Many people are familiar with this word, which means not only illness, but also a painful appearance, physical, and in a figurative sense, mental weakness. Yes, this is rickets. This disease refers to childhood pathology and is manifested 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 extremely necessary during the period of intensive growth of the child, during the formation of the cartilage and bone skeleton. In addition, the lack of this substance affects the intellectual sphere and physical development. It is necessary to notice even minor changes in the behavior of children, since the onset of the disease can proceed secretly.
History
For the first time this ailment was described in England in the middle of the seventeenth century, but in near-medical literature it has been encountered since the second or third century of our era. Several theories of the occurrence of this pathology and methods for its solution were proposed. An antidote was found - cod fat, but an explanation of 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, at the beginning of the twentieth century, a German doctor developed a method for the prevention of rickets using an ultraviolet lamp. She compensated for the lack of sun and prevented the development of the disease.
Development reasons
There are several predisposing factors that contribute to the development of rickets. They can be found both collectively 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.
- Deep prematurity of the newborn.
- Genetically determined disorders in the formation and metabolism of vitamin D.
- Racial predisposition.
The disease does not have a 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 affected.
In addition, modern mothers do not want to feed the baby naturally, preferring mixtures 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. Babies suffer from obesity, metabolic disorders, intestinal colic and, of course, rickets.
Pathophysiology of the disease
It is known that vitamin D itself does not take 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 properly grow and develop.
Forming in skin melanocytes, vitamin D enters the bloodstream and is transported by it to the liver, where the hydroxylation process takes place. The chemical transformations in the kidneys are being completed, and then, already in the form of 24.25-dioxi-vitamin D, 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 confused and is 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 it or connect 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 manifest neurological symptoms, such as sleep disturbance, anxiety, irritability. Then interest in food decreases, stool delays occur. At night, the child sweats heavily, and the smell of sweat is unpleasant, the head itches, and due to constant friction on the pillow, baldness of the nape appears. There are no visible bone 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 proceeds to the next period - heat. It is characterized by a depression of the chest, curvature of the bones of the lower extremities, the appearance of “rosaries” and “bracelets” in places of excessive production of bone tissue, as a compensatory reaction to thinning of the skeleton. With all this, the child is behind in both mental and physical development.
Timely prescribed treatment helps to reverse most of the changes, but skeletal deformities will remain for life. The consequences are especially severe for women, since the pelvic bones are deformed, and childbirth through the natural birth canal will be impossible.
Diagnostics
The official protocols for the diagnosis and prevention of rickets are quite complicated and confusing for the average doctor in the clinic. Previously, Sulkovich’s test was considered a reliable confirmation of the disease, which revealed loss of calcium in the urine, but now it has been recognized as nonspecific and has been abandoned in routine practice.
At the moment, a blood test for the content of electrolytes: calcium, phosphorus, magnesium is considered the most reliable. In addition, pay attention to such biochemical parameters as the level of alkaline phosphatase and creatinine in serum. Of the even more highly specialized, tests are prescribed to determine the level of vitamin D metabolites and thyroid and parathyroid hormones.
Of the instrumental diagnostic methods, X-rays of the bones of the lower leg and forearm are performed to examine areas of growth and bone density. With rickets, they will be deformed, the ossification zones are changed and expanded.
Degrees of disease
In children, there are three degrees of the disease:
- Easy flow. The child has one or two manifestations from the bone tissue, there is muscle hypotension, lethargy, but intellectual development corresponds to age.
- Moderate course. Serious changes in the skeleton, severe damage to the nervous system, problems from the internal organs are observed. Mental abnormalities 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 deficit, development does not correspond to age, other systems of internal organs are violated in response to a failure in the metabolic system.
Pregnancy Prevention
Any future mother will agree that it is unpleasant to hear a diagnosis of rickets from a local pediatrician.
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 they forget to walk elementarily. But this is the
non-specific prevention of rickets.
Preventive measures include healthy sleep at night and a break for rest 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 the diet.
Specific prevention of rickets in women at risk (eclampsia, diabetes, hypertension, chronic renal failure) is carried out together with an endocrinologist. In the third trimester from the twenty-eighth to thirty-second weeks, vitamin D is prescribed in a thousand international units every day for eight weeks. In this case, the season does not play a special role. Sometimes prescribed courses of ultraviolet radiation, which contributes to the endogenous production of cholecalciferol. Start with a small, somewhere 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 at risk or did not adhere to the recommendations of the antenatal clinic regarding her diet and nutrition during pregnancy. In the hospital, a child is given a bolus of up to four thousand units of cholecalciferol orally per day. And they continue to treat this until all the signs of the disease disappear. Then they switch to a maintenance dose of four hundred international units per day.
Prevention of rickets in newborns with malabsorption of vitamin D in the intestine is slightly different. In this case, the daily dose can reach up to ten thousand units.
Premature
It so happens that all the problems that a child born prematurely has also rickets. Causes, signs, prevention of this disease, he has some features. Given that the organ systems are not formed enough, doctors inject 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 blood phosphorus in order to prevent critical conditions.
Breasts
Prevention of rickets in infants consists in the proper care of them. This primarily concerns walking. It is important that the child walks more than four hours a day and sleeps in a well-ventilated area. If possible, parents should leave the child as naked as possible in the street so that as much of the skin as possible is exposed to ultraviolet radiation. In the evenings, you can bathe your child in salt or pine baths. This not only reduces irritability and prepares him for sleep, but also strengthens the immune system.
It is ideal to feed the baby with breast milk, as it contains all the necessary micro and macro elements, as well as the daily intake of proteins, fats and carbohydrates. But if this is not possible, then it is recommended to switch to adapted mixtures that contain the level of phosphorus and calcium that is as close to natural as possible. 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 of age also consists in competent feeding, which should contain a sufficient amount of vitamins B, A, C, as well as vegetable and animal fats. The use of dairy products is not even worth talking about. It's obvious.
Prevention of rickets in young children consists, in particular, in developing gymnastics and physiotherapy exercises. This is necessary for the harmonious development of the neuromuscular system, since there is a risk of bone deformation under the weight of the child, strong muscles will help to evenly distribute body weight and avoid gross skeletal curvature. Regular exercise, a gradual increase in workload, and other proactive measures help avoid rickets.
Contraindications to prevention
Like any medicine, vitamin D has exceptions for use. Specific prevention of rickets in children is not carried out if they have been diagnosed with Williams-Bourne disease, or, otherwise, idiopathic calcituria. In this case, calcium loss is not associated with vitamin D deficiency. The second exclusive disease is hypophosphatasia. In addition, in the presence of organic lesions of the central nervous system, microcephaly and craniostenosis, the prevention of rickets in infants is also not recommended. Komarovsky addresses this issue in his lectures in more detail.
Child over one year old
Do not think that when your child becomes a little older, the risk of developing metabolic disorders will go away. Prevention of rickets in children after a year is to enrich the diet with dairy products and antioxidants (fish oil, herbs, citrus fruits, fish). If there are disorders of the autonomic nervous system, such as excessive sweating, then appoint "Carnitine", "Glycine", "Panangin" or Asparkam "in a course dose for the month of admission.
To correct physical development, if necessary, it is recommended to take the drug "Acti-5". It contains a complex of vitamins and is well absorbed by the body of the child. In addition, the pediatrician recommends massage and exercise therapy, which will help cope with skeletal deformities and relieve symptoms.
Treatment
Do not despair if the doctor has diagnosed a child with rickets. Signs, prevention and treatment of it have long been known and successfully applied around the world. Medicines such as Aquadetrim, which contains vitamin D
3, have now been developed. It is well tolerated by children and can be used without the risk of overdose. In addition to it, on the modern pharmaceutical industry market there are Devisol, Vigantol, Vidin-2, which are oil solutions of vitamin D. They all have contraindications, so be sure to consult your doctor before starting treatment.
Overdose
Treatment, prevention of rickets may not be practical, and then an overdose of vitamin D occurs. The child develops symptoms of poisoning, such as nausea, vomiting, impaired stool and urinary retention. In case of detection of these alarming signs, you should immediately inform your local pediatrician and conduct a blood test for the calcium content in the plasma. You can add to the study and the Sulkovich test, 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. Do not fanatically seek and treat your child's rickets. Prevention can play a trick on too meticulous parents.
Medical examination
Children with a diagnosis of "rickets" must be put on the dispensary register after clinical and laboratory recovery occurs. Due to the complexity and severity of the consequences, these children are monitored for three years from discharge. They are called for inspection every three months.
By the way, the diagnosis of rickets, its prophylaxis 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.
In the modern world, the problem of rickets is no longer as acute as a century ago, but still do not forget that neglect of this disease can cause disability. Fortunately, the entry “rickets” in the child’s development map has already become an exception to the rule. Prevention and health education are carried out at the proper level, which ensures the literacy of young parents and their vigilance regarding the health status of their children. Even if such a problem arose, the medicine can be found in any pharmacy, and the success of treatment depends only on how much the parents of the small patient want it.