Dr. Komarovsky about rickets

Rickets - a diagnosis that scares parents of babies even more than the flu. Since childhood, moms and dads in their heads firmly sat down grandmothers frightening stories that if you eat badly, it will happen terrible rickets.

Girls and boys have grown up, they themselves have become parents and already know that rickets with the amount of food eaten has nothing in common, but it doesn’t get any less questions, especially if the district pediatrician sighs sadly at the next examination and says that the baby has a condition close to rickets or even some degree of rickets. Evgeny Komarovsky, a well-known pediatrician, tells about what it is and whether it is necessary to be afraid of it.

Rickets - a typical childhood disease. It is associated with insufficient mineralization of bones, with improper formation of bones of the skeleton. This condition occurs when the baby is actively growing, and in his body there is a lack of vitamin D pathologically. Rickets may be associated with a lack of calcium, phosphorus, and also sometimes it proceeds at absolutely normal indicators of these substances in the blood test. The disease can be acute, subacute and recurrent, and also has three degrees of severity.

Rickets begins, gains momentum, and then he declines, leaving doctors for research only signs of the disease. Secondary illness develops quite rarely, mainly against the background of severe kidney disease, serious metabolic disorders, as well as in children who have been given for a long time anticonvulsants drugs.

Artificialists more often develop rickets than babies who eat breast milk, since the former absorb only 30% of calcium, and the latter absorb up to 70%. Vitamin D deficiency impairs calcium absorption.

The main source of this important vitamin is the sun's rays that fall on the skin of a child.

The classic signs of rickets are: medicine considers sleep disturbance in an infant, tearfulness, poor appetite, fearfulness (when the baby shudders at loud noises), sweating, especially at night, baldness of the back of the head, which the baby rubs against a diaper or pillow due to itchy scalp. The smell of sweat the patient has a sour peculiar smell. All these symptoms are characteristic of the starting stage of the disease, which can last for about a month.

In the active stage of the disease, various disorders of the skeletal system, softening of the bones, deformity start, the child may experience a lag in mental and physical development. Typical signs - rickety "rosary", "bracelets" and "strands of pearls." With such beautiful names, medicine means not very beautiful manifestations of a thickening of the transition of cartilage to bone tissue. "Bracelets" - on the handles, "rosary" - on the ribs, "strands of pearls" - fingers. Another obvious sign is also called quite poetic - “Olympic forehead”. It manifests itself in a prominent protrusion of the frontal bone forward.

Then the disease is declining, leaving the child for the rest of his life the effects of rickets - a violation of posture, chest deformity, changes in the bones of the legs.Especially dangerous is the disease in girls, because the narrowing of the pelvic bones, which may remain after suffering rickets, in the future may cause difficulties in carrying out natural childbirth. These girls and women recommended cesarean section.

Modern pediatricians love this diagnosis. Firstly, because he relieves the doctor of all responsibility for possible problems in the development of the baby (anything can happen, but they warned that rickets is the same!), And, secondly, it is as difficult to refute him as it is to prove. In this case, the doctor makes a diagnosis that does not exist, for example, rickets of 0-1 degrees. There is no such disease, says Komarovsky. A rickets of 1 degree, if desired, can be found in nine out of ten toddlers of an early age. In 99% of these guys, the symptoms of rickets will pass by themselves.

If the doctor has reason to assume real rickets (and this happens very rarely), he will definitely give direction to an x-ray examination of the bones of the lower extremities and forearm, recommend donating blood for vitamin D, calcium, phosphorus.

Nowhere in the world is rychitis diagnosed by such signs as chest deformity, sweating, or anorexia. And baldness of the nape is generally not considered a sign of rickets, according to Komarovsky, just the thin hair of a newborn when it starts to twist its head (by 3-4 months) is mechanically “wiped off” about the diaper, and there is no need to look for any pathological reasons for this.

A curved chest in general can be hereditary, just look attentively at the sternum of the father, grandfather, and great-grandfather. If there is no family pattern, then again there is no reason for excitement, because when the need for calcium decreases, when bone growth slows down a bit, all the flaws and curvature will disappear by themselves.

But most pediatricians stubbornly do not want to notice the modern international standards for diagnosing this disease, continue to use the information published in medical textbooks 50 years ago, and therefore the number of children who, due to sweaty feet and bald head alone, had the verdict "rickets" , in Russia today it is approaching 70% of the total number of newborns and infants, while only 1% of children have a real problem.

Most often, doctors who have given the child rickets prescribe shock doses of vitamin D and pine-salt baths. Such water procedures are very useful for children's health, but they have nothing to do with the treatment of real rickets, Komarovsky says. The administration of shock doses of a vitamin is generally a medical offense. The maximum amount that a child needs is no more than 500 units per day or 1 drop of an aqueous solution.Akvadetrim". Overdose in a baby can cause severe vomiting, diarrhea, urinary dysfunction, increased pressure up to the development of cardiopathy and cardioneurosis.

Walking and fresh air for a child with rickets (or suspicion of it) is very helpful. In the diet of the baby should definitely enter the reception of cereals or mixtures with the vitamin content.Consultation of a good baby otropeda, which, on the basis of X-rays of the long bones of the legs (lower leg) and forearm, does not interfere, will dispel or confirm fears. In the second case, he will certainly give his recommendations.

If rickets is associated with a lack of phosphorus, calcium, and vitamin D deficiency, and this is confirmed by laboratory tests, newborns are treated with cholecalciferol. Depending on the test results, calcitriol may be prescribed. It is not enough for premature babies, they are recommended to take calcium gluconate and potassium phosphate.

The prognosis for most children with real, rather than fictional rickets is quite favorable. But what parents should definitely make sure is the absence of calcium deficiency, it occurs more often in children than rickets, both with it and separately. If blood tests showed this deficiency, then you should start giving the child calcium supplements in strictly defined age dosages.

Prevention of rickets is not something expensive, difficult and difficult. And because it, says Komarovsky, it is necessary to do without fail. If the baby is breastfed, vitamin D should be taken by the nursing mother, the baby will receive his dose with milk.

Artificialists, especially those who were born in winter, can be given the vitamin from almost the very birth (from the second or third week), but if he eats a mixture of adapted, then it already has this substance. As soon as a child who eats breast milk from his mother, complementary foods make up about a third of the daily ration, he needs to be given vitamin D if he is cooked with regular milk.

Half-hour exposure to the sun per day covers the daily need for vitamin D. If the sun is low (from October to March in most regions of Russia), then vitamin preparations should be taken strictly in the age dosage. An overdose of this vitamin is worse than its lack.

You can learn more about rachitis from the following program by Dr. Komarovsky.