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Rickets
Rickets - a disease caused by deficiency of vitamin D. Vitamin
D is produced skin under the influence of ultraviolet rays, and also found in
certain foods: fish oil, egg yolk, dairy products. Vitamin D actively promotes
the absorption of calcium from the intestine and its proper distribution in the
body, which is very important for the development of bone tissue of the central
nervous system and other organs.
Deficiency of vitamin D in the body may occur during the cold season, when
insufficient solar ultraviolet radiation, as well as undigested vitamin D from
the intestine (this often happens when dysbacteriosis and various fermentopathy).
Often rickets occurs in young children, ie in the first three years of life.
Happens and rickets in older children and even adults. During rickets
distinguish several stages. At the initial stage of vitamin D deficiency in
children up to year notes:
- Decreased appetite,
excessive sweating (especially the palms, feet and scalp),
- Anxiety
- Increased excitability
- Deterioration of sleep,
- Alopecia neck.
These symptoms may be seen, parents and the doctor during examination of the
child and pay attention:
on the edges of the malleability of a large fontanelle,
reduced muscle tone.
If during the initial appearance of signs of rickets did not take measures for
prevention and treatment, a few weeks developing the next stage - during the
crisis period. At this stage of the disease begin bone deformation:
modified form of the skull (occiput flattening, elongation of the skull in the
upper direction, the appearance of the frontal tubercles);
deformation of the chest (depression - chest cobbler or bulging - "chicken
breasts");
curvature of the leg bones, especially if the baby is already walking - there
are X - or O - shaped curvature, as is the restriction of the pelvis, the
emergence of bony outgrowths in the form of "brasletok", "strings of pearls",
"rachitic rosary" which are clearly visible on radiographs.
In addition to slowing the growth of bone deformities of teeth, there have been
serious violations of various organs: the disrupted heart and lungs, there is a
dysfunction of the gastrointestinal tract (often - constipation),
vegetative-vascular changes (very severe sweating, marbling of the skin).
Children with rickets in the height of the stage begin to lag behind in
development.
In the analysis of urine when rickets is the high content of phosphorus in the
blood analyzes - reduced amount of phosphorus, calcium - normal or elevated. The
diagnosis is mainly put on the totality of clinical manifestations.
At some point, the height of the signs of rickets are, the child begins to feel
better, but the traumas of rickets may remain for life in the form of deformed
bones: bow legs, a deformed shape of the skull, a narrow irregularly shaped
basin that for girls - future mothers is fraught with complications during
pregnancy and childbirth. In addition, children who had undergone rickets in
stage height, very long time recovering and are at risk of developing chronic
diseases or are frequently sick.
It is therefore not necessary to bring the situation to the height of rickets,
and engage in prevention before onset of clinical manifestations in the autumn -
winter - spring period or when the initial signs of rickets. Among the
activities that prevent development of rickets - the establishment of proper
nutrition, correction of intestinal dysbacteriosis, the introduction of
pharmaceutical forms of vitamin D.
11.1. Prevention of rickets
Once a child turns a month, you begin to make vitamin D, better water-soluble,
one drop every day. You can give all year round, because, although vitamin D is
produced in the summer sunlight, but in the proper quantity only if the child
all day is right under the sun naked. In other cases, we need to give vitamin D,
even at the cottage.
Should there be interruptions in vitamin D? You can stop in the summer, but only
if you have a whole day here with the baby in the sun under the scattered rays.
But with our summer and the rhythm of life is virtually impossible.
Could it be an overdose of vitamin D? If you give a drop of 1 times a day, I can
not. In the case of increasing the dose, of course, may be overdoses. Vitamin D
is given by 1 drop of 1 times per day, if it is water soluble, and if he is fat
soluble, then the next day, as in this case, its dosage is higher. All this will
appoint a pediatrician adequately and individually. The pediatrician also change
the prophylactic dose of vitamin A, if the baby is small fontanelle or rapidly
overgrown.
Proper nutrition for the prevention of rickets includes:
breastfeeding, as much as much as possible,
timely introduction of complementary foods (not before 5 months)
use for lactation aid only adapted mixtures
introduction into the diet of egg yolks, butter, liver, meat (after years).
Correction of violations of the intestinal microflora is also very important,
because the assimilation of vitamins and minerals from the intestine is largely
carried out this microflora.
Because of drugs prevention and treatment of rickets can be distinguished
vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). There are oil and
aqueous solutions. It may be noted the main points of the use of vitamin D:
* Vitamin D3 physiologic and effective vitamin D2;
* Aqueous solutions are less toxic than oil, so if you want to give a large dose
of vitamin D, it is desirable to give preference;
* Possible long-term continuous use of prophylactic doses during the entire cold
season (from late autumn to spring) when using higher doses of prevention, it is
desirable to take short breaks in 5 - 7 days after every 3 - 4 weeks of use of
these drugs;
* Use of adapted formula for feeding the child does not preclude the application
of medicinal forms of vitamin D for prevention and treatment;
* Reception multivitamin preparations does not preclude receiving vitamin D for
treatment and prevention.
One of the modern approaches to the treatment and prevention of rickets - the
appointment of a course dose (200 tys.ED) one-time fee with the repetition of
six months. This creates a depot of vitamin D in the liver and the body as their
need to use it, as a result maintained a good balance of vitamin D.
The prevention of rickets to hold all children up to 3 years, especially in
premature, immunocompromised, children of the first months of life, born in the
autumn-winter-spring period. But if there are signs of incipient rickets, should
always consult a doctor to adjust the treatment.
In the summer time, provided that the street warm and sunny, the use of vitamin
D is not recommended. Under the action of ultraviolet rays in the skin produces
its own vitamin D. It is not necessary that the child was under direct sunlight,
enough for it to be maximally open (short-sleeved shirt, panama hat, short
pants, and in warm weather can be quite naked, but with headgear)
By
Dr. Andrey L.Sokolov,
Dr. Yury A.Kopoanev
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