Symptoms of rickets

Rickets is a disease of the whole body with a significant disruption of the functions of a number of organs and systems. The first clinical symptoms of rickets are found in children 2-3 months. In premature infants the disease manifests itself earlier (from the end of the 1st month).

[1], [2], [3], [4], [5]

Disorders of mineral metabolism in rickets

[6], [7], [8], [9], [10], [11], [12], [13], [14], [15]

Calcipenic rickets

In addition to classical bone changes with a predominance of osteomalacia, the symptoms of increased excitability (tremor of hands, sleep disturbance, unmotivated anxiety) are noted. Also, children have a marked disorder of the autonomic nervous system (excessive sweating, tachycardia, white dermographism).

When biochemical blood test against a background of a significant decrease in the level of calcium, a high concentration of parathyroid hormone and a decreased concentration of calcitonin. Characterized by increased excretion of calcium in the urine.

[16]

Phosphopenic rickets

They note general lethargy, inhibition, pronounced muscular hypotension and weakness of the ligamentous apparatus, "frog stomach", signs of hyperplasia of the osteoid tissue.

Characterized by severe hypophosphataemia, high levels of parathyroid hormone and calcitonin in the serum, in the urine - hyperphosphaturia.

Rickets without significant changes in calcium and phosphorus concentrations in the blood

In patients with this form of rickets, as a rule, there are no distinct clinical changes in the nervous and muscular systems. Characteristic subacute course of the disease with signs of hyperplasia of the osteoid tissue (parietal and frontal tubercles).

Symptoms of rickets: damage to the nervous system

Functional disorders of the nervous system - the initial symptoms of rickets. They are manifested in the form of anxiety, tearfulness, sleep disturbance, wince in a dream, severe sweating. Particularly strong sweating head in the nape of the neck. Adhesive sweat irritates the skin, there is itching. The child rubs his head on the pillow, and as a consequence, there is baldness of the occiput - a characteristic sign of the beginning of rickets.

An important symptom of rickets from the nervous system is hyperesthesia. Often, when you try to take the child, the child cries, worries.

In severe rickets, changes in the central nervous system are noted: general motor inhibition, children become inactive, slow, the elaboration of conditioned reflexes becomes more difficult.

Symptoms of rickets: defeat of the bone system

The lesion of the entire skeleton is characteristic, but the clinical manifestations are more pronounced in those bones that grow most intensively at a given age. So, when rickets occur in the first 3 months of life, the changes are manifested by the bones of the skull. When the disease develops from 3 to 6 months, changes are detected in the bones of the chest. In the case of rickets, children older than 6 months are affected by the bones of the limbs and pelvis. There are 3 options for changing bones:

• osteomalacia;
• osteoid hyperplasia;
• osteoporosis.

Symptoms of osteomalacia

• Defeat of the bones of the skull. Note softening of the edges of the large fontanel and stitches, craniotabes [areas of softening of the body of the skull bones (most often the occipital bone is affected)]. The feeling obtained by pressing on these areas can be compared with pressing on parchment or felt hat. The softness of the bones of the skull leads to the appearance of its deformations: flattening of the occiput or lateral surface, depending on how the child is lying more.
• Lesion of the bones of the chest. As a result of the softening of the ribs, the Garrison's furrow is formed (at the attachment point of the diaphragm, the ribs are retracted, the inferior aperture of the thorax is unfolded), the curvature of the clavicles. The thorax is compressed from the sides, the sternum protrudes forward or sinks.
• Defeat of limb bones. Mark their curvature. The legs of the child acquire O- or X-shaped form.

Manifestations of osteoid hyperplasia

• Defeat of the bones of the skull. Mark increased frontal, parietal, occipital mounds.
• Lesion of the bones of the chest. Formation of rachitic "rosaries" on the ribs (V-VIII ribs) at the site of bone tissue transition into the cartilaginous.
• Defeat of limb bones. The appearance of "bracelets" in the wrist, "pearl strands" on the fingers.

Changes in the bone system in rickets

Department of the skeleton	Bony strains
Head	Craniotabes (softening of areas of the parietal bones, less often - areas of the occipital bone) Deformation of the bones of the skull Frontal and parietal mounds Disturbance of the ratio between the upper and lower jaws Later, the closure of the large fontanel, the violation of teething (untimely, wrong), defects in tooth enamel, a tendency to caries
Rib cage	Deformation of clavicles (strengthening of curvature) Rib "rosary" (hemispherical thickening in the place of transition of the cartilaginous part of the rib into the bone) Expansion of the lower aperture and narrowing of the upper, compression of the thorax from the sides Scaphoid indentations on the lateral surfaces of the chest Sternum deformity ("chicken breast", "cobbler's chest")
Spine	Kyphosis in the lower thoracic region Kyphosis or lordosis in the lumbar region Scoliosis in the thoracic region
Pelvic Bones	Flat pelvis Narrowing of the entrance to the small pelvis
Lower limbs	Twisting the hips forward and outward Various curvatures of the lower limbs (0- or X-deformations, K-shaped) Deformations in the joints
Upper limbs	Curvature of humerus and forearm bones Deformation in the joints: "bracelets" (thickening in the area of wrist joints), "strands of pearls" (thickening in the area of diaphysis of phalanges of fingers)

Muscular system

Important symptoms of rickets are weakness of the ligamentous apparatus and hypotension of the muscles. The weakness of the ligamentous apparatus leads to "loose" joints, which allows the patient to produce movements of a larger volume (for example, lying on his back, the child easily attracts a foot to his face and even throws it over his head). The pose of the patient is characteristic - he sits cross-legged and propps his body with his hands. Hypotension of the muscles of the anterior abdominal wall is manifested by the flattening of the abdomen with the divergence of the straight muscles ("frog stomach"). Violated static functions: children later begin to hold their heads, sit, stand, walk, they have a "rickety hump."

Violation of the functions of other organs and systems

• Some children in the midst of rickets have hypochromic anemia.
• Often noted increase in the liver and spleen (hepatolyenal syndrome).
• Changes in the chest and hypotonia of the muscles lead to respiratory disorders in rickets of grade II-III. Children have shortness of breath, cyanosis, pulmonary ventilation is impaired. There may be sites of atelectasis in the lungs, predisposing to the development of pneumonia.
• Violations of the chest excursion, insufficient reduction of the diaphragm lead to a violation of hemodynamics, which are manifested by tachycardia, muffling of heart sounds, functional systolic noise.
• In a number of cases, the pathology of the digestive and urinary systems is noted .

Periods of rickets

The period of the disease is determined by the clinical picture, the severity of osteomalacia and biochemical changes.

Symptoms of rickets in the initial period

It often occurs on the 2-3 th month of life and lasts from 2-3 weeks to 2-3 months.

Characteristic disorders of the autonomic nervous system, and only at the end of this period there are changes in the bone system in the form of compliance of the edges of the large fontanel and arrow-shaped suture.

On the part of the muscular system, hypotension, constipation is noted.

With a biochemical blood test, a slight decrease in the phosphorus content is noted, the level of calcium remains normal. Characteristic increase in activity of alkaline phosphatase.

Symptoms of rickets in the period of height ("blooming" rickets)

Progressive lesions of the nervous and bone systems are characteristic. Bony changes come to the fore. Note all 3 types of changes (osteomalacia, osteoid hyperplasia, osteogenesis disorder), but their severity depends on the severity and course of the disease.

In addition, for the peak period characterized by:

• clear muscular hypotension;
• weakness of the ligamentous apparatus;
• enlargement of the liver and spleen;
• hypochromic anemia;
• functional violations by other organs and systems.

The number of systems involved and the severity of their changes depends on the severity of the process.

When biochemical blood test, significantly reduced levels of calcium and phosphorus, increased activity of alkaline phosphatase.

Symptoms of rickets in the period of convalescence

They note the reverse development of the symptoms of rickets. Symptoms of nervous system damage disappear first, then the bones become denser, the teeth appear, the changes in the muscular system disappear (the static and motor functions change), the size of the liver and spleen decrease, and the functions of the internal organs are restored.

Increases to normal phosphorus levels; the concentration of calcium can remain low, the activity of alkaline phosphatase is increased.

Symptoms of rickets in the period of residual phenomena

It is observed in children older than 2-3 years. During this period, only the effects of rickets in the form of deformity of the bones are preserved, which indicate that the child has suffered the disease in severe form (I or III degree). Deviations in laboratory indicators of mineral metabolism are not noted.

Due to the subsequent processes of bone tissue remodeling, which is most active after 3 years, the deformations of the tubular bones disappear with time. Deformations of flat bones decrease, but remain. In children who have suffered rickets, the growth of parietal and frontal tubercles, occipital flattening, malocclusion, deformation of the thorax, pelvic bones remain.

The severity of rickets

I degree (light)

A small number of weakly expressed signs of rickets from the nervous and bone systems with involvement of the 1-2 parts of the skeleton in the process. Sometimes the unexpressed muscle hypotension is observed.

After rickets of the 1st degree, no residual effects are noted.

II degree (moderate severity)

III degree (heavy)

At present, almost does not occur. It is manifested by significant changes in the central nervous system: a violation of sleep, appetite, inhibition, lag in the development of speech and motor skills. Changes in the bone system have the character of multiple, distinctly expressed deformities (softening of the bones of the base of the skull, occlusion of the bridge of the nose, "Olympic" forehead, gross deformation of the thorax, limbs, pelvic bones). There may be bone fractures without bias or angular displacement. There are pronounced changes on the part of the muscular system (violation of static functions). Significantly increased liver and spleen, there are distinct functional disorders of the cardiovascular system, respiratory organs. Gastroenterologist, severe anemia.

The nature of rickets

Acute current

Rapid increase in symptoms, predominance of osteomalacia processes over the processes of osteoid hyperplasia. It is observed more often in the first half of life, especially in premature babies who have excess body weight, and often ill children.

[17], [18], [19], [20],

Subacute current

Slow development of the disease. They note mainly the symptoms of osteoid hyperplasia: frontal and parietal tubercles, "rosary" on the ribs, "bracelets", "strings of pearls". Craniotabes is not typical. It is more common after 6 months in children with high diet and in those who have received insufficient amounts of vitamin D for the prevention of rickets.

Recurrent course

Periods of improvement are replaced by exacerbations of the rickety process. This may be due to early interruption of treatment, the presence of conducive diseases, irrational nutrition. A characteristic radiographic symptom of rickets is the appearance in the zone of bone growth of streaks of ossification, the number of which corresponds to the number of exacerbations.

Principles of classification of rickets

Degree of severity

• I degree - easy.
• II degree - moderate severity.
• III degree - heavy.

Disease Period

• Initial manifestations.
• The heat.
• The fading.
• Reconvalescence.
• Residual phenomena.

Flow pattern

• Sharp.
• Subacute.
• Recurrent.

The nature of the disturbance of mineral metabolism

• Calcipenic rickets.
• Phosphopenic rickets.
• Rickets without significant changes in the content of calcium and phosphorus.

Examples of the formulation of the diagnosis

• Rachitis I, initial period, acute course.
• Rickets I, the peak period, subacute current.
• Rickets I, period of convalescence, subacute course.
• Rickets II, peak period, acute current.
• Rickets II, the period of swell, recurrent course.
• Rachitis III, peak period, acute course.

[21], [22]