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How to prevent rickets?
Last reviewed: 20.11.2021
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Ante- and postnatal specific and nonspecific prophylaxis of rickets is distinguished.
Antenatal prophylaxis of rickets
Antenatal prophylaxis of rickets should be started long before delivery. The pregnant woman must observe the regime of the day, it is enough to rest day and night. It is very important not less than 2-4 hours daily (in any weather) to be in the open air, to eat rationally. In a daily diet of a pregnant woman, not less than 180-200 g of meat, 100 g of fish, 150 g of cottage cheese, 30 g of cheese, 0.5 l of milk or fermented milk products should be present. Products should contain enough vitamins and trace elements. Pregnant women at risk (nephropathy, diabetes, hypertension, rheumatism) is necessary to the 32nd week of pregnancy to appoint additional vitamin D 3 (cholecalciferol) in the 200-400 ME dose for 8 weeks, regardless of the time of year.
It is recommended to take calcium supplements (if possible simultaneously with dairy products).
Postnatal nonspecific prophylaxis of rickets
Postnatal nonspecific prophylaxis of rickets provides for the organization of the correct nutrition of the newborn. Ideal is natural breastfeeding. To ensure successful and prolonged lactation, a woman must observe the regime of the day and eat right.
In the absence of breast milk, modern adapted mixtures, balanced by the content of calcium and phosphorus (ratio 2: 1 and more) and containing cholecalciferol (vitamin D 3 ) should be recommended .
Particular attention should be given to the child's physical development, tempering. In addition to walks in the fresh air and water procedures for rickets, therapeutic gymnastics and massage are applied in accordance with the principles of regularity, regularity, duration of treatment, gradual uniform increase in the load during the year.
Postnatal specific prevention of rickets
Specific prevention of rickets in term infants is carried out for all children, regardless of feeding in the autumn-winter-spring period during the first 2 years of life. For specific prevention of rickets used drugs containing cholecalciferol: water-soluble and oily vitamin D 3.
Water-soluble vitamin D 3 is absorbed more quickly from the digestive tract, well tolerated and conveniently dosed (in 1 drop contains about 500 ME cholecalciferol). The drug is indicated for premature infants with immature intestinal enzymes.
The prophylactic dose in healthy full-term infants is 400-500 IU / day, starting at 4 weeks of age. Vitamin D with a preventive purpose is advisable to appoint and in the summer with insufficient insolation (cloudy, rainy weather). In the climatic regions of Russia with low solar activity (northern regions of Russia, the Urals, etc.), the prophylactic dose of vitamin D can be increased to 1000 IU / day. For children at risk, the prophylactic dose is 1000 IU / day for a month, then 500 ME for 2 years of life.
Specific prophylaxis of rickets in children with first-degree prematurity is spent from 10-14th day of life to 400-1000 IU of vitamin D per day for the first 2 years, excluding summer months. In case of prematurity of III degree after the establishment of enteral nutrition, 1000 IU of vitamin D is prescribed daily during the first year of life, on the second - 500 ME, excluding summer months.
Contraindications to the prescription of a preventive dose of vitamin D can be idiopathic calciuria (Williams-Burne disease), hypophosphatase, organic CNS damage with symptoms of microcephaly and craniostenosis.
Children with small size or early closure of the large fontanel have only relative contraindications to the appointment of vitamin D. With normal indices of head circumference, the absence of neurologic symptoms and signs of organic pathology of the central nervous system, specific prevention of rickets in such children is carried out according to the usual method. In some cases, specific prevention of rickets can be delayed by initiating the intake of vitamin D from 3-4 months of life.
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