Rickets - Causes, Symptoms and Treatment .MF .
Rickets - a disease of infants and young children related to the disruption of normal bone formation in the period of intensive growth.The first medical description of rickets given English orthopaedist F. Glisson in 1650.The name of the disease comes from the Greek word rhachitis, which means that the spine.It is no coincidence, because the curvature of the spine is a characteristic manifestation of rickets.
child sick rickets with insufficient intake of vitamin D during the period of active growth.It is influenced by a number of reasons:
• deficiency of solar radiation.It is found that up to 90% of vitamin D produced in the skin under the influence of sunlight.Moreover, this ability have only rays of wavelength 290-315 nm.In large cities with high levels of pollution and smoke reaches the earth's surface, only a small number of such rays.It has been established that the presence on the streets for 1-2 hours with exposure to only the hands and face of the child vitamin D provides for
• Features power.It was found that the most frequently encountered rickets in formula-fed infants receiving mixed with insufficient vitamin D. In addition, in children breastfed late introduction of complementary foods at risk of developing rickets also increases.This is due to the fact that 1 liter of human milk contains 40-70 IU of vitamin D, while 1 g of egg yolk-140-390 IU, so it is important to promptly introduce solid foods according to a special calendar.
for the normal development of the skeletal system in addition to vitamin D is important to maintain an optimal balance of calcium and phosphorus available.It has been established that in some cereals contain substances that reduce calcium absorption in the intestine.Therefore, the excess cereals in the baby's diet can lead to rickets.In addition, at present in the vegetables due to the high prevalence of phosphate fertilizer increased phosphorus content.This, in turn, interferes with the normal intake of calcium leads to the activation of a number of hormones that negatively affect the exchange of vitamin D.
• pregnancy factors.It is known that the most intensive flow of calcium and phosphorus in the body of the child takes place in the last months of pregnancy.Therefore, children born prematurely, are more prone to the emergence of rickets when compared with full-term children.But be aware that an unhealthy diet and lack of women physical activity during pregnancy increases the incidence of the disease, even in children who were born at term.
Under the influence of these causes is formed in the body of the child deficiency of vitamin D. This in turn leads to a decrease in calcium absorption in the intestine.Calcium in an amount insufficient enters the bone, broken bone growth processes, deformed bone.In addition, calcium is an important element involved in muscle contraction.Therefore, a child with rickets muscles become flabby, atonic.
Separately isolated as a family hypophosphatemic rickets, diabetes, or phosphate, or vitamin-D-resistant rickets, which is caused by a genetic mutation, the disease is inherited and its treatment is quite different from rickets, caused by the above reasons.
Possible symptoms of rickets
In the course of the disease there are several periods.The initial period of rickets has no specific symptoms and is often overlooked by parents.Usually, the first signs of rickets appear at the age of 3-4 months.The child becomes restless, fearful, not sleeping and eating.In place of this there is a characteristic sweating: clammy sweat sour odor, especially during sleep or feeding.The child strongly sweats head, it rubs against the pillow, and in the neck formed receding hairline.This period lasts for about 2 months, then the disease goes into crisis period.
At this time, the fore distinct changes in the bones.Along with the natural fontanelle, in the frontal and parietal region of the head appear foci of softening of the bones.Due to this change of skull shape: flattened occiput, frontal and parietal hillocks increase in size and appear, perhaps, retraction of the nose with the formation of saddle nose.The head seems to be very large compared to the body, in some cases, it becomes asymmetric.Incorrect skull shape causes compression of the brain, which leads to delayed mental and physical development.The skeleton of the chest is also deformed.In the front edges on both sides appear thickening of bone tissue, so-called rachitic rosary.The rib cage is somewhat compressed laterally, and in the sternum protrudes forward, there is a "chicken" or "keeled" chest.In the back is formed by a hump-rachitic kyphosis.
Changing bone skeleton chest prevents the normal growth and development of the internal organs.For example, due to compression of the lungs, such children often suffer from colds, when the heart and blood vessels strain may develop heart failure.On the bones of the hands and feet, especially expressed in the forearm bones, thickening formed bone tissue - "rachitic bracelets."Bones phalanges also thicken.At the same time formed the O-shaped or X-shaped curvature of the legs combined with flat feet.
Appearance patient with rickets.Noteworthy "keeled" rib cage, forming a hump rachitic, "rachitic bracelets" on their hands, the X-shaped curvature of the legs.
Appearance patient with rickets.The child is determined by the irregular shape of the skull, a large atonic stomach, weakness of the lower extremities ligamentous apparatus.
O-shaped (right) and X-shape (left), bending the legs.
For children with rickets characterized by a later closing of the fontanelles, delayed teething.Due to the deformation of the jaw bone is formed malocclusion.A characteristic symptom of rickets is a big belly, resulting from the sagging muscles of the anterior abdominal wall.Due to the weakness of the ligamentous apparatus of the child may throw his legs over his shoulders, make the most bizarre movements of the joints.Sick children much later than peers, begin to hold head, sit up, walk.At the height of the disease in many young patients diagnosed with anemia, enlargement of the spleen and lymph nodes.
After treatment begins the recovery period, which is characterized by the disappearance of the bone tender, muscle weakness, anemia.At the age of 2-3 years in some children recover from rickets detected irreversible bone changes ( "rachitic rosary", O-shaped feet deformation, "keeled" rib cage) on the background of the lack of changes in laboratory assays.
Based on changes in blood tests, as well as the severity of the internal organs are determined by the degree of rickets.For first degree peculiar changes of the initial period. Rickets second degree assumes moderate pronounced changes in bone and internal organs.For thirds most severe rickets characterized by severe bone deformation, as well as significant changes in the internal organs delayed mental and physical development.
parents is very important in the event of even minimal signs of disease consult a pediatrician.Normal sweating in a child may be associated with diseases such as vegetative dystonia, heart failure, hyperthyroidism, cold, so it is important not to engage in self-diagnosis and self-treatment.The use of modern drugs with rickets in most cases leads to a complete cure.So timely appeal for medical help to avoid the formation of irreversible bone changes, disturbances of normal growth and development of internal organs, including the brain, which in severe cases can cause developmental delay or disability of the child.
diagnosis of rickets
Generally, for the diagnosis of rickets pediatrician may suggest blood tests.The blood tests characterized by a decrease in hemoglobin, red blood cells, calcium, phosphorus, accompanied by increased levels of alkaline phosphatase as a specific indicator of destruction of bone tissue.X-ray of the bones is recommended to confirm the diagnosis.For rickets are characteristic signs of the destruction of bone substance.
Effective treatment includes proper diet, adequate exposure to fresh air, as well as drug therapy.
Features of diet and lifestyle in the treatment of rickets
For infants breast feeding is recommended with the timely introduction of complementary foods.When feeding mixtures, preference is given to mixtures balanced in vitamins and minerals.children's menu should not be monotonous.In sufficient quantities child should receive foods rich in vitamin D and calcium.These products include: fish, especially fatty species (salmon, mackerel), milk and dairy products, egg yolks, butter, liver.
daily for 2 hours, the child must stay in the fresh air.Skin surface area on which the sun's rays fall, should be maximized.Therefore, even in the face of the child cold weather, you should try to keep open.
Drug treatment of rickets is the appointment of vitamin D (cholecalciferol, alfacalcidol).Supplementation of vitamin D dosage start with 2,000 IU per day with gradual increase in dose to 5,000 IU.The course of treatment an average of 35-45 days.After normalization of laboratory indices of vitamin D dose is gradually reduced and then completely cancel the drug.If necessary, it can be recommended to conduct repeated course in 3-6 months.
addition of vitamin D with reduced calcium level in the blood is assigned to calcium carbonate.The dosage is adjusted individually according to the identified calcium deficiency.
To increase the formation of vitamin D in the skin, in some cases, the recommended UV exposure procedures which are carried out in a specific pattern.
The recovery period is recommended massage, medical gymnastics and physiotherapy.Massage and physiotherapy should be held regularly, with the steady increase in load.It helps to restore muscle tone, enhance immunity.From physical therapy methods are recommended medicinal baths.Coniferous baths are preferred in children with increased excitability of the nervous system, for salt sluggish, apathetic children.Have a good effect of the bath infusions of herbs: plantain, succession, chamomile, sweet flag root.This treatment is carried out 2-3 times per year, for a course of treatment 8-10 baths.
After suffering rickets child for at least three years under the supervision of specialists.
Possible complications of rickets
In severe deformation of the skull bones develop severe mental impairment.The curvature of the bones of the chest leads to a violation of posture and compression of the lungs predisposes to the development of pneumonia, tuberculosis and other infectious diseases.Deformation of the pelvis may complicate childbirth for women.The curvature of the bones of limbs, and muscular weakness, prevents the normal physical development of the child.By changing the structure of bones in children with rickets are more often broken.
Prevention of rickets
to prevent rickets small children, in addition to proper nutrition and adequate stay in the fresh air, recommended hardening, massage and physiotherapy.Healthy young children in autumn-winter-spring period for preventive purposes should receive 400-500 IU of vitamin D per day.Currently allocated risk for rickets.Children in these groups are in need of specific prevention.Risk groups include children:
• premature, underweight.
• With chronic diseases of internal organs.
• With the diseases associated with malabsorption of vitamin D and calcium from the intestines (gastroenteritis).
• With limited physical activity (paresis, paralysis, bed rest after injuries and operations).
Specific preventive maintenance is carried out 10-14 days of life, appointed reception on 400-1000 IU of vitamin D daily, except for the summer months, during the first two years.
forecast with rickets favorable with timely treatment.After recovery, subject to the preventive measures of the disease recurrence is rare.
therapists Sirotkin EV