

If pregnancy is complicated by some disease, the dose of vitamin D is increased, but only on the recommendation of a doctor. Prevention of rickets in infants begins from the first days of life. The first three weeks, when the baby has accumulated a sufficient amount of vitamin D, requires nonspecific prevention:

- breastfeeding or special adapted formulas are necessary;
- avoid meals with large amounts of carbohydrates (unadapted mixtures), which only aggravate rickets;
- a nursing mother needs to take multivitamin preparations that enrich breast milk minerals, vitamins;
- the child needs air baths, gymnastics, massage, hardening - they stimulate the development of the musculoskeletal system;
- all year round (2-3 years), full-term healthy children at minimal risk of rickets should take 500 IU;
- For premature babies, to prevent rickets, certain medications are prescribed by a doctor, who determines the dose and prescribes calcium supplements.

Folk remedies for rickets

How to treat rickets in infants is also suggested traditional medicine, which has an abundance of folk methods used for rickets. We offer such folk remedies in the treatment of rickets:

- a decoction of the tripartite series, taken by the child three times a day in a large spoon. The decoction is prepared as follows: a large spoonful of herbs is boiled for about 15 minutes in a glass of water, infused for 3-4 hours, then filtered;
- peppermint infusion (a tablespoon of leaves is infused in a glass of boiling water for about half an hour, then filtered, and then taken three times a day, a teaspoon, each time half an hour before meals;
- infusion walnut(its leaves), which is prepared as follows: place a tablespoon of leaves in a preheated bowl, pour in a glass of boiling water, then leave for up to an hour, filter. Children take this infusion three times a day before meals;
- prepare a decoction of carrots, white cabbage, beets, which are boiled for about an hour, and then children take it several times a day;
- decoction of strawberry herb (two teaspoons of chopped strawberry herb are boiled in a glass of water for about 15 minutes, then drunk like tea, half a glass at a time). In addition, you can eat berries;
- burdock decoction (a tablespoon of burdock is boiled for about 15 minutes in a glass of water, and then consumed three times a day, a large spoonful);
- burdock root juice (drink fresh three times a day, 25 drops).

With decoctions of oat straw (a kilogram of chopped straw is boiled in a bucket of water for about an hour, filtered, poured into the bath);
- with a decoction of hay dust (200-300 grams of hay dust is boiled for up to 15 minutes in three liters of water over low heat, then filtered and poured into the bath;
- with an infusion of pine needles (50-100 grams of dry pine needles are infused for about 8 hours in a bucket of water, then filtered and added to the bath). This bath is alternated with baths using other means.

Another remedy is eggshells. Hungarian doctors have found that egg shells contain a lot of calcium carbonate, which is well accepted by the child’s body. The shell also contains other necessary microelements - copper, fluorine, sulfur, phosphorus, iron, zinc, molybdenum, silicon. Eggshell is identical in composition to human bones and teeth, improves hematopoietic function bone marrow. Take the remedy from eggshells Recommended for children after one year of age, when a constant supply of calcium is required. To prepare eggshells for use, you need to hard-boil the eggs, then grind the shells in a mortar. The child should be given this powder three times daily. Depending on age and weight, the dosage ranges from 1 to 3 grams.

Video

The diagnosis of “rickets” made by a doctor to a 3-4 month old child takes parents by surprise. Despite the fact that many people have heard the name of the disease, few can accurately determine its symptoms. A detailed study of the disease, finding out the reasons leading to the unpleasant diagnosis, and effective methods of treating the disease will help dispel the doubts and anxiety of parents.

The diagnosis is made exclusively by a specialist based on clinical picture and research

What is rickets?

Doctors mean by rickets a disorder in the development of a child’s bone tissue. Failures in the metabolic process of phosphorus and calcium lead to a lack of vitamin D; the child’s intestines poorly absorb calcium ions, which affects the baby’s bones. Their gradual demineralization and curvature occur, acquiring large volumes when the treatment of the disease is neglected. Changes can last a lifetime if not stopped early.

Progressive changes cause osteomalacia (softening of bones) and osteoporosis (thinning of long bones). All these negative processes lead to noticeable curvature of the bones.

Rickets in infants is often diagnosed at a very young age, at 2-3 months. Rickets is detected in children even at 2 years of age, but children under 1 year of age are most vulnerable to the painful disease. Much in the fight against rickets depends on the parents, so it is important for them to know both its causes and the symptoms of the disease.

Causes of disease in infants

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How much vitamin D a child’s body needs depends on many factors - there is no single standard. When calculating the indicator of an element, doctors take into account the specific nutrition of children, their place of residence, climatic conditions, characteristics of the child’s body, race, and weight. People living in the north of the country receive less sun than those living in the south. Obviously, their production of vitamin D is different. Let's look at common factors that contribute to the development of rickets.

If a child grows up in northern latitudes, he may have a lack of vitamin D

What are the main reasons?

The risk of developing rickets exists at any stage of a child’s development. The causes of the development of the disease can be:

• Artificial feeding, when the baby is given formula with insufficient amounts of calcium, vitamin D and phosphorus. Breastfed babies suffer less from rickets because they receive all these elements in sufficient quantities from mother's milk. Today there are many types available baby food with a rich content of three essential elements, but imperfect digestive system crumbs may not digest them well.
• Premature birth. Premature baby suffers from enzyme deficiency and metabolic problems, which leads to unstable absorption of vitamin D even when the baby gets enough of it.
• Colds. When you have a cold, the need for vitamin D increases, and it is absorbed more slowly. In addition, children are taken outside less, which affects the level of insolation (the child’s exposure to sunlight).
• Genetic predisposition. Poor absorption of vitamin D may be hereditary. Hypothetically, experts note that rickets is detected more often in children with blood group II. A tendency has also been established that boys suffer from the disease more often than girls.

Who is at risk?

Especially for parents, we have compiled a list of signs according to which children may be at risk for predisposition to rickets. Let's consider them:

• Babies with overweight, for which it is difficult to calculate correct dose vitamin D

Overweight children absorb vitamin D worse

• Children who receive little ultraviolet radiation. Most of the vitamin enters our body through sunlight. A child born in winter or autumn does not receive enough of it. The body also receives little ultraviolet radiation when walking on the balcony: glass prevents the full penetration of ultraviolet radiation. Only when it comes into direct contact with the skin does proper absorption of vitamin D occur.
• Dysbacteriosis. Microflora disturbances lead to disruptions in the gastrointestinal tract, the production of enzymes deteriorates, metabolism is destabilized, vitamin D is poorly absorbed, and a deficiency occurs. The consequence of such violations is a weakening of the protective properties of the child’s body. Frequent illnesses reduce the number of walks.
• Race and skin color. The mechanism of vitamin D absorption in white-skinned and fair-haired people goes faster than those with dark and black skin. Melanin, responsible for dark color skin, prevents cells from properly producing the vitamin.
• Physical inactivity. Dr. Komarovsky claims that inactivity due to lifestyle, lack of physical activity or disorders in the nervous system also causes rickets.

Symptoms of the disease by stage

It is not easy to detect signs of rickets in children, especially at an early age (more details in the article:). The newborn tightens his legs and arms, which looks natural for him, so it is impossible to identify the beginning curvatures. The first symptoms can be identified only by 4 months, during active formation bone tissue. The body reacts sharply to lack necessary for bones building material and clearly signals the dangerous manifestations. The development of the disease follows an increasing trajectory, passing through several stages. Let's look at each of them in more detail.

Stage 1

The development of rickets begins at the age of 2 months and lasts for 2-4 weeks. Doctors define this period as the initial stage of rickets, which is characterized by temporary disruptions in the central nervous system (irritation, cramps) and muscle tone. Irreversible consequences initial stage does not work and is successfully treated. Identified by the following symptoms:

• the child’s behavior changes, he often gets irritated for no reason or, on the contrary, becomes lethargic and apathetic;
• the baby’s body reacts with increased and frequent sweating;
• skin itching begins, the baby rubs the back of his head on the pillow, and a bald spot forms from the friction.

The symptoms described do not have a direct connection with rickets; profuse sweating may be a consequence of too dry air, and the appearance of bald spots may be due to excessive activity of the baby. However, they should not be ignored; it is necessary to show the baby to the pediatrician in order to protect him from illness. Research using analyzes will help to correctly identify the culprits of such changes and avoid their progression.

Stage 2

A moderately severe disease is manifested by a decrease in hemoglobin levels, disturbances in muscle tone, and a slight enlargement of internal organs. The disease provokes the destruction of bone tissue and is expressed in other noticeable changes:

• the fontanel does not overgrow, and in some cases even begins to enlarge (we recommend reading:);
• the tummy is rounded and protrudes, the functioning of the intestines is disrupted;
• The head grows disproportionately in relation to the body, the forehead becomes convex;

A convex forehead and a large head are a sign of rickets in a child

• thickenings (“rachitic rosary”) form in the wrist area and on the lower ribs;
• the baby does not sit or crawl due to weakness of the ligaments and muscles.

Agree, such changes are difficult not to notice, so all the blame for the child’s serious condition falls on the parents.

If symptoms are severe, a visit to the doctor cannot be postponed; the child needs urgent and serious help. The average severity of the disease requires a long course of treatment. If parents do not notice the development of rickets in time, the disease may progress to stage III, the most severe stage of the disease.

Stage 3

The most serious form of the disease, marked by severe disorders of bone and muscle tissue, serious disruptions in the functioning of the central nervous system and other organs. The progression of the disease leads to curvature of the entire skeleton of the child. Accompanied by the following unpleasant symptoms:

• the child is lagging behind mentally and motor development;
• the legs bend, taking the shape of the letter “X” or “O”;
• the disproportion of the torso and head is noticeable;
• the chest is depressed or becomes convex, the stomach is strongly rounded (see also:).

To be fair, we note that a severe form of the disease is diagnosed very rarely. What kind of negligence must parents have in order to bring the baby’s condition to a terrible state? Obviously, such a situation can develop in dysfunctional families where little attention is paid to the child. However, visits by a pediatrician to such a family can prevent exacerbation of the disease.

The severe stage is rarely diagnosed: routine visits to the pediatrician help to detect rickets in time

Experts point to the periodicity of rickets, which means that the disease has periods of exacerbation or complete disappearance of its symptoms. However, such frequency does not guarantee freedom from relapse of the disease. The disease can manifest itself in cold weather. It is criminal to allow such negligence in relation to the health of the baby; it must be immediately shown to doctors and treatment must begin.

What to do if rickets is diagnosed after a year?

An advanced form of rickets inevitably leads to severe disorders throughout the child’s body. If these disorders are not so noticeable in a baby, then for a one-year-old baby they become a real disaster. The child is severely delayed in development, he cannot crawl and walk, flat feet develop, and deformation occurs hip bones, legs become bent. Having affected the baby at an early age, rickets leads him to myopia, malocclusion, and scoliosis.

Close supervision of specialists is also required for a 3-year-old child with rickets. If parents do not persist in the fight against a dangerous illness, if they provide their baby proper nutrition and playing sports, the disease will recede without leaving serious consequences.

Fresh air and adequate sports activities are an excellent prevention of rickets for older children.

Chances of success and dangerous consequences

When rickets is diagnosed at the very beginning of its development, the chances of a full cure are very high if treated in a timely manner. High development medicine allows you to quickly identify the disease and take effective measures to eliminate it. Looking at the eloquent photos, it becomes clear that a severe form of the disease or time lost by parents for treatment leads to irreversible changes in infants:

• the baby is not growing well, his height remains low compared to his peers;
• tubular bones are significantly bent;
• kyphosis (poor posture) develops;
• the oral cavity is affected, teeth become uneven, a bad bite develops, tooth enamel is destroyed, caries appears;
• skeletal muscles remain underdeveloped;
• The pelvic bones in girls narrow, which leads to problems during childbirth.

How is rickets diagnosed?

Diagnosis of the disease begins with establishing a complete medical history based on the results of an interview with parents. Conducted visual inspection little patient. The doctor examines the baby's legs, arms, spine and head. The picture is emerging clinical symptoms. Special additional studies help to recognize the severity of the disease:

• a blood test is taken to determine the degree of anemia;
• blood biochemistry to determine the level of calcium, magnesium, phosphorus, creatinine and alkaline phosphatase activity;
• X-ray of the lower leg, wrist, forearm;
• ultrasound examination;
• The level of vitamin D metabolites is checked.

For diagnosis, you will need to draw blood from the child.

Treatment of rickets

In an effort to cure rickets in infants, doctors resort to a long-proven method - taking vitamin D solutions (more details in the article:). Why was this chosen? dosage form? The vitamin in soluble form is quickly absorbed by the child’s body and is excreted well by the kidneys. The following solutions are prescribed:

• "Aquadetrim" - the medicine contains vitamin D3 (colecalciferol) (we recommend reading:). Normalizes the exchange of phosphorus and calcium. Produced in the form of drops. The dosage is individual and depends on the child’s body weight, stage of the disease, nutritional characteristics, the baby’s lifestyle and other factors. Duration of use – up to 1.5 months, 6-10 drops. To prevent the disease, the drug is given 2-4 drops.
• "Devis Drops" (drops) - the drug is developed for small patients who do not suffer from dysbacteriosis and other gastrointestinal disorders. Dosage – 5 drops. Used in the prevention of illness in newborns. Analogues of the product are produced: “Videin” and “Vigantol” (we recommend reading:).
• Ergocolciferol is the main element of the drug vitamin D2. Serves as a preventive measure.
• Multivitamin complex - for infants and children up to 2 years old. Helps restore metabolism, contains a sufficient dose of vitamin D.
• Calcium gluconate - the drug serves as an additive and is taken simultaneously with vitamin D for 2 weeks. Often recommended for premature babies.

Ergocalciferol is used for the prevention and treatment of the disease

What to do to prevent the disease?

Prevention of rickets in children should begin in the first months of pregnancy. This means that the expectant mother takes responsibility for giving birth to a healthy baby. Pediatricians divide the prevention of rickets in infants into two phases: antenatal and postnatal. During the antenatal (before childbirth) phase, a pregnant woman should:

• take a walk in the fresh air every day;
• take sunlight in moderation;
• drink special vitamin complexes;
• choose foods with plenty of vitamin D (oatmeal, egg yolk, any fermented milk products, fish dishes, potatoes, butter and vegetable oil, parsley).

Procedures under a lamp and taking vitamin in solutions are not prescribed to pregnant women due to possible intrauterine disorders in the fetus. After the birth of the baby, preventive measures are supplemented by:

• desirable breastfeeding;
• prolonged exposure to the street;
• hardening the child;
• physical exercises (gymnastics);
• sunbathing (without direct sunlight);
• taking vitamin D in prophylactic doses.

For infants, the prophylactic dose of vitamin D does not exceed 1-2 drops, one-year-old babies are given 400 IU, from one year to 2-3 years - 500-600 IU. In the spring, the dosage of the drug is significantly reduced or not taken at all.

Useful clarifications

If from birth the baby receives the necessary vitamin from his mother’s milk, then after six months, when the time of complementary feeding comes, it is necessary to monitor his diet. Make sure that your child's diet includes fish and meat dishes. Gradually accustom your baby to butter and vegetable oil, diversify dairy menu cottage cheese, kefir, yogurt.

Health status small child largely depends on what his parents feed him, how long they walk him outside, and how accurately they follow the pediatrician’s recommendations. If the baby is constantly at home, does not receive mother’s milk, if complementary foods are not introduced into his diet in a timely manner, and all nutrition is limited to cow’s milk or milk formulas that are unbalanced in composition, he may develop rickets.

Rickets is a disease associated with deficiency and disorders of mineral metabolism in the body. Children of the first year of life suffer from rickets, and among those who fall ill most premature babies and “artificial babies” (babies fed formula milk).

Rickets does not pose a danger to the life of a child, but in the absence of adequate treatment, this disease can leave a mark for life - noticeable skeletal deformations, malocclusion, flat feet and other similar disorders.

Causes and mechanisms of development of rickets

It is known that for the formation of full-fledged bone tissue, calcium, phosphorus and vitamin D are needed, which ensure the absorption of the first two substances in the intestine. All these compounds enter the child’s body through food (breast milk, yolk, vegetable oil, fish, vegetables, etc.), and vitamin D is also synthesized in the skin under the influence of sunlight.

Newborn babies are born with a supply of calcium, phosphorus, vitamin D (these substances accumulate especially actively in the fetal body in last weeks intrauterine life, but only on condition that the mother eats properly and walks outside regularly), so up to 1-2 months their bone tissue develops normally. Subsequently, both due to the depletion of reserves and due to active growth, the child’s body begins to need more and more “building” material. If this need is not met, calcium and phosphorus are washed out of the bones. Because of this, bone tissue becomes less dense and easily deformed. Hence all the unpleasant manifestations of rickets from the skeleton.

In addition to the effect on bone tissue, disturbances in phosphorus-calcium metabolism negatively affect the condition of the child’s muscles and nervous system. Patients experience delayed psychomotor development, muscle hypotonia and other pathological symptoms.

Thus, the main cause of rickets is a deficiency of vitamin D; a lack of calcium and phosphorus also plays a certain role in the development of the disease. This deficiency occurs in the following cases:

• If the child does not receive all the substances he needs from food. For example, when parents replace breast milk with unbalanced formulas or cow's milk when complementary foods are introduced late (after 6-8 months), when cereals, especially semolina, dominate in the baby’s diet.
• If the child's skin is not exposed to sunlight for a long time.
• If the processes of digestion of food and absorption of nutrients are disrupted in the intestines (if a child has diseases of the gastrointestinal tract, even the most nutritious diet will not reduce the risk of developing rickets).

Risk factors for rickets

In addition to the obvious causes of rickets, a number of risk factors can be identified:

• Prematurity (babies born prematurely do not have time to make “reserves” of useful substances - this is, firstly, and secondly, they much more often have problems with the intestines and, in general, with the digestive system as a whole).
• Large weight of the newborn (the larger the baby, the more nutrients and he needs vitamins).
• Multiple pregnancy. Children born from such a pregnancy, as a rule, begin to feel a lack of calcium and phosphorus in utero. In addition, such babies are more often born prematurely.
• Congenital disorders of the digestive system.
• Dark skin color (dark-skinned children produce less vitamin D in their skin).

The first signs of rickets, which parents must pay attention to:

• Increased sweating of the baby (the mother should be wary that even when it is cool, the baby sweats on his forehead and nose during feeding, that his hands and feet sweat a lot, etc.).
• Poor sleep, causeless anxiety, shuddering.
• Baldness of the back of the head.
• Constipation (with rickets, hypotension of the muscles, including the intestinal wall, develops, so peristalsis weakens, which leads to fecal retention).

These symptoms may appear as early as 3-4 months of a child’s life. If the disease is detected at this stage (it is called initial) and treated, no negative consequences There won’t be any left for the baby’s health. If this moment is missed, the disease will progress (it will enter the peak stage), and the child will have more severe symptoms pathologies:

• Deformations of the skull, limbs and torso. An indicative sign is a flattened back of the head, a large forehead, an O- or X-shaped change in the legs, etc.
• Severe muscle weakness, due to which another indicative symptom appears - “frog belly”.
• Delay in motor development (the child does not begin to hold his head up, roll over, sit, although his peers are already doing all this, etc.).
• Late teething.
• Various disorders of the internal organs (primarily the gastrointestinal tract).

Gradually, the child’s condition, of course, improves (the recovery stage begins about 6-7 months after the onset of the disease), but the formed bone deformations do not disappear completely, and children remain with many of them for life. This and narrow pelvis, and large frontal tuberosities, and malocclusion, and a deformed chest (compressed from the sides and protruding forward), and flat feet.

Diagnostics

An experienced doctor can make a diagnosis of “Rachitis,” as they say, by eye, but to confirm the diagnosis, you still need to undergo one simple test -. This is a qualitative test for calcium in urine taken from the baby before the first morning feeding. To carry out the analysis, you should prepare (purchase a urine bag to make it more convenient to collect the child’s urine, make some dietary restrictions, etc.).

In severe cases, when doctors need to find out the degree of disturbance of phosphorus-calcium metabolism and the depth of damage to bone tissue, the patient undergoes a more extensive examination, including:

• Blood tests for electrolytes (calcium and phosphorus), alkaline phosphatase activity (an indicator of bone breakdown), and vitamin D metabolites.
• Determination of calcium and phosphorus content in daily urine.
• Ultrasound of the forearm bones.
• X-ray (in lately rarely used).

Treatment of rickets

It is necessary to treat children with rickets comprehensively, using specific and non-specific methods(necessarily taking into account the cause of the illness).

Nonspecific methods include nutrition and correct mode child's day, and various restorative procedures (massage, gymnastics, herbal, salt and pine baths, etc.). TO specific methods include the administration of vitamin D, calcium and phosphorus preparations, artificial irradiation of the skin with ultraviolet light (recently used less and less and mainly in premature infants).

Nutrition and daily routine

The nutrition of children with rickets should be aimed at providing the body with all the necessary substances. For babies under one year old, the best food is breast milk. If it is not possible to breastfeed your baby, you should choose adapted milk formulas; cow's and goat's milk are not suitable for this.

It is also important to introduce complementary foods in a timely manner, since the child’s needs grow every month, and the amount of nutrients in human milk, on the contrary, decreases every month. Therefore, pediatricians do not recommend exclusively breastfeeding a child after 6 years of age. one month old.

For a child with rickets, the first complementary foods can be introduced as early as 4 months, and it is better if it is vegetable puree, to which it is necessary to add over time natural sources vitamin D - vegetable oil, egg yolk, and after 7-8 months - fish and meat. In addition, a sick baby needs fruit purees and juices, as well as cottage cheese and fermented milk products. But with porridges, especially semolina, it is better to wait.

As for the daily routine, it should be organized in such a way that the child spends at least 2 hours outside every day. Moreover, it is not necessary to expose the baby to direct sunlight (this is even harmful); the light breaking through the greenery of the trees will be sufficient.

In addition, you should do exercises with your child, take him for a massage (or do it yourself after consultation with a specialist). Also, children with rickets are recommended to take salt, herbal, and pine baths (the doctor will tell you which one to choose). After such procedures, the child will eat and sleep better.

Drug treatment of rickets

Warp this treatment- this is taking vitamin D, and what drug to use and the dose should be prescribed only by a pediatrician, since with rickets it is dangerous as small dose medications (there will be no effect), and overestimated (there will be hypervitaminosis).

In addition to vitamin D, I can prescribe calcium and phosphorus supplements for the baby (it is not advisable to take them without vitamin D). Premature babies are often recommended complex medications that contain, in addition to vitamin D, other vitamins, as well as all the necessary minerals.

Rickets is one of the diseases the development of which is very easy to prevent with the help of a number of preventive measures. Such measures include:

In addition, a mother can give her child the prerequisites for a healthy future during pregnancy. To do this, a woman needs to eat a balanced diet, walk more in the air and take vitamin and mineral complexes if prescribed by a doctor.

Rickets

Children's disease early age, in which, due to vitamin D deficiency, the calcium-phosphorus metabolism, processes of bone formation and mineralization, as well as the function of the nervous system and internal organs.

“Classic” rickets remains a very common disease. It affects infants during rapid growth: aged 2 months to 2 years.

The occurrence of rickets in infants is associated with insufficient intake of vitamin D into the body.

It can enter the baby’s body in two ways: firstly, with food, being absorbed in the intestines; secondly, it is synthesized in the skin under the influence of solar (ultraviolet) rays. Subsequently, under the influence of enzymes, it is activated in the cells of the liver and kidneys, after which it begins to fully perform its functions (primarily, to promote the deposition of calcium in the bones).

Due to the fact that the intensive supply of calcium and phosphorus from mother to fetus occurs only in the last months of pregnancy, a child less than 30 weeks of the intrauterine period already at birth has a lower bone content minerals. This is also promoted poor nutrition pregnant woman.

The immaturity of the enzyme systems of the liver, kidneys, and skin, as well as their diseases, provoke the development of rickets, which is why it occurs especially often in premature infants.

For the normal ossification process, it is important to have sufficient protein, calcium and phosphorus in the food in the correct ratio, as well as trace elements of magnesium and zinc, vitamins B and A.

Insufficient physical activity of the child also leads to rickets, since the blood supply to the bones increases significantly with muscle activity.

Signs of rickets in initial period

The disease clearly manifests itself at the age of 3-6 months, sometimes as early as 1.5-2 months. In the initial period of rickets, changes in the activity of the nervous and muscular systems. The child becomes irritable, restless, flinches at loud sounds, the appearance of bright light, and sleeps restlessly. He sweats more, especially on the head.

The baby rubs his head on the pillow, and soon the back of the head becomes bald. You may notice an ammonia smell from wet diapers. After 2-3 weeks from the onset of the disease, infants exhibit softness of the bone edges in the area of ​​the large fontanel, along the sutures of the skull. Muscle tone decreases. Such signs are characteristic of rickets of the 1st degree. This period lasts from 1.5 weeks to 1 month.

High period.

At this stage of the disease, symptoms of disorder of the nervous and muscular systems increase. The child's sweating, weakness, and hypotonia of the muscles and ligaments increase.

This period of rickets is especially characterized by rapid progression of bone changes: softening flat bones skull, flattened occiput, asymmetrical head shape. The growth of immature bone tissue at the ossification points of the flat bones of the skull leads to the formation of the frontal and occipital tubercles. Because of this, the baby’s head takes on a square or buttock-like shape, and the skull becomes asymmetrical.

The baby may develop deformations of the facial part of the skull - a saddle nose, an "Olympic" forehead. The teeth of a child with rickets cut later, inconsistently, and are later easily affected by caries. Due to loose ligaments, the baby can easily reach his head with his feet and even suck his toes. Low muscle tone leads to an enlarged abdomen (flat, “frog” belly), causing the formation of a hernia.

The chest with rickets is also often deformed. On the ribs, at the junction of the cartilaginous and bone parts, “rosaries” are formed; “chicken breast” (protrusion of the sternum in the form of a keel) may form; rachitic curvature of the spine in the form of a hump or lateral. At the level of the attachment of the diaphragm on the outside, on the chest, the child develops a deep recess - the “Harrison's groove”, and the lower ribs, due to the large belly, are turned forward in the form of a hat brim. Depending on the timing of the onset of rickets in a baby, various curvatures of the lower extremities are possible, of which the most common are O-shaped legs.

If rickets continues after the baby has learned to step in the crib, he may develop X-shaped legs. As a rule, rickets is accompanied by flat feet.

In a child with severe rickets (grade 3), in addition to the bone system, other systems and organs are affected. Deafness of heart sounds, palpitations, systolic murmur appear, and prolonged inflammation lungs, liver and spleen enlarge. The baby's lag in psychomotor development becomes noticeable, conditioned reflexes his progress slows down, and acquired skills weaken or completely disappear.

The course of rickets depends on the child, the nature of feeding, the season of the year and weather sensitivity, the characteristics of the regime, upbringing and how correctly the disease is prevented. The onset and exacerbation of the disease are observed, as a rule, in late autumn, winter and early spring. In summer, the process subsides and recovery begins.

If therapeutic measures are not taken or they are insufficient, the baby develops a subacute course of rickets with moderate changes from the neuromuscular and skeletal systems. But even mild forms of rickets, with subtle external manifestations, reduce the resistance of the child’s body, which creates the preconditions for the occurrence of other diseases ( respiratory infections, anemia), often occurring with complications.

If the child finds himself in unfavorable conditions and treatment of rickets is stopped, wrong mode and excess carbohydrate nutrition, especially in winter time, the disease takes a relapsing course.

In premature babies, rickets is characterized early onset(2-3 weeks of life), predominance of bone changes, weak neurological symptoms. Bone changes in the baby they manifest themselves as softening of the temporal areas, flattening of the occiput, and an increase in the size of the large fontanel. Signs of rickets such as sweating, baldness of the temporal areas, anxiety, are mild in the early stages of the disease by the end of the 2-3rd month of the baby’s life.

Complex therapy for rickets in a child includes:

Calcium and phosphorus preparations;

Properly organized dietary and hygienic regimes;

Vitamin D or UVB;

Vitamins C, A, group B;

Citrate mixture containing citric acid, ATP;

Massage and gymnastics.

Specific prevention and therapy

To prevent rickets in a baby at risk, prevention consists of taking vitamin D from 2-4 weeks of life. Daily dose Vitamin D 400-500 IU per day is clearly insufficient to prevent rickets. According to domestic researchers, among children who received this dose for prophylactic purposes, rickets occurs in 50-80.6%.

A child with a small fontanelle or its early closure has only relative contraindications to D-vitaminization, and the danger of hypervitaminosis D in this case should be considered exaggerated. Such a baby usually undergoes delayed specific prevention rickets, starting from 3-4 months of life.

Nonspecific methods of prevention and treatment

Therapy without the use of vitamin D includes the organization of a proper sanitary and hygienic regime - with sufficient time for the child to spend time in the fresh air, walks in any season of the year, good sleep, provided that the baby is protected from unnecessary external irritants (noise, light). During the waking period, the baby's mental and motor activity should be stimulated.

A child suffering from rickets needs good nutrition and additional doses of vitamins C and group B (B1, B2, B6). A breastfed baby needs calcium supplements. A citrate mixture is widely used, which is given to the child 1 teaspoon 3-4 times a day for 1-1.5 months.

The diet depends on the age of the child. The best option in the first year of life there is breastfeeding.

If the child is on mixed or artificial feeding and receives adapted formulas, the presence of vitamin D in them should be taken into account (dosages per 1 liter of formula are indicated on the packaging).

It is advisable to treat a child older than six months using various medicinal baths: pine, salt and herbal decoctions. Pine baths are useful for an excitable baby, salt baths It is better to take a child with pronounced pastiness ("looseness") of the subcutaneous fat base, as well as a sluggish and inactive child, and baths with decoctions medicinal herbs recommended for a child with concomitant exudative diathesis.

Breastfeeding a child creates additional vitamin D needs for the mother. The daily requirement of a nursing woman is 1200 mg of calcium and 800 IU of vitamin D.

Special monitoring of compliance with preventive measures is carried out in relation to children at risk. These include premature, immature babies and those with low body weight; infants suffering from diathesis food allergies, chronic intestinal diseases; children receiving anticonvulsant therapy. All children with impaired intestinal absorption, with reduced motor activity.

IN last group includes infants being treated for dysplasia hip joints or certain neurological diseases.

Nutrition for a child with rickets

The diet of an infant suffering from rickets should solve the following problems::

Provide optimal protein levels and the best conditions for the absorption of calcium and phosphorus;

Be rich in vitamins C, B1, B2, A;

Correspond to the state of the gastrointestinal tract and the age of the baby;

Avoid one-sided dominance of products, be diverse.

If a child on mixed or artificial feeding has signs of rickets, it is necessary to use adapted formulas with more high content vitamin D (up to 400 IU per 1 liter of reconstituted product).

The calcium to phosphorus ratio in these mixtures should be 1.5:1 or 2:1.

It is advisable to introduce fermented milk products into the diet of such a baby, which have a beneficial effect on the body’s absorption of nutrients, including calcium. Juices and fruit purees can be introduced into the diet of a baby with manifestations of rickets from 1.5-2 months of age. In this case, you should pay attention to the content of vitamin C, calcium salts and phosphorus in them. Black currants, rose hips, lemon, orange, dogwood, cherries, sweet cherries and persimmons are richer in these substances.

Complementary foods in the form vegetable puree introduced ahead of schedule using the widest range of vegetables. It is advisable to enrich the puree with well-chopped garden herbs, which are a rich source of vitamin C, calcium salts and phosphorus. It is necessary to promptly give the child egg yolk, rich in fat-soluble vitamins, calcium salts, phosphorus and microelements. It also contains vitamin D. More early dates Cottage cheese and meat are introduced into the baby’s diet as sources of animal protein and calcium.

Poor (up to 20 mg)	Content	Moderately rich (up to 100 mg)	Content	Rich (more than 100 mg)	Content
Granulated sugar	2	Cookie	20-40	Cottage cheese	110-120
Honey	4-14	Rye bread	21-38	Milk, kefir, yogurt	120
Sausages	6-12	Butter	22	Canned meat for children	120
Bananas	8	Citrus	23-40	Ice cream	120-140
Apple juice	8	White bread	25-26	Goat milk	140
Tomatoes	8-14	Cabbage	26-48	Nuts	170-270
Meat	9-11	Apricot	28	Enpit antianemic	245
Potato	10	Fresh fish	35-80	Brynza	550
Bird	10-30	Carrot	36	Cheese "Roquefort"	639
Margarine	12-18	Beet	37	Processed cheeses	680-760
Apples	16	Pumpkin	40	Enpit protein	750
Berries	16-40	Chicken eggs	55	Tahini halva	824
Vegetables and fruit purees (canned food)	20	Sour cream	78-90	Cheeses "Dutch" "Kostromskaya" "Russian"	1040

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 enduring 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 cold areas are at risk of developing rickets. unfavorable conditions. Rickets in infants can provoke unhealthy diet mothers: if, afraid of gaining excess weight, she eats too little, she gives preference low-calorie foods, limits the consumption of milk, meat and fish.

In addition to this, there are following reasons 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 infant 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 abnormalities are noted: Despite the usual diet, diarrhea and constipation may occur.

If this is ignored, after a few weeks the 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, especially advanced cases, children cannot sit and stand up independently. 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 right early stage Therefore, 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

Has a positive effect on health physical therapy, massage. 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 the child’s nervous system.

Video

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

Bathing

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

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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 oil solution Vitamin D3 contains approximately 420 IU of cholicalciferol.

Vitamin D intake should be accompanied by constant monitoring of urine analysis to avoid overdose, because large doses can have adverse effects. toxic effect on the body. An overdose of this drug can cause decreased 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. Around 28 weeks intrauterine development The child’s body begins to actively store vitamins. Vitamin D accumulates in the liver, fat and muscle tissue 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. Besides 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 products 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 rule of the letter “r” - 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 drug prevention the need disappears.

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 dental caries 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).

In people mature age Osteoporosis may develop.

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