Rickets and Scoliosis - Common Bone Anomalies in Children
These diseases are very common in children of malnourished regions or regions of lack of sunlight, because vitamin D formation needs the first morning sunlight. A survery also suggests the reason for the rampant occurrences of the "non-straight" legs of the female arabians is due to the way they cover all parts of their bodies from childhood. This strongly contributes to their legs' deformation.
Rickets (Rachitis) is one of the most frequent deficiency diseases in infants, the main clinical symptoms of which are changes of the skeleton. The etiology of rickets is the deficiency of vitamin D (D2-ergocalciferol, D3-cholecaciferol).
• Delayed closure of fontanels
• Deformed shape of the head
1. the skull is flat and depressed toward middle
2. a prominence of frontal bones = 'Olympic forehead".
3. a prominence of the sides of the parietal bones = "caput quadratum"
4. prominence of parietal bones and depression toward middle. The suture between these bones = "caput natiforme"
5. craniotabes (softening of cranial bones, feeling during palpation like pressing on ping-pong ball)
6. softening of cranial bones may lead to enlarging all the sixes of the head that is called macrocephaly.
• rachitic rosary (enlargement of costochondral junction of ribs)
• Harrison's groove (horizontal depression in the lower portion of the rib cage).
• Pigeon chest (depression to the middle of lower part of sternum
• Kyphosis, scoliosis, lordosis
• Bowing of the arms and legs
• Knock-knee (X-shaped legs)
• Saber shins
• Instability of hip joints
• Pelvic deformity
• Enlargement of epiphysis at the ends of the long bones
• Delayed calcification, especially of permanent teeth
• Mal-eruption of teeth
• Potbelly, constipation
Rachitis tetany: seizures
Symptoms of rickets are usually found in children less than 2 years of age, some of them in reduced form can persist for the whole life.
1. Quantity of Calcium ions in the blood serum (normally; 2.25-2.5mmol/l).
2. sulkovich test (test for founding calcium in Urine).
Nursing care plan
1. Encourage foods in vitamin D, especially fortified Cow's milk.
2. In breast-fed infants encourage use of vitamin D supplements if maternal diet inadequate or infant exposed to minimal sunlight.
3. Emphasize the importance of exposure to the sun as the source of vitamin D.
4. In caring for the child with rickets
• Maintain a good body alignment
• Reposition frequently to prevent decubiti and respiratory infections;
• Handle the child very gently and minimally
• Instate seizure precautions
• Have 10% calcium gluconate available in case of tetany
• If prescribed, supervise proper use of orthopedic splints or braces.
A lateral curvature of the spine is usually associated with a rotary deformity
Test for scoliosis
1. Have the child stand erect, observe from behind and note the asymmetry of the shoulders and hips (Normally shoulders, scapula, and iliac crests are symmetric).
2. Have the child bend forward at the waist until the back is parallel to the floor, observe from side and note asymmetry prominence of rib cage.
Other signs of scoliosis include a slight limp, crooked hem or waistline, complaint of backache. Scoliosis and Rickets are semiotics of the bone and muscle system lesions.
Nursing care plan is almost similar to that or Rickets, extra aid may be needed to put the child to a normal position.
Though, Rickets and Scoliosis are not deadly diseases, yet, they should be treated with accuracy as the bone shape may remain abnormal as it stiffens or becomes harder in relation to the growth of the child.
The major prophylaxis against these main diseases is to expose your child to the morning sunlight and give your child adequate breast milk, because it contains a good amount of calcium necessary for the child's development.