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In children with a lack of vitamin D in the body, rickets develops as a result of a violation of the mineralization of bone tissue. It is one of the most common diseases in infants and young children, and it also occurs in many children under the age of one. Even the name itself - "rickets" - causes very unpleasant associations. But, as folk wisdom says: “The devil is not as terrible as he is painted!”

Vitamin D is a vitamin. Biochemists distinguish two of its forms: ergocalciferol, or vitamin D2, which enters the human body, and cholecalciferol, or vitamin D3, which comes from food of animal origin, and is also synthesized in the skin under the influence of ultraviolet rays. Interestingly, synthesis occurs at a rate of 18 IU/cm/hour.

Vitamin D, which enters the body with food, is absorbed in the duodenum in the presence of bile salts. Part of the cholecalciferol that has entered the body is stored in adipose tissue and muscles as a reserve, and the other part is transported to the liver with the help of special proteins, where it is converted into a more active form, then it enters the kidneys for further metabolism. It is there that the most active form of vitamin D3 is ultimately formed - calcitriol, which is involved in numerous biochemical reactions, ensuring the course of physiological processes. The conversion of vitamin D in the body occurs under the strict guidance of the level of parathyroid hormone and the concentration of phosphorus and calcium in the blood.

So, the spectrum of activity of vitamin D in the human body is as follows:

• Regulation of absorption in the intestine and maintenance of its level in the bloodstream;
• Increased absorption of phosphorus in the kidneys, the formation of phosphorus-calcium salt, which is necessary for the mineralization of bone tissue;
• Regulation of the synthesis of thyroid hormones;
• Stimulation of the growth of tubular bones, collagen, chondrocytes;
• Vitamin D also has a hormonal effect - it affects the cells of the intestine, thereby stimulating the production of a calcium carrier protein, and in the kidneys and muscles increases the absorption of that same calcium.

Thus, it is clear that the functions performed by vitamin D in our body are so multifaceted that without it the full operation of all systems is impossible.

The terrible word "rickets"! What does it mean?

On the left is normal bone, on the right is osteoporosis.

Rickets is a disease that develops as a result of vitamin D deficiency in the body, mainly of young children, as a result of which phosphorus-calcium metabolism is disturbed, leading to damage to many systems and organs, but primarily to the bone skeleton.

In older children and adults, vitamin D deficiency is manifested by osteoporosis (calcification of the bone tissue) and osteomalacia (softening of the bones), which leads to frequent fractures and skeletal deformities.

The disease has been known since ancient times. The frightening diagnosis "rickets" in Greek means only "spine", since the curvature of the latter is the main symptom of this disease.

Although at the moment rickets is more or less common in most children, due to timely and proper prevention, it is possible to avoid a severe course and serious complications of the disease.

The cause of the so-called classical rickets is hypovitaminosis of vitamin D of exogenous or endogenous origin.

Exogenous factors include:

1. Insufficient exposure of the child to fresh air, insufficient exposure of the skin to direct sunlight (in the risk zone residents of the Arctic, children born between October and April), which leads to a reduced synthesis of vitamin D in the epidermis.
2. Insufficient intake of foods rich in vitamin D, phosphorus and calcium, in particular fish oil, etc.
3. Artificial feeding, especially with unadapted milk mixtures, because they do not have a balanced amount of vitamins and trace elements needed by the baby. I hope that in the 21st century, no one feeds newborns with whole cow's milk, and even more so with goat's milk, because animal milk is only 40% able to cover a child's need for the substances he needs! Be prudent, do not spare money on.
4. Prematurity of the baby, multiple pregnancy.
5. Short intervals between pregnancies in the mother, the age of the woman in labor is up to 17 and after 40 years, pathology during pregnancy, causing depletion of minerals and vitamins.
6. Poor child care and unsuitable living conditions.

Endogenous causes:

1. Violation of the absorption of vitamin D, phosphorus and calcium in the intestine, which is observed in malabsorption syndrome, pathology of the biliary system.
2. Violation of the processes of vitamin D metabolism in the liver and kidneys due to the pathology of these organs or genetic disorders.
3. Defect in the functioning of vitamin D-sensitive receptors.

When should you be worried?

Rickets can be mild, moderate or severe. They also distinguish the initial period, the peak period, convalescence (recovery) and residual effects, but we will not delve into the essence of the classification, we will leave it to specialists. The most important thing is to know the symptoms of rickets in order to suspect it in time, consult a doctor and start therapy in a timely manner.

Thanks to the use of adapted mixtures containing vitamin D, improvement of living conditions, widely and successfully carried out prevention in our time, rickets rarely reaches the 3rd degree of severity, and the 2nd occurs only in advanced cases. Most children have mild or moderate signs of this disease, often without skeletal involvement.

You can notice the first signs of the disease in a baby at the age of 2-3 months, earlier rickets can only appear in premature babies. The first thing that will attract attention is a change in the behavior of the crumbs: anxiety, increased excitability, startling at a sharp sound or bright light, superficial sleep. There is also increased sweating, especially during sleep and feeding. Sweat with an unpleasant sour smell,. The head sweats the most and, accordingly, itches, so the child intensively rubs it against the pillow and gradually wipes the hair on the back of the head.

The child stops in development: motor, static functions are disturbed. Muscle tone is reduced, so the child cannot sit, crawl, walk; the frog pose becomes characteristic of the child - the baby lies on his back with arms and legs spread apart to the sides; due to the weakness of the abdominal muscles, an umbilical hernia and a hernia of the white line of the abdomen can form. This period lasts from 2 weeks to 2-3 months, in the absence of adequate treatment, the disease goes into the full stage. It falls somewhere in the second half of life.

The child becomes lethargic, capricious, lags behind in psychophysical development. Distinct deformations of the skeletal system are added to the already described symptoms. There is a flattening of the occiput and an increase in the frontal tubercles due to osteomalacia of the bones of the skull, the chest is deformed: an depression in the lower third ("the cobbler's chest") or a bulge - "keeled chest", there is also a curvature of the long tubular bones and the spine with a clear predominance of kyphosis over lordosis . Hypoplasia of the bone tissue entails a late closure of the fontanel and sutures of the skull, a delay in teething.

In a subacute course, at the border of the transition of cartilaginous tissue to bone on the ribs, in the interphalangeal joints, due to hyperplasia of the bone tissue, the so-called rosary, "strings of pearls" are formed.

During the period of convalescence, the child's condition improves, only muscle hypotension persists for quite a long time, and bone deformities will remind you of rickets all your life.

The main thing - without amateur performance! Talk to your pediatrician about your concerns. And decide together how to proceed. You will most likely need to take a biochemical blood test to determine the level of calcium, phosphorus and alkaline phosphatase. They will help to establish the final diagnosis. With the timely start of treatment, the result will not be long in coming.

Prevention of rickets

One of the measures to prevent rickets and osteoporosis is to regularly eat foods rich in calcium.

As for the treatment of rickets, there are special schemes for selecting dosages of vitamin D3, and it is precisely its solutions that are used as the base drug. The selection is carried out by the doctor, he will tell and explain everything in detail.

Let's talk about prevention in more detail.

Prevention begins during pregnancy. The fetus has a high need for calcium absorption, especially during the period from the 27th to the 40th week of pregnancy. Great importance is attached to non-specific methods of prevention, such as:

• Sufficient physical activity, stay at least 2 hours a day in the fresh air during daylight hours.
• Complete nutrition, enriched with proteins, vitamins, microelements, especially calcium and phosphorus.
• Treatment of toxicosis and pathologies that threaten the fetus.

The need for specific prevention arises only in the last months of pregnancy, and then if they fall in the autumn-winter period. Starting from the 28th week of pregnancy, the vitamin is taken at 1000 IU / day. (this is 2 drops of an aqueous solution of cholecalciferol). It is not recommended to use vitamin D as a specific prophylaxis in pregnant women over 30 years of age due to the likelihood of calcium deposition in the placenta and the development of fetal hypoxia.

After the birth of a child, you must:

• . Breast milk has a peculiarity - the anterior portions of milk contain calcium, and the posterior portions transfer the amount of vitamin D that is needed for the absorption of calcium. rickets in a baby is practically excluded; if breastfeeding is not possible for one reason or another, use adapted milk formulas.
• Sufficient stay in the sun - 2-3 hours in summer, at least 30 minutes in winter, observing the daily routine.
• Massage and gymnastics daily for 30 minutes.
• Specific prophylaxis is carried out using either an aqueous solution of vitamin D3, this is Aquadetrim, or an oily solution of D3 - Vigantol or Ergocalciferol. Start from the age of one month, 1 drop 1 time per day and continue during the 1st year of life, with the exception of the summer quarter. 1 drop of an aqueous solution contains 500 IU of vitamin D, and 1 drop = 1000 IU of an oil solution, so it is recommended to use an oil solution for premature babies from 2-3 weeks of age.

An interesting fact: in France, for the prevention of rickets, all children are prescribed 1000-1500 IU / day, because in this country cholecalciferol is not added to dairy products.

• A positive effect from the use of vitamin D is possible only if the child's need for calcium is met (200 mg / day for children of the 1st year of life). The main source of calcium are dairy products: milk, yogurt, cottage cheese, cheese.
• must be present: egg yolk, butter, liver of fish and birds, caviar and, of course, dairy products.

The use of vitamin D is contraindicated for the treatment and prevention in case of hypoxia or intrauterine trauma in a child, nuclear jaundice, and with a small size of a large fontanel at birth.

If you spend several hours in the sun every day, this will be enough to never run into a lack of vitamin D.

Video version of the article:

The term "vitamin D" or "calciferol" combines several biologically active compounds at once, which are necessary for the absorption and assimilation of such vital elements as phosphorus and calcium. These include D2 (ergocalciferol), which the body receives only through the diet, and D3 (cholecalciferol), which is synthesized in human skin under the influence of UV radiation. Compounds D4, D5 and D6 are also known, which are provitamins.

Calciferol refers to fat-soluble substances (lipovitamins). The presence of a sufficient amount of lipids in food is an indispensable condition for the normal absorption of vitamin D. The compound tends to be deposited in the body. Its reserves are created mainly in the summer months due to insolation (the effect of solar ultraviolet radiation on the skin).

Why is vitamin D needed?

Thanks to calciferol, the absorption of calcium, phosphorus and magnesium, which are necessary for the formation and growth of bones, is carried out. The absorption of these trace elements occurs mainly in the duodenum, and the vitamin increases the permeability of the epithelial cells of the intestinal walls for Ca2+ and P ions.

Due to the regulation of mineral metabolism, calciferol prevents the development of rickets in adults and children. Vitamin D is responsible for the calcification of hard dental tissues (in particular, dentin).

Studies have shown that this compound is involved in a number of metabolic processes, stimulates the biosynthesis of certain hormonal compounds and regulates the process of cell division.

Cholecalciferol helps lower blood pressure (it is especially effective during pregnancy).

Calciferol is the only vitamin compound that is able to act as a hormone, increasing the reabsorption of calcium ions and being directly involved in the production of the protein responsible for Ca2+ transport.

Important:the activity of calciferol preparations is usually measured in IU (international units). 1 mcg vitaminD corresponds to 40 IU.

A normal level of vitamin D in the liver and plasma reduces the likelihood of heart, skin and joint pathologies. In regions where products contain little calciferol, the incidence is higher (including in) and.

Vitamin D contributes to an increase in the body's resistance due to the strengthening of non-specific. It normalizes the functional activity of the thyroid gland, and also prevents muscle weakness.

Stimulation of the absorption of magnesium and calcium allows you to restore the myelin sheaths of nerve fibers, so calciferol preparations are used as part of the complex therapy of such a severe pathology as multiple sclerosis.

Calciferol (particularly D2) is found in a number of foods of plant and animal origin.

Animal products:

• fatty fish;
• caviar;
• whole milk;
• dairy products;
• cheeses;
• butter;
• eggs (yolk).

note: The phosphorus present in cow's milk greatly hinders the absorption of calciferol.

Of natural products, the most effective remedy for the prevention of rickets and other manifestations of hypovitaminosis is fish oil.

Absorption of calciferol from food occurs in the small intestine. An indispensable condition for its normal absorption is the presence of bile, so hypovitaminosis can develop against the background of pathologies of the liver, gallbladder and ducts.

Herbal products containing vitaminD:

• parsley (greens);
• nettle (leaves).

note:a lot of vitaminD is found in herbs such as alfalfa and horsetail.

Cholecalciferol (D3) is produced in the skin from provitamins (sitosterol, ergosterol and stigmasterol) under the action of UV radiation. The body receives provitamins from plant products or as a result of the biotransformation of cholesterol.

It has been established that with good insolation, the body can independently produce vitamin D in a volume sufficient for normal metabolism.

The volume of synthesized cholecalciferol depends on the following factors:

• human age (in aging skin, the level of vitamin production is significantly reduced);
• the degree of pigmentation of the skin (in fair skin, the process is more active);
• wavelength of sunlight (the optimal time for insolation is dawn and sunset);
• the degree of air pollution (smoke and smog trap a significant amount of UV radiation).

note: the incidence of rickets (a disease that is caused by a deficiency of vitaminD) higher among the children of the industrial regions of Asia and Africa. This is due to a combination of insufficient solar ultraviolet radiation and malnutrition.

An adult requires an average of 2.5 mcg of vitamin D per day. The need for it increases dramatically in pregnant and lactating women. To ensure normal growth and formation of the skeleton of the fetus and infant, they need to take 10 micrograms of calciferol per day.

Babies from birth to 3 years of age need 10 mg of vitamin D per day, and for children over 4 years of age, the intake is the same as for adults.

The need for the vitamin increases significantly in individuals who receive less UV radiation.

The likelihood of developing hypovitaminosis increases in the following categories of people:

• night shift workers;
• patients who do not leave the enclosed space (lying);
• living in areas where the atmosphere is highly polluted;
• inhabitants of high latitudes.

In older people, the ability of the skin to synthesize cholecalciferol is reduced by an average of 2 times. Vitamin D hypovitaminosis is especially common among vegetarians and those who consume few foods containing natural lipid compounds.

The most serious manifestations of severe vitamin D deficiency are osteomalacia (softening of bone tissue due to insufficient mineralization) and rickets.

Clinical manifestations of hypovitaminosisD:

• sleep disorders;
• burning sensation in the mouth and throat;
• loss of appetite;
• weight loss;
• decrease in visual acuity.

For more information about the problems associated with vitamin D deficiency in children, you can watch the video review:

Indications for taking calciferol preparations

Vitamin intakeD is prescribed if the patient is diagnosed with:

• hypo- and beriberi;
• rickets in children;
• osteoporosis (including age);
• osteomalacia;
• bone fractures (to accelerate fusion);
• bone tissue dystrophy (against the background of kidney pathology);
• against the background of a violation of the synthesis of hydrochloric acid;
• intestinal malabsorption syndrome;
• inflammation of the intestine, accompanied by osteoporosis;
• chronic pancreatitis (with decreased secretory function).

note: It is advisable for women to take vitamin D during menopause.

Expectant mothers are prescribed D2 in the third trimester, starting at 30-32 weeks. The duration of the course is 10 days, during which a total of 400,000-600,000 IU of the vitamin is taken. During lactation, it is advisable to take 500 IU of ergocalciferol from the first day of breastfeeding until the child himself can receive the remedy to prevent rickets.

D3 babies are usually given (starting at 3 weeks) in small doses but continuous courses. The total dose for the course is 300,000 IU.

Diagnosed rickets requires daily administration of vitamin D2 at 2000-5000 IU for 30-45 days.

Important:if treatment with high doses of calciferol is necessary, vitamins A should be taken in parallel,and group B compounds.

For effective prevention of hypovitaminosis, 300-500 IU D3 per day is indicated.

Contraindications to vitamin therapy with calciferol preparations are:

• organic myocardial damage;
• hypercalcemia;
• ulcerative lesions of the digestive tract;
• acute and chronic liver pathologies;
• kidney failure.

Hypervitaminosis D

Since vitamin D3, like other lipovitamins, is deposited in the body, alimentary intake rarely leads to hypervitaminosis, but accumulation is possible when receiving high doses of calciferol preparations.

Vitamin D causes hypercalcemia. If a large amount of calcium accumulates in the vascular walls, then the likelihood of formation increases. The process is aggravated by insufficient intake of magnesium ions.

With hypervitaminosisD develop the following clinical manifestations:

• general weakness;
• loss of appetite;
• severe arthralgia;
• muscle pain;
• arterial;
• dizziness;
• insomnia.
• bradycardia (decreased heart rate);
• feverish reaction;
• convulsions.

Long-term use of very high doses of calciferol can cause the following complications:

• bone demineralization;
• soft tissue calcification (including heart valves);
• the formation of calcifications in the kidneys, heart muscle and organs of the digestive and respiratory systems.

When treating D-hypovitaminosis, you need to consume a sufficient amount of vegetable (preferably animal) fats.

It is undesirable to take vitamin D preparations in parallel with drugs to reduce the absorption of calciferol is negatively affected by mineral laxative drugs.

Corticosteroid hormones accelerate the elimination of vitamin D from the body, while simultaneously disrupting calcium absorption.

The metabolism of calciferol is badly affected by difenin and drugs from the barbiturate group. Their intake can provoke the development of osteoporosis.

For the normal course of vitamin D metabolism in the liver, a sufficiently high level of vitamin E is required.

Plisov Vladimir, dentist, phytotherapist

Treatment of hypovitaminosis in children

Treatment of children suffering from various forms of hypovitaminosis includes, first of all, rational nutrition. With mixed or artificial feeding, it is necessary to prescribe adapted mixtures, carry out correction and complementary foods in a timely manner (the first complementary food is vegetable), do not abuse carbohydrates, provide a sufficient amount of fats and animal proteins in the diet. Observe the technology of preparation and storage of food products.

Drug treatment of childhood hypovitaminosis consists in substitution therapy, while therapeutic doses of vitamins should exceed the physiological need of the child by 2-4 times. Based on the fact that children often develop polyhypovitaminosis, multivitamin preparations such as "Multitabs", "Kinder-biovital gel" are recommended.

If necessary, monopreparations of vitamins are prescribed:

Vikasol (vitamin K) intramuscularly - 1 mg / kg, but not more than 5 mg per day for 3 days or vitamin K inside;

Vitamin B2 - 0.005-0.01 g 2 times a day, in severe forms - 2 mg intramuscularly 3 times a day;

Vitamin B6 - 0.005-0.01 g 4 times a day, with convulsions 2.0-5% solution intramuscularly;

Folic acid - 0.001 - 0.005 2 times a day;

Vitamin B12 - 5-8 mcg / kg intramuscularly every other day;

Nicotinic acid (vitamin PP) - 0.01-0.03 g 2 times a day, with severe hypovitaminosis - up to 100 mg per day intramuscularly or intravenously;

Ascorbic acid - 200-300 mg per day (in the first days parenterally 100-150 mg per day).

Prevention of hypovitaminosis

Prevention of hypovitaminosis in children involves, first of all, proper varied nutrition of the child with sufficient use of vegetables and fruits, especially in spring, when vitamin deficiency often develops.

When feeding a child in the first months of life with cow's milk and its dilutions, it is necessary to additionally prescribe vitamins C, A, PP, E in doses corresponding to daily requirements.

It should be borne in mind that the child's need for vitamins increases with infectious diseases with fever, chronic diseases of the digestive system, respiration, liver, kidneys, prescription of antibiotics and sulfonamides, as well as during periods of increased growth and development, during eruption and change of teeth.

In this regard, on the one hand, it is reasonable to include vitamins C, B1, B2, B6, A in the complex of treatment of various diseases, even in the absence of signs of hypovitaminosis, and on the other hand, fortification of mass consumption products is carried out - flour of the highest and first grade (B1 , B2, PP), margarine (vitamin A), milk (vitamin C). In kindergartens, hospitals, maternity hospitals, sanatoriums, vitamin C is added to the first and third courses.

HYPOVITAMINOSES IN CHILDREN AND THEIR PREVENTION

The role of vitamins for the health of the body has been known since ancient times. For example, the ancient Egyptians knew that the liver helped with "night blindness." In 1747, Scottish doctor James Lind discovered that citrus fruits prevent scurvy. In 1889, a Dutch doctor, Christian Eikman, discovered that chickens, when fed boiled white rice, become ill with beriberi, and when rice bran is added to food, they are cured. In 1911, the Polish scientist Casimir Funk isolated a drug, a small amount of which cured beriberi. The drug was called Vitamine (from the Latin vita- "life" and English amine- "amine, nitrogen-containing compound"), then "e" from the word vitamins was withdrawn because open vitamin C did not contain amines. Already in 1929, Hopkins and Aikman received the Nobel Prize for the discovery of vitamins.

Vitamins are essential substances, the vast majority of them are not synthesized by the human body, and they come mainly from food. The need for each specific vitamin is subject to fluctuations due to the action of various factors that are taken into account in the recommended intake rates. For example, the recommendations of the FAO / WHO may differ significantly from those given, for example, in the UK, France, the USA, etc. However, it is undeniable that the need for vitamins increases significantly in children during a period of intensive growth, under the influence of certain climatic conditions. and weather conditions leading to prolonged hypothermia, with sudden changes in atmospheric temperature, with intense physical exertion, with neuropsychic stress, after suffering acute infections or surgery, when following restricted diets, with diseases of the gastrointestinal tract, etc.

The main causes of hypovitaminosis- lack of vitamins in food, increased consumption during illness, impaired absorption, distribution, processing and excretion. It is very important that the human body is not able to store vitamins for a more or less long time, a full set of vitamins must be supplied regularly in accordance with the physiological need. At the same time, the adaptive capabilities of the body are quite large, and for a certain time, vitamin deficiency does not manifest itself clinically: vitamins deposited in organs and tissues are consumed, and various compensatory metabolic mechanisms are activated.

It must be remembered that when milk is boiled, the amount of vitamins contained in it is significantly reduced. After 3 days of storing food in the refrigerator, 30% of vitamin C is lost, and at room temperature - 50%. During heat treatment of food, from 25 to 90–100% of vitamins are lost. In the light, vitamin B 2 is destroyed, and vitamin A is exposed to ultraviolet rays. Peeled vegetables contain significantly less vitamins. Drying, freezing, mechanical processing, storage in metal containers, pasteurization reduce the content of vitamins in the original products.

In the last month of winter and spring, the child especially acutely feels the lack of vitamins in the body. The Institute of Nutrition of the Russian Academy of Medical Sciences conducted a study that showed that in recent years the content of vitamins and minerals in vegetables, fruits, meat, and fish has sharply decreased. The researchers took 1963 as a starting point and found that since then, the vitamin A content of apples and oranges has decreased by 66%. According to the US Department of Agriculture, the content of the most valuable calcium element in greens decreased by 46.4%, and in one of its richest sources - kale - by 85%, the magnesium content in parsley, dill, cilantro and celery decreased by 35% , iron - by 41.5%, and in beef - by 28%.

In apples, plucked last fall, by spring, vitamin C is destroyed by 50%, in oranges, tangerines and lemons - by 30%, and in greenery in a day its reserves are depleted by 40-60%. In potatoes, by the end of spring, vitamin C remains 6 times less than its initial level. Also, at the same time, there is a deficiency of pyridoxine and folic acid: in order to get the same amount of vitamins as in autumn, in the cold season one would have to eat 2-3 times more vegetables and fruits.

According to studies in the Russian Federation, by the end of the 20th century, in almost all regions, the deficiency of ascorbic acid among the child population reached 70–100%, and 60–80% of children were found to be insufficiently provided with such essential vitamins as thiamine, riboflavin, pyridoxine, niacin and folic acid. acid. The causes of vitamin D deficiency are lack of sunlight, insufficient intake of foods containing vitamin D. Some chronic diseases, especially of the liver and kidneys, can also lead to the development of vitamin D deficiency.

vitamin deficiencies affect the state and functioning of all organs and systems of the human body without exception, and the availability of vitamins and vitamin status are the most important indicators of psychosomatic health. Insufficient intake of vitamins has an extremely negative effect on the indicators of the general physical development of children, causing the gradual development of metabolic disorders and chronic diseases. Insufficient vitamin supply aggravates the course of respiratory diseases and other infectious diseases. In addition, antibiotics and sulfa drugs, often prescribed for this pathology, by suppressing the intestinal microflora, disrupt the endogenous synthesis of vitamin K, biotin and pantothenic acid, and acetylsalicylic acid inhibits the utilization of folate.

Classic beriberi are now very rare, hypovitaminosis is more common. Hypovitaminosis consider the content of vitamins in the body reduced compared to the needs, and the deficiency of several vitamins at the same time is called polyhypovitaminosis. Without obvious clinical manifestations, a subnormal supply of vitamins reduces the adaptive capacity of the body, which is expressed in a decrease in resistance to infectious and toxic factors, physical and mental performance, a slowdown in recovery from acute diseases, and an increase in the likelihood of exacerbation of chronic diseases.

So, vitamin B deficiency 1 (thiamine) leads mainly to lesions of the nervous system (peripheral polyneuritis) and cardiovascular disorders, the clinical manifestations of which in avitaminosis B 1 are described as beriberi disease. With hypovitaminosis B 1, headache, pain in the heart and abdomen, irritability, tachycardia, loss of appetite, nausea, and constipation are noted.

Vitamin B deficiency 2 (riboflavin) characterized by damage to the mucous membrane of the lips (cheilitis), angular stomatitis, glossitis, seborrheic peeling of the skin around the mouth, on the wings of the nose, ears, in the nasolabial folds.

Vitamin B deficiency 6 (pyridoxine) manifested by irritability, drowsiness, polyneuritis, lesions of the skin and mucous membranes (seborrheic dermatitis, stomatitis, cheilitis, conjunctivitis, glossitis). In some cases, especially in children, vitamin B6 deficiency leads to the development of microcytic hypochromic anemia.

Vitamin B deficiency 12 (cobalamin) characterized by impaired hematopoiesis with the development of macrocytic hyperchromic anemia, damage to the nervous system, digestive organs. Among the endogenous factors that determine the development of cobalamin deficiency are conditions associated with a violation of the synthesis of the internal factor of Castle (atrophic changes in the gastric mucosa, congenital defects in enzyme systems, etc.).

Folate deficiency (folic acid and its derivatives) manifested by the development of megaloblastic hyperchromic anemia, morphologically similar to anemia in Addison-Birmer disease, changes in the white blood germ, damage to the digestive organs (stomatitis, gastritis, enteritis). Folate deficiency during pregnancy is one of the causes of miscarriage, the development of anemia in pregnant women and the occurrence of congenital malformations in the fetus.

Scurvy (Meller-Barlow disease) due to an absolute deficiency of vitamin C. Hypovitaminosis C worsens health, physical and mental performance, resistance to infectious diseases, negative effects on the body of harmful working conditions and the environment. Children catch colds more often, get sick more severely, perform worse at school, and endure physical exertion with great difficulty. In addition, a deficiency of ascorbic acid in the body increases the risk of cardiovascular disease.

Vitamin A (retinol) deficiency leads to a generalized lesion of the epithelial tissue, characteristic skin lesions, characterized by dryness, follicular keratosis, respiratory diseases, and impaired twilight vision. Violation of the barrier properties of the epithelium, combined with a change in the immune status in vitamin A deficiency, dramatically reduces the body's resistance to infections.

Vitamin D (cholecalciferol) deficiency common among young children, in whom it is manifested by the clinical picture of rickets. There are a number of hereditary forms of vitamin D deficiency in children (pseudo-deficient vitamin D-dependent rickets, de Toni-Debre-Fanconi syndrome, etc.), well known to pediatricians.

Vitamin K deficiency manifested by a slowdown in blood coagulation and the development of a pronounced hemorrhagic syndrome due to inhibition of the synthesis of prothrombin and VIII, IX, X coagulation factors, as well as a slowdown in the conversion of fibrinogen to fibrin.

One of the effective ways to ensure the optimal intake of vitamins is the inclusion of fortified foods in the diet, as well as the regular intake of multivitamin preparations for preventive purposes.

It is necessary to diversify diets and include all food groups in their composition. It should be remembered that the consumption of fresh vegetables and fruits, the importance of which is well known, it is meat and meat products that are the main source of vitamin B 12 and rich in B vitamins 1 , AT 2 , AT 6 . Milk and dairy products provide the body with vitamins A, B 2 , cereals - vitamins B 1 , AT 6 , AT 2 , PP, vegetable fats - vitamin E, animal fats - vitamins A and D.

When choosing a multivitamin preparation for a child, you need to pay attention to the balance of the vitamins that make up its composition, the convenience of the dosage form, and safety. Products that meet these requirements include Actival ® Kid manufactured by Beres Pharma JSC (Hungary) in the form of chewable tablets with 5 different flavors (raspberry, apple, cherry, chocolate or walnut), manufactured in accordance with GMP standards.

Hypovitaminosis in children is a pathological condition associated with an insufficient content of one or more vitamins in the body, hypovitaminosis is most often observed in children. Vitamins are a group of low molecular weight compounds of organic origin and various chemical nature, united on the basis of absolute necessity for the normal functioning of the metabolic process in the body.

Classification of hypovitaminosis in children

1. according to the type of vitamin deficiency;

• endogenous (violation of the release of vitamins from food or violation of the implementation of the mechanism of their action);

1. acquired;
2. hereditary.

• exogenous (reduced amount of vitamins entering the body with food).

2. by the type of vitamin, as a result of which deficiency a pathological condition develops.

Causes of hypovitaminosis in children

For exogenous hypovitaminosis, the cause of development is the insufficient content of essential vitamins in the food entering the body.

For endogenous acquired hypovitaminosis, the causes of development are the following factors: a violation of the processes of digestion of food and the release of vitamins from it, an increased need for vitamins in certain periods, a violation of the absorption of vitamins in the gastrointestinal tract, disturbances in the vitamin delivery system (deficiency of transport proteins, impaired binding with transport proteins or release from the transport system), impaired intake of vitamins into the cell, impaired implementation of the effect of the vitamin at the cellular level.

The causes of endogenous hereditary hypovitaminosis are genetic disorders in the molecular systems of the cell responsible for the transport and implementation of the effects of vitamins.

Symptoms of hypovitaminosis in children

• Hypovitaminosis A: deterioration of color vision, decreased vision in low light, dryness and flaking of the skin, dandruff, decreased immunity, reduced potency.
• Hypovitaminosis B1: irritability, convulsions, numbness of the extremities, paresthesia, impaired coordination of movements, dyspeptic disorders, tachycardia, arterial hypotension.
• Hypovitaminosis B2: general weakness, dizziness, blurred vision, loss of appetite, hair loss, dry skin, dermatitis, stomatitis.
• Hypovitaminosis B6: convulsions, insomnia, impaired coordination, irritability, delayed reactions, dyspeptic disorders.
• Hypovitaminosis B9: general weakness, loss of appetite, insomnia, growth retardation in children, dry mucous membranes, stomatitis, dizziness, decreased immunity, anemia.
• Hypovitaminosis B12: anemia, dry mucous membranes, stomatitis, ulcerative lesions of the gastrointestinal tract, impaired coordination, convulsions, paresthesia.
• Hypovitaminosis C: weakness, irritability, bleeding gums, nosebleeds, petechial hemorrhages in the skin, pain in the limbs, dryness and peeling of the skin.
• Hypovitaminosis D: sleep disturbance, blurred vision, increased bone fragility, muscle weakness; children have bone deformities, lag in growth and development.
• Hypovitaminosis E: weakness, shortness of breath, decreased muscle tone, decreased muscle mass, anemia, heart rhythm disturbances, reduced potency.
• Hypovitaminosis K: tendency to bleeding from the gums, nosebleeds, increased skin injury, bone fragility.

Symptoms (general)

• weakness
• loss of appetite
• fatigue
• decreased exercise tolerance
• dry skin and mucous membranes

Diagnosis of hypovitaminosis in children

Based on the clinical picture and the results of trial therapy with vitamin preparations.

Treatment of hypovitaminosis in children

It consists in diet therapy - the formation of a varied diet with a sufficient amount of both plant and animal food. The use of vitamin preparations is necessary only when prescribed by a doctor, since with excessive and irrational use they can cause a condition characterized by an excess of a certain vitamin - hypervitaminosis. When using vitamin preparations, preference should be given to monopreparations (containing any one vitamin), since some vitamins can adversely affect the absorption of others in the gastrointestinal tract or compete for transport systems in the body.

Vitamins take an active part in many physiological processes, and their lack significantly affects the general health of adults and children. Every day, the human body consumes a certain amount of fortified substances, and these losses must be replenished so that an imbalance does not occur. Hypovitaminosis arising from a lack of various vitamins in the body is dangerous for the body in that it can lead to the development of quite serious diseases. It is important to identify this disease in time and take appropriate measures to cure it.

Every day, the human body needs a variety of groups of vitamins, ranging from C, B and ending with such as D, K. Depending on which vitamins the body currently needs, the type of hypovitaminosis is classified. Each type of disease has its own specific symptoms that you need to pay attention to. There is also a general clinical symptomatology, which is characteristic of all patients. So, in patients with hypovitaminosis, a general state of weakness, slight dizziness, insomnia and periodic mood changes are observed.

Despite the abundance of symptoms indicating various types of hypovitaminosis, the most characteristic signs of all types of this disease are various changes in the skin, as well as increasing brittleness and weakness of the hair.

Hypovitaminosis in adults

If there is a lack of vitamin A in the body, then a person may begin to have vision problems. In addition, this type of hypovitaminosis is characterized by frequent damage to the mucous membranes, dry patches and slight peeling can be observed on the skin. In some cases, the patient develops a dry cough, as well as the first signs of erosive gastritis. Hypovitaminosis A can contribute to a fairly long course of infectious diseases in the digestive system, urinary organs, and respiratory tract.

Vitamin A deficiency can cause vision and skin problems

Quite often there is hypovitaminosis caused by a lack of vitamin B1. . This type of disease is characterized by nonspecific symptoms and sluggishness.. Patients may develop severe irritability, a sleep disorder appears, and disability is impaired. With the progressive course of the disease, the patient has an aversion to certain foods, memory impairment, and constipation. In addition, a decrease in skin sensitivity is possible, as well as muscle weakness in the form of asymmetric atrophy.

Lack of vitamin B2 in the body is typical for those patients who suffer from pathologies of some organs of the gastrointestinal tract. The main symptoms of this type of hypovitaminosis can be observed in the mouth and eyes.. Small, sometimes bleeding wounds and cracks appear on the lips, a person experiences pain when the mouth is opened wide. The inner surface of the oral cavity acquires a grayish tint. There may be photophobia, a decrease in visual acuity, in some cases purulent develops.

If hypovitaminosis has developed due to a lack of vitamin B6 in the body, then the main manifestations in a person can be changes in the nervous system and on the skin. The patient has signs of polyneuritis, and small pustular lesions pop up on the skin. The characteristic symptoms of this disease for persons who abuse alcohol are short convulsive seizures.

An imbalance in the body of vitamin B12 can manifest itself as three different syndromes.. Symptoms of anemic syndrome are circulatory disorders in the limbs, as well as the appearance of headaches and general weakness. Neurological abnormalities are characterized by a decrease in sensitivity and changes in the functioning of some tendon effects. With the gastroenterocolitis nature of the disease, the patient may feel changes in taste sensations, regular nausea, periodic aching pain in the abdomen. In addition, non-systematic alternation of loosening of the stool with constipation is possible.

Hypovitaminosis belonging to group C, as a rule, is characterized by the appearance in patients of extensive areas of subcutaneous hemorrhages. In addition, the gums are very often subject to regular bleeding, symptoms characteristic of intermittent fever may be observed. With varying degrees of intensity, respiratory and hemodynamic disorders occur.

Hypovitaminosis group C is characterized by persistent subcutaneous hemorrhages

Insufficient intake of vitamin D by the body, as a rule, is characterized by the appearance of signs, which leads to an increase in bone fragility and, as a result, the development of pathological fractures. In some cases, some anomalies of bone formation are detected. In pregnant women, this manifests itself in the form of severe toxicosis and extragenital pathologies..

Hypovitaminosis PP and E is quite rare. Patients with this ailment are irritable, suffer from constant feelings of weakness, and have trouble sleeping.. They can actively develop various cognitive impairments, damage to the skin, which are trophic in nature, as well as some symptoms of enterocolitis. The lack of vitamins of group E manifests itself in the form of muscular dystrophy and the appearance of infertility in women..

It is believed that foods rich in vitamin E help maintain youth and attractiveness. For this reason, this vitamin is included in the diets of many famous people.

The absence of vitamins of group K in the body can be characterized by violations of the processes responsible for blood clotting. Patients in the mouth and nose appear heavily bleeding small wounds. In all areas of the skin, a generalized petechial rash can be observed. In addition, there is a risk of intracranial hemorrhage.

The manifestation of hypovitaminosis in children

More often in childhood and adolescence, hypovitaminosis of groups B, A, D, as well as C and PP is observed.. With a lack of vitamin A in the body of a child, there may be a change in the shade of the cornea, the appearance of dry skin, as well as a feeling of dry mouth, blepharitis. Small pustules appear on children's skin, photophobia develops, and some infectious diseases of the respiratory tract are possible.

Group D hypovitaminosis is characterized in children by the appearance of typical symptoms of rickets, namely: irritability, anxiety, sweating, and so on. Children with a lack of vitamin C experience pain in the muscles, their appetite worsens significantly, a state of lethargy and weakness appears in the legs. Small hemorrhages can be detected on the skin and in the oral mucosa. In addition, characteristic friability and bleeding appear on the gums.

If the child's body lacks vitamin B1, then the child develops sleep disturbances, he becomes irritable and restless. Sensitivity in muscle groups increases, their hypotension develops. Sometimes the disease is accompanied by vomiting and loose stools. In children at an early age, slow weight gain, hypertension, cardiospasm, and pylorospasm can be observed.

Vitamin B1 deficiency in children can cause sleep disturbances and emotional imbalance

In children with hypovitaminosis B2, small cracks and ulcerations appear in the mouth area, sebaceous plugs in the nasolabial folds, as well as cracks on the lips of a transverse view. When examining the tongue, you can see a smooth shiny surface with small atrophied papillae. This type of disease is characterized by corneal vasodilatation and palmar erythema. There is a risk of dermatitis in various parts of the face.

The main symptoms of hypovitaminosis PP in children are: thickened tongue with a red tint, ulcerative stomatitis, brittle nails. Brown spots may also appear on the skin. Sometimes there is loose stools and a tendency to flatulence. Lack of vitamin B6 leads to increased excitability, anxiety, decreased appetite. Seborrheic eczema may appear on the skin. In addition, attention should be paid to growth retardation and slowing of weight gain.