Treatment of rickets

Specific drug therapy

The main tool in combating the disease is the administration of vitamin D3 (cholecalciferol) preparations. In clinical practice, pediatricians traditionally use two main pharmacological forms:

• Aqueous solution (e.g., Aquadetrim).
• Oily solution (e.g., Vigantol).

The prescription of specific therapy has clear indications. First and foremost, this is vitamin D-deficient rickets. This diagnosis is established based on a thoroughly taken medical history and confirmed by laboratory methods. The key biochemical criterion is a reliable decrease in serum 25(OH)D levels.

Interestingly, cholecalciferol preparations are used not only for true vitamin deficiency. There is the so-called mineral-deficient form of the disease. In this case, even with completely normal indicators of vitamin D supply in the body, the drug is still included in the treatment regimen. Here, it acts as a potent regulator that specifically improves phosphorus-calcium metabolism.

Principles of cholecalciferol dosing

The selection of the therapeutic dose is always strictly individual. The physician must take into account the severity of the clinical manifestations and the current period of the disease. According to the classical scheme (by S.V. Maltsev), the average therapeutic dosages during the acute stage are distributed as follows:

1. Grade I severity: 1,000 to 1,500 IU per day is prescribed. The total duration of the treatment course is exactly 30 days.
2. Grade II severity: the daily dose is increased to 2,000–2,500 IU. The course of therapy is extended to 45 days.
3. Grade III severity: the patient requires the maximum dosage—3,000 IU per day. The duration of administration is also 45 days.

There is an important rule that must not be forgotten: after the main treatment course is completed, therapy must under no circumstances be discontinued abruptly. The patient must be smoothly transitioned to a maintenance (prophylactic) dose to consolidate the result.

Restorative therapy and rehabilitation

Non-pharmacological methods play a crucial role in the complete recovery of the child, but their introduction must be strictly delayed. They are prescribed exclusively against the background of already deployed and ongoing specific drug therapy.

The main areas of restorative treatment include:

• Physical rehabilitation. Includes professional massage and physical therapy sessions (exercise therapy). Note: these procedures are permitted to begin no earlier than 2–3 weeks after the first dose of therapeutic vitamin D.
• Balneotherapy. An additional method involving a course of specialized salt and conifer baths.

Vaccination tactics

The issue of immunization often raises concerns, but an established diagnosis of "rickets" in itself is by no means an absolute contraindication and does not serve as a reason for a prolonged medical exemption from vaccinations.

Routine vaccination is officially permitted. The main condition is to wait an interval of 3–4 weeks after the start of specific drug treatment. By this time, the child should enter the stage of clinical remission, making vaccination safe and effective.

Class and exam questions

What else to study on this topic

• Clinical picture and criteria for grades I, II, and III severity
• Specific laboratory markers of phosphorus-calcium metabolism
• Differences between vitamin D-deficient and mineral-deficient forms
• Maintenance and prophylactic doses of cholecalciferol
• Mechanisms of action of aqueous and oily vitamin D3 solutions

Other topics in "Chapter 3. Adaptation, Early Childhood Nutrition, Rickets"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.