Rickets in young children: prevention and treatment. Rickets - prevention and treatment Conversations with mothers about the prevention of rickets

“PREVENTION OF RICHITS (Memo for parents) What is rickets? Rickets is a disease characterized by metabolic disorders, primarily phosphorus-calcium. It leads to..."

PREVENTION OF RICKITIS

(Memo for parents)

What is rickets?

Rickets is a metabolic disorder characterized by

first of all, phosphorus-calcium. This leads to damage to the bones, and

also to the violation of the functions of all organs. The immediate cause of this

The most common pathology is vitamin D deficiency.

Why is rickets dangerous?

The formation of the skeleton is disturbed, bone deformities occur

skull, spine, chest with its protrusion (“chicken breast”) or indentation (“cobbler’s chest”), legs (curvature of the legs like the letters “O” or “X”), pelvis (in girls, it may complicate the course of childbirth in the future ), flat feet Incorrect and untimely teething, the development of caries Decreased immunity, a tendency to frequent infectious diseases, especially from the upper and lower respiratory tract.

The child becomes restless, irritable, sleep is disturbed Decrease in muscle tone and lag in psychomotor development Appearance of constipation Formation of myopia at school age Average terms of development of skills in children Smiling 5 weeks Crawling 7 months Cooing 7 weeks Voluntary grasping 8 months Holding the head 2 months Standing up 9 months Directed 4 months Supported steps 9.5 months Hand movements Rolling over 5 months Standing alone 10.5 months Sitting 6 months Walking alone 11.7 months Time of eruption of deciduous teeth Teeth Age (months) Lower Upper Middle incisors 5-8 6-10 Lateral incisors 7-10 8-12 Canines 16-20 First large molars 11-18 Second large molars 20-30 Why does rickets occur?

The main cause of rickets is insufficient intake of vitamin D from food or its formation in the skin under the influence of ultraviolet rays.

Vitamin D increases the absorption of calcium in the intestines and its deposition in the bones (in the form of a compound with phosphorus). With a deficiency of vitamin D, the absorption of calcium decreases and there is no sufficient deposition of its salts in intensively growing bones. They become soft and easily deformed.

The child's immunity decreases, the nervous system suffers.

There is little vitamin D in food. For example, in one liter of cow's milk it is 20 times less than the daily requirement of a child. An exception is the egg yolk, but it is given only from 6 months.

The daily requirement of an infant for vitamin D is 400-500 IU, and for calcium - 0.3-0.5 g. In the first months of life, the child has enough calcium contained in breast milk, but from the second half of the year additional calcium is required. A good source of calcium is cottage cheese, after 1 year - cheese.

Timing of the introduction of complementary foods and additional nutritional factors to healthy children in the first year of life

–  –  –

Cereals, especially wheat, are rich in phytin, which contains phosphorus. Phosphorus binds calcium in the intestine, preventing its absorption. Therefore, children who are given semolina or mashed potatoes 2-3 times a day receive less calcium and have an increased risk of developing rickets.

How often do children get rickets?

Rickets is a very common disease. Experts believe that in the absence of specific prevention, about half of all children develop rickets.

Which children are at high risk for developing rickets?

Children born to women who had:

Pathology of pregnancy (toxicoses, threatened miscarriage, severe illness during pregnancy);

Complicated childbirth;

nutritional defects;

Non-compliance with the regime of the day (insufficient exposure to fresh air in sunny weather, low physical activity);

Lack of prevention of rickets with vitamin D.

On the part of the child predispose to the development of rickets:

Improper feeding of the child (deficiency of protein, calcium, phosphorus, vitamins, use of non-adapted milk mixtures);

Insufficient motor activity of the child (tight swaddling, irregular gymnastics and massage, paresis, paralysis);

Insufficient exposure to fresh air;

Skin diseases; dysfunction of the gastrointestinal tract, kidney and liver disease;

prematurity;

Birth of twins, triplets, etc.;

Long-term treatment with anticonvulsants;

Frequent colds.

What are the first Clinical signs rickets?

Attentive parents can note the initial signs of the disease from 1-2 months of age. There is anxiety, shivering. The child’s sleep may worsen, he begins to turn his head, “baldness” is noted

occiput. There is increased sweating with a characteristic sour smell. Persistent prickly heat appears on the skin. Characteristic is reduced muscle tone, constipation. Bone changes during this period are usually absent. The doctor during the examination notes the softening of the edges of the fontanel.

Which children should be treated for rickets?

Prevention of rickets should be carried out in absolutely all children of the first two years of life.

When should rickets prevention be started?

You need to think about the prevention of rickets even before the birth of the baby.

A pregnant woman should:

Eat right (eat at least 0.5 liters of dairy or sour-milk products, 150 grams of cottage cheese, 30 grams of cheese).

It is enough (at least 2-4 hours) to stay in the fresh air;

It is enough to move and engage in physiotherapy exercises;

Take vitamin-mineral complexes containing vitamin D (500 IU) in accordance with the daily requirement, for example, MultiTabs Perinatal at a dosage of 1 tablet daily.

How to prevent rickets after the birth of a child?

In order for the baby to grow up healthy, it is necessary to use all methods of preventing rickets in time - systematic physiotherapy exercises, massage, taking air baths in the morning for 15-30 minutes on sunny days in the summer, water procedures, and maintaining breastfeeding.

But even with the organization proper care for the child and rational nutrition, an indispensable condition for preventing rickets in a child is the intake of vitamin D.

How is vitamin D prescribed to prevent rickets?

Vitamin D is prescribed for healthy full-term children from the age of 1 month at a dose of 400-500 IU per day in the autumn-winter-spring period. The drug should be controlled by a doctor. For premature babies, prophylaxis is carried out from 10-14 days of life. If a child receives adapted milk formulas as food, then with them the child receives vitamin D, the amount of which should be taken into account when prescribing the drug. Usually in these cases, the dose of vitamin D is reduced to 200-250 IU.

The dose for premature babies and from risk groups (often ill, with pathology of the gastrointestinal tract, etc.) is individually determined by the doctor.

What vitamin D preparations should be used to prevent rickets?

Best to use various forms vitamin D3. Multi-Tabs Bzbi drops have proven themselves well. Vitamin D is in this preparation in the form of D3. In addition, Multi-Tabs Baby contains vitamins A and C, which are necessary for the effective functioning of vitamin D: vitamin C promotes the conversion of vitamin D into an active form, and vitamin A increases cell sensitivity to it. The complex of these three vitamins ensures the proper development of bone, dental tissue, the immune system, the normal condition of the skin and mucous membranes of the child. Drops Multi-Tabs Baby do not contain sugar and dyes.

Clinical trials have shown high efficacy and low frequency or complete absence of side effects, including allergic reactions. A dark glass bottle protects the vitamins from destruction by light and air.

A convenient built-in pipette guarantees dosing accuracy: 1 ml contains 400 IU of vitamin D.

What vitamin preparations containing vitamin D can be given to children after a year?

The Ferrosan company offers Multi-Tabs Kid chewable tablets for children from 1 to 4 years old, Multi-Tabs Junior for children over 4 years old, and Multi-Tabs Teenager for teenagers. The quality of Multi-Tabs multivitamins with minerals is guaranteed by the GMP certificate, which is awarded World Organization health care the best producers medical products.

Advice on the prevention of rickets was given by the chief regional rehabilitation specialist, head. Department of Faculty Pediatrics, VSMA, Professor,

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Many parents had to deal with such a childhood disease as rickets. Rickets usually manifests itself in children of the first two years of life. More often rickets can be found in babies born in autumn and winter. This article is devoted to the following issues. So what is rickets? What are the symptoms of rickets? Is it necessary to prevent rickets? How to treat rickets in children?

Rickets is a complex disease that is characterized by changes in the bone, muscle and nervous systems of the body. Rickets occurs as a result of a lack of vitamin D, a violation of phosphorus-calcium metabolism.

With rickets (at an early stage), the baby's nervous system is the first to suffer. He is often naughty, cries, sleeps poorly, eats less. Also, the baby begins to sweat, this is especially noticeable when crying or feeding the baby. Most of all, the head, palms and feet sweat. Hair rolling at the back of the head is possible. Further, if you do not pay attention to these symptoms, you can observe a lag in physical development. The baby begins to later hold his head, roll over from side to side, sit and walk. The fontanel heals poorly, teeth grow later.

Prevention of rickets

Has several steps. Prevention of rickets at the stage of pregnancy.

• proper and complete nutrition. The food of a pregnant woman should be varied, rich in proteins, fats, carbohydrates, as well as essential vitamins, trace elements and minerals.
• walks in the open air. It is necessary every day, regardless of weather conditions, to walk in the fresh air (at least 2 hours).
• correct daily routine. Rest and sleep future mother are an important part of a child's development.

Prevention of rickets at the stage of breastfeeding:

• - the best nutrition for the baby, provided that it is correct and complete.
• with artificial feeding, it is necessary to choose a mixture that most closely resembles breast milk in composition.
• massage. Necessary right from the start early age give babies a massage, gradually increasing the load as the child grows.
• rubbing and dousing. These hardening procedures are very useful for the prevention of rickets.
• daily outdoor walks. Vitamin D is produced when the skin is exposed to sunlight. You need to walk for at least 2-3 hours. Don't forget to ventilate the room.
• taking a prophylactic dose of vitamin D. It is best to give an aqueous solution of vitamin D (for example, aquadetrim), as it is better and faster absorbed by the body.

The daily requirement for vitamin D for children is different and depends on certain factors: the age of the child, season, climate, type of feeding. Usually, the prophylactic dose is 1-2 drops per day. It is better to consult with a specialist.

How to treat rickets in children?

You can't cure rickets on your own! Treatment of rickets is prescribed by a pediatrician based on the causes and severity of rickets, as well as the age of the child.

Treatment is prescribed complex and consists of several parts that complement each other:

• Proper nutrition. It is necessary to use foods that contain vitamin D in the diet. These are egg yolk, cheese, salmon, dairy products, butter. Eat less flour products, as they interfere with the absorption of calcium.
• The correct dosage of vitamin D and the duration of treatment.
• Walks in the open air.
• Massage, rubbing, dousing, exercise.

Prevention of rickets will help to avoid unnecessary worries and problems. Watch the baby, follow the rules of prevention, and at the first warning signs, consult a specialist, and even better, two or three.

Rickets (from the Greek word ῥάχις, rhachitis - spine) is, alas, not a disease of the past, but quite modern, and one of the most common diseases of children and adolescents. This disease mainly occurs in early childhood(in children under 2 years of age).

Rickets has been known since ancient times. This disease was first mentioned in 98 AD. e. (works of Soran of Ephesus). It is manifested by a violation of phosphorus-calcium metabolism due to a lack of vitamin D in the body. Accompanied by disorders of the skeletal and nervous system, as well as internal organs.

Interestingly, for some time rickets was considered a disease of the British, since it was in England that this disease was most common. By the way, it was the Englishman, the orthopedist Glisson, who studied rickets in the most detail, and compiled a complete description of this disease, gave the disease the name rickets from the Greek = spine. Previously, the disease appeared under the name rickets (from Old English wrickken = to warp).

Forewarned is forearmed, and it is useful for mothers to know about this disease so as not to miss possible symptoms and ensure the prevention of rickets for the baby.

Risk factors

It is important to know the main causes (or so-called risk zones) and factors of rickets:

- lack of sun (depending on climate, life, season);
- extensive multiple rashes on the skin;
- insufficient intake of vitamin D from food, for example, as a result of late introduction of complementary foods;
- unbalanced nutrition of the mother;
- feeding with non-adapted milk mixtures;
— disorder of the gastrointestinal tract, dysbiosis;
- diseases of the liver or kidneys;
- endocrine disorders;
- insufficient physical activity;
- long-term anticonvulsant therapy;
- in cases where the age of the mother exceeds 35 years or less than 18;
- unbalanced nutrition of a pregnant woman;
- prematurity of the baby;
- Boys and children with the second blood group are more difficult to tolerate.

One more important reason, which can cause rickets, is improper nutrition / feeding of the child.
It has been proven that breastfed babies are less likely to get rickets (of course, provided that the mother has a normal, healthy metabolism). And, conversely, if feeding is artificial or mixed, then the risk of rickets becomes higher.

Why is this happening? The fact is that when breastfeeding, the absorption of calcium by the child is 70%, and with artificial feeding - only 30%. As for phosphorus, then, again, with breastfeeding, the child absorbs 50%, and with artificial - only 20% or 30%. This is a very important factor in breastfeeding protection. Very good assimilation phosphorus and calcium by a child in raw human breast milk. It is so well conceived by nature that in breast milk there is such a ratio of phosphorus and calcium that this ratio is ideal for absorption by the baby (the ratio is: 1 to 1, 3-1.5). So the joy of many mothers for natural breastfeeding is not at all unfounded!

Of course, there are endogenous / internal causes of the disease, but they are much less common.

For example, due to chronic diseases of the kidneys and liver, the processes of transition of the inactive form of vitamin D to the active one can be disrupted. The absorption of vitamin D may be impaired (also an endogenous cause).

External signs

How can parents themselves suspect rickets in a child?

We will analyze the three degrees of severity of rickets.

First degree- the easiest. The child has anxiety, irritability, tearfulness; excessive sweating, which causes itching, and slight baldness behind the back of the head; flattening of the neck; moderate hypotension mainly in the arms and legs; due to hypotension, there may be constipation, dry skin and a decrease in its elasticity. These signs can already appear in the first three months of the child.

Second or medium severity. All signs of the first degree are more pronounced. To them are added a "frog belly", a convex roller along the midline of the abdomen due to muscle hypotension; imbalance of the joints, weakness of the ligamentous apparatus; developmental delay; various bone defects are laid and manifested: deformity of the occiput, protrusion of the frontal, parietal or occipital tubercles, teeth erupt later, the fontanel, saddle nose closes later, deformity of the chest (“shoemaker’s chest” or vice versa keeled), flat rachitic pelvis, x- or o- shaped legs, poor posture, rickety "bracelets" on the legs and arms, "strings of pearls" on the fingers ... all this already manifests itself at the age of three to six months.

Third degree rickets- heavy. The child is lethargic, apathetic, inactive; severe muscle hypotension; severe bone deformities that can already remain for life; severe constipation, apathy, liver enlargement ...

Treatment and prevention!

- Vitamin D, calcium and phosphorus preparations
- Massage
— Gymnastics
- Hardening.

The peak period or the acute course of the disease is a contraindication for massage. Outside of the acute period, massage and gymnastics are prescribed 2 weeks after the start of drug treatment. It is recommended to donate blood for biochemistry to check the presence of calcium and phosphorus.

Rickets can be found in different countries world, but still most often rickets occurs in those climatic conditions where there is little sun, bad air, dampness. Experts have even noticed that children who have a birthday in winter or autumn suffer from rickets more often than those whose birthday falls in spring and summer. This is not strange, because it is in late autumn and winter that there is less sun, and children spend less time outdoors.

If a child receives insufficient ultraviolet radiation, moves little, spends a lot of time indoors - all this can serve as the development of rickets. In autumn and winter, the sky is gloomy, and the sun's rays rarely visit our climate zone. And if they occasionally visit, then through dense gray clouds, very few sun rays reach the earth, and even then mainly at certain hours of the day. Therefore, it is so important to regularly walk with children during the day in late autumn and winter, when you can catch ultraviolet light.

There are many ways to prevent rickets. You can start a set of measures already during pregnancy. What are they? First, get enough sleep. Secondly, daily walks in the air, whatever the weather (from two to four hours). Nutrition of a pregnant woman is also one of the important factors in prevention. It is necessary to ensure that during pregnancy the mother and child are not disturbed by phosphorus-calcium metabolism. This is important to track after childbirth, during lactation.

If a pregnant mother has hypertension, diabetes, nephropathy or rheumatism, it is important to ensure that there is enough vitamin D and make up for its deficiency with the help of drugs. Ultraviolet irradiation in small doses is also considered very effective, but for this it is necessary to consult a doctor.

After childbirth, the prevention of rickets should continue. Breastfeeding is very helpful. Proper nutrition of a nursing mother is especially important in order to provide the baby with everything necessary. If breastfeeding is impossible for some reason, you need to choose the milk formula that is as close as possible to the female breast milk. It's 100% lactose, and has a one to two ratio of phosphorus to calcium. This is important, because there are mixtures in which this ratio can be equal to 1.2 or 1.5.

An important prevention is exercise therapy (physiotherapy exercises) and massage on a regular basis.

If the baby is premature, he is prescribed daily help in the form of vitamin D (from about the 10th day of life). Although healthy and full-term babies are also prescribed the minimum prophylactic dose as a prophylaxis. It is determined by the doctor, but, as a rule, it is 400 IU per day.

After the positive effect of the so-called artificial mountain sun (mercury-quartz lamp) on children with rickets was discovered in 1919, irradiation with certain rays began to be considered a good prevention of this disease. However, everything is very individual, and should be agreed with a competent and experienced doctor.

Today, vitamin D is prescribed to almost all children. But we must not forget that an overdose and excess calcium in the baby's body can destroy his kidneys. Therefore, in everything you need to know the norm.

And no drugs can replace good nutrition, walks and hardening of the baby.

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The word "rickets" comes from the Greek "backbone". Indeed, rickets is primarily associated with a violation of phosphorus-calcium metabolism and the process of bone formation, in which the skeleton is formed incorrectly in the first place. The cause of the disease is most often a lack of vitamin D.

Rickets is a fairly common disease among young children. Most often it occurs in children of the first two years of life. Rickets can also develop in a child during a period of intensive growth, so sometimes it is defined as growth disease.

Why is rickets dangerous?

A child with rickets is much more difficult to tolerate acute respiratory infections, gastrointestinal and other diseases that, with rickets, are protracted and fraught with complications. Moderate and severe forms of rickets are manifested by a pronounced violation of bone formation and gross deformation of the skeleton. In the future, the child, if rickets is not treated, will have short stature, a large head, a curved chest and crooked legs, and a rickety pelvis. He develops visual defects, flat feet, malocclusion. It also slows down the neuropsychic development of the child. If rickets is detected in time and treatment is started at the initial stage of the disease, it will not leave any traces.

What are the causes of rickets?

Lack of sunlight

Lack of sunlight and insufficient exposure to fresh air. The fact is that vitamin D, which almost always plays a major role in the prevention of rickets, is formed in the body under the influence of sunlight. It is sad that in large cities, due to air pollution, too few rays with anti-rachitic properties reach the earth's surface.

Malnutrition

For example, children who are formula-fed and receive unadapted mixtures are more likely to suffer from rickets; children with late introduction of complementary foods or receiving vegetarian complementary foods without the required amount of animal protein.

Other reasons

1. perinatal factors. For example, prematurity.
2. Intestinal dysbacteriosis, which is accompanied by diarrhea.
3. Low physical activity (blood supply to the bones improves with muscle activity).
4. Chronic diseases of the liver and kidneys.
5. hereditary factors.
6. Bad ecology.

What are the first signs of rickets?

The first signs of the disease in children appear most often on the 2nd or 3rd month of life, and they are noted from the side of the nervous system: the child becomes restless, excitable, his sleep is disturbing and superficial. He has excessive sweating, which causes prickly heat and itchy skin. The baby tosses and turns restlessly on the pillow, as a result of which he begins to develop baldness at the back of his head. Gradually, the disease progresses and leads to a lag in the child's physical and psychomotor development, changes in the structure of the skeleton.

Can rickets be prevented?

During pregnancy

Prevention of rickets in a child should be started by the mother during pregnancy. To do this, she must:

Follow the regime

Observe the regime of the day, while being in the fresh air as much as possible and, if possible, maintain physical activity at all stages of pregnancy.

Eat balanced

Her diet should include foods containing calcium and phosphorus salts in a ratio of 2 to 1, as well as in sufficient quantities the necessary vitamins, minerals and complete protein. Do not neglect the treatment of toxicosis.

Vitamin D

The child who is on breastfeeding receives vitamin D from mother's milk. Mom needs to take a special vitamin complex, which includes this vitamin. After the introduction of complementary foods, vitamin D is started to be given to the child, but the doctor must prescribe the dose. It depends on what time of the year it is outside and what cereals the mother gives the child as complementary foods - many children's ready-made cereals already contain vitamin D. Children who are bottle-fed do not need to take vitamin D, since it is part of all adapted milk formulas.

Walking during sunny weather

A good prevention of rickets is walking a child or a nursing mother in sunny weather, and it is enough to be in the sun for at least half an hour. Therefore, vitamin D is not prescribed in the summer - it is important that it is produced naturally in the sun.

Summing up

The most relevant prevention of rickets in the autumn-winter months - from November to March. During this period, the doctor, according to indications, may prescribe vitamin D. It is impossible to prescribe this vitamin to a child: firstly, an overdose is dangerous, and secondly, there are contraindications: intracranial birth trauma, hypoxia, nuclear jaundice, small sizes of a large fontanel.

Observation

for young children with "background" pathology

NORTHERN STATE MEDICAL UNIVERSITY

DEPARTMENT OF PEDIATRICS AND PROPADEUTICS OF CHILDREN'S DISEASES

Series for students

From the notebook of a pediatrician

Release 5

Observation of young children with "background" pathology

(rickets, anemia, chronic eating disorders and anomalies of the constitution)

Arkhangelsk - 2002

Reviewer - Assoc. T.L. Shiryaeva

Approved at the meeting of the CCMS SSMU, chairman - prof. A. M. Vyazmin

Prototyping V.A.Plaksin, tel. 20-90-11,

e-mail: [email protected]

(make-up, replication, electronic versions of brochures)

ã Northern State

Medical University, 2002.

ã Department of Pediatrics and PDB,

Design, series, 2002.

RICKETS

(E55 - active rickets, E64.3 - consequences of rickets)

Rickets is a widespread disease in children of the first 2 years of life, due to a temporary discrepancy between the needs of a growing body for calcium and phosphorus and the insufficiency of systems that ensure their delivery to the body. It is manifested mainly by a peculiar change in the bones.

The main key mechanism for the development of rickets: insufficient intake of vitamin D from food and its formation in the skin, impaired phosphorus-calcium metabolism in the liver and kidneys.

Factors predisposing to rickets:

Clinic:

The first symptoms of rickets usually appear at the age of 1-2 months, clinical picture at 3 - 6 months.

Initial period. Symptoms from the central nervous system: anxiety, shyness, irritability, startling in bright light, loud sound, sleep disturbance, sweating (sticky sweat), red dermographism, loss of appetite. Alopecia of the nape appears, tissue turgor decreases, muscle hypotension develops, and constipation appears. On the side of the bones: a slight compliance of the edges of a large fontanel. X-ray changes are absent, calcium content in the blood remains normal, phosphorus content decreases or remains normal, alkaline phosphatase increases, phosphaturia, Sulkovich's test (+). The duration of the initial period is from 2-3 weeks to 2-3 months.

Height period. Symptoms of osteomalacia (softening of the bones): compliance of the cranial sutures, flattening of the occipital bone, craniotabes, saddle nose. Under the influence of the load, curvature of the spine (kyphosis, lordosis, scoliosis), chest (“Garisson's” furrow, deployed lower aperture of the chest, chest “cobbler”, “chicken” chest), pelvic bones (flat pelvis), lower extremities (X -shaped, O-shaped). Symptoms of osteoid hyperplasia (growth of bone tissue): costal "rosary" - thickening in the area of ​​​​the bone-cartilaginous joints of 7-10 ribs, "bracelets" - in the area of ​​\u200b\u200bthe epiphyses of tubular bones, "strings of pearls" - in the area of ​​\u200b\u200bthe epiphyses of the phalanges of the hands, "square" scull,. Symptoms of hypogenesis: late teething, asymmetrical teething, hypogenesis of the main bone of the skull manifests itself in the form of such symptoms as a "saddle" nose, "Olympic" forehead. Sweating, weakness, muscular hypotonia (“frog” belly, constipation) increases, due to the weakness of the ligamentous apparatus, “looseness” of the joints appears. The child is emotionally labile, there is a delay in neuropsychic development, frequent morbidity. Calcium and phosphorus are reduced in the blood, alkaline phosphatase is increased, hypochromic anemia, phosphorus in the urine is increased or normal. On radiographs: osteoporosis, goblet expansions of the metaphyses, blurring and indistinctness of the zones of preliminary calcification.

convalescence period. The state of health improves, vegetative and neurological disorders decrease, calcium and phosphorus are normalized, and growth zones are thickened on x-rays.

Residual period(by 2-3 years). Bone deformities persist. At an older age - flat feet, scoliosis, flat pelvis, dental caries, stunting, myopia.

Classification:

By severity

1 - easy. Changes in the central nervous system, autonomic nervous system, muscular system, compliance of the large fontanel are expressed.

2 - moderate. Bone changes are expressed, but not more than in 2-3 groups of bones.

3 - heavy. Softening of the bones of the base of the skull, retraction of the bridge of the nose, exophthalmos, pronounced bone deformities, hypotension, delayed motor, statistical functions, changes in the internal organs, the development of severe anemia, hepatosplenomegaly, myocardial dystrophy.

With the flow

Acute. More often in the first half of life, symptoms increase rapidly, symptoms of osteomalacia are characteristic.

Subacute. More often in the second half of life, the slow development of symptoms, the symptoms of osteoid hyperplasia predominate. It occurs in children with malnutrition, in acute diseases it can turn into an acute course.

Recurrent. Improvement is replaced by deterioration against the background of various somatic pathologies, changes in the conditions of care and feeding. The cardinal sign is the appearance of symptoms of osteomalacia against the background of existing bone changes such as osteoid hyperplasia. X-ray - the appearance of Lowser zones.

Prevention of rickets

Antenatal non-specific prevention - prevention of miscarriage, extragenital pathology in women of childbearing age, a rational diet, sufficient exposure to fresh air for a pregnant woman, early diagnosis and treatment of any pathology during pregnancy.

Specific antenatal prophylaxis consists in taking vitamin D by women not older than 30 years old, from the risk group (nephropathy, diabetes mellitus, hypertension, rheumatism) at a dose of 400-500 IU, starting from 28-32 weeks of pregnancy for 8 weeks, regardless of the time of year . In practice, this is carried out by giving 2 tablets of Gendevit or other vitamin D-containing complex multivitamin preparations. In the North, during the "polar night" in winter and spring, UVI can be recommended from ¼ biodose to 2.5-3 biodoses, every other day, No. 20-30.

Postnatal non-specific prevention - compliance with the regimen, rational feeding of the child, performing massage and gymnastics complexes, sufficient exposure to air (at least 4 hours a day).

For the purpose of specific prevention of rickets, vitamin D is prescribed at a dose of 400-500 IU daily, for full-term babies from 3 weeks of age, for premature babies from 2 weeks of age. For children at risk, the dose can be individually increased to 1000 IU. Children living in the North are advised to prescribe vitamin D in the summer as well. Vitamin D is recommended to be taken during the entire first year of life, and for children at risk, children who have had rickets in the first year of life - in the 2nd year of life in the autumn winter time, and in the 3rd year of life - in the winter. If the child receives adapted mixtures, when prescribing vitamin D, its content in the mixture is taken into account. When prescribing prophylactic doses of vitamin D, control of calciuria (Sulkovich's test) is not carried out.

The small size and early closure of the large fontanel are not a contraindication for the appointment of specific prevention of rickets, but it should be carried out with greater caution. It is necessary to evaluate the anamnestic data, the somatic and neurological status of the child, the size of the circumference of the head and chest, and examine the urine for the Sulkovich reaction. In the absence of symptoms of microcephaly, organic damage to the central nervous system, hypercalciuria, the prevention of rickets is carried out in the usual doses. In doubtful cases, you can limit yourself to using UVI 2 times in the autumn-winter period of the year, periodically prescribing a citrate mixture.

In the event of any disease, the prevention of rickets is not interrupted. In some cases, the dose of vitamin D may be increased (for diseases of the gastrointestinal tract, frequent illnesses respiratory infections) subject to a weakly positive or negative Sulkovich reaction.

With a high risk of developing rickets, the complex of preventive measures includes vitamins B 1 and B 2, 1 mg x 2-3 times a day, B 5, 3 mg x 3 times a day for 10-12 days, B 6, 3 mg x 3 times a day, vit. From 25-30 mg x 2-3 times a day in courses of 2-3 weeks, 2 times a year.

Treatment

Therapeutic measures include adherence to a regimen appropriate for the age and state of health of the child with sufficient exposure to fresh air (walks at least 2 times a day, daytime sleep in the air).

A prerequisite is the rational nutrition of the nursing mother and the rational feeding of the child. Maximum preservation of natural feeding. When translated into mixed and artificial feeding preference is given to adapted mixtures. Timely introduction of complementary foods. The diet of a nursing mother should be rich in calcium (cheese, yogurt, kefir, milk and other dairy products; parsley, dried apricots, cottage cheese, beans). In the diet, vegetable dishes should prevail over cereals.

The performance of a complex of massage and gymnastics by age, the use of salt-coniferous baths are shown. Baths are prescribed 2-3 times a week, in total for the course No. 15-20. The duration of the bath is at least 10 minutes. Sea salt at the rate of 50-100 g per 10 l of water, coniferous concentrate at the rate of 10 ml per 10 l of water.

General UV according to the scheme No. 15-20 is prescribed during the period of convalescence of rickets or for the prevention of relapse in the autumn-winter season (simultaneously with vitamin D is not prescribed).

Pharmacotherapy includes:

Calcium preparations: it is preferable to use calcium glycerophosphate, because. it contains not only calcium, but also phosphorus. Dose 0.05 g 2-3 times a day for 3-4 weeks. Can also use calcium gluconate at a dose of 0.15-0.25 g 2-3 times a day for 3-4 weeks.

Citrate mixture for 10 days: citric acid - 2.1; sodium citrate - 3.5; water 100.0 1 teaspoon 2-3 times a day (improves the absorption of calcium and phosphorus salts in the intestines). With simultaneous appointment with vitamin D, the dose of the latter is reduced by 2 times.

In order to improve metabolic processes, magnesium preparations are indicated (panangin, asparkam - 10 mg / kg per day for 3-4 weeks), potassium orotate 10-20 mg / kg per day, carnitine chloride 20% aqueous solution, 4-12 drops 3 times per day for 1 month.

Vitamin therapy in age doses (B 1 and B 2, 1 mg x 2-3 times a day, B 5, 3 mg x 3 times a day for 10-12 days, B 6, 3 mg x 3 times a day, vitamin C 25-30 mg x 2-3 times a day) in courses of 2-3 weeks 2 times a year.

Before the appointment of vitamin D, a Sulkovich test is performed. If the test results are (++, +++, ++++), then vitamin D is not temporarily prescribed, treatment is carried out with the drugs listed above. After 2 weeks, a second test of Sulkovich. If the Sulkovich test is negative or (+), vitamin D is prescribed at a therapeutic dose.

It is preferable to prescribe vitamin D 3 , which is a more active form compared to vitamin D 2 . It is recommended to use from 2000 to 5000 IU of vitamin D 3 per day for 30 to 45 days. Further, the dose of vitamin D 3 is reduced to prophylactic (500 IU) daily for 2 years and in the third year of life in winter. It is recommended to start treatment with a dose of 2000 IU for 3-5 days, with a gradual increase in it, with good tolerance, to an individual therapeutic dose (from 3000 to 5000 IU). A dose of 5000ME is prescribed for pronounced bone changes. Children at risk 3 months after the end of the 1st course can be given anti-relapse treatment with vitamin D 3 at a dose of 2000-5000 IU for 3-4 weeks (Methodological recommendations of the Ministry of Health of the USSR, 1990). When calculating the dose of vitamin D, it must be remembered that 2.5 mcg corresponds to 100 IU.

Children with an increased risk of hypervitaminosis D (premature, immature newborns, born with intrauterine malnutrition, who have undergone hypoxic or infectious-toxic damage to the central nervous system, infectious-toxic damage to the liver and kidneys) along with vitamin D can be prescribed vitamins A (1000 IU / day ) and E (10 mg / day), which have an antioxidant and membrane-stabilizing effect, for 2 weeks or minimal single and course prophylactic doses of vitamin D are prescribed, emphasis is placed on non-specific methods of prevention.

Brief plan for dispensary observation of children with rickets

1. The duration of dispensary observation is at least 3 years.

2. Examinations by a pediatrician are carried out at the decreed time in accordance with the age of the child.

3. Consultations of medical specialists are carried out according to the scheme of clinical examination of young children. According to indications - consultation of an orthopedist and dentist.

4. Laboratory research:

Complete blood count 1 time in 3 months 1 year of observation, then 2 times a year, urinalysis 1-2 times a year;

Sulkovich's test monthly in the 1st year of life, quarterly in the 2nd and 1 time in 6 months - in the 3rd year of life. If the child receives therapeutic doses of vitamin D, then the frequency of the study is maintained 1 time in 10 days, with a reaction (+++) and (++++) vitamin D is temporarily canceled;

ECG - prolongation of the QT interval indicates hypocalcemia

5. Prevention of rickets (specific and non-specific).

6. Treatment of rickets:

Compliance with the regime corresponding to age and state of health.

Balanced diet

Performing a complex of massage and gymnastics by age.

Salt and coniferous baths

General UV during the period of convalescence of rickets or for the prevention of relapse in the autumn-winter season (simultaneously with vitamin D is not prescribed).

Pharmacotherapy (vitamin D, calcium preparations, citrate mixture, magnesium, potassium preparations, carnitine chloride)

7. Preventive vaccinations are allowed after 2-3 weeks from the start of treatment.