Signs of rickets in infants. Prevention and treatment of rickets

The article will provide a description of the first signs of rickets.

There are some diseases that have long beenconsidered to be “diseases of the last century”, but as medical practice shows, they are not rarely seen today, and may not depend on the standard of living, child care and nutrition. These pathologies include rickets in infants.

Signs of rickets should be known by all parents.

Causes of the disease

There are only two prerequisites for the development of rickets in a child- Inadequate nutrition and deficiency in the body of vitamin D (calciferol), which is involved in a number of important metabolic processes, and this, in turn, becomes the main cause of the development of rachitic disorders in bone tissue. This vitamin comes with several products, and can also be produced in the skin under the action of solar radiation.

If the baby’s diet is poor in foods containingvitamin D, and the child himself rarely walks in sunny weather, the pathological phenomena in the bones, internal organs and muscles become inevitable for him.

However, such reasons are easily eliminated.It is enough to correct the child's diet, adding to it a greater amount of milk, butter, fish oil, boiled beef or poultry liver. Prerequisite are also frequent walks.

Internal pathologies and genetic abnormalities as the cause of rickets

Much more difficult is the situation with those children who have had some pathologies of internal organs since birth: intestines, liver, kidneys.

Impaired intestinal absorption of nutrientssubstances, obstruction of the biliary tract, some genetic diseases that interfere with the absorption of vitamin D - all this leads to the first symptoms of rickets in infants, and this pathology with comorbidities is very difficult to treat.

Signs and symptoms of rickets are important to identify in a timely manner.

Other factors of rickets

Artificial feeding and prematurity are two equally important factors affecting the metabolic process in the child's body and the absorption of substances from food.

Например, у недоношенного ребенка потребность в vitamin D is significantly higher than that of those children who were born on time, so very often the food does not cover the deficit in this vitamin, and rickets is only aggravated if one does not notice its signs in time and does not change the feeding system.

Artificial nutritional children suffer from rickets.due to the fact that in goat and cow's milk, as well as in artificial mixtures, the proportions of phosphorus and calcium - the most important elements for the construction of bone tissue - are violated.

Mothers who do not feed their children naturalbreast milk should know that the ideal artificial mixtures do not exist today, so the nutrition of the children of artificial animals should be organized so that the deficit of vitamin D, phosphorus and calcium can be constantly covered by additional supplements.

Signs of rickets in infants will be presented below.

Classification of the disease

The classification of rickets in modern pediatrics associated with the effectiveness of treatment with calciferols. In this case, the following types of this disease are distinguished:

1. The most common is classic D-deficient rickets.
2. Secondary.
3. Vitamin D-resistant.
4. Vitamin D-dependent.

The classic look of rickets is also subdivided intodepending on changes in the concentration of phosphorus and calcium in the blood, therefore, there are phosphopenic and calcium-penic types of it that indicate a significant deficiency of these elements. Sometimes the classic form of rickets occurs with normal concentrations of phosphorus and calcium.

The course of the D-deficient form of rickets is acute, recurrent and subacute. This disease goes through several stages: the initial stage, the height of the disease, recovery, the stage of residual effects.

Острая форма наблюдается у вполне здоровых внешне kids: they grow well, gain weight, but still suffer from a similar pathology. It arises due to the lack of calciferols in the monotonous carbohydrate diet and is characterized by bright, intense symptoms of the nervous and vegetative nervous systems, as well as pronounced changes in bone tissue.

In the subacute form, the symptoms of rickets moresmoothed and expressed moderately. Such a variant of the disease is observed in those children who had previously received specific prophylaxis with mixtures containing vitamin D.

When a recurrent form occurs, forwhich is characterized by periods of exacerbations and remissions of rickets, is most often observed in children from dysfunctional families, in the absence of proper care, proper feeding and sufficient air exposure.

Вторичный рахит развивается вследствие нарушения absorption of vitamin D in the intestines, as well as obstruction of the bile ducts, kidney diseases, which are associated with impaired metabolic processes. It also occurs in children who take anticonvulsant drugs for a long time, diuretic drugs and hormones. There is a possibility of the occurrence of the disease of secondary rickets in children who are parenterally fed in hospitals.

Vitamin D-dependent form of rickets is of two types and is usually caused by a defect in the synthesis of calciferols in the kidneys and a deficiency of receptors that are responsible for their absorption.

Vitamin D-resistant rickets occurs against the background of orphan pathologies of congenital nature - with Debre-Fanconi syndrome, phosphate diabetes, hypophosphatasia - impaired bone mineralization, etc.

These pathologies are very rare and they are accompanied, as a rule, by many other severe changes in mental and physical development.

The main signs of rickets

This disease happens in three stages:

1. The first stage is characterized by the initial manifestations of the disease with minimal symptoms.
2. The second stage is a moderate course of the disease.
3. The third stage is severe rickets, in which there are marked changes on the physical level and a lag in mental and mental development.

The first stage of rickets

Parents, first of all, should be alerted by signs of rickets in infants, which include:

1. Increased sweating child with a sour pungent odor.
2. Baldness of the occiput, which is often accompanied by severe itching.
3. The occurrence of prickly heat (small rashes on the skin).
4. Tendency to develop constipation while respecting the normal drinking regime.

Additional signs of rickets include the following:

1. Spontaneous muscle twitching.
2. Fear of light.
3. Increased irritability of the child.
4. Difficulties with falling asleep.
5. Decreased appetite.

Rickets first degree in infants begins, as a rule, in the third month, and in premature babies even earlier.

The second stage

The further course of this pathology is complicated by the emergence of new signs. Rickets in infants who did not receive treatment for this disease in the first stage develops as follows:

1. The softening of the cranial bones in the area of ​​the fontanel is craniotabes.
2. The change in the shape of the nape is the flattening of its bones.
3. Also a frequent sign of rickets in infants at 3 months is chest deformity - “shoemaker's chest”, if it is slightly depressed, or “chicken breast”, if it is protruded.
4. Curvature of tubular bones: "X" -shaped or "O" -shaped legs.
5. The appearance on the wrists of the specific "rosary" rickets.
6. The beginning of violations in the work of internal organs.
7. Later closing the fontanel.
8. Delay teething.

To notice the signs of rickets in infants at 3 months is simple.

Рахит второй степени у грудничков сопровождается, as a rule, increased vegetative and neurological symptoms - lethargy, drowsiness, excessive fatigue, heavy sweating, especially when screaming and other loads. Such children are very far behind their peers, not only in physical development, but also in psychomotor and mental.

Third stage rickets

Third stage rickets is most oftenresult of the lack of therapeutic measures when the child is deprived of parental attention and observation of doctors. In this case, there is not even a question of how to identify the first signs of rickets in such a child - his symptoms are so pronounced and severe. The following pathological conditions can be noticed:

1. Rough violations of bone and muscle tissue.
2. The weakness of the ligament apparatus.
3. Delayed motor activity.
4. Extremely severe dysfunctions of internal organs, frequent pneumonia and bronchitis.

Usually these signs of rickets after a year appear.

For all children who have ever had a severe or moderate degree of this disease, changes in the bones remain, as a rule, for a lifetime:

• deformed limbs;
• bulging or sunken chest.

In girls, rachitic defects of the pelvic bones are often preserved. The pelvis becomes flat, which later becomes the cause of various birth injuries at the birth of their children.

Signs of pathology in children from one year to two years

Малыш становится беспокойным, плаксивым, пугливым - after 2 years the symptoms worsen. Innervation of the liver leads to the fact that hepatocytes are affected, the destruction of liver tissue begins, and pathological foci of scar tissue grow.

Signs of rickets in a child of 2 years may frighten parents.

Vegetative disorders accompanyvasomotor reactions. If you run your finger over the skin, then you can see red linear stripes. Vegeto-vascular problems become stronger after feeding the baby. Red bubbles appear on the back of the head on the skin. There is severe itching.

Another sign of rickets in a 2-year-old child is hyperesthesia. Hypersensitivity of skin receptors irritates the child.

Diseases of the central nervous system accompany the reflex pathology with inhibition, motor activity. When rickets appear changes in the muscles.

Soreness of the joints, curvature of the legs appear after a year when the child learns to walk.

We examined the main signs of rickets in children after a year.

Treatment of rickets at an early stage of its occurrence

Therapy of rickets in infants - very longprocess, since it takes months, and in some cases even years, to restore bone tissue. Treatment methods are selected depending on the severity of symptoms and the severity of the disease.

Non-specific therapeutic methods include:

1. Elimination of strong noise and bright light in the child’s room.
2. Long daily walks, as well as sun and air baths - according to the season.
3. Hardening in the form of rubdowns with cool and warm water.
4. Coniferous and salt baths for the correction of the process of inhibition and excitation in the nervous system.
5. Therapeutic gymnastics and massages.
6. Diet.

About the diet should be said separately: it remains a major factor for further recovery. The treatment of rickets at an early stage requires a revision of the usual nutritional system:

1. Replacing ordinary water with fruit and vegetable decoctions.
2. Early introduction of protein foods in the form of cottage cheese and egg yolk.
3. Appointment of vegetable foods in the form of mashed stewed and boiled vegetables, grated raw vegetables.

After diagnostic procedures that detect deficiency of phosphorus and calcium, children are prescribed a course of vitamins C, A, B, as well as calcium drugs.

Assessing the severity of the disease, the doctor can add to the non-specific therapy and elements of specific treatment, which include:

1. Ultraviolet irradiation for 20 days with the selection of individual biodosage.
2. Oil, alcohol or aqueous solutions of vitamin D - "Videhol", "Ergocalciferol", "Videin", "Cholecalciferol", "Akvadetrim", etc.

The drug "Ergocalciferol" is prescribed, as a rule, to all children, regardless of the severity of the disease.

Для исключения рецидивов заболевания грудничкам from the risk category, medications with a vitamin D content of 4 weeks daily are often prescribed to prevent the onset of rickets. Komarovsky (famous pediatrician) recommends the following preventive measures.

Prevention of rickets

Prevention of this disease in infants begins in the period of intrauterine development. Pediatricians recommend mothers to observe the following rules:

1. Periodically, preferably by courses, give the child special multivitamin complexes.
2. Adhere to a special diet, that is, such a baby's diet that will satisfy its need for calcium and phosphorus.
3. Frequent walks in the fresh air in any weather.

Prevention of this disease during pregnancy is carried out by taking a single dose of vitamin D of 200,000 IU in the seventh month of carrying a child.

Need to timely recognize the signs of rickets ininfants in 4 months. From the very birth of a child, it is necessary to closely monitor its diet and daily pattern. It is advisable to breastfeed it, because only breast milk contains all the substances necessary for the child that cannot be replaced by any artificial formula existing today.

In addition, the child requires dailywalking, and according to the season you can keep your baby naked for some time in the shade of the trees. A wellness massage for 20 minutes per day is also recommended, with interruptions. If necessary, pediatricians advise parents to introduce early protein and vegetable supplements.

It is also highly advisable to usecitrate mixture, which is based on the use of 2.1 g of citric acid, diluted in 100 ml of water. The resulting solution must be given to the child a teaspoon three times a day for 10 days, followed by a repetition of the course after one month.

Specific prevention is also needed.this pathology: healthy children are prescribed a course of exposure to a UV lamp in the amount of ten sessions in the winter, autumn or spring. In the summer, such sessions of UV therapy, as a rule, are not conducted. After them, the dosage forms of vitamin D are canceled for 2 months. Children from the risk category carry out such irradiation from two weeks of age.

Medical preparations containing vitamin D,for the implementation of specific prophylaxis, children born in time are prescribed, as a rule, in a dosage of 400 IU in the form of an oily or aqueous solution during the entire first year of life. For premature babies, this dose is somewhat higher and amounts to 1000 IU.

It must be remembered that vitamin D drug preparations are not always helpful. Their use is prohibited in the following pathological situations:

1. After suffering hypoxia during pregnancy.
2. After intracranial birth injuries.
3. With small sizes of large fontanel.
4. With nuclear jaundice.

Calciferols are also prescribed with caution to children who received adapted dairy mixes with a vitamin D content.

Walk with the baby should be daily, andThis should be done in any weather. If it is cold and frosty outside, the walk should last at least one hour, if it is sunny and warm - at least 3-4 hours. The only exception is strong wind, even in the warm season, when bringing an infant to the street is strictly prohibited.