As sad as it may be, in the modern world there are many different childhood diseases. Rickets is a disease that is associated with a slowdown and a violation of the normal development of children. It strongly affects the life of the child, as a result of which even elementary actions are given to him with great difficulty. The pathogenesis of rickets in children (a brief description of this disease will be discussed later) is caused by metabolic disorders in the body, as a result of which bone and muscle tissue do not receive enough vitamins, minerals and nutrients, which significantly slows down and completely stops their formation and development. The disease can occur not only from the musculoskeletal system, noticeable deviations are observed in the functioning of the internal organs and central nervous system. In most cases, rickets occurs in early childhood, and clinical symptoms, as a rule, come to light already in the first months of life.
Causes of the development of the disease
Rickets (the pathogenesis will be briefly reviewed in the text) develops in children as a result of insufficient exposure to ultraviolet light, which contributes to the development of vitamin D in the body. It is he who is responsible for the normal absorption of calcium from various foods. It is important to understand that this reason is the main, but not the only one. The main prerequisite for the appearance of rickets is considered to be a deficiency of vitamins A, B and E, as well as ascorbic acid - one of the main components involved in the formation of bone tissue.
The pathogenesis of rickets (the causes of the disease can be very diverse) is also closely associated with the lack of such elements as:
- calcium;
- iron;
- magnesium;
- copper;
- cobalt;
- zinc and many others.
Thus, we can conclude that the bone formation disorder occurs as a result of a lack of nutrients necessary for the normal development of the body.
Disease predisposition and main risk group
Let's dwell on this in more detail. The pathogenesis of rickets is associated not only with a deficiency of vitamins and minerals. The development of the disease is influenced by many factors. At risk are children who receive malnutrition and poor nutrition.
The predisposition to rickets is also due to the following reasons:
- in the first year of life in children, the skeletal system actively develops, so they need a large amount of vitamin D;
- difficult pregnancy;
- various chronic diseases in the mother;
- overfeeding a child;
- use for feeding cow's milk and infant formula;
- infectious diseases;
- violation of the intestinal absorption capacity;
- rare walks in the fresh air;
- low mobility of the baby;
- long-term use of various medications.
Rickets in children (etiology, pathogenesis were considered earlier) most often develops if the babies were born earlier than expected. This is due to the fact that their body has a smaller supply of vitamins and nutrients, bone tissue is not densified enough, the body's low protective functions, as well as the digestive system, are poorly developed, as a result of which it is not able to properly absorb nutrients.
The mechanism of the origin and development of the disease
So what is he like? The pathogenesis of rickets in children is a very complex process that has many features. If the bearing of the fetus and childbirth took place without any complications, then in the newborn the thyroid glands, which are responsible for the production of the hormone necessary for the absorption of calcium and phosphorus, as well as metabolic processes, function and proceed normally. Under the influence of solar radiation, biological and chemical processes are activated in the skin, resulting in the synthesis of vitamin D, due to which bone tissue normally absorbs phosphorus and calcium.
With an insufficient amount of vitamins in the child's body, the intestine is not able to absorb calcium normally, as a result of which its level in the blood decreases very much. To compensate for the deficiency of this element, the body begins to draw it out of the bone tissue.
Thus, the pathogenesis of rickets is often associated with the development of osteoporosis, in which the following occurs:
- bone tissue becomes softer and more fragile;
- the skeleton begins to deform;
- cartilage ossification occurs;
- excessive formation of unusual osteoid tissue.
In addition to all of the above, the child also has a violation of the protein, carbohydrate and fat metabolism.
Clinical manifestations
What are they like? So, we examined what the pathogenesis of rickets is. Symptoms of the disease can be different and depend on the severity and stage.
The course of the disease is divided into the following periods:
- elementary;
- progressive;
- final;
- recurrent.
To understand how the disease develops and proceeds, as well as what clinical manifestations are observed in this case, let's dwell on each of them in more detail.
Initial period
The pathogenesis of rickets in children (briefly about what constitutes an ailment, was described earlier) at the initial stage of development manifests itself in 2-3 months of a baby's life. The duration of this period is usually from 14 to 28 days. In most cases, the manifestations are associated with deviations in the functioning of the central nervous system. Behavioral factors change in a child, and frequent mood changes are observed. He behaves more restlessly and irritably, is constantly acting up, and also sleeps poorly.
Due to ANS dysfunction in children, sweating increases. This is especially noticeable during sleep and feeding. In this case, sweating is accompanied by an unpleasant sour smell, and the baby's body becomes sticky. Irritation may appear on the skin. In the neck, hair begins to fall out and a so-called venous pattern forms, which is clearly visible. With a visual examination of the baby’s head, you can notice a slight softening of the non-ossified areas and sutures of the skull.
The pathogenesis of rickets in children at the initial stage of the development of the disease can be detected by the excretion of waste products. The stool becomes unstable, and the smell of urine gives off ammonia. As for the chemical composition of the blood, the calcium level is within the normal range, but the phosphorus content is slightly reduced.
It is worth noting that at the initial stage, rickets can be treated, therefore, when the first symptoms of the disease appear, you should immediately contact a pediatrician. If treatment is not started on time, then the disease will take on a more severe form.
Progressive period
The pathogenesis of rickets at this stage is pronounced. In the children's body, significant changes in the bone skeleton and muscle tissue occur, as well as violations in the functioning of internal organs. Softened areas appear on the skull, the back of the head becomes flat, and the shape of the head can change. Mounds are often formed on the forehead and crown of the head, and the bridge of the nose looks sunken. In some cases, the baby's eyeballs are shifted, as a result of which vision may deteriorate.
Calcium deficiency in case of bone formation disorder leads to a slowing of teething of milk teeth and a change in their order. There are thickenings on the ribs between the bone and cartilage, and the chest is deformed and begins to protrude slightly forward. At 6-8 months of life, thickenings also appear on the fingers, lower leg and wrists.
The lower limbs change their shape, as a result of which, in the future, a narrowed pelvis will form in girls. In this case, the ligamentous apparatus and muscles develop very weak, so the so-called "frog" stomach appears in children, and the joints become loose. Changes in the shape of the chest disrupt the respiratory system, which is accompanied by severe shortness of breath. Very often, children develop pneumonia of the viral etiology. In addition, the heart shifts to the right, as a result of which its rhythm quickens, and blood pressure decreases.
Rickets (etiology and pathogenesis may be different) in the progressive stage is very often accompanied by the following clinical changes and concomitant diseases, such as:
- anemia;
- an increase in the size of internal organs;
- violation of wave-like contractions of the large intestine;
- decreased appetite;
- unstable chair.
If for a long period of time there is no proper treatment for rickets, then due to a deficiency of calcium and phosphorus in the blood, children develop spasmophilia.
Final period
The pathogenesis of rickets during convalescence is accompanied by reverse symptoms. Pronounced clinical manifestations in most cases disappear before the calcium and phosphorus levels normalize in the blood, and the child’s well-being improves. At the same time, the biochemical composition of the blood is slightly deviated from the norm, since calcium intensively enters the bone tissue.
Recurrent period
Rickets can continue to make itself felt after completing a course of therapy during the first 2-4 years of a baby's life. Depending on the individual characteristics of the organism, these periods may be longer. The progression of the disease stops, but over a long period of time, the size of the internal organs remains increased. In some cases, deformation of the limbs, skull and chest remains in children for life, however, fortunately, this happens extremely rarely and is rather an exception than a regularity.
Diagnosis of the disease
You already have a detailed idea of how the pathogenesis of rickets is manifested. Diagnosis of the disease includes a set of studies that accurately determine and confirm the presence of a bone formation disorder in the baby. For this, the child is assigned a biochemical blood test aimed at studying its composition. Doctors are interested in the readings of calcium, phosphorus and enzymes in a certain group. In addition, a general examination of patients is carried out. Based on the clinical picture of the patient, an accurate diagnosis is made and a treatment program is selected.
Disease treatment
Depending on the stage of the disease, the pathogenesis of rickets also changes. In this case, treatment is selected individually, depending on the complexity of the course of the disease and its period. In most cases, therapy is based on the use of medications that contain vitamin D. At the same time, doctors recommend paying great attention to the nutrition of children. A special balanced diet is selected for them. It is also recommended to spend as much time as possible with the baby in the fresh air, perform therapeutic gymnastic exercises, conduct ultraviolet irradiation, do special massage, and also take salt, coniferous and sun baths. In addition, vitamin therapy and a number of measures aimed at strengthening the body are prescribed. If the patient has an acute calcium deficiency, then preparations are prescribed that contain this element in large quantities, as well as normalize the intestinal absorption capacity.
According to medical statistics, in most cases, treatment proceeds normally and allows you to completely defeat the disease if therapy was started at its initial stage. At later dates, irreversible changes occur in the child's body, which, unfortunately, remain for life.
How to prevent the development of the disease?
This issue should be given special attention. Any disease is much easier to prevent than subsequently cured. Adhering to certain tips and recommendations, you can significantly reduce the likelihood of developing a bone formation disorder. Prevention of rickets (the pathogenesis of the disease discussed earlier) should be carried out both at the stage of gestation and during the first months of the baby's life. Most activities relate to breastfeeding.
They mean the following:
- Do not use artificial mixtures to feed your baby. Breast milk is the best source of vitamins, minerals and nutrients.
- If for some reason breastfeeding is not possible, then take the choice of mixture very seriously.
- From the first days of a child's life, do a special firming massage.
- To strengthen the body and improve its protective functions, perform dousing and rubbing.
- The best source of vitamin D is sunlight, so try to spend as much time as possible in the fresh air every day.
- Give your child an Aquodetrim solution. This drug contains a large amount of vitamin D, so it will provide the baby with the necessary daily dose of steroid prohormone.
Despite the fact that rickets does not lead to death, nevertheless it is a very serious disease that can ruin a child’s life. Therefore, try to adhere to the tips listed above in order to minimize the likelihood of developing this ailment in your baby. At the first symptoms of any problems, immediately seek help from a qualified doctor.