is the disease of intensively growing organism caused by a lack of vitamin D and its derivatives, which is characterized by disturbances of phosphorus-calcium exchange and a mineralization of the new formed bone.
Rickets, in essence, is the general disease of an organism which is characterized by variety of structural and functional changes of various bodies and systems.
Distribution, forms and weight of rickets depend on climatic features and living conditions.
The incidence of rickets is higher at defects of feeding and leaving, at premature children, at a delay of pre-natal development, deep immaturity of endocrine organs and fermental systems, at the children who suffered an intracranial birth trauma and also at other types of perinatal pathology.
Distinguish vitamin - In - scarce rickets and vitamin-in-resistant rickets.
Causes of rickets
Insufficient quantity of the sun, one of many causes of this disease. Vitamin D begins to be produced under the influence of ultraviolet rays, but in the fall and in the winter, especially in city conditions of the sun it is not enough that leads to insufficient formation of vitamins of group D.
Diseases of mom during pregnancy, a gestosis, difficult delivery, artificial feeding, late introduction of feedings up, a large number of porridges in a diet (the substances which are contained in cereals slow down absorption in calcium intestines), all this is the contributing factors to developing of rickets. Premature children are also more subject to this disease. In addition carry to the contributing factors: ecological factors, insufficient physical activity (blood supply in bones decreases), and other diseases of the child.
Classification of rickets
Rickets can be subdivided on the periods, disease severity and the nature of a course. Period: initial, disease heat, convalescence, residual phenomena. Severity:
I \easy (mild symptomatology, mainly from nervous and skeletal system);
II \moderately severe (disturbances from nervous and bone systems, pathological changes from muscular and haematogenic systems, secondary changes from respiratory organs, a cardiovascular system and also digestive tract); III \heavy (pronounced changes from all the bodies and systems listed earlier). Rickets course: sharp, subacute, recurrent.
At early stages of a disease the child becomes irritable, whimsical. There is a perspiration, especially during feeding and a dream. Clammy sweat, with an unpleasant smell. The child rubs the head about a pillow, and nape hair drop out. With a course of a disease skull bones are softened, the head gains square shape; the teething slows down, the bite is broken; bones of a thorax become soft, the thorax is deformed. The hump can appear in hard cases.
Diagnosis of rickets
Diagnosis of rickets does not represent complexity today. The disease has to be detected by the pediatrician during clinical examination on the basis of well-known symptoms and laboratory diagnostic methods of this disease. And, nevertheless, in more than 50% of cases the diagnosis rickets in time is not made.
Let's dwell upon laboratory diagnostics. The earliest and sensitive indicator of presence of rickets is increase in level of alkaline phosphatase in blood serum, at the same time this marker often advances the above clinical symptoms and biochemical changes.
Changes of level of calcium and phosphorus in blood serum in rickets usually have phasic character.
In the first stage
of hypovitaminosis of D the absorption of calcium in intestines decreases that leads to decrease in its quantity in blood (hypocalcemia). In this stage the content of phosphorus remains normal.
The lack of calcium stimulates production of parathormone which leads to increase in level of calcium in blood
in the second stage
, but at the same time absorption of phosphorus and amino acids in kidneys oppresses that leads to decrease in Phosphorus in blood (hypophosphatemia).
The third stage
– at further deficiency of vitamin D changes sensitivity of bones to excess of parathormone that leads to reduction of extraction of calcium from bones and to emergence of a hypocalcemia in blood against the background of a fosfaturiya (the raised discharge of phosphates with urine) and hypophosphatemia (the lowered content of phosphates in blood).
Also for detection of rickets the test of urine is widespread on Sulkovich. This analysis defines concentration of calcium, and subsequently it helps to trace treatment outcome though not always is reliable.
Besides, in hard cases do the roentgenogram on which it is possible to see extent of disturbance of a mineralization of bones. However such method is not suitable for early diagnosis of rickets.
Treatment of rickets
An important role is played by a balanced diet, normalization of the mode with sufficient stay in the fresh air, massage, gymnastics. At initial manifestations to the full-term children appoint D2 vitamin drugs on 300 - 800 ME/days, to course 400,000 - 600,000 ME; in the period of a heat in medium-weight and heavy rickets 10 000 - 16 000 ME/days in 2 - 3 receptions, appoint to course 600,000 - 800,000 ME. The method of shock doses applied at the severe complicated rickets forms is not used now. Drugs of vitamin D should be given at meal time. Sometimes prescribing of D2 vitamin is combined from 25% solution of citric acid, by 20% sodium citrate solution (in intestines easily soluble and well soaked up calcium citrate complex is formed) inside on 20 ml a day. During treatment it is necessary to exercise the simplest control of sensitivity of a children's organism to vitamin D by means of Sulkovich's test for prevention of a hypervitaminosis. Ultra-violet therapy has beneficial effect in an initial stage and at a subacute course
of rickets at children
of early age. The method and a dosage of radiation depend on age of the child, his physical state, environmental conditions, a phase and severity of rickets. It is recommended to carry out ultra-violet radiation by the course including 15 - 20 sessions appointed every other day with gradual increase of exposure. The first session to children up to 3 months is begun about 1/8 biodoses, to children 3 months are more senior - about 1/4 biodoses. At the subsequent treatment through each 2 sessions the exposure is increased by 1/8, or 1/4 biodoses. At insufficient stay in the open air, artificial feeding, a recurrent course of rickets the course of treatment is extended prior to 25 sessions and repeated in 2 months. At an initial phase of rickets the radiation is often limited to one course consisting of 15 - 20 sessions, in a heat phase the course in 2 - 3 months is raised. In intervals between courses of radiation carry out specific prevention by D2 vitamin or fish oil. Massage and gymnastics are performed during any period, but not at a sharp course.
Folk remedies of treatment of rickets
1. Herbs and collecting from rickets
To fill in 2 tablespoons of a grass of a train with 2 glasses of boiled water, to insist within 30 minutes, to filter. To give to the child from rickets 0.5 glasses 2-3 times a day.
To fill in 1 tablespoon of a root of a burdock with 2 glasses of boiled water, to insist 2 hours, to filter. To take infusion from rickets 3-4 times, hot up to 0.3 glasses, a day.
To fill in 15 g of a grass of a peppermint of 100 ml of alcohol, to insist, filter. To accept as folk remedy from rickets till 15-20 of drops 3 times a day.
2. Medical bathtubs in rickets
To mix 200 g of a root of an inula and a root of a burdock and to fill in boiled water mix 10l. To put on weak fire and to heat 15 minutes, to insist 1.5 hours, to filter. To pour out broth in a bath and to bathe the child.
To mix 150 g of a root of an acorus marsh and a root of a nettle, to fill in mix of 10 l of abrupt boiled water, to heat on slow fire of 10 minutes, to insist 50 minutes, to filter and use for bathtubs.
To take 400 g of a grass of a series of three-separate and 100 g of flowers of a yarrow ordinary, to make boiled water mix 10l. To put on slow fire and to heat within 5 minutes. To insist 50 minutes, to filter. To prepare warm water in a bathtub, to mix it with broth and to bathe the child.
Prevention of rickets at children about one year
Now recommend to focus on nonspecific methods of prevention of rickets both to, and after the child's birth.
Antenatal prevention of rickets includes good nutrition of the pregnant woman, long walks in the fresh air, exercises, constant reception of a complex of vitamins for pregnant women with microelements (pregnavit). Pregnant do not appoint Ural federal district and vitamin D in high doses as there are data that at children whose mothers received during pregnancy of Ural federal district the perinatal damages of central nervous system develop more often and proceed heavier. Vitamin D in high doses can lead to damage of a placental barrier and a delay of pre-natal fetation.
Post-natal prevention of rickets includes natural feeding, observance of a day regimen, hardening, massage and gymnastics, constant reception by the nursing mother of a complex of vitamins, walks in the fresh air. It is not necessary to cover a child's face even with fine fabric during walk as it interferes with access of sunshine to skin. At the same time it is necessary to preserve the child's skin against hit of direct sunshine. In the summer of rather 10-30-minute air bathtub in a shadow of trees to satisfy week need of the child for vitamin D.