RICKETS

Description

  • Rickets is the failure of mineralization of growing bones, caused by a lack of vitamin D, calcium, or phosphate. These nutrients are important for making healthy bones, thus resulting in delayed growth and softening and weakening of bones
  • Occurs only in children( growth plates have not fused)

Etiology

  • Deficiency of Vit D, calcium, or phosphorus
  • Prolonged exclusion of breast milk without supplementation is an important cause of nutritional rickets
  • Poor exposure to sunlight 
  • Lack of vitamin D rich food like fish oil, egg yolks, salmon, milk, cereals
  • Problems with absorption –
  • Celiac disease 
  • Inflammatory bowel disease 
  • Cystic fibrosis
  • Kidney problem
  • Medications – certain types of anti-epileptic antiretroviral medications

Risk factors

  • children having dark skin
  • children living in a northern latitude
  • premature birth

Types

The child will exhibit the following skeletal deformities like

  • Craniotabes – softening of the skull
  • Bending of primarily the long bones
  • Widening of the wrist
  • Bowleg
  • Knock knee
  • Developmental delay
  • Pain in the spine, pelvis, and legs
  • Recurrent upper respiratory tract infections 
  • Rachitic rosary – bead-like distention of the bone cartilage junctions in the ribs
  • Marfan sign – distention of the bone cartilage junctions in the joint
  • Harrison sulcus – Depression of the thoracic outlet due to muscle pulling along the costal insertion of the diaphragm

Investigation

  • Low Serum calcium (Normal: 8.0 – 10.5mg/dL)
  • Low Serum phosphate (Normal: 3.8-6.0)
  • 25-OH Vit D levels below 20ng/ mL are considered hypovitaminosis
  • X-ray wrist- widening, cupping, fraying

Treatments

  • 6 lakh units of Vit D as a single oral or IM dose

Ayurvedic Treatment

  • Use of Tila(Sesamum indicum), Guda in diet

Choorna

  • Ashta choorna, Thaleesadi choorna : 
    • Infant: 2-3 gm
    • Toddler- 5gm
    • School going- 7-10gm
    • Anupana: honey or water or along with food

Arishta

  • Depending on the status of the child
  • Mustarishta
  • Abhayarishta
    • Up to 2yrs- ½ tsp arishta diluted with 1 tsp water
    • 2-5 years- 2.5ml-5ml diluted with 5 ml of boiled water
    • 5-10 years- 10ml
    • 10-15 years- 15ml

 Gandharva hasthadi kashaya as Vata anulomana :  

  • Up to 1 year: for mother: 2tsp sookshma choorna is boiled in 2 glass water, strained and given to mother. If agni bala permits give 1 tsp thrice to the child
  • 1 year to 5 years: ½ tsp powder boiled in 1 glass of water and given as divided doses mixed with sugar or jaggery
  • 5 to 10 years: 1 tsp powder boiled in 1 glass of water and given as divided doses mixed with sugar or jaggery
  • 10-15 years: 1 ½ tsp powder boiled in 1 glass of water and given twice daily mixed with sugar or jaggery

Brimhana therapies after correction of Agni:

Gritha 

  • Indukanta gritha, Kalyanaka gritha
    • Up to 1 years: given as drops: always one should have a proper assessment of agni before administering sneha kalpana -2drops to 5 drops depending on agni
    • Above 1 year: always start with a minimum dose- even 2 drops will be sufficient to get the desired effect
    • Properly monitor the status of agni and increase the dose

Preenana modaka: Priyalamajjadi modaka

Prashas and lehas: Chyavanaprasa ½ tsp to 2 tsp

Bhasma 

  • Pravala bhasma-
    • Infant: 2gm
    • Toddler- 3gm, 
    • School going- 5g
    • Anupana: milk

Taila abhyanga

Dhanwantara taila, Mahamasha taila , Lakshadi taila

Department

Kaumarabhrithya

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