Rickets: prevention in children. Prevention of rickets in infants

Many people know this word, which denotes not only a disease, but also a painful appearance, physical, and in a figurative sense, mental weakness. Yes, it's rickets. This disease refers to a child's pathology and manifests itself at an early age as a violation of the formation of bones. The reason for this is a lack of vitamin D in the body, which is extremely necessary during the period of intensive growth of the child, during the formation of the cartilaginous and skeleton of the skeleton. In addition, the lack of this substance affects the intellectual sphere and physical development. It is necessary to notice even minor changes in the behavior of children, since the onset of the disease can be hidden.

History

For the first time this malady was described in England in the middle of the seventeenth century, but in near-medical literature it is still dating from the second-third century of our era. Several theories of the origin of this pathology and ways to solve it have been proposed. An antidote - cod fat was found, but the explanation of its effectiveness was discovered much later. Thanks to the experiments conducted by McCollum, the whole world learned about the existence of such a substance as vitamin D. Later, at the beginning of the twentieth century, a German doctor developed a technique for the prevention of rickets using an ultraviolet lamp. She compensated for the lack of sun and prevented the development of the disease.

Causes of development

There are several predisposing factors that contribute to the development of rickets. They can be found all together, or separately.

1. Insufficient amount of sunlight, including due to weather and climate conditions.
2. Incorrect feeding of the child, and, as a result, poor assimilation of calcium and phosphorus, as well as excessive content of animal fats in food.
3. Deep prematurity of the newborn.
4. Genetically caused disturbances in the formation and metabolism of vitamin D.
5. Racial predisposition.

The disease does not have a favorite place on the world map, it is found everywhere. Most often, its manifestation occurs in the cold season, when due to natural causes, a lack of sunlight develops. Particularly badly affected are children born in late autumn and winter.

In addition, modern mothers do not want to feed the baby naturally, preferring mixtures or cow's milk. This disrupts the process of correct colonization of the baby's intestines. Also, artificial substitutes contain insufficient amount of necessary substances for the harmonious growth and development of the baby. Toddlers suffer from obesity, metabolic disorders, intestinal colic and, of course, rickets.

Pathophysiology of the disease

It is known that participation in the assimilation of calcium and the process of bone formation is not taken by Vitamin D itself, but by its metabolites, which are formed in the liver and kidneys. After the birth of the child, many enzyme and metabolic systems have not yet reached sufficient development to take on the full load that this tiny organism needs to grow and develop properly.

Formed in skin melanocytes, vitamin D enters the bloodstream and is transported to the liver where the hydroxylation process passes. Chemical transformations in the kidneys are completed, and then, already in the form of 24,25-dihydroxy-vitamin D, takes part in the mineral metabolism and formation of the skeleton. The whole process is subject to destabilization at any stage. Therefore, the pathogenesis of rickets is very confusing and is not fully understood even by narrow specialists.

Manifestations

As a rule, the first disturbing bells appear already at the age of six months of the child, but they are so unspecific that parents do not pay attention to it or connect them with other diseases. In this regard, significant changes become visible only to four to five months of age.

First of all, the child begins to show neurological symptoms, such as a sleep disorder, anxiety, irritability. Then the interest to food decreases, there are cases of stool delay. At night, the child sweats heavily, and the odor of sweat is unpleasant, the head is scratched, and due to constant friction on the pillow, baldness appears on the head. There are no visible bone manifestations, they will appear much later. The first stage lasts up to a month.

If no preventive measures have been taken, the disease progresses and passes into the next period - the swing. It is characterized by depression of the chest, distortion of the bones of the lower limbs, the appearance of "rosaries" and "bracelets" in places of excessive production of bone tissue, as a compensatory reaction to the thinning of the skeleton. With all this, the child lags behind in both mental and physical development.

Scheduled treatment helps reverse most changes, but deformations of the skeleton will last a lifetime. Particularly difficult consequences are reflected in women, as there is deformation of the pelvic bones, and births through natural birth canals will be impossible.

Diagnostics

Official protocols on the diagnosis and prevention of rickets are quite complex and complicated for the ordinary doctor in the clinic. Earlier, Sulkovich's trial, which revealed calcium loss in urine, was considered a reliable confirmation of the disease, but now it was recognized as non-specific and refused to be used in routine practice.

At the moment, the most reliable blood count for the content of electrolytes: calcium, phosphorus, magnesium. In addition, pay attention to such biochemical indicators as the level of alkaline phosphatase and creatinine in the serum. Of even more highly specialized, they are prescribed tests for determining the level of metabolites of vitamin D and hormones of the thyroid and parathyroid glands.

From instrumental diagnostic methods, radiography of the shin and forearm bones is performed, in order to examine the growth zones and bone tissue density. With rickets, they will be deformed, the zones of ossification are changed and expanded.

Degrees of disease

Children have three degrees of disease:

1. Easy flow. The child has one or two manifestations of bone tissue, muscle hypotension, lethargy, but intellectual development corresponds to age.
2. Medium-heavy current. There are serious changes in the skeleton, marked damage to the nervous system, problems from the internal organs. Psychic deviations from the norm and a backwardness in intellectual development begin to appear.
3. Heavy degree. Persistent coarse bone deformities that do not regress after recovery. The child has an intellectual deficit, development does not correspond to age, other systems of internal organs are violated in response to a malfunction in the metabolic system.

Prevention during pregnancy

Any future mother will agree that it is unpleasant to hear from a district pediatrician a diagnosis of rickets. Prevention of this condition can begin while the child is pregnant. Strangely enough, pregnant women usually carelessly treat this issue. They drink a handful of folic acid and multivitamin complexes, but forget to walk around elementary. But this is the nonspecific prevention of rickets.

Preventive measures consist of a healthy night's sleep and a rest break during the day. In addition, midwives recommend walking at least two to four hours in the open air, regardless of the weather. It's important to eat well and eat well:

• Daily use of meat or fish;
• There is a sufficient amount of cottage cheese, cheese, milk and other fermented milk products;
• Include white bread and vegetables in the diet.

Specific prevention of rickets in women at risk (eclampsia, diabetes, hypertension, CRF) is carried out in conjunction with an endocrinologist. In the third trimester from the twenty-eighth to thirty-second weeks, vitamin D is prescribed per thousand international units every day for eight weeks. The time of year in this case does not play a special role. Sometimes prescribed courses of ultraviolet radiation, which contributes to the endogenous production of cholecalciferol. Begin with small, somewhere a quarter of the permissible dose, gradually increasing to two doses. Sessions are held every day or every other day.

Newborns

Prevention of rickets in newborns is carried out when the mother is compromised by a risk group or did not follow the recommendations of a woman's consultation regarding her diet and diet during pregnancy. In the hospital, the child is administered a bolus up to four thousand units of cholecalciferol orally per day. And they continue to treat so until all the signs of the disease disappear. Then they switch to a maintenance dose of four hundred international units a day.

Prevention of rickets in newborns with a violation of absorption of vitamin D in the intestine is somewhat different. In this case, the daily dose can go up to ten thousand units.

Preterm

It so happens that to all the problems that a child born before the term has, rickets also join. The causes, signs, prevention of this disease, he has some features. Given that the organ systems were not formed enough, doctors injected calcium gluconate (sixty milligrams of pure calcium per day per kilogram). To equilibrate it with phosphorus, add thirty milligrams of potassium phosphate per day for each kilogram of weight.

Be sure to monitor the level of calcium and phosphorus in order to prevent critical conditions.

Thoracic

Prevention of rickets in infants is the proper care for them. First of all it concerns walks. It is important that a child walks more than four hours a day and sleeps in a well-ventilated room. If possible, parents should leave the child in the street as much as possible undressed, so that as much as possible the skin is exposed to ultraviolet radiation. In the evenings, you can bathe your child in salty or coniferous baths. This not only reduces the excitability and prepares him to sleep, but also strengthens the immune system.

It is ideal to feed the baby with mother's milk, since it contains all the necessary micro- and macronutrients, as well as the daily norm of proteins, fats and carbohydrates. But if there is no such possibility, then it is recommended to switch to the adapted mixtures, which contain as close to natural phosphorus and calcium levels. Prevention of rickets in infants depends entirely on the consciousness and desire of the parents.

Age: Up to 1 year

Preventing rickets in children under one year is also a literate lure that must contain enough vitamins B, A, C, as well as vegetable and animal fats. The benefits of dairy products are not even worth talking about. It's obvious.

Prevention of rickets in young children is, among other things, in developing gymnastics and physiotherapy exercises. This is necessary for the harmonious development of the neuromuscular system, since there is a danger of deformation of the bones under the weight of the child, strong muscles will help to evenly distribute the body weight and avoid gross skeletal distortions. Regular exercises, a gradual increase in the load and other preventive measures help to avoid rickets.

Contraindications to prevention

As with any medicine, vitamin D has an exception for admission. Specific prophylaxis of rickets in children is not performed if they are diagnosed with Williams-Burne disease, or, otherwise, idiopathic calcituria. In this case, the loss of calcium is not due to a deficiency of vitamin D. The second excluding disease is hypophosphatase. In addition, in the presence of organic lesions of the central nervous system, microcephaly and craniostenosis, prevention of rickets in infants is also not recommended. Komarovsky highlights this issue in his lectures in more detail.

A child older than a year

Do not think that when your child becomes a little older, the danger of developing metabolic disorders will go away. Prevention of rickets in children after a year is to enrich the diet with dairy products and antioxidants (fish oil, greens, citrus, fish). If there are violations from the autonomic nervous system, such as excessive sweating, then appoint "Carnitine", "Glycine", "Panangin" or Asparcum "in the course dose for the month of admission.

To correct physical development, if it is necessary, recommend taking the drug "Akti-5". It contains a complex of vitamins and is well absorbed by the child's body. In addition, the pediatrician recommends massage and exercise therapy, which will help cope with deformities of the skeleton and level the symptoms.

Treatment

Do not despair if the doctor diagnosed the "rickets" in the child. Signs, prevention and treatment of it have long been known and successfully used around the world. Now there are such medicines as "Aquadetrim", which contains vitamin D ₃ . It is well tolerated by children, and it can be used without the risk of overdose. In addition to this, there are "Devisol", "Vigantol", "Videin-2", which are oil solutions of vitamin D. In the modern market of pharmaceutical industry, they all have contraindications, so be sure to consult with your doctor before taking the medication.

Overdose

Treatment, prevention of rickets may be impractical, and then there is an overdose of vitamin D. The child develops symptoms of poisoning, such as nausea, vomiting, stool and urinary retention. In case of detection of these anxiety signs, you must immediately inform your district pediatrician and conduct a blood test for the calcium content in the plasma. You can add to the study and Sulkovich's trial, although it is not included in the standard protocol.

After detecting an overdose, the drug is canceled for a while and parents are asked to restrict their walks and diet. It is not necessary to seek fanatically and treat rickets from your child. Prevention can play a cruel joke with overly meticulous parents.

Clinical examination

Children with an established diagnosis of "rickets" should be placed on dispensary records after the clinical and laboratory recovery comes. Due to the complexity and severity of the consequences, these children are monitored for three years from the date of discharge. They are called for inspection every three months.

By the way, the diagnosis of "rickets," its prevention or treatment is not a contraindication for routine vaccination. The main thing - to warn about this doctor who will do the injection, and the district pediatrician.

In the modern world, the problem of rickets is no longer as acute as it was a century ago, but nevertheless one should not forget that negligence with this disease can cause disability. Fortunately, the record in the child's development chart "rickets" has already become an exception to the rule. Prevention and sanitation are carried out at the proper level, which ensures the literacy of young parents, their vigilance regarding the health of their child. Even if such a problem has arisen, the medicine can be found in any pharmacy, and the success of treatment depends only on how much the parents of a small patient will want it.