Treatment of rickets

Objectives of rickets treatment

• Elimination of 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 with rickets

The optimal is breastfeeding, since in human milk calcium and phosphorus are contained in the optimal ratio for absorption. For mixed or artificial feeding of patients with rickets, children use adapted mixtures containing preventive doses of vitamin D (400 IU per liter) and a complex of other vitamins. It is advisable to use fermented milk mixtures (NAN fermented milk, ASU-1 fermented milk) in an amount of 1 / 2-1 / 3 of the daily volume. It is very important timely introduction into the diet of fruit and vegetable juices, vegetable broths, yolk of chicken eggs, cottage cheese, complementary foods. As the first complementary food is strongly recommended vegetable puree, which is introduced from 4-4.5 months. The second lure - porridge on a vegetable broth or with the addition of vegetables and fruits. From 5 months it is advisable to appoint a liver in the form of a souffle, from 6-6,5 months - minced meat.

Control of the child's diet is carried out with the help of regular (1-2 times per week) calculation of nutrition with subsequent correction. If the child is breastfeeding, attention should be paid to the mother's diet.

Calcium in food

Product, 100 g	Calcium content, mg	Product, 100 g	Calcium content, mg
Milk	120	Cabbage	60
Sour cream	100	Salad	83
Yogurt	120	Green onion	60
Cottage cheese	150	Green Beans	40
Hard cheese)	600	Olives green	77
Cheese (fused)	300	Oranges	35
Egg	55	Dried apples	45
Bread white	Thirty	Figs	57
Bread, black	60	Dried apricots	170
Boiled fish	Thirty	Raisins	56
Beef	Thirty	Almond	254
Fish, dried (with bones)	3000	Peanut	70
-	-	Sesame	1150

Mode

The organization of the correct regime of the child's day provides for sufficient rest, elimination of various stimuli (bright light, noise, etc.). It is necessary to stay in the fresh air (> 2-3 hours daily), regular airing of the living room.

Massage and physiotherapy exercises for rickets

Two weeks after the start of drug therapy, the complex treatment includes exercise therapy and massage for 1.5-2 months, which contribute to the accelerated recovery of muscle tone and prevent the violation of posture and the development of flat feet.

Balneotherapy

Apply after the end of drug treatment.

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

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

The courses of balneotherapy are carried out 2-3 times a year.

Medicinal treatment of rickets

Assign an aqueous (aquadetrim) or oily (viganthol) solution of cholecalciferol in a dose of 2500-5000 ME in courses of 30-45 days. Oily solutions are absorbed worse, their effect is less prolonged.

In the presence of concomitant acute diseases in patients with rickets (ARVI, pneumonia), the intake of vitamin D should be suspended for the duration of the fever (usually 2-3 days). After normalizing the temperature, treatment should be continued.

After the end of treatment, a preventive intake of vitamin D ₃ at a dose of 200-400 IU is prescribed from October to April for 2-2.5 years.

In children older than one year you can use preparations of fish oil.

Preparations of vitamin D are prescribed in combination with vitamins of group B (B _g B ₂, B ₆ ), C, A, E. Especially important is the combination with vitamins B ₂ and C, as with their deficiency of the effect of vitamin D treatment may not be.

To normalize the function of parathyroid glands and reduce the severity of vegetative symptoms in the complex treatment of rickets include potassium and magnesium preparations (panangin * asparam *) from the calculation of 10 mg / kg body weight per day for 3-4 weeks.

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

Children who are on natural feeding and premature are recommended 2-3 weeks of calcium therapy, the dose of which depends on the age, severity of bone and metabolic disorders. In Table. 11-6 shows the calcium content of various preparations. For the correction of phosphorus metabolism, calcium glycerophosphate or osteogenone * (178 mg of calcium and 82 mg of phosphorus in one tablet) is used for 3-4 weeks.

Calcium content in various preparations

Calcium preparations	Calcium content, mg / g salt
Calcium carbonate	400
Three-base calcium phosphate	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 for 1 tsp. 3 times a day. Citric acid helps maintain an acid reaction in the intestine, forms a soluble and easily digestible complex of calcium citrate.

During treatment with vitamin D, a Sulkovich sample is periodically performed, which determines the excretion of calcium in the urine, and also assesses the calcium content in the blood plasma for the timely detection of hypercalcemia.

Indications for hospitalization

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

Clinical examination

Children who have suffered rickets of the 1st degree are observed by a pediatrician up to 2 years, and those who have suffered rickets of II-III degree - for 3 years. All children are subject to a quarterly examination.

According to the indications, the pediatrician can prescribe a biochemical blood test (determination of calcium, phosphorus and alkaline phosphatase content), densitometry or radiography of bones, consult a child with an orthopedic surgeon.

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

Forecast

With timely diagnosis and treatment of non-severe forms of rickets, the prognosis for life and health is favorable. In case of severe disease progression and a recurring process, the prognosis for health is relatively favorable, since gross violations of the musculoskeletal system can be maintained, requiring observation and treatment in the orthopedic surgeon.