The article will describe the first signs of rickets.
There are some diseases that have long been considered "diseases of the last century", but as medical practice shows, they are not so rare today, and may not depend on the standard of living, child care and nutrition. These pathologies include rickets in infants.
Signs of rickets should be known to all parents.
Causes of disease development
There are only two prerequisites for the development of rickets in a child - malnutrition and a lack of vitamin D (calciferols) in the body, which is involved in a number of important metabolic processes, and this, in turn, becomes the main cause of the development of rickets in bone tissue. This vitamin is found in several foods and can also be produced in the skin by exposure to sunlight.
If the child's diet is poor in foods containing vitamin D, and the child himself rarely goes for walks in sunny weather, then pathologicalphenomena in the bones, internal organs and muscles become inevitable for him.
However, such reasons are easily eliminated. It is enough to adjust the child's diet by adding more milk, butter, fish oil, boiled beef or poultry liver to it. Frequent walks are also a prerequisite.
Internal pathologies and genetic abnormalities as the cause of rickets
The situation is much more complicated with those children who have some pathologies of internal organs from birth: intestines, liver, kidneys.
Impaired intestinal absorption of nutrients, obstruction of the biliary tract, some genetic diseases that prevent the absorption of vitamin D - all this leads to the onset of the first symptoms of rickets in infants, and this pathology with concomitant diseases is very difficult to treat.
Signs and symptoms of rickets are important to recognize early.
Other factors causing rickets
Artificial feeding and prematurity are two more equally important factors affecting the metabolic process in the child's body and the absorption of substances from food.
For example, in a premature baby, the need for vitamin D is significantly higher than in those children who were born on time, so very often nutrition does not cover the deficiency in this vitamin, and rickets only worsens if it is not noticed in a timely manner signs and do not change the feeding system.
Children on artificial nutrition suffer from rickets due to the fact that in goat and cow milk, as well as inartificial mixtures violated the proportions of phosphorus and calcium - the most important elements for the construction of bone tissue.
Mothers who do not feed their children with natural breast milk should know that ideal artificial mixtures do not exist today, therefore, the nutrition of artificial children should be organized so that the deficiency of vitamin D, phosphorus and calcium can be constantly covered complementary food.
Signs of rickets in infants will be presented below.
Disease classification
Classification of rickets existing in modern pediatrics, associated with the effectiveness of treatment with calciferols. In this case, the following varieties of this disease are distinguished:
- The most common is classic D-deficient rickets.
- Secondary.
- Vitamin D resistant.
- Vitamin D dependent.
The classic type of rickets is also subdivided depending on changes in the concentration of phosphorus and calcium in the blood, so there are phosphopenic and calciumpenic varieties of it, which indicate a significant deficiency of these elements. Sometimes the classic form of rickets occurs with normal concentrations of phosphorus and calcium.
The course of the D-deficient form of rickets is acute, recurrent and subacute. This disease goes through several stages: the initial stage, the height of the disease, recovery, the stage of residual effects.
The acute form is observed in apparently he althy babies: they grow well, gain weight,however, they still suffer from such a pathology. It occurs due to a lack of calciferols in a monotonous carbohydrate diet and is characterized by bright, violent symptoms from the nervous and autonomic nervous systems, as well as pronounced changes in bone tissue.
In the subacute form, the symptoms of rickets are more smoothed and moderately expressed. This variant of the disease is observed in those children who have previously received specific prophylaxis with mixtures containing vitamin D.
When a recurrent form occurs, which is characterized by periods of exacerbations and remissions of rickets, it is most often observed in children from dysfunctional families, in the absence of proper care, proper feeding and sufficient exposure to the air.
Secondary rickets develops due to impaired absorption of vitamin D in the intestines, as well as obstruction of the bile ducts, kidney diseases, which are associated with metabolic disorders. It also occurs in children who take anticonvulsant drugs, diuretics and hormones for a long time. There is a possibility of secondary rickets in children who are parenterally fed in hospitals.
Vitamin D-dependent form of rickets is of two types and is usually caused by a defect in the synthesis of calciferols in the kidneys and insufficiency of receptors that are responsible for their absorption.
Vitamin D-resistant rickets occurs against the background of orphan pathologies of a congenital nature - with Debret-Fanconi syndrome, phosphate diabetes, hypophosphatasia - a violation of bone mineralization, etc.e.
These pathologies are very rare and are usually accompanied by many other severe changes in mental and physical development.
Main signs of rickets
This disease has three stages:
- The first stage is characterized by the initial manifestations of the disease with minimal symptoms.
- The second stage is a moderate course of the disease.
- The third stage is severe rickets, in which there are pronounced changes at the physical level and a lag in mental and mental development.
First stage of rickets
Parents, first of all, should alert the signs of rickets in the baby, which include:
- Increased sweating baby with sour pungent odor.
- Alopecia at the back of the head, often accompanied by intense itching.
- The onset of prickly heat (small skin rashes).
- Tendency to develop constipation while maintaining a normal drinking regimen.
Additional signs of rickets include the following:
- Spontaneous muscle twitches.
- Fear of the light.
- Increasing the irritability of the child.
- Difficulty falling asleep.
- Decreased appetite.
Rickets of the first degree in infants usually begins in the third month, and in premature babies even earlier.
Second stage
The further course of this pathology is complicated by the emergence of new signs. Ricketsinfants who did not receive treatment for this disease in the first stage develops as follows:
- Softening of the cranial bones in the fontanelle area - craniotabes.
- Change in the shape of the back of the head - flattening of its bones.
- Also a common sign of rickets in infants at 3 months is chest deformity - “cobbler's chest”, if it is slightly depressed, or “chicken breast”, if it is protruded.
- Curvature of tubular bones: "X"-shaped or "O"-shaped legs.
- Appearance on the wrists of specific "beads" of rickets.
- The beginning of disturbances in the work of internal organs.
- Late fontanel closure.
- Delayed teething.
It's easy to notice signs of rickets in babies at 3 months.
Rickets of the second degree in infants is usually accompanied by an increase in autonomic and neurological symptoms - lethargy, drowsiness, excessive fatigue, severe sweating, especially when screaming and other stresses. Such children are very behind their peers not only in physical development, but also in psychomotor and mental development.
Third stage of rickets
Rickets of the third stage is most often the result of a lack of therapeutic measures, when a child is deprived of parental attention and medical supervision. In this case, the question does not even arise of how to determine the first signs of rickets in such a child - his neglected symptoms are so pronounced and severe. You may notice the following pathological conditions:
- Severe violations of bone andmuscle tissue.
- Weakness of the ligamentous apparatus.
- Delays in motor activity.
- Extremely severe dysfunction of internal organs, frequent pneumonia and bronchitis.
Usually, these signs of rickets appear after a year.
In all children who have ever had a severe or moderate degree of this disease, changes in the bones remain, as a rule, for life:
- deformed limbs;
- bulging or sunken chest.
Girls often have rickety defects of the pelvic bones. At the same time, the pelvis becomes flat, which subsequently causes various birth injuries when their children are born.
Signs of pathology in children from one to two years old
The baby becomes restless, whiny, shy - after 2 years the symptoms increase. The innervation of the liver leads to the fact that hepatocytes are affected, the destruction of the liver tissue begins, and the pathological foci become overgrown with scar tissue.
Signs of rickets in a child at 2 years old can scare parents.
Vegetative disorders accompany vasomotor reactions. If you run your finger over the skin, you can see red linear stripes. Vegetative-vascular problems become stronger after feeding the child. Red vesicles appear on the back of the head on the skin. Severe itching occurs.
Another sign of rickets in a child at 2 years old is hyperesthesia. Hypersensitivity of skin receptors irritates the child.
Diseases of the central nervous system accompany the pathology of reflexes with inhibition, motor activity. Atrickets appear changes in the muscles.
Looseness of the joints, curvature of the legs appear after a year when the child learns to walk.
We examined the main signs of rickets in children after a year.
Treatment of rickets at an early stage of its occurrence
Therapy of rickets in infants is a very long process, since it takes months, and in some cases even years, to restore bone tissue. Treatment methods are selected depending on the severity of the symptoms and the severity of the disease.
Non-specific therapies include:
- Eliminate strong noise and bright light in baby's room.
- Long daily walks, as well as sun and air baths - according to the season.
- Hardening in the form of rubdowns with cool and warm water.
- Coniferous and s alt baths to correct the process of inhibition and excitation in the nervous system.
- Therapeutic gymnastics and massages.
- Diet.
About the diet should be said separately: it remains the main factor for further recovery. Treatment of rickets at an early stage requires a revision of the usual nutrition system:
- Replacing ordinary water with fruit and vegetable broths.
- Early introduction of protein complementary foods in the form of cottage cheese and egg yolk.
- Purpose of vegetable complementary foods in the form of mashed stewed and boiled vegetables, grated raw vegetables.
After diagnostic procedures that reveal a deficiency of phosphorus and calcium, children are prescribed a coursevitamins C, A, B, as well as calcium drugs.
Assessing the severity of the disease, the doctor can add elements of specific treatment to nonspecific therapy, which include:
- UV irradiation for 20 days with selection of individual biodosage.
- Oil, alcohol or aqueous solutions of vitamin D - "Videhol", "Ergocalciferol", "Videin", "Cholecalciferol", "Aquadetrim", etc.
The drug "Ergocalciferol" is prescribed, as a rule, to all children, regardless of the severity of the pathology.
To exclude recurrence of the disease, infants at risk are often prescribed medications containing vitamin D for 4 weeks daily to prevent the onset of signs of rickets. Komarovsky (a well-known pediatrician) recommends the following preventive measures.
Prevention of rickets
Prevention of this disease in infants begins in the period of intrauterine development. At the same time, pediatricians recommend that mothers follow the following rules:
- Periodically, preferably in courses, give the child special multivitamin complexes.
- Adhere to a special diet, that is, such a diet for the baby, which will satisfy his need for calcium and phosphorus.
- Frequent walks in the fresh air in any weather.
Prevention of this disease during pregnancy is carried out by taking a single dose of vitamin D at 200,000 IU at the seventh month of gestation.
It is necessary to timely recognize the signs of rickets in infants at 4 months. From the very birth of a child, it is required to carefully monitor his diet and daily routine. It is desirable to breastfeed him, since only breast milk contains all the substances necessary for the child, which cannot be replaced by any artificial mixture that exists today.
Besides this, the baby needs daily walks, and seasonally you can keep the baby naked for some time in the shade of trees. Wellness massage is also recommended for 20 minutes a day, with breaks. If necessary, pediatricians advise parents to introduce early protein and vegetable complementary foods.
It would also be very appropriate to use a citrate mixture, which is based on the use of 2.1 g of citric acid diluted in 100 ml of water. The resulting solution must be given to the child in a teaspoon three times a day for 10 days, followed by a repetition of the course in one month.
Specific prevention of this pathology is also necessary: he althy children are prescribed a course of irradiation with a UV lamp in the amount of ten sessions in winter, autumn or spring. In summer, such sessions of UV therapy, as a rule, are not carried out. After them, dosage forms of vitamin D are canceled for 2 months. For children at risk, such exposure is carried out from the age of two weeks.
Medicinal preparations containing vitamin D, for the implementation of specific prophylaxis for children born at term, are prescribed, as a rule, at a dosage of 400 IU in the form of oily or aqueous solutions during the entire firstyears of life. For premature babies, a similar dose is slightly higher and amounts to 1000 IU.
It must be remembered that vitamin D medications are not always helpful. Their use is prohibited in the following pathological situations:
- After suffering fetal hypoxia during pregnancy.
- After intracranial birth trauma.
- With a small size of a large fontanelle.
- For nuclear jaundice.
With caution, calciferols are also prescribed to children who received adapted milk formulas containing vitamin D.
Walk with the baby should be daily, and this should be done in any weather. If it is cold and frosty outside, the walk should last at least one hour, but if it is sunny and warm, at least 3-4 hours. The only exception is a strong wind, even in the warm season, when it is strictly forbidden to take a baby outside.
