Update: October 2018
AT списке заболеваний младенческого возраста нарушение
Phosphorus-calcium metabolism, called rickets, takes honorary
second place. Группой риска по дебюту rickets является более
half of children under the age of 2 years.
Typical rachitic – a child from six months to one and a half years,
born prematurely or with greater weight living in
industrial city in northern latitudes, often ill and
Рахит у babies – частая причина отставания в развитии и
failures in the immune system.
Where in human vitamin D
About seven variations of vitamin D are known. They fall into
the body with food or synthesized in the skin. The most active vitamin
D2 (ergocalciferol) contained in plant products, and D3
(cholecalciferol) coming from animal food.
AT коже при облучении ультрафиолетом в витамин Д3 превращается
provitamin D. After the vitamin has been synthesized or absorbed into
the intestine, part of it is deposited in the fatty tissue of the muscles, and the other
transferred to the liver.
AT почках и печени неактивная форма витамина подвергается
hydroxylation processes and turns into active metabolites. AT
liver helps this enzyme 25-hydroxylase, and in the kidneys –
1-alpha hydroxylase. The result is a formation in the liver.
calcidiol. And in the kidneys – calcitriol.
How does vitamin D
- Provides calcium absorption by the intestinal wall
- Strengthens the return capture of calcium and phosphorus renal
- Accelerates soaking with bone mineral salts
- Works as an immunomodulator
- Stimulates the exchange of tricarboxylic acids
How risk factors work
- Premature babies – a newborn who was unlucky
be born prematurely, has a lot of errors in the enzymatic
systems, which makes it difficult to absorb vitamin D even during normal
- Large baby – requires large amounts of vitamin than its
- Artificial artist – gets food, in which phosphorus-calcium
the ratio is different from that in breast milk and makes it difficult
digestion of these minerals.
AT babiesом периоде организм ребенка недостаточно зрел, чтобы
normalize all types of exchange even in conditions where there is no
Besides, в этот период времени ребенок, проживающий в условиях
tough climate, more wrapped up, even in the warm season
(because it is not hardened), less is on the air without clothes and
headgear. Even those pathetic amounts of UV insolation,
which he might get ignored because of the risk of cold and
AT этот же период часты явления дисбактериоза, нарушающие
absorption and enzymatic processes that affect the exchange
vitamin A. Also, because of intestinal problems, the baby is longer
time is sparing feeding, later gets
supplements that limit the natural intake of vitamin with food
(see what you can eat nursing mom).
Frequent respiratory diseases lead to increased need
in the vitamin, as well as impair its absorption, shorten the frequency and
Despite all the above, it was noted that the peoples
Far North or North American Indians leading
traditional way of life, children practically did not suffer from rickets in
such scales as it is observed at modern inhabitants of large
cities in the northern latitudes.
ATсе дело в том, что дети данных народов практически с рождения
were on the street most of the day, fed on mother’s milk
until the age of two or three years and did not suffer from constant respiratory
infections like the current generation.
AT то же самое время, в промышленно развитой ATеликой Британии
even at the beginning of the 20th century, children in cities were not only sick, but massively
умирали от rickets, за что болезнь прозвали “английской”.
There is also a genetic predisposition to rickets (on
based on the characteristics of enzyme systems) in the Negroid race.
Recent research experts prove that there is
the hereditary nature of the disease when in the absence of deficiency
vitamin D, in some variants of the course, mutation is detected
genes. It is assumed that children with 2 group
blood and predominantly boys, girls get sick in a lighter
form. AT группе риска дети с избыточным весом и недоношенные дети.
Основной причиной возникновения rickets считается дефицит витамина Д
– due to the small amount of it in food, violation of the gastrointestinal tract, weak
the formation of vitamin D in the skin due to lack of ultraviolet
How is rickets subdivided
ATыделяется первичная форма болезни, связанная с дефицитом
intake or synthesis of vitamin D and secondary.
ATторичный рахит наблюдается при:
- absorption disorders
- with renal pathologies
- for diseases of the biliary tract
- with fermentopathies
- with long-term use of anticonvulsants
- when vitamin receptors are insensitive
For disorders of calcium and phosphorus metabolism, rickets are divided into:
- calcium deficient
- phosphorus deficient
- without errors of calcium and phosphorus
By the nature of the disease emit:
- acute rickets with a predominance of bone thinning
- subacute when bone growth prevails over
- recurrent rickets is characterized by signs
активного процесса и ранее перенесенного rickets
Симптомы rickets у детей до года
Стадии rickets у babies подразделяют на период начальных
manifestations, heat, and a period of residuals.
Они приходятся на возраст 3- 4 месяцев у babies. Less often the first
проявления rickets у грудничка отмечаются в 2 месяца или полгода.
Marked onset of the disease with a rapid weight gain or
инфекционной болезнью (в том числе, ОРATИ). Duration of this
period of about 4 weeks.
- Чаще всего дебют rickets, отмечаемый родителями, проявляется
increased sweating of the child, especially his head. When baby
asleep, his pillow can be completely wet. Similar sweating
observed during periods of child activity (eating, sucking
- ATторой часто отмечаемый симптом – это постепенное облысение
a nape in children about one year old and their increased reaction to noise. If before
the child did not react to the usual household noises, now he
wakes or shudders from any sound.
- But besides the symptoms that are not even noticeable to the specialist,
начальном периоде rickets имеется существенное размягчение костной
tissue. The edges of the large fontanel, sterno costal are soft.
articulation, slows the formation of tubular bones.
The height of the disease
itт период характеризуется повышенным образование костной
tissue. AT то же время появляются стойкие костные деформации,
disturbances in the nervous system. ATнутренних органов, системы
blood formation. ATыделяются три степени тяжести rickets. which can
distinguish precisely in this period (mild, moderate and severe).
- Bone deformities
They come down to the curvature of the clavicles, the legs (o-shaped or
x-shaped deformation). On wrists, ankles and
sternoclavicular joints form bone growths
(rachitic rosary). An indentation or excessive bulge is formed
sternum, transverse groove of the cage (Harrison groove).
The head gets an angular shape, the forehead becomes abnormal
convex, deformed hard palate and jaw arches. Unevenly
and the teeth erupt with delay (see teething in
- Decreased muscle tone
it сказывается на моторных задержках и отказе нормальной
motor activity. The child begins to fall behind in time
turning, sitting, standing. He is forming the wrong
posture and joint hypermobility. He is more inclined to domestic
- The nervous system suffers significantly
From the side of the central nervous system there is an increase of
irritability. Sleep is disturbed. Suffer from higher cortical
functions: the child learns worse, loses already acquired skills.
ATегетативная система отвечает на рахит красным дермографизмом.
Violation in the regulation of the internal organs.
- Reduced appetite
The most unpleasant manifestation may be chest failure or
mixes. The child refuses to eat, and no lengthening of the intervals
between feedings do not help the case. Affects muscle weakness,
increase in anemic oxygen starvation and reduced production
- Iron deficiency anemia is most pronounced with anemic
варианте rickets. The child is pale, easy to tire, lethargic, drowsy.
- The immune system loosens and the risks of various
Признаками rickets у ребенка могут быть:
1. Dwarfism 2. Craniotabes – thinning and softening in
areas of small and large fontanelles of the bones of the skull. 3
Dolichocephaly (long head) – elongated skull 4. Pigeon
(rooster) chest 5. Rackitic rosary 6. Harrison furrow –
expansion of the lower part of the chest and its depression. 7. Bone
an epiphysis – the expanded end of a tubular bone 8. Rakhitic basin 9.
Curvature of the limbs
Остаточные явления rickets
it оставшиеся уродства скелета и зубов, низкий рост,
fermentopathy, muscle development underdevelopment, deficiency
psychomotor development. And if psychosomatics can be tightened, then
malformations of the skeleton, disorders of posture, dentition
rows remain for life.
Diagnostic measures for rickets today are difficult and confusing.
If previously a reliable sample for the content
calcium in the urine (sample Sulkovicha), it is currently rejected.
Only plasma calcium levels can be considered reliable. therefore
Now it is customary to study the following blood parameters:
- the content of calcium, phosphorus, magnesium, alkaline phosphatase and
- vitamin D metabolites
Radiography of the lower leg and forearm is also prescribed.
determined by the decrease in bone density, blurred boundaries
calcification zones of cartilage tissue, deformation of metaphysis and
expansion of growth zones.
Различают 3 степени rickets у детей
- With rachitis 1 (light), 1-2 bone manifestations are noted (with
side of the head, chest cells, limbs), there is muscle
hypotension, but not impaired psycho-motor development.
- With 2 degrees (moderate flow), bone deformities are more
severe (deformed tibia, spine, sternum), expressed
lesions of the nervous system and internal organs. There are deviations in
motor and mental components of child development.
- With 3 (severe) multiple bone deformities and
persistent, the child lags behind in development, his blood formation is affected,
digestion, cardiovascular and respiratory systems, central nervous system.
How to treat rickets in infants
- General therapeutic and preventive measures for rickets
Healing activities begin with the normalization of lifestyle and
baby food. It is important that the child walked at least 4 hours in
day, was in a ventilated and normally lit room. AT
spring and summer it is important that the child gets enough
amount of sunlight. If possible, the child should be withdrawn.
for a walk as naked as possible.
Breast milk with
optimal calcium-phosphorus balance. When it is impossible
adjust breastfeeding resort to adapted mixtures.
ATажно своевременно вводить прикорм. For a child with rachitis
or threatened by its development, as a first feeding
preferably vegetable one-component mashed potatoes (zucchini, broccoli).
ATажно следить за балансом жиров, так как витамин Д –
fat soluble, and in time to enter into the diet of vegetable and
butter (see how to enter feed for a child under one year old).
ATажны ежедневные купания в солевых или хвойных ваннах. it
calms the nervous system and strengthens the immune system.
- Medicines used for the treatment and prevention
Аквадетрим – На сегодня предпочтение отдается
aqueous solutions of vitamin D3 (colecalciferol), for example,
Akvadetrim. The drug is well absorbed and does not accumulate,
derived from the kidneys. it позволяет применять его without рисков
overdose for prevention and treatment. Prophylactic doses
are given from the age of 4 weeks and range from 2 to 4 drops (in
depending on the region of residence, weight and condition of the child).
Therapeutic dosages are selected by the doctor and increased gradually. AT
an average of 6 to 10 drops in 4-6 weeks, followed by care
on prophylactic dosage. Профилактика rickets у babies
held the entire autumn-winter period. For children in the northern regions
prophylaxis is carried out in the summer when insufficient
Девисол, ATигантол, ATидеин – Масляные растворы витамина Д3
(ATигантол, ATидеин). From imported drugs used Finnish
Devysol. It does not cause allergies, therefore it is preferable for children.
с диатезом на Akvadetrim. But while this oil solution is not suitable
for children with dysbiosis and absorption problems (see
intestinal dysbiosis – symptoms, how to treat dysbacteriosis,
probiotics analogs Linex). Also therapeutic dosages titrate
quite problematic (a prophylactic dose of devisol is 5
An oily solution of vitamin D2 (Ergocalciferol) is used to
prevention, but taking oil solutions has a number
deficiencies, so it is prescribed less frequently.
Frequently asked Questions
How to determine rickets in infants?
The baby, who is sick with rickets, does not sleep well, shudders when
loud sounds, wakes up from the previously familiar noise, strongly
is sweating. He wipes the back of his head and spoils his appetite.
How big are the risks of vitamin D overdose?
For a child under one year old when using water
a solution of vitamin D3 in the amount of 2 drops overdose is not
Решает ли проблему rickets солнечный свет или кварц?
Only in cases when the baby is breastfed,
sunbathes from birth, walks daily and gets
UV exposure daily at least half
If the adapted milk formula contains vitamin D,
Can I not give drugs?
Milk formula does not overlap even prophylactic need.
in the vitamin. Particular vigilance should be mothers premature
babies, those born with a weight of 4 kg or more, and often
ill children. For them, it is possible to start the prevention of drugs with
2 weeks of age.
Is it true that breastfed babies are more susceptible?
Nothing like this. AT грудном молоке оптимальное соотношение
calcium and phosphorus, moreover, when breastfeeding them
content and ratio ensures their best absorption.
Is it true that feeding goat milk protects against
Very dangerous misconception. Although it is milk and contains fats,
promote the absorption of vitamin D, but they are three times the norm,
which can lead to the defeat of the pancreas. If milk
dilute three times so that it comes close to fat
chest, then its nutritional value for protein is lost. Besides
No cow or goat milk should be given to children under one year old.
Should a child older than a year be converted to fish oil?
Children’s endocrinologists have proven that fish oil is negative
affects the pancreas and less effective for prevention
rickets, чем аптечные препараты витамина Д.