Rickets in children: symptoms, treatment and prevention
The state of health of a young child depends largely on what his parents are feeding, how long they walk with him on the street and how they follow the pediatrician's recommendations.If the toddler is always at home, does not receive mother's milk, if his diet is not timely introduced lures, and all food is limited to cow's milk or unbalanced in composition by milk mixtures, it can develop rickets.
Rickets is a disease associated with deficiency of vitamin D and a violation of the mineral metabolism in the body.Suffer from rickets children of the first year of life, and among the sick are the most premature babies and "artificers"( babies feeding on milk formulas).
For a child's life, rickets are not dangerous, but in the absence of adequate treatment, this disease can leave a trace for life - a noticeable deformation of the skeleton, an incorrect bite, flat feet and other similar disorders.Causes and mechanisms of rickets development Risk factors for rickets Symptoms of rickets Diagnosis Treatment of rickets
Causes and mechanisms of development of rickets
It is known that calcium, phosphorus and vitamin D are needed to form a complete bone tissue, ensuring the absorption of the first two substances inIntestines.In the child's body all these compounds come with food( breast milk, yolk, vegetable oil, fish, vegetables, etc.), and vitamin D is also synthesized in the skin under the influence of sunlight.
Newborn babies are born with a supply of calcium, phosphorus, vitamin D( these substances are especially active in the fetus in recent weeks of fetal life, but only on the condition that the mother is eating properly and regularly walks in the street), so up to 1-2 months their bone tissue develops normally.In the following, and because of the exhaustion of stocks, and because of the active growth, the children's body begins to need more and more "building" material.If this need is not met, calcium and phosphorus are washed out of the bones.Because of this, bone tissue becomes less dense and easily deformed.Hence all the unpleasant manifestations of rickets from the side of the skeleton.
In addition to affecting the bone tissue, the violation of phosphorus-calcium metabolism negatively affects the condition of the muscles and nervous system of the child.Patients have a delay in psychomotor development, hypotonia of the muscles and other pathological symptoms.
Thus, the main cause of rickets is a deficiency of vitamin D, a certain role in the development of the disease is also played by the lack of calcium and phosphorus. There is such a scarce state in the following cases:
- If the child does not receive all the necessary substances with food.For example, when parents substitute breast milk with unbalanced mixtures or cow milk, when lures are introduced late( after 6-8 months), when the porridge dominates in the baby's diet, especially semolina.
- If the child's skin is not exposed to sunlight for a long time.
- If the digestion of food and the absorption of nutrients are disturbed in the intestine( if the child has gastrointestinal disease, even the most nutritious food will not reduce the risk of rickets).In addition to the obvious reasons for rickets, there are several risk factors:
- Prematurity( babies born before the term do not have time to make "stocks" of useful substances - this is, firstly, Secondly, they are much more likely to have problems with the intestines and in general with the digestive system as a whole).
- Big weight of a newborn( the baby is bigger, the more nutrients and vitamins it needs).
- Multiple pregnancy.Babies born from such a pregnancy, as a rule, begin to feel a shortage of calcium and phosphorus still in utero.In addition, these babies are more likely to be born prematurely.
- Congenital disorders of the digestive system.
- Swarthy skin color( in swarthy children, less vitamin D is produced in the skin).
Symptoms of rickets
First signs of rickets, which parents need to pay attention to:
- Increased sweating of the baby( the mother should be alerted that even when the child has a cool sweat during the feeding on the forehead and spout, that it sweats heavily the hands and feet, etc.).
- Bad sleep, unreasonable anxiety, start.Baldness of the nape.
- Constipation( with rickets, muscle hypotension develops, including the intestinal wall, so peristalsis weakens, which leads to a delay in stool).
These symptoms can appear already on 3-4 months of a child's life.If the disease is detected at this stage( it is called the initial one) and treated, there will be no negative consequences for the baby's health. If this moment is missed, the disease will progress( it will go to the stage of heightening), and the child will have more serious symptoms of the pathology:
- Deformities of the skull, limbs and trunk.Indicative feature - flattened back of the head, large forehead, O-or X-shaped change of legs, etc.
- Strong muscle weakness, because of which there is another indicative symptom - "frog stomach".
- Lag in motor development( the child does not begin to hold his head, turn over, sit, although his peers already do it all, etc.).Teeth dissection.
- Various disorders of the internal organs( primarily the gastrointestinal tract).
Gradually, the child's condition, of course, improves( the recovery stage begins somewhere in 6-7 months after the onset of the disease), but the formed bone deformities do not disappear completely, with many of them the babies remain for life.This is a narrow pelvis, and large frontal tubercles, and an incorrect bite, and a deformed thorax( squeezed from the sides and protruded forward), and flat feet.
To diagnose "Rickets" an experienced doctor can, as they say, by eye, but to confirm the diagnosis still need to go through one simple study - a urinalysis of Sulkovich.This is a qualitative test for calcium in the urine taken from the baby before the first morning feeding.To conduct the analysis should be prepared( to purchase a urine collection, so it was more convenient to collect the urine of the child, make some restrictions in nutrition, etc.).
In severe cases, when physicians need to find out the extent of calcium phosphate metabolism and the depth of bone tissue damage, the patient undergoes a more extensive examination, including:
- Blood tests for electrolytes( calcium and phosphorus), alkaline activityPhosphatase( an indicator of destruction of bone tissue), as well as metabolites of vitamin D.
- Determination of calcium and phosphorus in daily urine.
- US of the bones of the forearm.
- Radiography( recently used rarely).
Treatment of rickets
Treatment of children with rickets is necessary in a complex, using specific and nonspecific methods( necessarily taking into account the cause of the disease).
Nonspecific methods are the nutrition, the correct regime of the child's day, and various restorative procedures( massage, gymnastics, herbal, salt and coniferous trays, etc.).Specific methods include the administration of preparations of vitamin D, calcium and phosphorus, artificial irradiation of the skin with ultraviolet( recently applied more rarely and mainly in premature infants).
Nutrition and day regimen
The nutrition of children with rickets should be aimed at providing the body with all the necessary substances.For babies up to a year the best food is breast milk. If there is no possibility to breastfeed the baby, you should choose adapted milk mixtures, cow and goat milk for this is not suitable.
It is also important to introduce lures in a timely manner, as the child's needs are growing every month, and the number of beneficial substances in human milk decreases with each month.Therefore, pediatricians do not recommend breastfeeding exclusively after 6 months of age.
For a child with rickets, the first lure can be administered already at 4 months, and it is better if it is a vegetable puree, to which over time it is necessary to add natural sources of vitamin D - vegetable oil, egg yolk, and after 7-8 months - fish and meat.In addition, the sick baby needs fruit purees and juices, as well as cottage cheese and sour-milk products.But with porridge, especially semolina, it is better to wait.
Regarding the regime of the day, it should be organized in such a way that the child is on the street every day for at least 2 hours. And it is not necessary to substitute the baby under direct sunlight rays( this is even harmful), enough light will break through the green of the trees.
In addition, you should do with the baby charging, drive him to massage( or do it yourself after consulting a specialist).Also, children with rickets are shown saline, herbal, coniferous baths( which one to choose, the doctor will tell).After such procedures the child will eat and sleep better.
Drug medication for rickets
The basis of this treatment is the intake of vitamin D, and which drug should be used and the dose should be prescribed only by the pediatrician, as with rickets, both a small dose of the drug( there will be no effect) and overestimated( hypervitaminosis) will be dangerous.
In addition to vitamin D, a baby can prescribe calcium and phosphorus( without vitamin D, it is not advisable to take them).Premature babies are often recommended complex medications, in which, in addition to vitamin D, there are other vitamins, as well as all the necessary minerals.
Prevention of rickets in children
Rickets refers to diseases, the development of which is very easy to prevent with the help of a number of preventive measures.Such measures include:
- The intake of vitamin D( 400-500 ED) daily during the year, except May-September.In regions with insufficient sunny days, there are no breaks in taking the drug.For premature babies the doctor can prescribe a large dose of vitamin.
- Rational nutrition.In the first months of life - exclusively breast milk, after 4 months - breastfeeding and lure by age.
- Daily walks in the fresh air.In the warm season, it is advisable not to wrap up the baby, but at least some parts of his body should be placed under indirect sun rays.
In addition, the mother can give her child prerequisites for a healthy future even during pregnancy.For this, a woman needs to eat a balanced diet, walk more in the air and take vitamin and mineral complexes if they are prescribed by a doctor.
Zubkova Olga Sergeevna, medical reviewer, epidemiologist-doctor