Rickets: symptoms and treatment
Rickets is a disease in which there is a disruption of the musculoskeletal system due to a lack of vitamin D. Rickets, the symptoms of which are also caused by a disruption in the metabolism of phosphorus and calcium, is accompanied, in addition, by a violation of bone growth. Despite the fact that this disease is not fatal, it, meanwhile, provokes the development of irreversible deformation to which the skeleton of the sick child is exposed (namely the «child» disease is rickets), and also contributes to a significant inhibition of a number of processes associated with its development .
The developmental disorder in rickets in particular concerns the physical condition of the growing child’s body and the mental state. Moreover, against the background of rickets also increases the risk of subsequent development of various diseases (infectious, etc.).
In general, when considering rickets, it can be identified that this disease in children in the first year of life manifests itself quite often. It is not possible to determine exact figures for the prevalence of rickets, and, nevertheless, in many small patients, certain types of residual phenomena are identified that are directly related to its transfer. These phenomena include various anomalies in the growth of teeth and bite, deformations of the lower extremities, chest, skull, etc. Given that rickets create certain conditions for the subsequent predisposition of children to infectious and other diseases, children suffering from rickets often get sick.
Rickets are usually one disease, but this is not entirely true. The fact is that, in fact, rickets are a group of diseases and disorders directly related to metabolic processes, due to the characteristics of which one common feature has been determined for them. As such a sign, a decrease in the calcium level in the bone tissue is considered (this determines a pathology like osteopenia). This can not only provoke a vitamin D deficiency, but also certain internal or external factors. Given this, the first signs of rickets do not necessarily require treatment with the use of this vitamin — to begin with in this issue determine the need to identify the specific causes that caused these symptoms. Moreover, in certain situations, vitamin D is generally contraindicated in use, which should also be considered when anxiety signs and symptoms appear.
We consider the disease as a disease of active growth, which is explained by the specifics of its manifestation. Rickets develop, as we have already identified, only in young children and only at the stage within which active growth of their skeleton takes place, during which time a temporary imbalance between the incoming vitamin D and calcium and between their consumption by the body is formed.
In the CIS countries, signs indicating a lack of vitamin D are detected in more than half of cases among full-term babies and in 80% of cases in preterm babies. The causes of rickets (and, in fact, a lack of vitamin D, which is also defined as hypovitaminosis D) are the inadequacy of vitamin D formation in the skin due to the sunlight contributing to this effect. It is the sun’s rays, as, probably, the reader knows, are the main source of this vitamin.
The solar spectrum determines the relevance of the vitamin-forming effect only due to the influence of ultraviolet radiation. Vitamin D, formed in this way, begins to accumulate in the form of «stocks» in the skin and fatty tissue, as well as in the hepatic muscles. Due to these reserves, it is then possible to prevent the development of toxic effects from its side, in addition, the vitamin D supply provides it to the body in the cold season, when less time is spent on exposure to the sun and in general the skin is hidden from exposure Its rays.
The need for vitamin D is dictated by age in each case. The greatest amount of this vitamin is required, as is already clear, for children, in particular during the first months and years of their life — this will ensure adequate formation of their bone tissue. Within the specified age period, the requirement for this vitamin is 1 kilogram of weight 55 mg. Gradually, as the skeleton of the child will develop in the future, the need for the vitamin in question decreases. With regard to the question of the need for vitamin D in adults, here it is 1 kilogram of weight 8 mg, which, as can be seen, is several times less than the amount that is mandatory for children.
Based on the above features, as well as other additional factors that cause the development of such a disease as rickets in a child, we can distinguish the following number of reasons leading to the development of this disease:
- Prematurity. This factor is particularly relevant in treating rickets due to the fact that it is during the last months of pregnancy with the greatest intensity that the phosphorus and calcium enter the fetus.
- Incorrect feeding. For this reason, rickets may also develop, as a result of inadequate intake of phosphorus and calcium from food. In addition, it also takes into account a certain irrational feeding, if it is caused by the fact that it occurs at the expense of other people’s milk, this, in turn, is the reason for inefficient absorption of calcium. Similarly, children who have a ration of monotonous protein foods or lipid food are also at risk. It also includes the artificial feeding of a child. And, finally, this includes the inadequate intake of vitamin A, B and trace elements.
- Impaired transportation of calcium and phosphorus in the kidneys, gastrointestinal tract and bones. This is due to the immaturity of the enzyme systems or the existing pathology that is relevant for the organs listed.
- Increased level of demand for minerals. This factor fully corresponds to the specificity of the disease, given the fact that rickets is a disease that develops in the process of intensive growth of the body.
- Features of ecology. Under unfavorable environmental conditions with the actual excess of chromium, iron, strontium, lead salts or magnesium deficiency in it, an appropriate basis for the development of rickets in the child is also determined.
- Specific features of the body. It is known that the development of rickets is more predisposed to boys, in addition, they also bear it much heavier. It has also been observed that swarty boys with the second blood group are more likely to suffer a disease than children in the first blood group (in the latter case, the disease is less often diagnosed).
- Endogenous or exogenous vitamin D deficiency
- Actual disorders in the endocrine system (lesion of the thyroid, parathyroid gland).
- Hereditary predisposition.
The classical variant of rickets (or classical rickets) with vitamin D deficiency can be isolated in a specific form, which is determined for him depending on the specific clinical manifestations, the features of the course, severity of the disease and its specific periods .
- Rickets for clinical options on the basis of changes in the concentration in the blood serum of phosphorus and calcium can be diagnosed in the following varieties of forms:
- calcium penicillin rickets
- phosphopenic rickets;
- rickets, which manifests itself without significant changes in the level of actual phosphorus and calcium levels
- Rickets, conditioned by the specific features of their own current:
- Acute course of rickets . It is accompanied by the prevalence of neurological symptoms and the phenomena of osteomalacia. Osteomalacia is a systemic disease in which the bone tissue is not sufficiently mineralized, which is also associated with a violation of vitamin D metabolism or its lack, with a deficiency of microelements or macronutrients provoked by an increased degree of their filtration by the kidneys or a violation in the absorption processes (which is already relevant for Intestines). As the main phenomena accompanying osteomalacia, one can distinguish pain in the bones, muscle hypotension (decreased muscle tone, combined with a violation of muscle strength), and hypotrophy (a deficiency of body weight accompanied by a decrease in the thickness of the subcutaneous tissue), as well as deformation of the bones of the skeleton and the appearance of pathological fractures
- Subacute rickets course . This form of rickets is accompanied by a predominance of phenomena characteristic of osteoid hyperplasia. Osteoid hyperplasia is a condition in which the osteoid tissue grows exponentially with rickets. In particular, such phenomena as the appearance of parietal and frontal tubercles, a thickening formed in the wrist area (which is defined as rachitic bracelets), as well as thickening in the areas of transition of the part of the bone into the cartilaginous part from the ribs (defined as rachitic rosaries) and the thickening of the area Interphalangeal joints on the fingers (accompanied by the formation of so-called strands of pearls).
- Wavy or recurrent rickets . The acute diagnosis of acute rickets in the present case is combined with signs of a different scale (laboratory, clinical, radiological), on the basis of which a picture accompanying the transfer of the active form of rickets in the past is visible.
- Rickets, due to the peculiarities of the degree of severity of manifestation:
- I degree of rickets — mild degree — the features of the flow correspond to the initial period of the disease
- Second degree of rickets — moderate severity — the course of the disease is characterized by moderate changes in the severity of changes affecting the internal organs and bone system
- The third degree of rickets is a severe degree — in this case, several parts of the bone system are affected at the same time, the nervous system and internal organs are severely affected, the developmental lag (physical, psychic) is noted, due to the compression of the skull due to its incorrect Formation, the complications of the disease are revealed.
- The cyclicity of the course of the disease, corresponding to the passage through four successive stages in this process, and this: the initial period of rickets, the period of rickets, the period of repair (reconvalescence) and the period characterized by residual phenomena of the disease.
Rickets may also be secondary (respectively, secondary rickets ), often it develops against the background of the following factors:
- The relevance of malabsorption syndromes. Malabsorption by itself implies in the literal translation from Latin «bad absorption». If this deviation is more accurately determined, then it implies the loss of those nutrients (in single or in the plural form), which enter the digestive tract with an inadequate degree of absorption of them later through the small intestine.
- Presence of chronic bile duct disease or kidney disease.
- The presence of diseases directly related to the metabolism (cystinuria, tyrosinemia, etc.)
- Prolonged use of anticonvulsants (phenobarbital, diphenin), glucocorticoids, diuretics; Parenteral nutrition
Vitamin D-dependent can manifest itself in two types: type I and type II. Vitamin D-resistant rickets develops against a backdrop of diseases such as renal tubular acidosis, phosphate-diabetes, hypophosphatase, de Tony-Debreu-Fanconi syndrome.
Depending on the period of the disease, the features of its symptoms, respectively, are determined.
- Initial period of rickets
The first symptoms of rickets, as a rule, are noted from the first to third months of the child’s life (in preterm babies they may appear even earlier). They are included in the altered behavior, in which the fearfulness, increased anxiety and excitability can be traced, when the external stimuli (flash of light, noise) are exposed, the child flinches. The changes also apply to sleep — there is also anxiety and its general superficiality.
Sweating is worse, especially on the face and the scalp. For sweat is characterized by an acidic odor, because of its effect the skin is irritated, due to which, in turn, there is an itch. Because of this, you can see that the child begins to rub his head on the pillow, for the same reason in the nape of the neck subsequently appear areas of alopecia. Actual for this age hypertension of the muscles against the background of the disease is converted into muscle hypotension (on which we stopped above). The edges of the large fontanel and the seams of the skull and become supple, on the side of the ribs there are characteristic thickenings, in particular, they are concentrated in the region of the costal cartilaginous joints, as a result of which the so-called «rachitic rosaries» are also formed.
If an X-ray is taken during this period, then some rarefaction from the bone tissue is detected. Based on the biochemical blood test, either a normal or altogether elevated calcium concentration is detected with simultaneous decrease in phosphate concentration.
- Rachita Flood Period
This period is mainly for the period of completion of the first half of the child’s age, disorders of the musculoskeletal system and the nervous system here become even more significant in the nature of manifestation. Due to the processes of osteomalacia (which are particularly intense in the manifestation of the acute course of the disease), the flat bones of the skull are softened, then often the one-sided thickening of the occipital develops. Also, the bridge of the nose can fall, because of what a saddle nose can form. In comparison with the body, it seems that the head is too large. The thorax becomes supple, deformed, and the sternum is inflamed from the lower third of the third (which defines the name «cobbler’s chest» for this pathology), in other cases, its bulging («keeled», «chicken» breast) may develop. Long tubular bones are bent along the O-shaped (somewhat less often X-shaped) type.
Against the backdrop of the development of a number of topical in this case, the formation of a flat-narrowed narrowed pelvis takes place. Due to the fact that the ribs are subject to considerable softening, along the line of the diaphragm a depression is formed (the so-called «Harrison’s furrow»). The predominant hyperplasia of osteoid tissues in the subacute course of rickets, in this case manifests itself in the form of parietal and frontal tubercles of hypertrophic type. In addition, there is an even greater thickening of the costal cartilaginous joints, wrists, areas of interphalangeal joints of the upper extremities (previously considered «bracelets», «rosary», «strings of pearls»).
- Rickets Convalescence Period
This period is characterized by an improvement in the well-being of the child and his general condition. Static functions are subject to improvement or normalization. In the blood there is a normalization or a slight excess of the indices of the content of phosphorus in it. Hypocalcemia can persist at an insignificant level, in some cases, its increase is noted.
- Residual rickets phenomena
Within this period of the disease, blood analysis (biochemistry) normalizes, the symptoms of the active form of rickets disappear, which indicates, respectively, the transition of the disease to the inactive stage, that is, to the stage of residual phenomena. Muscular hypotension and residual forms of deformation, which has undergone against the background of rickets skeleton, for a long period of time can persist.
We examined in general terms the course of the disease, identify additional points associated with it.
Rickets Symptoms: Muscle System
Reducing muscle tone in children leads to the appearance of a «frog’s belly», which is accompanied by an increase in muscle tone due to a change in muscle tone (abdominal muscles in particular are in this case in a relaxed state). The flexibility of the joints allocated above can also be defined as «looseness», because of this the child begins to walk later, it is also possible that the body can not be kept in an upright position.
Symptoms of rickets: internal organs
Because of the lack of calcium and vitamin D in the body, the work of internal organs (digestive tract, spleen, liver) is disrupted. Quite often in children with rickets there are such symptoms as anemia, jaundice and constipation. Again, due to the squeezing of the lungs against the background of the altered state of the skeleton of the chest, normal development and growth of the internal organs are in violation. When lungs are compressed, colds often develop, heart deformation causes heart failure. Rodneys close later, teething occurs with a delay, an incorrect bite develops. The weakness of the ligamentous apparatus determines the ability of the child to perform the most unusual movements of the joints. To sit, walk and hold the head, children with rickets begin later than the same age.
Sources of vitamin D
As it is already clear, the main percentage of vitamin D obtained by our body occurs by exposure to ultraviolet radiation from the sun’s rays (about 90%). It is not widely distributed in other natural resources, for this reason, the production of vitamin D through food is only about 10% of the body’s required volume. In particular, as sources of vitamin D, fish oil is considered (the largest amount of possible consumption), egg yolks, margarine and vegetable oil. In the West, foods rich in vitamin D are particularly in demand, but even if you consume such foods, there is no guarantee that the body will receive the required amount.
A particular point concerns constant information, which in particular often sounds in recent years, indicating the damage from exposure to solar radiation, as well as the risk of ultraviolet rays that affect the skin, as the main of such risks in In particular, skin cancer is considered in its various variations. On the basis of this, within the framework of official medicine, appropriate calls are made for the need to limit the effects of solar radiation on the skin, which is especially true for children. Based on this, as its main source of vitamin D can be considered its dosage forms, due to the reception of which the prevention of rickets. About these or other variants of this type of medication can be learned from the pediatrician’s treating child.
Diagnosis and treatment
The diagnosis of rickets is established on the basis of blood tests (biochemical analysis), based on the dynamics and the overall ratio of calcium, phosphorus and phosphatase concentrations, it is determined which period corresponds to the course of the disease. Also, the diagnosis is based on a visual examination of patients.
Treatment of rickets is determined, again, on the basis of the period of its manifestation, and also on the basis of the severity of the flow. It is based on the use of specific drugs, which include vitamin D. Equally important role is given to the issue of rational nutrition, it is recommended to have sufficient time on the air, therapeutic gymnastics, massage, salt, solar, coniferous baths, UFO are indicated. In addition, vitamin therapy and the implementation of measures aimed at achieving a general strengthening effect are shown. With hypocalcemia, calcium preparations can be prescribed, to improve its absorption by the intestine, a citrate mixture can be indicated.
The prognosis for rickets for children is mostly favorable (in case of transferring the classic form of the disease). If treatment is not performed, irreversible changes in nature, such as, for example, deformation of bone structures, develop. Preventive maintenance of a rickets consists on the measures realized both before a birth of the child, and after it.
If you have any symptoms that indicate a possible rickets in a child, you should contact the pediatrician.