Wednesday, January 6, 2016

RICKETS [RICKETS]

It is the characteristic result of vitamin D deficiency in children. 
CAUSES:  It is less common in breastfed infants.
• Less exposure to sunlight. 
• Dark skinned infants. 
• Dietary deficiency of vitamin D. 
• Malabsorption. 
• Chronic liver disease. 
• Renal osteodystrophy. 
• Calcium wasting. 
• Hereditary. 
SIGN AND SYMPTOMS: 
• Head: – Prominent forehead. 
– Delayed closing of anterior fontanels (normally closes by 6 months of age). 
– Frequent rocking movement of the head. 
– Temporary teeth usually appear late. 
– Excessive sweating over the forehead. 
• Thorax: – Beading of ribs (rachitic rosary), at the junction of the ribs and cartilages. 
– Prominent sternum (Pigeon`s Breast). 
• Spinal column: – Patient has hump in the back (Kyphosis).
• Extremities: – Bow legs. – Knock knees. – Outwards curving of bones of forearm. – Dwarfism in severe cases. – Green stick fractures can occur in severe cases. 
• Ligaments and muscles: – Weakness of legs. – Delayed walking and standing. – Over extension of knee joints. – Pot belly due to weakness of abdominal muscles
• Digestive system: – Indigestion due to liver and spleen affection.
• Nervous system: – Restless at night. – Rocking of head on the pillow. – A predisposition to titanic convulsion. 
• Respiratory system: – Adenoid and tonsillar hypertrophy. – Rhinitis. – Pharyngitis (inflammation of mucous lining of the pharynx). – Bronchitis. – Bronchopneumonia. 
• Spasmophilia: – Triad of tetany. – Laryngismus strides. – Convulsion may be expected in low calcium type of rickets. 
DIETARY MANAGEMENT: Avoid: • Avoid bony injuries, to prevent factures.
 CONSUME: • You should have sun bath for at least 1 – 2 hrs every day.
• Consume foods rich in vitamin D: – Animal food: egg yolk and fish liver oils are riches source. – Liver, veal, beef, oyster, salt water fish – mackerel, kipper, herrings, salmon, sardines and tuna. – Dairy products like – cream, butter, cheese, fortified milk and margarines. – Plant foods are low in vitamin D – vegetable oils, fruits, nuts and green leafy vegetables. 
• Reduce calcium intake (reduce but do not completely avoid calcium as it is needed for maintenance of our body):- – milk and sea food, nuts, green leafy vegetables, whole grains, peas, lotus stem, pulses, legumes and oil seeds– Should avoid custard apple and banana as they are high in calcium. 
• Breast feeding should be continued. 
• You can take vitamin D supplements – cod liver oil, fortified milk. 
CONSULT PHYSICIAN: • Consult physician if you have any of the above sigh and symptoms. 
• Associated illness should be treated. 
• Vitamin D injections can be injected under the guidance of your physician. 
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