Rickets - Causes, symptoms and treatment. MF.

Rickets is a disease of infants and young children associated with a violation of the normal formation of bones during their intensive growth. For the first time the medical description of rickets was given by the English orthopedist F. Glisson in 1650.The name of the disease comes from the Greek word rhachitis, which means the spine. This is not accidental, because the curvature of the spine is a very characteristic manifestation of rickets.

Causes of rickets

A child develops rickets with insufficient intake of vitamin D during an active growth period. This happens under the influence of a number of reasons:
• Deficiency of solar irradiation. It is established that up to 90% of vitamin D is formed in the skin under the influence of sunlight. And this ability is possessed only by rays with a wavelength of 290-315 nm. In large cities with a high level of pollution and smokes the surface of the earth reaches only a small number of such rays. It is established that staying on the street for 1-2 hours with irradiation only of the hands and face provides the child with vitamin D for a whole week. But, unfortunately, many children and their parents, especially residents of big cities, often walk along the street prefer to stay at home.

• Features of power supply. It was found that the most frequent rickets occur in children on artificial feeding, receiving mixtures with insufficient vitamin D. In addition, in children with natural feeding with late introduction of lactation, the risk of developing rickets also increases. This is due to the fact that in 1 liter of human milk contains 40-70 IU of vitamin D, while 1 g of egg yolk is 140-390 IU, so it is very important to introduce lures in a timely manner according to a special calendar.
For normal development of the bone system, in addition to vitamin D, it is important to maintain an optimal balance of calcium and phosphorus intake. It is established that the croup contains some substances that reduce the absorption of calcium in the intestine. Therefore, the excess of cereals in the diet of a child can lead to rickets. In addition, currently in vegetables, because of the high prevalence of phosphate fertilizers, the content of phosphorus is increased. This, in turn, interferes with the normal intake of calcium into the body and leads to the activation of a number of hormones that adversely affect the metabolism of vitamin D.

• Pregnancy factors. It is known that the most intensive intake of calcium and phosphorus in the body of a child occurs in the last months of pregnancy. Therefore, children born before the due date are more predisposed to rickets than to full-term children. But it must be taken into account that a woman's inadequate nutrition and insufficient motor activity during pregnancy increases the incidence of the disease even in children who were born on time.

Under the influence of these reasons in the child's body, vitamin D deficiency is formed. This, in turn, leads to a decrease in calcium absorption in the intestine. Calcium in insufficient quantity enters the bone, the processes of growth of bone tissue are broken, the bones are deformed. In addition, calcium is an important element involved in muscle contraction. Therefore, with rickets, the muscles of the child become sluggish, atonic.

Separately, familial hypophosphatemic rickets, or phosphate-diabetes, or vitamin-D-resistant rickets, caused by a genetic mutation, are inherited and its treatment is fundamentally different from rickets caused by the above reasons.

Possible symptoms of rickets

During the disease, several periods are distinguished. The initial period of rickets has no specific symptoms and is often overlooked by parents. As a rule, the first signs of rickets appear at the age of 3-4 months. The child becomes restless, fearful, does not sleep well and eats. In a place with this there is a characteristic sweating: a sticky sweat with a sour smell, especially during sleep or feeding. At the kid the head strongly sweats, it rubs about a pillow, and in a field of a nape bald places are formed. This period lasts about 2 months, then the disease goes to the peak.

At this time, distinct changes in bones come to the fore. Along with the natural fontanelles, foci of softening of the bone appear in the frontal and parietal areas of the head. Due to this, the shape of the skull changes: the nape is flattened, the frontal and parietal mounds grow in size and protrude, possibly, the nose of the nose with the formation of the saddle nose. The head seems very large in comparison with the trunk, in some cases it becomes asymmetric. An irregular shape of the skull causes compression of the brain, which leads to a delay in mental and physical development. The skeleton of the chest is also deformed. In the region of the ribs, thickening of the bone tissue appears on both sides from the front, the so-called rachitic rosary. The chest is somewhat squeezed from the sides, and in the sternum is protruded forward, there is a "chicken" or "keeled" chest. In the region of the back, a rickety hump-kyphosis forms.

Changing the skeletal structure of the chest impedes normal growth and development of internal organs. So, for example, because of the compression of the lungs, such children often suffer from cold diseases, with the deformation of the heart and blood vessels, the development of heart failure is possible. On the bones of the hands and feet, especially this is expressed in the bones of the forearms, there are thickening of the bone tissue - "rachitic bracelets".The bones of the phalanges of the fingers also thicken. At the same time, O-shaped or X-shaped curvature of the legs in combination with a flatfoot is formed. Appearance of the patient with rickets. Attention is drawn to the "keeled" thorax, the forming rickety hump, the "rickety bracelets" on the hands, the X-shaped curvature of the legs. Appearance of a patient with rickets. The child has an irregular shape of the skull, a large atony abdomen, a weakness of the ligament apparatus of the lower limbs.

O-shaped( right) and X-shaped( left) curving legs.

For children with rickets is characterized by a more recent closure of the fontanelles, a delay in teething. Due to deformation of the jaw bones, an incorrect bite is formed. A characteristic symptom for rickets is the large abdomen, which arises from the flaccidity of the muscles of the anterior abdominal wall. Due to the weakness of the ligament apparatus, a child can throw his feet on his shoulders, perform the most bizarre movements in the joints. Sick children much later than peers, begin to hold the head, sit down, walk. At the height of the disease, many small patients are diagnosed with anemia, enlarged spleen and lymph nodes.

After treatment, there comes a period of recovery, which is characterized by the disappearance of softness of bones, muscle weakness, anemia. At the age of 2-3 years, some of the children who have had rickets have had irreversible bone changes( "rachitic rosary", O-shaped deformity of the legs, "keeled" thorax) against the background of the absence of changes in laboratory analyzes.

Based on changes in blood tests, as well as the severity of internal organ damage, the degree of rickets is determined. For the first degree of is characterized by changes in the initial period. Rickets of the second degree imply moderately pronounced changes in bones and internal organs. For , the third of the most severe grade of rickets is characterized by pronounced deformity of the bones, as well as significant changes in the internal organs with a delay in mental and physical development.

It is very important for parents to consult a pediatrician if even minimal signs of the disease appear. Ordinary sweating in a child can be associated with such diseases as autonomic dystonia, heart failure, thyroid hyperfunction, colds, so it's important not to engage in self-diagnosis and self-medication. The use of modern drugs in rickets in most cases leads to a complete cure. Therefore, timely application for medical help will avoid the formation of irreversible bone changes, disruption of normal growth and development of internal organs, including the brain, which in severe cases can cause developmental disability and disability of the child.

Diagnosis of rickets

As a rule, for the diagnosis of rickets, a pediatrician can offer to take blood tests. Blood tests are characterized by a decrease in the level of hemoglobin, erythrocytes, calcium, phosphorus, against the background of an increase in the level of alkaline phosphatase as a specific indicator of destruction of bone tissue. To confirm the diagnosis, an X-ray of the bones is recommended. Rickets are characterized by signs of destruction of bone substance.

Effective treatment means proper nutrition, adequate exposure to fresh air, as well as drug therapy.

Features of nutrition and lifestyle in the treatment of rickets

For infants, natural feeding with timely introduction of lures is recommended. When feeding with mixtures, preference is given to mixtures balanced in vitamins and trace elements. Children's menu should not be monotonous. In sufficient quantities, the child must receive foods rich in vitamin D and calcium. Such products include: fish, especially fatty varieties( salmon, mackerel), milk and dairy products, egg yolk, butter, liver.
Every day for 2 hours a child must be outdoors. The surface area of ​​the skin, which receives the sun's rays, should be maximal. Therefore, even in cold weather, the child's face needs to be kept open.

Drug medication for rickets

Drug medication for rickets is the administration of vitamin D preparations( cholecalciferol, alfacalcidol).The intake of vitamin D preparations starts at a dosage of 2000 IU per day with a gradual increase in the dose to 5000 IU.The average course of treatment is 35-45 days. After normalization of laboratory parameters, the dose of vitamin D is gradually reduced, and then the drug is completely canceled. If necessary, it may be recommended to repeat the course in 3-6 months.

In addition to preparations of vitamin D with a reduced level of calcium in the blood, calcium carbonate is prescribed. Dosage is selected individually according to the revealed calcium deficiency.

To improve the formation of vitamin D in the skin, in some cases, procedures for ultraviolet irradiation are recommended, which are carried out according to a certain scheme.

In the recovery period, massage, physiotherapy and physical therapy are recommended. Massage and therapeutic exercises should be conducted regularly, with a constant increase in the load. This helps to restore muscle tone, improve immunity. Of the physiotherapeutic methods, therapeutic baths are recommended. Coniferous baths are preferred in children with increased excitability of the nervous system, saline for sluggish, apathetic children. A good effect is a bath of broths of herbs: plantain, turn, chamomile, root of aira. This treatment is conducted 2-3 times a year, for treatment 8-10 baths.
After having had rickets, the child has been under the supervision of specialists for at least three years.

Possible complications of rickets

When severe deformity of the bones of the skull develops severe mental insufficiency. Curvature of the bones of the chest leads to a violation of posture, and lung compression predisposes to the development of pneumonia, tuberculosis and other infectious diseases. Pelvic deformities can complicate the birth period in women. Curvature of the bones of the limbs, as well as muscle weakness, prevents the normal physical development of the child. Due to changes in the structure of bones in children with rickets, there are often fractures.

Prevention of rickets

For the prevention of rickets in small children, in addition to proper nutrition and sufficient stay in the fresh air, it is recommended hardening, massage and therapeutic gymnastics. Healthy young children in the autumn-winter-spring period for preventive purposes should receive 400-500 IU vitamin D per day. At present, risk groups for rickets are identified. Children in these groups need specific prevention. The risk groups are children:

• premature babies, with a deficit of body weight.
• With chronic diseases of internal organs.
• With diseases associated with impaired absorption of vitamin D and calcium from the intestine( gastroenteritis).
• With limited motor activity( paresis, paralysis, bed rest after injuries and surgeries).

Specific prevention is carried out from 10-14 days of life, taking 400-1000 IU of vitamin D daily, except for the summer months, during the first two years.

Prognosis for rickets is favorable for timely treatment. After recovery, subject to the maintenance of preventive measures, relapse of the disease is rare.

Doctor therapist Sirotkina EV