Rickets, commonly known as calcium deficiency, is more common in infancy.
Rickets is a disease caused by vitamin D deficiency that disrupts calcium and phosphorus metabolism in the body, resulting in poor bone calcification. Rickets develops slowly and does not easily attract attention. Rickets lowers the resistance of children and can easily be combined with pneumonia and diarrhea, affecting the growth and development of children. Therefore, it must be actively prevented and treated. Rickets is what we often call “calcium deficiency” in infants and young children, (calcium deficiency in the elderly is likely to cause osteoporosis) Even now the standard of living has improved a lot, but the incidence of rickets is still very high. It is reported that in the south, infants and children under 1 year old, the rate of rickets is 20-30%, in the north is even higher, (20-45%, closely related to the time of sunlight) but, one thing to be happy about, the majority are mild to moderate calcium deficiency, severe calcium deficiency is now rare only occasionally from some of the countryside children can see similar chicken chest, O-leg, etc.
The main manifestations of calcium deficiency in babies
Excessive sweating, night terrors, irritability, occipital protrusion and various bone changes
Excessive sweating
Calcium deficiency causes excessive sweating, not all excessive sweating is calcium deficiency, but excessive sweating at night, especially after sleeping, is typical of calcium deficiency. The excessive sweating caused by calcium deficiency is also called “night sweating” and “night sweating”. It is normal to sweat a lot during the day when eating milk or during activities, not calcium deficiency.
Night sweats
Night terrors are sudden awakening, crying, or even screaming at night. If the irritability occurs during the day or in the waking state, it is not caused by calcium deficiency. If you have a mild calcium deficiency or early calcium deficiency, you may not wake up in the night, but just have trouble sleeping in the middle of the night, grunting and tossing and turning. Many parents have told me about this situation during this time. The main reason is that the time of real effective exposure to sunlight is too short and the area of skin exposed is too small.
Occipital baldness
It is the back of the baby’s head, there is a circle of light protruding hairless place. This condition is also very common. Especially during this time.
Ectropion of the rib cage
This is when the lower edge of the baby’s rib cage is turned up. This requires an experienced doctor to make an accurate determination. Many babies have varying degrees of rib protrusion.
Another situation that needs attention is that some parents have the habit of lifting their baby’s pants so high that the rubber band at the front of the pants presses against the rib cage, which can also cause the rib cage to flare out. Therefore, when wearing pants, we should pay attention to the fact that the rubber band should not be too tight, and the rubber band should not be higher than the rib cage. Other bone deformations are chicken chest, funnel chest, X-leg, O-leg, rib beads, bracelets and anklets, which are more serious rickets only. Now it is rare. So I won’t talk about these. Don’t guess, these skeletal deformities must be looked for by experienced and medically ethical doctors to make an accurate judgment.
Infancy
(within one year) This period is the focus: 1.
1, the baby should be more sunshine and outdoor activities, this as the first point, but also the most important, but also the most economical, the most effective.
2. Starting from the first month of life, take the right amount of vitamin D every day, 400-800 IU per day (equivalent to one capsule of Betadine or Icocin) as recommended by the Program. Cod liver oil should be taken every day, until about 1.5 years old.
3. Breastfeeding is recommended. During breastfeeding, the mother should take appropriate amount of calcium, cod liver oil and sunshine, and drink milk powder every day.
4. After 6 months of age, you should take the right amount of calcium every day.
5. Drink more milk.
There is a difference between sunbathing and outdoor activities. Outdoor activities are not necessarily the same as sunbathing. Sunbathing refers to the direct exposure of human skin to sunlight. And, the time of exposure 0, 5 to 1 hour per day. The parts that can receive sunlight in winter are the face, small hands and feet, buttocks, etc. Parents have to grasp the time and manner of exposure according to the specific situation. Make sure to take one capsule of cod liver oil every day. If you forget to take it today, you will have to take two capsules the next day. Cod liver oil and sunlight should be combined and complement each other. For example, if it’s cloudy for a long time and you can’t get sunlight, then you can take 9 capsules of cod liver oil every week. You have to believe that if you follow the above dose of vitamin D, there is absolutely no poisoning, and you do not have to worry about this at all. (Note, I emphasize absolutely not. )
The amount of calcium supplementation
6 to 12 months: 100 mg per day
12 to 24 months: 150 to 200 mg per day
After 2 years of age: 250 mg per day
Recommended amount of milk
Up to 4 months: All milk
4～6 months：1～2 supplements per day, other milk
6～8 months：600～800ml
9～12 months：800ml or more
Over 1 year：about 600ml
2 years old and above: about 500 ml
Early childhood (1 to 3 years old)
1. Babies should get more sunlight and outdoor activities, which is the first and most important point as well as the most economical and effective.
2. To supplement an appropriate amount of vitamin D every day, from 1 to 1.5 years old, one capsule of cod liver oil every day, the recommendation of the Program is 400 to 800 IU per day (equivalent to one capsule of Betadine or Icocin). after 1.5 years old, if you often do not get sunlight, you should also supplement cod liver oil frequently, you can take 3 to 5 capsules of cod liver oil per week.
3, to supplement the right amount of calcium every day.
4. Drink more milk. (500～600ml per day)
How to scientifically and professionally diagnose whether the baby is suffering from rickets?
This is also something that is of great interest to parents.
First of all, I would like to emphasize that the diagnosis of rickets cannot be based on one aspect alone, but must be a comprehensive analysis. This includes whether there are susceptibility factors for calcium deficiency, whether there is calcium deficiency, whether there is bone deformation, and also combined with the results of biochemical tests.
Fetal period
Pregnant women and their fetuses have an increasing need for vitamin D, calcium and phosphorus, so they should go outdoors more often, get more sunlight, eat nutritious substances, and actively treat those with hypocalcemia and osteochondrosis. Pregnant women who lack sunlight exposure, those with low appetite, those who are weak and sickly, or those who are in the late stages of pregnancy in winter, should take vitamin D and calcium supplements to prevent congenital rickets. Vitamin D supplementation in the middle and late stages of pregnancy; 400-800 IU per day, or 50,000-100,000 IU per month, once or in divided doses orally; or just once, 150,000-200,000 IU, along with oral calcium supplements.
Infancy
Since vitamin D deficiency rickets has a great impact on pediatric development, and the disease stems from a series of lesions caused by vitamin D deficiency due to various factors, rickets can be prevented. There is 7-dehydrocholesterol in human skin, which is turned into cholecalciferol, or endogenous vitamin D3, by ultraviolet radiation in sunlight, and is also the main source of vitamin D in humans. The rickets prevention can be carried out from two aspects, namely sunbathing and vitamin D. Infants should be exposed to sunlight as early as possible, as long as the outdoor temperature is above 18 degrees and the wind is not too strong, carry the baby to outdoor sunbathing, but avoid direct sunlight to the eyes, spring, summer, autumn and winter should adhere to outdoor activities, each time the time can be gradually extended from a short time to 20-30 minutes. Do not live indoors for a long time.
In addition, the content of vitamin in breast milk is about 4-6 IU/dl, which is not much different from the content in cow’s milk, so whether breastfeeding or artificial feeding should start giving vitamin D prophylaxis at about 1 month after birth, 400Iu/day (i.e. 400 international units per day). Premature infants should be given vitamin D 2 weeks earlier and the amount should be doubled in the first 3 months, i.e. 800 Iu/day. after 3 months, the amount should be changed to 400 Iu/day. generally, after 2 years of age, the growth rate slows down and outdoor activities increase, so rickets is less likely to occur and no further vitamin D supplementation is needed for prevention.
Early childhood
After 1 year of age, children can adopt the prevention method of “sunbathing in summer and vitamin D in winter”. Generally, 200,000 to 300,000 IU should be given once in winter, and more sunlight should be given at other times to increase nutrition. In areas with high incidence, vitamin D can be given at intervals of 2 to 3 months and then 200,000 to 300,000 IU once. Other times should be more sunshine and increase nutrition.
Childhood
Late onset rickets can occur in children after the age of 5 to adolescence. For those who are often prone to fatigue, weakness, sore legs, leg pain and joint pain without any other explanation, further examination and prevention should be given. The method and dosage of vitamin D prophylaxis are the same as in early childhood. In the application of vitamin D prevention, breast-fed children may not add calcium, but infants weaned from breast milk after 6 months of age, artificial feeding, low appetite, excessive growth, adolescent children or those with acute and chronic diseases may be supplemented appropriately.
Treatment
Active rickets should be treated actively according to clinical manifestations with the aim of controlling the disease activity and preventing deformities.
Mild active rickets: Vitamin D 200,000~300,000 IU, 1 time oral or intramuscular injection, 1 month interval, 1~2 times, and calcium, 0,5~1 gram each time, 2~3 times a day, for 1~2 months.
Moderate or severe active period: Vitamin D 200,000-300,000 IU, 1 oral or intramuscular injection, at an interval of 1 month, may be given 2 to 3 more times, while giving calcium, 0,5 to 1 gram each time, 2 to 3 times a day, for 2 to 3 months.
Recovery period: Generally, vitamin D can be dispensed with, and more sunlight and improved nutrition are sufficient. However, in winter and spring to prevent recurrence can be cast to vitamin D 200,000 ~ 300,000 IU, once oral or intramuscular injection, to the above vitamin D treatment amount, can maintain the role of 2 to 3 months, so there is no need to give maintenance doses of oral to prevent vitamin D poisoning, more sunlight can be the above is the conventional method of drug control. Now the specific drugs are mainly vitamin D tablets, pills, injections, emulsions, in addition to vitamin D3 to be absorbed faster than vitamin D2, the effect is good.
What diseases can be complicated by rickets?
This disease mainly causes infants to raise their heads, sit, stand and walk late. There is hyperextension due to joint relaxation, slow formation of abnormal conditioned reflexes in the cerebral cortex, delayed language development, anemia and other symptoms.
In some children with more severe rickets, other skeletal deformities such as corpus cavernosum, funnel chest, X-leg, O-leg, rib crossties, bracelets and anklets are also seen.