Children of the first years of life, and especially premature babies, have a rapid growth rate and a high activity of bone remodeling processes, so they have a great need for phosphate salts and calcium and vitamin D.
Therefore, in this group of children, a disease such as rickets is common.
Rickets – A violation of the mineralization of growing bone, more common in infants and young children, occurs with a disorder of bone formation, which is caused by a temporary discrepancy between the calcium and phosphate needs of the growing body, as a result of the vitamin D deficiency and its active metabolites.
Causes and predisposing factors.
Rickets that is deficient in vitamin D may be Primary school and high school.
Primary occurs when insufficient intake of vitamin D and minerals from outside. The secondary rickets deficient in vitamin D occurs due to the pathology of the organs and systems involved in the metabolism (in particular, the vitamin and mineral).
On the side of the child:
- Lack of sun exposure: it has been established that daily exposure to the sun for 1-2 hours with only radiation on the face and hands is sufficient to prevent vitamin D deficiency
- Time of birth of a child: children born from October to March are more likely to get sick
- Insufficient stay outdoors.
- Prematurity and morphofunctional immaturity: the most active entry of Ca (calcium) and P (phosphate) from the mother to the fetus occurs in the last months of pregnancy, therefore, a child born before 30 weeks may have osteopenia at birth ( low mineral content in the bone tissue). Another point is that premature babies have more intense growth rates and require a higher amount of calcium and phosphate. Also this group of children has much smaller reserves in the body of vitamin D and its metabolites.
- Large mass at birth – more than 4 kg
- Intensive weight gain during the first 3 months of life.
- Nutritional factors Early and mixed feeding with non-adapted milk formulas (to which vitamin D is not added). The subsequent introduction of complementary foods (for example, 1 g of egg yolk contains 140-390 IU of vitamin D, while 1 liter of breast milk contains 40-70 IU of vitamin D, and only the cow of 5-40 IU ). Long-term vegetarian foods (vegetables, oats), without enough animal proteins and butter. Deficiency of calcium and phosphate in foods.
- Insufficient motor mode: tight wrapping, lack of massage and gymnastics. Since the blood supply to the bone, and therefore the nutrition, is carried out more intensely during muscular activity
- Perinatal encephalopathy
- Frequent cold and intestinal infections.
- Reception of anticonvulsants (phenobarbital, diphenine, etc.)
- Syndromes of absorption and utilization of nutrients (syndromes of malabsorption and poor digestion). These syndromes occur in diseases such as cystic fibrosis, celiac disease, diseases of the pancreas, inflammatory bowel disease, insufficient lactase activity, prolonged intestinal dysbiosis.
- Necrotizing enterocolitis
- Chronic diseases of the liver, kidneys, intestines.
- Ecological factors: an excess in soil and water, foodstuffs of strontium, zinc and lead, lead to the fact that these substances replace calcium in the bones and contribute to the development of rickets, as well as osteomalacia and osteoparosis .
- Chronic infectious diseases
- Interruption of the physiological relationship of osteotropic hormones (parathyroid hormone and calcitonin) in hypoparathyroidism.
Predisposing factors on the mother’s side:
- Maternal age under 17 years and over 35 years.
- Toxicosis during pregnancy
- Extragenital pathology during pregnancy – metabolic diseases, pathology of the gastrointestinal tract, liver, kidneys
- Nutritional defects during pregnancy and lactation – deficiency of proteins, fats, calcium, phosphorus, vitamins, etc.
- Lack of monitoring the daily routine during pregnancy: inadequate stay in the sun and air, sedentary lifestyle
- The threat of termination during pregnancy.
- Complicated delivery
- Unfavorable socioeconomic conditions.
Classic rickets can not be considered unequivocally as a manifestation of exogenous hypovitaminosis D (ie, vitamin D deficiency from outside). The development of rickets in children, especially in young children, is largely due to the rapid growth rates, the high rate of skeletal formation, the deficiency of calcium and phosphates in the child’s growing body, shaped imperfect of its metabolism, transport and utilization (from an early age, the final maturation and the formation of many organs and systems of the body).
Therefore, many modern experts attribute rickets in young children to border conditions.