Treatment of rickets

Goals of Rickets Treatment

• Correcting vitamin D deficiency.
• Normalization of phosphorus-calcium metabolism.
• Elimination of acidosis.
• Strengthening the processes of bone tissue formation.
• Correction of metabolic disorders.

Non-drug treatment of rickets

Rational nutrition for rickets

Breastfeeding is optimal, since breast milk contains calcium and phosphorus in an optimal ratio for absorption. For mixed or artificial feeding of children with rickets, adapted mixtures containing prophylactic doses of vitamin D (400 IU per 1 l) and a complex of other vitamins are used. It is advisable to use fermented milk mixtures (NAN fermented milk, AGU-1 fermented milk) in the amount of 1/2-1/3 of the daily volume. It is very important to timely introduce fruit and vegetable juices, vegetable broths, chicken egg yolks, cottage cheese, and complementary foods into the diet. Vegetable puree is strongly recommended as the first complementary food, which is introduced from 4-4.5 months. The second complementary food is porridge on vegetable broth or with the addition of vegetables and fruits. From 5 months it is advisable to prescribe liver in the form of a soufflé, from 6-6.5 months - minced meat.

The child's diet is monitored using regular (1-2 times a week) nutrition calculations with subsequent correction. If the child is breastfed, it is necessary to pay attention to the mother's nutrition.

Calcium content in food products

Product, 100 g	Calcium content, mg	Product, 100 g	Calcium content, mg
Milk	120	Cabbage	60
Sour cream	100	Salad	83
Yogurt	120	Green onions	60
Cottage cheese	150	Green beans	40
Cheese (hard)	600	Green olives	77
Cheese (processed)	300	Oranges	35
Egg	55	Dried apples	45
White bread	30	Fig	57
Black bread	60	Dried apricots	170
Boiled fish	30	Raisin	56
Beef	30	Almond	254
Dried fish (with bones)	3000	Peanut	70
-	-	Sesame	1150

Mode

Organizing a proper daily routine for a child requires sufficient rest, elimination of various irritants (bright light, noise, etc.). Sufficient time (>2-3 hours daily) spent in the fresh air, regular ventilation of the living room is necessary.

Massage and therapeutic exercise for rickets

Two weeks after the start of drug therapy, exercise therapy and massage are included in the complex treatment for 1.5-2 months, which promote accelerated restoration of muscle tone and prevent poor posture and the development of flat feet.

Balneotherapy

It is used after completion of drug treatment.

Coniferous baths are prescribed to excitable children (calculate 1 teaspoon of liquid extract per 10 liters of water, temperature 45 °C) daily. The course consists of 10-15 procedures lasting 8-10 minutes.

Salt baths are recommended for sluggish, sedentary children with muscular hypotonia (calculate 2 tablespoons of sea or table salt per 10 liters of water; the course consists of 8-10 procedures for 3-5 minutes). They note the intensification of metabolic processes, increased oxygen consumption and carbon dioxide release. After the bath, the child is washed with warm fresh water.

Balneotherapy courses are conducted 2-3 times a year.

Drug treatment of rickets

A water (aquadetrim) or oil (vigantol) solution of cholecalciferol is prescribed in a dose of 2500-5000 ME in courses of 30-45 days. Oil solutions are absorbed worse, their effect is less long-lasting.

If patients with rickets have concomitant acute diseases (ARI, pneumonia), vitamin D intake should be suspended for the duration of fever (usually 2-3 days). After the temperature has returned to normal, treatment should be continued.

After completion of treatment, prophylactic administration of vitamin D3 is prescribed _at a dose of 200-400 IU from October to April for 2-2.5 years.

For children over one year old, fish oil preparations can be used.

Vitamin D preparations are prescribed in combination with vitamins of group B (B _g B ₂, B ₆ ), C, A, E. The combination with vitamins B ₂ and C is especially important, since if there is a deficiency of them, there may be no effect from treatment with vitamin D.

To normalize the function of the parathyroid glands and reduce the severity of vegetative symptoms, potassium and magnesium preparations (panangin*, asparkam*) are included in the complex treatment of rickets at a rate of 10 mg/kg of body weight per day for 3-4 weeks.

To stimulate metabolic processes, improve weight and growth indicators, and eliminate muscle hypotension, potassium orotate is prescribed at 10-20 mg/kg per day, carnitine at 2-3 drops once a day for 1-3 months.

Breastfed and premature infants are recommended to take 2-3-week courses of calcium preparations, the dosage of which depends on age and the severity of bone and metabolic disorders. Table 11-6 shows the calcium content of various preparations. Calcium glycerophosphate or osteogenon* (178 mg calcium and 82 mg phosphorus in one tablet) are used for 3-4 weeks to correct phosphorus metabolism.

Calcium content in various preparations

Calcium supplements	Calcium content, mg/g salt
Calcium carbonate	400
Calcium phosphate tribasic	400
Calcium phosphate dibasic anhydrate	290
Calcium chloride	270
Calcium phosphate dibasic dihydrate	230
Calcium citrate	211
Calcium glycerophosphate	191
Calcium lactate	130
Calcium gluconate	90

To improve the absorption of calcium and phosphorus salts in the intestine, use a citrate mixture (citric acid 2.1 g; sodium citrate 3.5 g; distilled water 100 ml) for 10-12 days, 1 teaspoon 3 times a day. Citric acid helps maintain an acidic reaction in the intestine, forms a soluble and easily digestible calcium citrate complex.

During treatment with vitamin D, the Sulkovich test is periodically performed to determine the excretion of calcium in the urine, and the calcium content in the blood plasma is also assessed for the timely detection of hypercalcemia.

Indications for hospitalization

Severe forms of rickets occurring against an unfavourable background (premature babies with somatic diseases in the decompensation stage), as well as the need for differential diagnosis with rickets-like diseases when standard therapy is ineffective.

Clinical examination

Children who have had stage I rickets are observed by a pediatrician for up to 2 years, and those who have had stage II-III rickets are observed for 3 years. All children are subject to quarterly examination.

Based on the indications, the pediatrician may prescribe a biochemical blood test (determination of calcium, phosphorus and alkaline phosphatase levels), densitometry or bone radiography, and consult the child with an orthopedist or surgeon.

Rickets is not a contraindication for preventive vaccinations. After completing the vitamin D treatment, the child can be vaccinated.

Forecast

With timely diagnosis and treatment of mild forms of rickets, the prognosis for life and health is favorable. In severe cases of the disease and recurrent process, the prognosis for health is relatively favorable, since gross disorders of the musculoskeletal system may persist, requiring observation and treatment by an orthopedist and surgeon.