Many are familiar with this word, denoting not only a disease, but also a painful appearance, physical, and in a figurative sense, mental weakness. Yes, it's rickets. This disease refers to childhood pathology and manifests itself at an early age by a violation of bone formation. The reason for it is the lack of vitamin D in the body, which is essential during the period of intensive growth of the child, during the formation of the cartilaginous and bone skeleton. In addition, the lack of this substance affects the intellectual sphere and physical development. It is necessary to notice even slight changes in the behavior of children, since the onset of the disease may be hidden.
History
For the first time this ailment was described in England in the middle of the seventeenth century, but in the near-medical literature it has been found since the second or third century AD. Several theories have been proposed for the occurrence of this pathology and ways to solve it. An antidote was found - cod fat, but the explanation for its effectiveness was discovered much later. Thanks to the experiments conducted by McCollum, the whole world learned about the existence of such a substance as vitamin D. Later, inAt the beginning of the twentieth century, a German doctor developed a method for preventing rickets using an ultraviolet lamp. It compensated for the lack of sun and prevented the development of the disease.
Reason for development
There are several predisposing factors that contribute to the development of rickets. They can meet both together and separately.
- Insufficient amount of sunlight, including due to weather and climatic conditions.
- Improper feeding of the child, and, as a result, poor absorption of calcium and phosphorus, as well as excessive content of animal fats in food.
- Profound prematurity of the newborn.
- Genetic disorders in the formation and metabolism of vitamin D.
- Racial predisposition.
The disease has no favorite place on the world map, it is found everywhere. Most often, its manifestation occurs in the cold season, when, due to natural causes, a lack of sunlight develops. Children born in late autumn and winter are especially hard hit.
In addition, modern mothers do not want to breastfeed their baby, preferring formula or cow's milk. This disrupts the process of proper colonization of the intestines of the child. Also, artificial substitutes contain an insufficient amount of the necessary substances for the harmonious growth and development of the baby. Toddlers suffer from obesity, metabolic disorders, intestinal colic and, of course, rickets.
Pathophysiology of the disease
It is known that not vitamin D itself takes part in the absorption of calcium and the process of bone formation, but its metabolites formed in the liver and kidneys. After the birth of a child, many enzyme and metabolic systems have not yet reached sufficient development to take on the full load necessary for this tiny organism to grow and develop properly.
Formed in melanocytes of the skin, vitamin D enters the bloodstream and is transported by it to the liver, where it undergoes the process of hydroxylation. Chemical transformations in the kidneys are completed, and then, already in the form of 24, 25-dioxy-vitamin D, it takes part in mineral metabolism and the formation of the skeleton. The whole process is subject to destabilization at any stage. Therefore, the pathogenesis of rickets is very confusing and not fully understood even by narrow specialists.
Manifestations
As a rule, the first alarm bells appear already at the age of one and a half months, but they are so non-specific that parents do not pay attention to this or associate them with other diseases. In this regard, significant changes become noticeable only by four to five months of age.
First of all, the child begins to show neurological symptoms, such as sleep disturbance, anxiety, irritability. Then interest in food decreases, stool delays occur. At night, the child sweats a lot, and the smell of sweat is unpleasant, the head itches, and due to constant friction on the pillow, baldness of the back of the head appears. Visible bonethere are no manifestations, they will appear much later. The first stage lasts up to a month.
If no preventive measures have been taken, the disease progresses and goes into the next period - the peak. It is characterized by depression of the chest, curvature of the bones of the lower extremities, the appearance of "rosary" and "bracelets" in places of excessive production of bone tissue, as a compensatory response to the thinning of the skeleton. With all this, the child lags behind in both mental and physical development.
Treatment prescribed on time helps to reverse most of the changes, but skeletal deformities will remain for life. The consequences are especially severe for women, as the pelvic bones are deformed, and childbirth through the natural birth canal will be impossible.
Diagnosis
Official protocols for the diagnosis and prevention of rickets are quite complex and confusing for an ordinary doctor in a clinic. Previously, the Sulkovich test, which detected calcium loss in the urine, was considered a reliable confirmation of the disease, but now it has been recognized as nonspecific and has been abandoned in routine practice.
At the moment, the most reliable are blood tests for electrolytes: calcium, phosphorus, magnesium. In addition, attention is paid to such biochemical indicators as the level of alkaline phosphatase and serum creatinine. Of the even more highly specialized, tests are prescribed to determine the level of vitamin D metabolites and hormones of the thyroid and parathyroid glands.
Frominstrumental diagnostic methods, radiography of the bones of the lower leg and forearm is carried out in order to examine the growth zones and bone density. With rickets, they will be deformed, the ossification zones will be changed and expanded.
Degrees of disease
In children, there are three degrees of the disease:
- Easy current. The child has one or two manifestations of the bone tissue, there is muscle hypotension, lethargy, but intellectual development corresponds to age.
- Moderate. There are serious changes in the skeleton, severe damage to the nervous system, problems with the internal organs. Mental deviations from the norm and a lag in intellectual development begin to appear.
- Severe degree. Persistent gross bone deformities that do not regress after recovery. The child has an intellectual deficiency, development does not correspond to age, other systems of internal organs are disturbed in response to a failure in the metabolic system.
Prevention during pregnancy
Any mother-to-be will agree that it is unpleasant to hear a diagnosis from a district pediatrician - rickets. Prevention of this condition can begin even in the process of bearing a child. Oddly enough, but pregnant women are usually careless about this issue. They drink handfuls of folic acid and multivitamin complexes, but forget to simply walk. But this is non-specific prophylaxis.rickets.
Preventive measures include he althy sleep at night and rest breaks during the day. In addition, obstetricians recommend walking for at least two to four hours in the fresh air, regardless of the weather. It is important to eat well and properly:
- eat meat or fish daily;
- there is a sufficient amount of cottage cheese, cheese, milk and other dairy products;
- include white bread and vegetables in your diet.
Specific prevention of rickets in women at risk (eclampsia, diabetes, hypertension, chronic renal failure) is carried out in conjunction with an endocrinologist. In the third trimester from the twenty-eighth to thirty-second weeks, vitamin D is prescribed at a thousand international units every day for eight weeks. The time of year in this case does not play a special role. Sometimes courses of ultraviolet irradiation are prescribed, which contributes to the endogenous production of cholecalciferol. Start small, about a quarter of the allowable dose, gradually increasing to two doses. Sessions are held every day or every other day.
Newborns
Prevention of rickets in newborns is carried out when the mother is compromised by the risk group or did not adhere to the recommendations of the antenatal clinic regarding her regimen and nutrition during pregnancy. In the maternity hospital, a child is given a bolus of up to four thousand units of cholecalciferol orally per day. And continue to treat like this until all signs of the disease disappear. Then they switch to a maintenance dose of four hundred international units per day.
Prevention of rickets in newborns withmalabsorption of vitamin D in the intestine is somewhat different. In this case, the daily dose can reach up to ten thousand units.
Preterm babies
It happens that to all the problems that a child born prematurely has, rickets also joins. Causes, signs, prevention of this disease in him have some features. Considering that the organ systems were not formed enough, the doctors injected him with calcium gluconate (sixty milligrams of pure calcium per day per kilogram). To balance it with phosphorus, add thirty milligrams of potassium phosphate per day for every kilogram of weight.
Be sure to monitor the level of calcium and phosphorus in the blood to prevent critical conditions.
Babies
Prevention of rickets in infants is the proper care of them. First of all, it concerns walking. It is important that the child walks for more than four hours a day and sleeps in a well-ventilated area. Whenever possible, parents should leave their child as undressed as possible on the street so that as much skin as possible is exposed to ultraviolet radiation. In the evenings, you can bathe your child in s alt or pine baths. This not only reduces excitability and prepares him for sleep, but also strengthens the immune system.
It is ideal to feed a baby with mother's milk, as it contains all the necessary micro and macro elements, as well as the daily norm of proteins, fats and carbohydrates. But if this is not possible, then it is recommended to switch to adapted mixtures that contain a level as close to natural as possible.phosphorus and calcium. Prevention of rickets in infants depends entirely on the consciousness and desire of the parents.
Age: up to a year
Prevention of rickets in children under one year old also consists in competent complementary foods, which should contain a sufficient amount of vitamins B, A, C, as well as vegetable and animal fats. The benefits of dairy products are not even worth talking about. This is understandable.
Prevention of rickets in young children is, among other things, in developing gymnastics and physiotherapy exercises. This is necessary for the harmonious development of the neuromuscular system, since there is a danger of deformation of the bones under the weight of the child, strong muscles will help to evenly distribute the weight of the body and avoid gross curvature of the skeleton. Regular exercise, gradually increasing the load and other preventive measures help to avoid rickets.
Contraindications for prevention
As with any drug, vitamin D has exceptions for taking. Specific prevention of rickets in children is not carried out if they are diagnosed with Williams-Bourne disease, or, otherwise, idiopathic calcituria. In this case, calcium loss is not due to vitamin D deficiency. The second rule-out disease is hypophosphatasia. In addition, in the presence of organic lesions of the central nervous system, microcephaly and craniostenosis, prevention of rickets in infants is also not recommended. Komarovsky covers this issue in his lectures in more detail.
Child over one year old
Do not think that when your child gets a little older, the danger of developmentmetabolic disorders will go away. Prevention of rickets in children after a year is to enrich the diet with dairy products and antioxidants (fish oil, greens, citrus fruits, fish). If there are disorders of the autonomic nervous system, such as excessive sweating, then Carnitine, Glycine, Panangin or Asparkam are prescribed in a course dose for a month of admission.
For the correction of physical development, if necessary, it is recommended to take the drug "Akti-5". It contains a complex of vitamins and is well absorbed by the child's body. In addition, the pediatrician recommends massage and exercise therapy, which will help to cope with skeletal deformities and alleviate symptoms.
Treatment
Don't be discouraged if the doctor diagnosed your child with rickets. Signs, prevention and treatment of it have long been known and successfully used around the world. Now drugs such as Aquadetrim have been developed, which contain vitamin D3. It is well tolerated by children and can be used without risk of overdose. In addition to it, on the modern pharmaceutical market there are "Devisol", "Vigantol", "Videin-2", which are oil solutions of vitamin D. All of them have contraindications, so be sure to consult your doctor before taking it.
Overdose
Treatment, prevention of rickets may be inappropriate, and then there is an overdosevitamin D. The child develops symptoms of poisoning, such as nausea, vomiting, impaired stools and urinary retention. If these warning signs are found, you must immediately inform your local pediatrician and conduct a blood test for calcium in the plasma. You can add Sulkovich's test to the study, although it is not included in the standard protocol.
After an overdose is detected, the drug is canceled for a while and parents are asked to limit themselves to walking and dieting. You should not fanatically look for and treat rickets in your child. Prevention can play a trick on overly meticulous parents.
Dispanserization
Children diagnosed with rickets should be registered in the dispensary after clinical and laboratory recovery. Due to the complexity and severity of the consequences, such children are monitored for three years from the date of discharge. They are called for inspection every three months.
By the way, the diagnosis of rickets, its prevention or treatment is not a contraindication for routine vaccination. The main thing is to warn the doctor who will give the injection and the local pediatrician about this.
In the modern world, the problem of rickets is no longer as acute as it was a century ago, but still, one should not forget that carelessness with this disease can cause disability. Fortunately, the entry in the child's development chart "rickets" has already become an exception to the rule. Prevention and he alth education are carried out at the proper level, which ensures literacyyoung parents, their vigilance regarding the he alth of their child. Even if such a problem arose, the medicine can be found in any pharmacy, and the success of the treatment depends only on how much the parents of the little patient want it.
