rickets

rickets is a disease that has almost died out in Germany and is often referred to as "bone softening". It is a disease that occurs in childhood but can continue into adulthood if left untreated.

What is rickets

The word rickets is derived from the Greek term "rhachis", which means "spine".

Before the industrial revolution, rickets was very widespread in Europe because children in particular worked as cheap labor in factories and mines and saw little sunlight. The air in the cities was stuffy and polluted, and sunlight barely penetrated the people. It wasn't until much later that doctors discovered the connection between rickets and sunlight.

Rickets is a metabolic disease caused by a vitamin D deficiency. Vitamin D is essential so that the blood can absorb calcium and phosphate and transport them to the bones.

If there is a vitamin D deficiency, the vitamin can no longer be converted into its effective level in the skin. In rickets, the bones that are growing do not calcify properly, they remain soft and become crooked under stress. Rickets mainly affects the spine, but also the legs.

causes

As mentioned above, the rickets the vitamin D metabolism is not working properly. The cause for this is either a protein malnutrition, insufficient exposure to the sun or an incorrect absorption of nutrients in the gastrointestinal tract.

There is also a special form of rickets that is not caused by a vitamin D deficiency.

In order to properly build calcium and phosphate into the bones, the body needs vitamin D. In addition, vitamin D ensures that calcium and phosphate can be absorbed from the intestines and regained by the kidneys. If there is a vitamin D deficiency, this absorption is impaired. The bones become soft and deformed.

The human body produces vitamin D in the skin itself with the help of ultraviolet radiation from sunlight. A small part of the vitamin D requirement is taken in with food. Ingestion from food is not sufficient to prevent rickets, however.

Symptoms, ailments & signs

Rickets is a bone disease in children that is mostly caused by a vitamin D deficiency. It is also known as the English disease. The petant of the disease that occurs in adulthood is osteomalacia. In general, calcium deficiency rickets is spoken of. The often inherited phosphate deficiency rickets is far less common.

The disorder is caused by loss of phosphate through the kidneys. The first symptoms of the disease appear around the second month of the child's life. The children generally become restless and easily frightened. There is also a sweat and an itchy rash.

This is caused by increased sweating. After another four weeks, general muscle weakness and the characteristic, soft "frog belly" become noticeable. The children are prone to constipation and muscle cramps. The softening of the skull bone creates a strongly flattened back of the head with the typical image of a "square skull".

The rib cage and joints of the extremities widen. Defects are also noticeable on the jawbone. The children teething late, the tooth enamel is defective and an open bite can develop. Rickets is accompanied by various bone deformities. A typical sign are bow legs. These are caused by the curvature of the long bones. Adults with rickets caused by vitamin D deficiency do not show any bone deformations because bone growth has already been completed.

Course of disease

Symptoms appear as early as the second or third month of life rickets. Restlessness, nervousness and profuse sweating on the back of the head are among the early symptoms. There is also an itchy rash.

Constipation, a sagging abdominal wall, cramps and changes in the skeleton are symptoms that appear in the third to fourth month of life. Skull sutures that are still open only close with a delay, and skull bones soften. The typical rachitic rosary can be seen on the ribs. These are swellings at the bone-cartilage border of the ribs that look like a string of pearls.

Tooth eruption is delayed, the formation of enamel is disturbed and the children are prone to tooth decay. Typically, the thighbones deform in rickets and the children have strong bow legs.

Complications

Complications are not to be expected in the case of prompt and adequate treatment. Therapy based on high-dose vitamin D in combination with calcium usually lets the symptoms subside very quickly. However, failure to treat it can lead to a number of complications. Rickets is a disorder that occurs in childhood, but can severely impair the quality of life of those affected in adulthood if it is not treated or not treated adequately.

The bones that are growing in children do not calcify properly in the case of a vitamin D metabolic disorder; they remain soft and curve when they are stressed. In severe cases and if therapy is delayed, so-called "green wood fractures" are to be expected, especially in children. This is an incomplete fracture in which the elastic periosteum surrounding the bone remains intact.

However, the patients usually still have to wear a cast for a long time, which is usually very difficult for children in particular. If severe bone deformities have occurred due to rickets, these can usually only be corrected with an operation. This is not possible in all cases. The patient can then suffer lifelong from deformations that reduce the quality of life and develop other disorders, for example constant shortness of breath with a curvature of the thorax, which accompany him into adulthood.

When should you go to the doctor?

The disease usually occurs in children. The first signs of an irregularity can be seen from the second month of life. If left untreated, long-term effects can occur that last into adulthood. Therefore, parents, relatives and legal guardians should react as early as possible to changes in the child's state of health and consult a doctor. Abnormal skin appearance, itching or sweating indicate a health impairment. There is a need for action as soon as the symptoms persist for several days or weeks. An increase in irregularities is worrying. In these cases, you should see a doctor as soon as possible.

Medical help is required if the digestive tract is disturbed, constipated or if you feel generally ill. Cramps or the loss of control over the muscular system are considered to be a distinguishing feature of rickets. If there are abnormalities in the body structure during the growth process, a doctor should be consulted. If the skull shape is square, the legs are O-shaped, or the chest is widened, the observations should be discussed with a doctor. Deformations or curvatures of the skeletal system as well as peculiarities of the jaw should be examined and clarified. Any abnormalities in the teeth, tooth enamel or delayed tooth growth are signs of a disease. If there is an open bite, a control visit to a doctor should take place so that research into the cause can be initiated.

Treatment & Therapy

It used to be rickets Treated with cod liver oil, as cod liver oil contains vitamin D. Today, sick children receive vitamin D for three weeks and, in the case of calcium deficiency, calcium in high doses. Treatment of vitamin D deficiency rickets should be up to the age of 4 weeks with 1000 IU vitamin D3 and additional calcium supplements (40-80 mg / kg per day) for about 12 weeks. This should be followed by prevention with 500 IU vitamin D3 until the end of the first year of life. Babies from the 4th week of life to the 12th month receive 3000 IU vitamin D3 and additional calcium doses (40-80 mg / kg per day) for a period of 12 weeks.

Thereafter, prevention should be treated with 500 IU vitamin D3 until the end of the 1st year of life. Children and adolescents from the age of one year are treated with 5000 IU vitamin D3 and additional calcium doses (40-80 mg / kg per day) for a period of 12 weeks. Afterwards, ensure sufficient exposure to the sun and a supply of calcium through a balanced diet (e.g. milk). (Source: Guidelines of the Society for Pediatrics and Adolescent Medicine (DGKJ))

Since a lack of sunlight is also a cause, sunlight or high-altitude solar radiation is also part of the therapy. A calcium-rich diet must be maintained after drug therapy. Regular sunlight is also necessary.

In the case of phosphate deficiency symptoms, phosphate must be substituted with medication. The bone deformities usually heal with this treatment. Severe thigh deformations caused by rickets, however, often have to be corrected with splints.

prevention

rickets is almost extinct in Germany today. During the first year of life, newborns and infants are given one 500 IU vitamin D tablet every day as a prophylactic measure, since breast milk and cow's milk do not contain enough vitamin D.

Baby milk is usually fortified with vitamin D. Actually, 100-200 IU per day is recommended for children of this age, with the higher dosage of the tablet, fluctuations and occasional forgetting to take the tablet are to be absorbed.

In most cases, it is now administered in combination with fluorine for caries prophylaxis. The tablets are soluble in milk and water and can therefore be administered with baby milk or tea to prevent rickets.

Playing outside in the open air or in the sun also ensures a healthy vitamin D balance. However, especially in summer, parents should make sure that their children do not get sunstroke, heat stroke or sunburn.

Aftercare

In most cases, there are no special or direct follow-up measures available to those affected by rickets, so that they should consult a doctor early on in the event of illness. Most of the time, self-healing cannot occur either, so a visit to a doctor is always necessary for the patient. The sooner a doctor is contacted, the better the further course of the disease will usually be.

Most of those affected are dependent on an operation, which can permanently alleviate the symptoms. Those affected should definitely rest after such an operation and take care of their bodies. Definitely refrain from physical exertion and stressful activities.

The further course depends very much on the type and severity of the malformations, so that a general prediction is usually not possible. The life expectancy of the child may also be significantly restricted or reduced as a result of this disease. Further follow-up measures are not available to those affected with this disease and are usually not necessary. In many cases, rickets reduces the life expectancy of those affected.

You can do that yourself

With rickets, bed rest and warmth are important. At the same time, the sick person should bring a lot of sunlight and air into the body. In summer you can sleep with the window open. Hot compresses relieve pain and help you recover quickly. Warm milk with honey also helps with rickets with sore throats and difficulty swallowing. Other effective natural remedies are heather, willow rod, thyme and lady's mantle. These remedies can be drunk as tea or applied to the skin in the form of a brew.

In consultation with the family doctor, the sick person can start a diet consisting of vegetables, honey and milk products. The most important thing is a diet rich in iron and other minerals and vitamins. Moderate sport as well as exercises from yoga and Pilates can support physiotherapy and contribute to recovery. Since rickets is usually chronic, aids such as walking aids or a wheelchair must be organized in the long term. For this, the person concerned should contact the family doctor directly, who can clarify further with the health insurance company.

Finally, the cause of rickets must be found and treated. If this succeeds early on, only a few complications occur and the home remedies mentioned are sufficient for a rapid improvement in the state of health. If the complaints get worse despite all measures, the family doctor must be informed.