Pediatric rickets is one of the most common chronic nutritional diseases in infancy and early childhood. It is caused by the lack of vitamin D in children’s bodies, resulting in abnormal calcium and phosphorus metabolism, causing bone lesions and affecting the functions of nerves, muscles, hematopoiesis, immunity and other tissues and organs, which seriously affects children’s physical health. The disease occurs in children within 2 to 3 years of age and during the winter and spring seasons.
The disease is often called “calcium deficiency”, which is inaccurate and can lead parents to believe that the cause is calcium deficiency and only give simple calcium treatment, which can delay the control of the disease.
A. What are the common causes of this disease?
1. Insufficient sunlight is the main reason. The most important reason is the lack of sunlight.
2, natural food including milk contains very little vitamin D, can not meet the needs, if not add vitamin D or sunlight is not enough, easy to cause vitamin D deficiency.
3, fast-growing infants and children are prone to the onset of vitamin D deficiency, accelerated growth in adolescence, such as less sunlight, late-onset rickets can occur.
4. Other diseases such as chronic diarrhea, hepatobiliary disorders, long-term application of hormones and anticonvulsant drugs can affect the absorption or metabolism of vitamin D.
Second, what are the manifestations of this disease?
The disease mostly develops before 3~6 months of age.
Initial stage: there are often non-specific neuropsychiatric symptoms such as easy to startle, easy to wake up, easy to excite, cry, good tantrums, more irritable, sweating and room temperature, season, clothing, etc., often appear occipital baldness.
Radical phase: Mostly seen in children from 3 months to 2 years old. In addition to the above symptoms, there may be the following skeletal changes, such as: softening of the skull, square cranium, late closure of the chimney door, delayed teething or reversal of the order of emergence, rib beading or rib edge exostosis, chicken chest or funnel chest, abdominal muscle relaxation, large abdomen (“fiddle belly”), spinal deformity, bracelets or anklets, the two lower limbs of those who can walk due to the effect of gravity to form “O” or “X” shaped legs.
Determination of bone alkaline phosphatase level or alkaline phosphatase activity in blood (both elevated) and X-ray examination of the wrist bones are reliable methods to diagnose early rickets. In the early stage of rickets, serum calcium and phosphorus concentrations are in the normal range and only decline when severe, therefore, the determination of calcium and phosphorus in blood has little significance for the early diagnosis of rickets. Hair or urine calcium tests also cannot be used as a basis for the diagnosis of rickets.
How to prevent and treat rickets?
At present, early prevention is advocated, and early detection, early diagnosis and early comprehensive treatment are desirable when the disease occurs.
Appropriate sunlight is the most effective, convenient and economical method to prevent rickets. Children should be outdoors for more than 1~2 hours a day on average, and mild to moderate rickets can sometimes be cured by simple sunlight in summer. You should not sunbathe through the glass, because ultraviolet light can not fully penetrate the glass, so it will affect the effect of sunlight.
In addition to sunshine, the main thing is to supplement vitamin D, preferably under the guidance of a doctor. If it is difficult to take daily in rural and remote areas, you can also apply 50,000 to 100,000 IU of vitamin D at one time under the guidance of a doctor on a monthly and quarterly basis according to the age group.
The dosage of vitamin D should be increased appropriately for children with active rickets, and the application of continuous small doses of vitamin D for rickets is currently advocated. The dosage should be 1000~2000 IU per day for children with rickets in the initial stage and mild stage, 3000~4000 IU per day for children with moderate stage and 5000~6000 IU per day for severe stage.
When taking preventive vitamin D orally during infancy, it is generally not necessary to take calcium tablets at the same time because there is sufficient calcium in milk and breast milk, and calcium powder is often added to many fortified milk substitutes for infants, which is sufficient to meet the growth needs of children. The ratio of calcium to phosphorus in breast milk is reasonable and the absorption rate is high. Milk and soy products have a high calcium content and should be consumed more often.
At present, it is less advocated to add vitamin D to various children’s foods or calcium supplements, because on the one hand, vitamin D decomposes very easily when it sees light, and on the other hand, it is difficult to judge the amount of vitamin D intake, which may easily cause insufficient intake or poisoning of vitamin D in children.
When choosing vitamin AD preparations, it is advisable to use 3 to 1 or 2 to 1 preparations. 10 to 1 is used to supplement vitamin A deficiency and cannot be used to prevent rickets, otherwise it is easy to cause vitamin A poisoning, and it is best to use pure vitamin D preparations.
Children with active rickets should not stand and walk early for a long time to avoid deformities of the lower limbs.