Quite often, various disorders of mineral and basal metabolism are recorded in children. They cause persistent functional disorders in babies. One of these diseases is rickets.
What it is?
A systemic disease in children caused by a violation of calcium-phosphorus metabolism is called rickets. The discrepancy between the great need for minerals against the background of the active growth of the child leads to the appearance in him of a pronounced deficiency of biologically active substances necessary for physiological development. Persistent metabolic disorders lead to the development of a disease in the baby - rickets.
The disease can be diagnosed already in children under one year old. There are no exact statistics for this disease. This is usually due to the fact that mild forms of the disease remain unnoticed for a long time and do not fall into statistical documents when generating medical reports. According to some researchers, the incidence of rickets in the general population ranges from 25 to 60%.
The history of the study of this disease began in the middle of the 17th century. The first indication of this childhood disease was made by the anatomist R. Sishop. When forming the name of the disease, the Greek word is used, which in the exact translation means "back ridge". This is no coincidence. In fact, the name denotes the pathogenesis of the development of the disease and indicates the predominant localization of the pathological process.
For several centuries, scientists have been actively studying rickets. And by the end of the 20th century, the medical community already believed that it had all the necessary knowledge about this childhood disease. At this time, scientific studies appeared that proved a reliable connection between the development of the disease and the presence of deficiency of vitamin groups.
Interest in this disease can be noticed much earlier than in the 17th century. The paintings of artists of the Middle Ages depict babies with a curved chest and a curved spine. It is very likely that this is how the authors wanted to portray children suffering from rickets. In an earlier period of time, people did not know that such a disease exists and what it is associated with. The birth of babies with curvature of the spine meant that this is a "devil's curse" for the whole family and a very bad sign.
It is important to note that the prevalence of this disease is different. So, in unfavorable conditions of northern cities and countries, a large number of cases of rickets are recorded in infants and older children.
Nowadays, there is an increasing number of scientific studies that indicate that car exhaust and air pollution are also factors affecting the increase in the incidence of rickets in children.
Causes
Already in the XXI century, doctors and scientists came to a consensus that rickets occurs due to the insufficient content of vitamin D in the child's body. It usually comes with certain foods that the child eats. Also, this useful vitamin is produced inside the body when exposed to sunlight or artificial ultraviolet radiation. Vitamin D, or as it is also called "tocopherol", is very important for participation in calcium-folate metabolism, which means it is vital for all biological reactions.
The following reasons can cause a decrease or a pronounced deficiency of this necessary substance in a baby:
- Decreased intake with food. This usually happens with non-rational, as well as improperly selected nutrition. For toddlers, vitamin D problems often occur during the complementary feeding phase when the baby is not getting all the foods it needs.
- Insufficient exposure to ultraviolet rays. Children living in northern cities have a higher risk of developing rickets than their southern small peers. If little walks with the baby on the street, and the children's room is constantly curtained with too dense curtains, then the child often has a pronounced and persistent deficiency of vitamin D.
- Chronic diseases of the gastrointestinal tract. Some of these pathologies, especially enteritis, can interfere with the absorption of vitamins from food during digestion. In infants, such pathologies are, as a rule, congenital.
- Various diseases in the expectant mother. Vitamin D deficiency can be observed even during intrauterine development. Usually this is caused by chronic diseases of the expectant mother, and insufficient intake of vitamins along with food.
- Prematurity. Babies born much earlier than the due date are at risk for the development of various diseases with impaired vitamin metabolism. This feature is due to the fact that in a premature baby, many body systems have not yet been completely formed.
Anatomical defects that lead to chronic gastrointestinal diseases often contribute to the malabsorption of vitamin D from human milk or formula.
The first signs in newborns
Clinical manifestations of rickets appear in premature babies as early as 1-3 months. They can be expressed to varying degrees. In some children, adverse symptoms appear quite clearly. Usually, the diagnosis of the disease in such a situation does not cause difficulties for doctors. In this case, the diagnosis of rickets is established already in the first 6 months after the birth of the baby.
You can suspect a disease in a newborn baby by the following clinical signs:
- Behavior change. The kid becomes easily excitable, overreacts violently to any influences directed to him. The child's sleep is disturbed. This is usually manifested by the fact that the baby often wakes up in the middle of the night or practically does not sleep. Putting newborn babies to sleep with pronounced signs of rickets is a rather difficult task.
- The appearance of increased anxiety. The kid becomes very shy. Any sounds can scare him: doorbell ringing, doors opening or closing, object falling on the floor and others. The child usually reacts to such external stimuli quite sharply: he begins to cry and even scream. Often, babies are afraid of nocturnal sounds, so they also often wake up in the middle of the night.
- Slow physical development. Disturbance in calcium metabolism against the background of a reduced calciferol content leads to pathologies in the formation and development of bone tissue. The spine and bones of a child with rickets grow somewhat more slowly than those of his healthy peers. Usually, doctors identify this clinical sign in newborns during regular clinical examinations.
- The appearance of an unpleasant skin odor. Many pediatricians say that clean and healthy baby's skin "smells" like mother's milk. In the case of rickets, this smell changes and becomes very unpleasant, sour. This is due to the altered chemical composition of sweat due to changes in the content of various substances due to impaired metabolism in the body. Acrid sweat irritates your baby's skin, causing prickly heat and skin irritation.
- Impaired scalp hair growth. This can usually be seen in babies at 2-4 months. Heavy sweating leads to itching. A small child does not yet realize how he can scratch his skin, so he starts rubbing his head against the pillow. This leads to the fact that the hair on the back of his head grows worse.
- Formation of violations of the structure of the body. This is the initial stage of future pronounced bone pathologies, which will form with persistent and not eliminated rickets in time.
It is quite difficult to notice the first signs in a newborn baby. Usually these changes are identified by a specialist.
Symptoms
In its development, the disease goes through several successive stages. The initial period is usually ½ to 1 month. At this time, the first non-specific clinical manifestations appear, which are often "overlooked" by doctors and parents, since they are not significantly expressed. If the course of the disease is subacute, then this period can be 1.5-3 months. At this time, the child does not have any pathological changes in the internal organs.
If this time is missed, then the development of the disease moves to a new level. It is called the height. This time is very unfavorable, since the baby is already developing persistent pathologies in the work of many internal organs and pronounced violations of the architecture of the structure of the bone tissue appear. The height of the disease usually occurs after 6 months of a child's life. The baby has autonomic and neuromuscular manifestations, rickets of the head and chest begins to form.
A sick child becomes sedentary, practically does not play with favorite toys or avoids active games. Babies, as a rule, stand on their legs later and begin to crawl late. They are also strongly disturbed by severe sweating, hypotonia of muscles and ligaments appears. By the end of the year, the child usually has the first visible signs of osteomalacia (destruction of bone tissue).
Changes in the configuration of the head lead to the appearance of a classic appearance with rickets when there is an asymmetry of the head and a significantly flattened nape. The rib cage is also involved in the process. The lower third of the sternum becomes depressed, which provokes the appearance of the so-called shoemaker's chest. In some cases, it can protrude strongly forward ("chicken breast").
The pelvic bones are also involved in the systemic pathological process. There is a pronounced deformity of the pelvis. Rickets is characterized by damage to the bones that grow most actively. They are bent and various deformations appear, which cause numerous orthopedic pathological conditions in the baby. Disorders of bone tissue lead to severe pathologies with teething and the formation of an incorrect bite.
Another classic symptom of the disease is changes in the architecture of the spine. The spinal column becomes altered, its various curvatures appear - kyphosis, lordosis and scoliosis. Pathologies that arise in the ligaments against the background of excessive muscle weakness contribute to the formation of excess mobility in the joints. Severe hypotonia of the muscles forming the anterior abdominal wall leads to flattening and "spreading" of the abdomen. This symptom is also called "frog belly" by doctors.
Pronounced bone defects lead to not only orthopedic problems. A flattened chest contributes to the formation of respiratory pathologies and a decrease in the ventilation capacity of the lungs. Compression of internal organs causes disruption of their blood supply, which ultimately leads to the development of multiple chronic diseases in the child. The most common pathologies occur in the liver and gastrointestinal tract.
If the signs of rickets were noticed, and treatment was prescribed, then the main autonomic and neuromuscular disorders begin to disappear.
This period of the disease is called convalescence. At this time, as a rule, the child's muscle tone is restored, the work of the joints is normalized, and the general well-being improves. The indicators of the work of internal organs during this period also return to normal. The baby's laboratory tests are normalizing.
Pediatricians note that residual manifestations of the disease remain in a child until the age of 2-3 years. They are manifested by a slightly reduced muscle tone and joint mobility. Other clinical and laboratory changes are not recorded. With properly selected rehabilitation, the residual symptoms of rickets disappear and the child returns to normal life.
Diagnostics
Determining the clinical signs of rickets, even at an early stage, is not a difficult task, since they are usually quite pronounced. Every day, district pediatricians identify new cases of the disease in babies. The appearance of neurological and autonomic disorders in a child should motivate parents to consult a doctor for advice. The doctor will conduct the necessary clinical examination and recommend the necessary additional tests to establish the correct diagnosis.
In order to establish the severity of the impaired metabolism, doctors resort to the following laboratory tests:
- Determination of the amount of calcium. Normally, it is 2.5-2.7 mmol / l. If its lower normal values are reduced and amount to 2 mmol / l, then this indicates that the child has signs of impaired calcium-phosphorus metabolism.
- Determination of phosphorus content. Normally, it is 1.3-2.3 mmol / l. With rickets, this indicator is significantly reduced. In a severe course of the disease, it can drop to 0.5 mmol / L.
- Determination of alkaline phosphatase. This biologically active substance is necessary for the transfer and interaction between calcium and phosphorus ions. The normal value of this enzyme is up to 200 U / L. An excess in the tests over the norm indicates that the baby has signs of disorders with the exchange of phosphorus and calcium.
When bone defects appear, doctors resort to establishing the degree of their severity. To do this, they use the bone x-ray method. With the help of this study, you can determine the density of bone tissue and identify various abnormalities that have appeared as a result of the course of the disease. With an excessive accumulation of calcium in the bones, X-ray shows areas with such seals. Changes in flat and tubular bones are well diagnosed.
With the help of radiography, you can see the specific changes characteristic of rickets. These include: "rickety rosary", pathological curvatures in the chest and spinal column, "rickety bracelets" (pathological bone defects in the wrist), as well as deformities of the bones of the lower extremities.
You can also resort to conducting computed tomography. This method also shows quite accurately all the changes that have occurred in the bone tissue. Computed tomography has a high resolution, which ensures high accuracy of the results. The method has significant radiation exposure, so it should be carried out only according to strict indications. There are also contraindications to the study, the presence of which in the child is determined by the attending physician.
To establish a diagnosis, a comprehensive diagnosis should be carried out. In some cases, it includes the appointment of several diagnostic tests at once. Complex clinical situations require a more careful and attentive attitude.
The importance of correct diagnosis is enormous. A timely diagnosis will allow you to maintain an excellent quality of life for your baby and prevent the development of dangerous adverse complications.
Effects
Rickets is not a harmless disease. It can also be dangerous. With untimely diagnosis and the absence of treatment, this childhood pathology leads to the development of adverse consequences.These include: curvature of the limbs, impaired bite, chronic diseases of internal organs, a pronounced decrease in tolerance to physical activity, lag in physical development, disturbances in the work of the cardiovascular and respiratory systems.
In order to prevent the development of these consequences of the disease, you should carefully monitor the baby's well-being and have regular checkups with a pediatrician. The appearance of the first signs of the disease should be the reason for the appointment of a treatment complex, during which mandatory monitoring of its effectiveness is carried out.
The positive effect of therapy is manifested by an improvement in the child's well-being, as well as by the normalization of calcium metabolism in laboratory tests.
Treatment
Rickets therapy is complex. It involves combining different therapeutic methods. During the treatment, the baby's condition is assessed by several medical specialists of different specialties at once: a pediatrician, a neurologist, an orthopedist, a dentist, an exercise therapy doctor, a children's masseur. Only this complexity of therapy can lead to a lasting positive effect of the treatment.
To eliminate the adverse symptoms of the disease, the following methods of therapy are used:
- Medical treatment. Reduced to compensation for impaired calcium and phosphorus metabolism. To achieve this goal, doctors prescribe a sick child various medications containing vitamin D. The selection of drugs and their dosages is carried out taking into account the age of the baby, as well as the severity of his functional disorders.
- Normalization of the daily routine. For the synthesis of vitamin D, regular sun exposure is required. Daily walks in the fresh air are a prerequisite for treating babies who have rickets. For walking, you should choose comfortable clothes so as not to cause hypothermia or overheating of the baby.
Walking with the child during a bright sunny day is especially effective for treatment.
- Keeping breastfeeding as long as possible. Mother's milk is a unique nutritious product created by nature. It contains all the necessary vitamins and minerals that are needed for the growth and development of a little man. If it is impossible to keep breastfeeding for a number of medical reasons, then you should choose adapted nutritional formulas for your baby. They should also contain adequate amounts of vitamin D.
- Massage. Helps eliminate pronounced neuromuscular manifestations. Special tactics of carrying out children's massage allow you to fight hypotonia. Usually, after a course of massage, the baby's well-being improves markedly, and the child begins to feel much better.
- Schedule complementary foods taking into account the age of the baby. For babies who have pronounced signs of rickets, doctors prescribe a special diet. It includes eating foods that contain vitamin D.
- Physiotherapy. It is a necessary and important component of treatment. Regular exercises help the child cope with various neuromuscular disorders, improve posture and encourage the child to get up and crawl on their own. Usually classes are held in conjunction with an exercise therapy instructor. However, they can also be done at home.
- Treatment of concomitant diseases. Therapy of chronic diseases of the gastrointestinal tract is necessary to eliminate severe metabolic disorders. A pediatric gastroenterologist is involved in the treatment of such pathologies.
- Physiotherapy procedures. They are usually prescribed to babies who have no contraindications to their conduct. To normalize calcium-phosphorus metabolism, various methods of ultraviolet irradiation are used. Such procedures are carried out in the clinic, in the physiotherapy room. The number of visits is determined by the pediatrician.
Medicines
To normalize the level of calcium in a child's body with rickets, it is necessary to prescribe additional products and drugs containing its active metabolite - calciferol (vitamin D)... In children's practice, doctors give preference to water-soluble forms. They contain vitamin D in the most optimal state for absorption in the intestine.
One of these medicines is "Aquadetrim". On average, the general course of treatment with preparations containing vitamin D lasts 1 to 2 months. During this time, the indicators of calcium-phosphorus metabolism are normalized, and laboratory indicators are also improved. After the intensive treatment course, they do not refuse to take vitamin D completely, but use it in prophylactic dosages.
To select the optimal dosage for water-soluble forms of calciferol, you should consult a doctor. You should not independently select a therapy regimen if the child has already established signs of rickets. Such self-medication will help lead to a severe overdose of vitamin D, which is also a very dangerous condition. The doctor selects the optimal dosage of the medicine taking into account many factors: the age of the child, the severity of the disease, as well as the presence of concomitant pathologies of internal organs in the baby.
If the end of the treatment course falls in the winter season, then in some cases, after the end of the main treatment, doctors recommend continuing to take vitamin D for another month to finally eliminate the symptoms of calcium deficiency in the child's body.
Typically, this method of therapy is used for severe and persistent rickets. To avoid an overdose of calciferol in the child's body, he must be tested for the level of calcium in the blood several times during the entire treatment.
Massage
To normalize the reduced neuromuscular tone, as well as to improve the overall well-being of the baby, he is prescribed a course of therapeutic healing massage. Usually, the duration of one procedure in infants is 20-30 minutes. This time is quite enough for a specialist to work out the affected areas of the body.
The duration of the course is calculated individually by the attending physician, taking into account the age of the baby and the severity of his adverse symptoms of the disease.
During the procedure of medical massage for children, the specialist performs several consecutive actions:
- Stroking. This technique helps to calm the child and tune him in the right way. Usually stroking is used at the very beginning of the procedure. They help your baby to feel more relaxed. It is better that during the entire procedure, mom is nearby. This will help the baby feel most comfortable.
- Rubbing... This technique has a pronounced effect on the muscles and helps to relieve hypotonia. Rubbing helps to improve metabolic processes and activates the blood supply to internal organs.
- Kneading... This technique has a deeper penetration. It helps to massage the damaged muscles well and eliminates all pathological disorders that have arisen in them during the course of the disease. During active kneading, various muscle groups relax: arms, legs, tummy, back, neck. All movements of the masseur are usually very well-coordinated, the degree of pressure is small, but quite sufficient to work out the muscles.
- Vibration. Helps to improve metabolic processes, helps to normalize hypotonia, eliminates muscle soreness. This technique can be performed in two modes: intermittent and continuous. The intermittent method helps to increase the tone and reduce muscle atrophy, and the continuous method eliminates severe spasm and activates the skeletal muscles for further movements.
Prevention
Children's specialists in all countries of the world are engaged in the prevention of rickets. The disease is of particular importance in the northern states, where the level of solar insolation during the year is quite low. In some European countries, there are government programs to support families and children. They provide for the free provision of medicines containing vitamin D to all children to prevent the onset of rickets.
In our country, there is also a fairly high incidence of this pathology.
Children living in cold and northern regions need to get enough vitamin D from outside. The main source of it for babies is various correct complementary foods.
A large amount of calciferol is found in fermented milk products and egg yolk... The daily requirements for these products are determined taking into account the age norm.
Babies who are not yet receiving complementary foods should receive vitamin D from their mother's milk. A nursing mother should remember that her nutrition during lactation is very important. The diet of a lactating woman must necessarily contain foods containing a sufficient amount of calciferol. These include: cottage cheese, cheese, dairy products, chicken yolk, meat. A woman during lactation must definitely include dishes containing these products in her daily diet.
Outdoor walks are also important in preventing rickets. Ultraviolet radiation helps to produce enough vitamin D inside the child's body. Mommies should go out with the child every day. Especially good sunny days are not to be missed. Sunlight will help your baby to have strong bones and active health for years to come.
Active activities with a child reduce the likelihood of developing various orthopedic pathologies. To form strong bones, the baby must not only receive adequate nutrition, but also actively move. Such exercises not only improve the psycho-emotional connection between the mother and the baby, but also help the baby not to get sick with diseases of the musculoskeletal system.
Active play develops physical development and promotes good growth.
It is very important to remember that many forms of rickets can be congenital... Planning a healthy pregnancy is very important. The expectant mother should remember that while carrying a baby, she should eat well and properly, avoid nervous stress, and be sure to walk in the fresh air. Doctors prescribe multivitamin complexes for all pregnant women. Such simple prevention allows expectant mothers to give birth to healthy babies in the future.
For what rickets in children is, see the next video.
