What is hypotrophy of the 2nd degree. Hypotrophy in children: causes and treatment for underweight children. Characteristic signs of pathology

There is nothing worse for parents than the illness of their child. And when a baby is sick, still inexperienced parents often cannot cope with it in time, because they do not know the main symptoms of diseases and what they can lead to. This article will focus on such a pathological condition as malnutrition, which is often found in infants.

What is hypotrophy? Types of malnutrition and the main danger.

Hypotrophy is a chronic nutritional disorder in a child, which is characterized by an energy and / or qualitative lack of nutrients, which leads to a lack of body weight of the baby, impaired physical and intellectual development, pathological changes in all organs and systems. The disease affects mainly children under 3 years of age. In different countries, the frequency of malnutrition varies from 2 to 30%, depending on the economic and social development of the country.

There are two types of malnutrition:

• congenital;
• acquired.

Congenital or intrauterine malnutrition is a malnutrition that occurs even in the period of intrauterine development of the child.

The main causes of congenital fetal malnutrition:

• insufficiency of uteroplacental circulation;
• chronic fetal hypoxia;
• chromosomal and genomic mutations;
• pathology of pregnancy;
• constitutional features of the mother's body (small stature, body weight, age);
• mother's bad habits;
• malnutrition in pregnant women.

Acquired malnutrition is a chronic eating disorder of a child, which is characterized by a slowdown or cessation of the growth of the baby's body weight, a violation of normal body proportions, thinning and disappearance of subcutaneous fatty tissue, a violation of the digestive processes, a decrease in the body's resistance to infections, a predisposition to various diseases and a delay in neuropsychic development . It is this type of malnutrition that occurs most often and brings a lot of grief to young parents, therefore, further we will talk about this violation.

Physiological weight loss in newborns

Before you panic due to the fact that the child stopped gaining weight after birth or lost several hundred grams, you need to be aware of such a phenomenon as physiological weight loss in newborns.

It occurs in all babies, regardless of what weight was at birth. The mechanism of this phenomenon is as follows. Before birth, all metabolic processes in the body of the fetus are greatly activated, which provides it with the necessary energy during childbirth and in the first hours of independent life. Also, in the first days of a baby’s life, his body loses more fluid than it consumes (with breathing, feces, evaporation through the skin).

The newborn loses weight until about the 4th day of life, from the 5th day the baby should begin to gain weight again and by the 7-10-14th day his weight should again be the same as at birth, if this does not happen, then you need to look for the cause (such a phenomenon already considered pathological and requires intervention). The rate of weight loss is up to 7% of the original, if more, then this is already a pathology.

Proper care of the child, early breastfeeding, sufficient fluid intake in the child's body, prevents greater weight loss. If physiological weight loss has not occurred, then it is necessary to think about possible reasons. Most often this is due to congenital disorders of the excretory system, due to which fluid accumulates in the child's body.

Etiology of acquired malnutrition

There are many reasons for acquired malnutrition and it is not always possible to establish why the child is not gaining weight.

The main causes of acquired malnutrition:

• nutritional factors (quantitative or qualitative malnutrition of the infant, violation of the feeding regime, the use of low-energy formulas for feeding);
• diseases of the child's digestive tract;
• chronic and acute infectious diseases (pneumonia, SARS, sepsis, intestinal infections, etc.);
• poor child care;
• hereditary diseases;
• congenital malformations;
• anomalies of the constitution (diathesis);
• neuroendocrine diseases.

Clinical signs and degrees of malnutrition

The clinical picture of the disorder is dominated by 4 main syndromes.

1. Syndrome of trophic disorders.

It includes such signs as a lack of mass and / or body length for the age of the child, various violations of body proportions, gradual thinning and disappearance of subcutaneous fatty tissue, the skin becomes dry, inelastic, and the muscles of the child become thinner over time.

2. Syndrome of violation of the state of the central nervous system.

It includes violations of the emotional state (the child cries all the time) and reflex activity (all reflexes weaken). The baby sucks poorly or refuses to breastfeed at all, the muscle tone is reduced, the child moves little, does not roll over, does not hold his head well, etc. The baby’s sleep is disturbed, he does not keep a stable body temperature well.

3. Syndrome of reduced food tolerance.

Over time, the child's appetite decreases until the development of anorexia, he refuses to breastfeed. Disorders of the digestive tract develop (regurgitation, unstable stool, vomiting).

4. Syndrome of reducing the body's resistance (immunological reactivity).

The child becomes prone to frequent inflammatory and infectious diseases.

Depending on the severity of the signs of the disease and weight loss, there are 3 degrees of malnutrition.

Hypotrophy 1 degree:

• weight deficit is 10-20%;
• the child's condition is satisfactory;
• PZhK is moderately thinned only on a stomach;
• tissue turgor is moderately reduced;
• the skin is pale, their elasticity is slightly reduced;
• no growth lag;
• psychomotor development is not disturbed;
• food tolerance is not impaired;
• immunological reactivity is normal.

Hypotrophy 2 degrees:

• body weight deficit 20-30%;
• the condition of the child is moderate;
• The pancreas becomes thinner on the abdomen, limbs and torso;
• tissue turgor is reduced;
• the skin is pale, dry, its elasticity is reduced;
• growth lag is 1-3 cm;
• psychomotor development slows down;
• immunological and food tolerance are reduced.

Hypotrophy 3 degrees:

• weight deficit is more than 30%;
• complete disappearance of PZhK;
• the child's condition is severe;
• tissue turgor is sharply reduced;
• there is no elasticity of the skin, ulcers, cracks appear on the skin;
• growth lags behind by 3-5 cm;
• significant lag in psychomotor development;
• immunological and food tolerance is sharply reduced.

Principles of treatment of malnutrition

Hypotrophy of the 1st degree is treated on an outpatient basis, and 2nd and 3rd degrees - only in a hospital.

The main directions of therapy:

• elimination of the cause of malnutrition;
• diet therapy;
• correction of metabolic disorders;
• organization of proper care;
• therapy for comorbidities.

The basis of the treatment of malnutrition is diet therapy, which has 3 stages: the elimination of the syndrome of reduced food tolerance, the increase in food loads, the complete elimination of malnutrition in a child. A gradual increase in caloric content and volume of food leads to an improvement in the child's condition, he gradually begins to
gain mass. If children have a weakened sucking or swallowing reflex, then they are fed with a probe. The missing volume of fluid is administered intravenously.

In the complex of treatment, doctors prescribe enzymes, vitamins, microelements, preparations for the normalization of intestinal microflora, anabolic hormones.

The prognosis for malnutrition of 1 and 2 degrees with timely access to a doctor and diet therapy started on time is favorable. With malnutrition of the 3rd degree, despite intensive treatment, mortality reaches 20-50%.

To prevent this condition in your baby, it is enough to follow a few recommendations. Regularly visit the district pediatrician to examine the child and take all anthropometric measurements. Adhere to all the principles of proper nutrition for your child, introduce complementary foods and complementary foods on time. It is necessary to control the dynamics of the growth of the child's body weight, organize proper care, and eliminate risk factors for the development of malnutrition.

Hypotrophy is a disease that is diagnosed in children from 0 to 2 years of age. Also, malnutrition can be congenital and manifest itself in a child during intrauterine life. The disease is characterized by an eating disorder, which leads to a lack of body weight of the baby. In this case, the diagnosis is made only if the weight of the child is below normal for his age by 10% or more.

You should not make a diagnosis on your own and try to supplement the child - this is the task of specialists Causes of the disease

We have already found out that malnutrition in children can be congenital, as well as acquired. What are the main causes of this disease?

Congenital pathology is most often diagnosed in cases of malnutrition of a pregnant woman. Newfangled diets, on which future mothers sit, pose a danger to the fetus. In addition, the baby may suffer if a pregnant woman is diagnosed with placental insufficiency, somatic diseases, and toxicosis.

At risk are women who decide to bear a child at an advanced age or at a young age, as well as if the father and mother are in a related marriage. Often, congenital malnutrition accompanies the development of children with chromosomal mutations, for example, Down syndrome.

Acquired malnutrition can be provoked by several factors. Let's consider each of them separately:

• Underfeeding, and it can be both quantitative and qualitative. In the first case, the child does not receive the required amount of nutrition, in the second case, he is fed with a low-calorie mixture.
• Infectious diseases in young children, as well as their consequences. This is sepsis, constantly recurring diseases of the upper respiratory tract or gastrointestinal tract.
• Developmental defects. Atresia of the biliary tract, heart disease, kidney disease, central nervous system, and other diseases.
• Malabsorption syndrome is a chronic disorder of food digestion processes. As a rule, patients with cystic fibrosis, lactase deficiency, celiac disease or food allergies are at risk.

Children with Down syndrome are at risk for malnutrition How is the disease diagnosed?

Hypotrophy in children is usually classified as mild, moderately severe, or critical. These three degrees of malnutrition can be diagnosed in newborns and older children.

Degree 1. At first glance, the baby feels satisfactory. If you examine it more closely, you can find a decrease in skin elasticity, a low subcutaneous fat layer on the abdomen. According to the parents, the child's appetite is reduced, weight is growing slowly. Objectively, the doctor notes that body weight is 10-20% lower than normal. A decrease in the level of digestive enzymes can be detected, while the body temperature is normal and the development of motor functions is within the normal range.

Degree 2. The child is depressed, his activity is reduced, his appetite is disturbed. The skin is pale, dry, inelastic, weak muscle tone. The subcutaneous fat layer is noticeably reduced on the abdomen, arms and legs, but on the face it is normal. The temperature fluctuates during the day within one degree, which indicates a disorder of thermoregulation. The baby almost does not grow weight (it is 20-30% less than the norm), tachycardia, muffled heart tones may be noted. These symptoms are not the only ones: the child begins to lag behind in development - he lacks the strength to catch up with his peers.

Degree 3. This is the most severe degree of malnutrition, it is diagnosed when the child's general condition is significantly impaired. The baby does not have a subcutaneous fat layer - on the stomach, arms and legs, on the face. The child resembles a skeleton covered with skin. His weight does not increase and may even decrease. The mood of the baby changes - from lethargy and apathy, he goes into the stage of irritability and tearfulness. The body temperature drops, hands and feet are cold. Breathing is shallow, heart sounds are muffled, arrhythmia is manifested. The child is constantly spitting up, he has frequent loose stools, urination in small portions. Weight below normal by more than 30%.

The third degree of malnutrition is the complete exhaustion of the body. Chair with malnutrition

The classification of stool in malnutrition serves as an additional way to diagnose this disease. The changes are quite pronounced, so we will talk about them separately. The most characteristic types of stool:

• Hungry. Very scanty, dense, dry, almost colorless. In some children, the "hungry" stool becomes green, patches of mucus are noticeable in it, and the smell is putrid, unpleasant. Such a chair often occurs against the background of the development of dysbacteriosis.
• Mealy. This type of stool is usually thin, greenish, with mucus impurities. During a coprological examination, a lot of fiber, starch, neutral fat, mucus and leukocytes are found.
• Protein. The stool is hard, dry, crumbly. The study revealed lime and magnesium salts.

Complications

Hypotrophy is a dangerous condition for a baby. If this disease is not treated, lack of body weight can provoke the development of concomitant serious diseases. The second and third stages often give complications and are accompanied by:

• inflammation of the lungs;
• developmental delay, including mental;
• inflammation of the large and small intestines;
• rickets;

Hypotrophy can lead to the development of rickets

• anemia
• inflammation of the middle ear;
• the development of dysbacteriosis;
• violation of the enzymatic activity of the body.

Treatment of malnutrition can be divided into four components. Each of them is important, but the effectiveness will be low if not used in combination:

• The first thing to do is to identify the cause of the disease and eliminate it.
• The next step is to establish proper care for the child. It is important to walk with him at least three hours a day (however, at a temperature not lower than 5˚C), regularly massage, baths with warm water (about 38˚C).
• Optimize the nutrition of a small patient. It is important that the baby receives the necessary amount of proteins, fats, carbohydrates.
• If necessary, use drug therapy.

It is important to optimize the feeding of a child with malnutrition and carry it out by the hour

Also, treatment can be conditionally divided into stages. Each of them requires a thoughtful approach and careful adherence to the doctor's advice:

• stage of adaptation;
• interim period;
• stage of enhanced nutrition.

Child care during recovery

Newborns with a diagnosis of "hypotrophy" should be in cuveuses, in which the temperature is constantly maintained at about 30 ° C. So that the skin does not dry out, after the bath they wipe the body with oil, to which vitamin A is added. Older children also need to provide appropriate conditions: the air temperature in the room should be about 24 ° C, humidity - 60-70%.

Children with 1 and 2 degrees of malnutrition should be massaged regularly. All exercises must be performed by laying the child on his back, then turning over on his stomach. One of the conditions for the massage is the preparation of the room: a recognized expert in pediatrics, Dr. Komarovsky, notes that the room must be ventilated, and the air temperature is about 22˚С.

The simplest massage techniques:

• stroking hands and feet;
• spreading the arms to the sides and crossing them on the chest;
• massage of the abdomen with circular movements;
• flexion and extension of arms and legs;
• turning over on the stomach;
• the child should reflexively try to crawl, for this you need to put your palm under his heels and lightly press;
• foot massage.

There are other massage techniques that can be used depending on the condition of the child, as well as his age. With caution, massage is performed for those children who have been diagnosed with the 3rd degree of the disease. Stroking should be the main elements of such a massage.

Diet therapy is the main method of treating malnutrition in both newborns and older children. It is necessary to organize a diet in compliance with the recommendations of a doctor. If you feed the baby immediately with the amount of food that is shown to him at this age, you can aggravate the condition, cause vomiting, indigestion, and weakness. We will outline the basic principles for calculating the number of feedings and the daily amount of food - they are unchanged for each stage of the disease.

Adaptation period

This period is intended for a smooth transition from a critical state to the process of normalizing weight and setting appetite. Its duration and principles may vary and depend on factors such as the degree of the disease.

The adaptation period is necessary for the normalization of weight and appetite.

With 1 degree of malnutrition, the adaptation period is usually 1-3 days. On the first day, the child can eat 2/3 of the total diet. The number of feedings should not exceed 6-7 times a day. Regardless of the age of the baby, it should be fed only with mother's milk or a mixture.

The second degree of malnutrition implies a longer period of adaptation - up to seven days. The first day is very important - the total amount of the mixture on this day should be within ½ - 2/3 of the norm. In this case, you need to use a mixture intended for children younger than the patient by 2 months. The entire period of adaptation is necessary to gradually increase the number of feedings per day - by one or two. Since it is desirable to treat a baby with 2 degrees of malnutrition in a hospital, the child should receive a 5% glucose solution or glucose-salt preparations through a gastric tube. At the moment of reaching the calculated daily amount of nutrition, the patient proceeds to the next stage - intermediate or reparative.

During the treatment of the third degree of malnutrition, the adaptation period should be even longer - from 10 days to 2 weeks. On the first day, the volume of food eaten should be half the norm, and the number of feedings should be ten. Every day you need to increase the amount of food per day by 100 ml. During the adaptation period, it is necessary to gradually switch to 8 meals a day. This stage can be considered passed when the amount of food eaten per day will be equal to 1/5 of the child's body weight.

The total amount of food eaten should reach one-fifth of the child's weight 2 and 3 stages of therapeutic nutrition

At the second (reparation) stage, the amount of daily food is finally brought to the required norm, according to the weight and age of the child. In addition, special therapeutic mixtures are introduced into the diet.

The third stage involves enhanced high-calorie nutrition. At a rate of 100-120 kilocalories per day, the baby should receive 200. In order to achieve this goal, you can use high-protein mixtures, as well as add cereals from buckwheat, rice and corn to the diet.

Medical therapy

Drug treatment includes vitamin therapy - vitamins C, B12, B6, B1, A, folic acid are prescribed. To improve digestion, enzymes are prescribed: pancreatin, festal, creon, mexase. Also, the doctor may recommend hormonal and non-hormonal drugs with an anabolic effect. Of particular note are medicines containing L-carnitine, for example, Elcar. This drug is indicated for children with underweight, malnutrition - it stimulates appetite, increases overall tone.

If the baby has a severe form of malnutrition, he will be given a dropper with albumin, glucose, and special nutrition. Also, such patients are infused with blood, plasma, and hormonal preparations are prescribed.

Often this disease is accompanied by intestinal dysbacteriosis, then the doctor will recommend special preparations with beneficial bacteria that will help improve the functioning of the intestine. In addition, it is required to correct the functional disorders of the nervous system, so children are prescribed soothing herbal preparations, valerian, motherwort. Herbs in the form of tincture are given orally, and also added to bath water.

Bath with soothing herbs is very beneficial for the nervous system

The first and second stages of the disease respond well to treatment if the cause that led to the deficiency of body weight is identified. Proper nutrition, adequate child care will allow you to get the first results in a month. The prognosis for children diagnosed with the third stage of malnutrition is not so rosy. A lethal outcome is observed in 30-50% of cases, while the rest of the patients with the third stage of malnutrition may well have a history of quite serious diseases.

Prevention

Prevention of malnutrition is to eliminate the possible causes that can lead to such a condition. A pregnant woman should eat right, undergo examinations in a timely manner and give up bad habits. After the baby is born, you should follow the doctor's standard recommendations - breastfeed the newborn or formula if breastfeeding is not possible. It is also important to go outside with the baby every day, treat possible foci of infection in a timely manner, and keep chronic diseases under control.

Nutrition should be balanced: from six months, vegetable food is introduced into the baby's menu, closer to a year - meat, fish, eggs. It is important to observe the drinking regimen and make sure that the child drinks not only formula or breast milk, but also water, various teas, compotes. An infant should be shown to the pediatrician every month and control weighings and measurements of physical indicators should be carried out. At the first sign of a lag in weight or height, the cause of such deviations should be found and eliminated. Subject to all these recommendations, the likelihood of developing malnutrition will be minimized.

Very often in children there is a pathological malnutrition, which is accompanied by a small increase in body weight compared to the norm in relation to age and height. If this gap is more than 10%, malnutrition is diagnosed, which most often manifests itself before 3 years.

In pediatrics, this disease is considered as an independent type of dystrophy. Since malnutrition in young children is accompanied by very serious disorders in the body (failure of metabolic processes, decreased immunity, lag in speech and psychomotor development), it is important to identify the disease in a timely manner and begin treatment.

Causes of the disease

Correctly identified causes of malnutrition will help doctors prescribe the best treatment in each case. Factors of the prenatal or postnatal period can lead to a pathological malnutrition of a child.

Intrauterine malnutrition:

• unfavorable conditions for the normal development of the fetus during its gestation (bad habits of a woman, malnutrition, non-compliance with the daily regimen, environmental and industrial hazards);
• somatic diseases of the expectant mother (diabetes mellitus, pyelonephritis, nephropathy, heart disease, hypertension) and her nervous breakdowns, constant depression;
• pregnancy pathologies (preeclampsia, toxicosis, premature birth, fetoplacental insufficiency);
• intrauterine infection of the fetus, its hypoxia.

Extrauterine malnutrition:

• congenital malformations up to chromosomal abnormalities;
• fermentopathy (celiac disease, lactase deficiency);
• immunodeficiency;
• constitutional anomaly;
• protein-energy deficiency due to poor or unbalanced nutrition (underfeeding, sucking difficulties with flat or inverted nipples in the mother, hypogalactia, insufficient amount of milk formula, abundant regurgitation, micronutrient deficiency);
• poor nutrition of a nursing mother;
• some diseases of the newborn do not allow him to actively suckle, which means - to eat fully: cleft palate, congenital heart disease, cleft lip, birth trauma, perinatal encephalopathy, cerebral palsy, pyloric stenosis, alcohol syndrome;
• frequent SARS, intestinal infections, pneumonia, tuberculosis;
• unfavorable sanitary and hygienic conditions: poor child care, rare exposure to the air, rare bathing, insufficient sleep.

All these causes of childhood malnutrition are closely interrelated, have a direct impact on each other, thus forming a vicious circle that accelerates the progression of the disease.

For example, due to malnutrition, malnutrition begins to develop, while frequent infectious diseases contribute to its strengthening, which, in turn, leads to malnutrition and weight loss by the child.

Classification

There is a special classification of malnutrition in children, depending on the lack of body weight:

1. Hypotrophy of the 1st degree is usually detected in newborns (in 20% of all infants), which is diagnosed if the child's lag in weight is 10–20% less than the age norm, but growth rates are absolutely normal. Parents should not worry about such a diagnosis: with timely care and treatment, the baby recovers in weight, especially when breastfeeding.
2. Hypotrophy of the 2nd degree (average) is a decrease in weight by 20–30%, as well as a noticeable lag in growth (by about 2–3 cm).
3. Hypotrophy of the 3rd degree (severe) is characterized by a lack of mass, exceeding 30% of the age norm, and a significant lag in growth.

The above three degrees of malnutrition suggest different symptoms and treatments.

Symptoms of childhood malnutrition

Usually, the symptoms of malnutrition in newborns are determined already in the hospital. If the disease is acquired, and not congenital, attentive parents, according to some signs, even at home will be able to understand that their child is sick. Symptoms depend on the form of the disease.

I degree

• satisfactory state of health;
• neuropsychic development is quite consistent with age;
• loss of appetite, but within moderate limits;
• pale skin;
• reduced tissue turgor;
• thinning of the subcutaneous fat layer (this process begins with the abdomen).

II degree

• impaired activity of the child (excitation, lethargy, lag in motor development);
• poor appetite;
• pallor, peeling, flabbiness of the skin;
• decreased muscle tone;
• loss of tissue turgor and elasticity;
• disappearance of the subcutaneous fat layer on the abdomen and limbs;
• dyspnea;
• tachycardia;
• muscle hypotension;
• frequent otitis, pneumonia, pyelonephritis.

III degree

• severe exhaustion;
• atrophy of the subcutaneous fat layer on the entire body of the child;
• lethargy;
• lack of response to banal stimuli in the form of sound, light and even pain;
• a sharp lag in growth;
• neuropsychic underdevelopment;
• pale gray skin;
• dryness and pallor of the mucous membranes;
• muscles atrophy;
• loss of tissue turgor;
• retraction of the fontanel, eyeballs;
• sharpening of facial features;
• cracks in the corners of the mouth;
• violation of thermoregulation;
• frequent regurgitation, vomiting, diarrhea, conjunctivitis, candidal stomatitis (thrush);
• alopecia (baldness);
• hypothermia, hypoglycemia, or bradycardia may develop;
• infrequent urination.

If malnutrition is detected in a child, an in-depth examination is carried out to clarify the causes of the disease and appropriate treatment. For this, consultations of children's specialists are appointed - a neurologist, a cardiologist, a gastroenterologist, a geneticist, an infectious disease specialist.

Various diagnostic studies are carried out (ECG, ultrasound, EchoCG, EEG, coprogram, biochemical blood test). Based on the data obtained, therapy is already prescribed.

Treatment of the disease

On an outpatient basis, treatment of malnutrition of the I degree in young children is carried out, inpatient - II and III degrees. The main activities are aimed at:

• normalization of nutrition;
• diet therapy (gradual increase in calorie content and volume of food consumed by the child + fractional, frequent feeding);
• compliance with the regime of the day;
• organization of proper child care;
• correction of metabolic disorders;
• drug therapy (enzymes, vitamins, adaptogens, anabolic hormones);
• in the presence of a severe form of the disease, intravenous administration of glucose, protein hydrolysates, vitamins, saline solutions is prescribed;
• massage with elements of exercise therapy.

With timely treatment of the disease of I and II degrees, the prognosis is favorable, but with hypotrophy of the III degree, a lethal outcome is noted in 50% of cases.

Prevention methods

Prevention of malnutrition in children involves a weekly examination by a pediatrician, constant anthropometry and nutritional correction. You need to think about the prevention of such a terrible disease even while carrying a baby:

• observe the daily routine;
• eat on time;
• correct pathologies;
• exclude all adverse factors.

After the birth of the crumbs, an important role is played by:

• high-quality and balanced nutrition of a nursing mother;
• timely and correct introduction of complementary foods;
• body weight control;
• rational, competent care of the newborn;
• treatment of any, even spontaneously occurring concomitant diseases.

Having heard such a diagnosis as malnutrition, parents should not give up. If the child is provided with normal conditions for the regimen, care and nutrition, quick and effective treatment of possible infections, severe forms can be avoided.

Often, young children have insufficient weight gain for their age and height. Chronic weight gain of 10% or more that is missing in a baby is called malnutrition.

This pathologically disturbed nutrition is an independent disease - a kind of dystrophy. More often it is observed in babies of the first 3 years of life, causes serious changes in the body, so it is so important to identify and treat it in time.

Hypotrophy is also accompanied by a slowdown in growth, psychomotor development. A lack of body weight is due to insufficient intake of food or problems with the absorption of nutrients in the baby's body.

Classification

Depending on the period of development of malnutrition, there are:

1. Congenital, or occurring in utero (prenatal), malnutrition, which develops as a result of oxygen starvation of the fetus, with a delay in its development.
2. Acquired malnutrition (postnatal), which occurs as a result of a protein-energy deficiency in the body that is not compensated by the calorie content and composition of food. Deficiency may be due to an unbalanced composition of food, a violation of its digestion or absorption of nutrients.
3. Mixed malnutrition, during the development of which additional postnatal causes (alimentary or social order) are added to the factors of the prenatal stage.

According to the severity, malnutrition is distinguished:

• 1 (mild) degree: the weight deficit is 10-20% of the norm by age, and the growth of the baby is normal;
• 2 (medium) degree: weight is reduced by 20-30%, and height - by 2-3 cm from the average age norm;
• 3 (severe) degree: the weight deficit exceeds 30% of the due against the background of a pronounced lag in growth.

During malnutrition in children, periods are distinguished:

• elementary;
• progression;
• stabilization;
• recovery or convalescence.

Causes of malnutrition

Preeclampsia and placental dysfunction can lead to intrauterine hypotrophy of the fetus.

Hypotrophy of a child can be caused by many factors of the prenatal and postnatal stages of its development.

Intrauterine malnutrition may be associated with:

1. Pathology of pregnancy:

• toxicosis;
• preeclampsia;
• fetoplacental insufficiency;
• premature birth;
• fetal hypoxia;
• intrauterine infection.

1. Factors unfavorable for the development of the fetus:

• bad habits in a pregnant woman;
• stressful situations or frequent depression;
• malnutrition of a woman when carrying a child;
• non-compliance with the daily routine during pregnancy;
• unfavorable environment;
• industrial hazards.

1. The presence of a serious pathology in the expectant mother:

• heart defects;
• diabetes;
• chronic pyelonephritis;
• hypertension;
• nephropathy.

Acquired malnutrition in a child can be caused by endogenous or exogenous causes.

Endogenous causes include:

• congenital anomalies of development (including chromosomal);
• enzymatic deficiency, including malabsorption syndrome, lactase deficiency, celiac disease, etc.;
• constitutional anomalies (diathesis);
• immunodeficiency state.

Among the exogenous factors that cause malnutrition, there are alimentary, infectious and social factors.

1. Alimentary factors are unbalanced or insufficient food, the consumption of which causes a protein and energy deficiency. Alimentary factors include:

• regular malnutrition associated with impaired sucking (due to inverted or flat nipples of the mother's breast);
• lack of nutrition with a decrease in lactation or a decrease in the volume of milk mixtures;
• profuse regurgitation in the baby;
• poor-quality composition of milk with insufficient nutrition of the mother;
• infant diseases that impede the process of sucking and proper nutrition: pyloric stenosis, cleft lip, cleft palate, cerebral palsy, congenital heart defects, etc.

1. Infectious factors that can lead to malnutrition:

• intestinal group of infections;
• severe pneumonia;
• frequently occurring respiratory diseases;
• tuberculosis, etc.

1. Social factors play an important role in the appearance of malnutrition. These include:

• insufficient financial support for the family;
• unsanitary conditions and errors in caring for the baby (lack of walks in the air, non-compliance with the daily routine, insufficient sleep, etc.).

If there are several reasons for hypotrophy, then the disease progresses at an accelerated pace, since they complement each other. Insufficient nutrition reduces immunity, contributes to the occurrence of an infectious pathology, which provokes weight loss and increases malnutrition. A vicious circle is formed, and malnutrition is rapidly increasing.

Symptoms

Manifestations of malnutrition depend on the severity of the process. Doctors determine the congenital form of the disease already at the first examination of the baby. Postnatal malnutrition is diagnosed in the process of monitoring the development of the baby according to characteristic features.

With a mild degree of the disease, the general condition of the crumbs does not suffer. In neuropsychic development, the child does not lag behind. There may be some loss of appetite. From objective data, the following manifestations can be detected:

• pale skin;
• tissue elasticity is reduced;
• the subcutaneous fat layer in the abdomen is thinned.

Children with moderate malnutrition are characterized by reduced activity. Lethargy can be replaced by excitement. Characterized by a lag in the development of motor skills. Appetite is greatly reduced. Flaky, flabby, pale skin. Muscle tone is reduced. Due to the deterioration of elasticity, skin folds are easily formed, cracking down with difficulty.

The subcutaneous fat layer is preserved only on the face, and is completely absent in other parts of the body. Respiration and heart rate are quickened, blood pressure is reduced. Children often develop somatic diseases - pyelonephritis, pneumonia, otitis, etc.

With severe malnutrition, the subcutaneous fat layer in children disappears not only on the trunk and limbs, but also on the face. The child lags far behind both in physical and neuropsychic development. Growth is significantly reduced, muscles are atrophic, tissue density and elasticity are completely lost.

The baby is lethargic, almost motionless. There is no reaction to external stimuli - not only to light, sound, but even to pain. It is obvious that the child is emaciated. Babies have a sunken large fontanel. The skin is pale, has a grayish tint.

Pallor and dryness of the mucous membranes, cracked lips, sharpened facial features, sunken eyes are expressed. Thermoregulation is broken. Babies spit up (or vomit), are prone to diarrhea, and urinate infrequently.

For children with severe malnutrition, the following diseases are characteristic:

• fungal infection of the oral mucosa (thrush);
• conjunctivitis;
• anemia;
• pneumonia (inflammation of the lungs);
• rickets;
• alopecia (hair loss), etc.

In the terminal stage, the temperature drops sharply, the heart rate slows down, and the blood sugar level drops.

Diagnostics

The doctor will detect fetal hypotrophy during the next ultrasound examination conducted by the pregnant woman.

Intrauterine malnutrition can be detected during an ultrasound screening examination of pregnant women. The measured dimensions of the fetal head, body length and the calculation of the estimated weight of the fetus make it possible to assess its development in accordance with the gestational age, to identify intrauterine maturation delay.

A pregnant woman is hospitalized in order to identify the cause that caused fetal hypotrophy. Congenital malnutrition is diagnosed by a neonatologist (pediatrician of the maternity ward, specialist in newborns) at the first examination of a born baby.

Acquired malnutrition is detected by a pediatrician when observing a child on the basis of controlled anthropometric data: height, weight, chest circumference, head, abdomen, hips and shoulders. The thickness of the skin-fat fold in different parts of the body is also determined.

If malnutrition is detected, a deeper examination is prescribed to identify its cause:

• consultations of pediatric specialists (cardiologist, neuropathologist, geneticist, gastroenterologist, endocrinologist);
• laboratory methods: blood test (clinical and biochemical method), urinalysis, feces for dysbacteriosis, coprogram;
• hardware research: ECG, ultrasound, echocardiography, electroencephalography, etc.

Treatment

Treatment of children with mild (1st) degree malnutrition can be carried out at home in the absence of concomitant pathology and a minimized risk of complications. When diagnosing moderate and severe malnutrition (2nd or 3rd degree), the child is hospitalized.

Complex therapy is prescribed, the purpose of which is:

• elimination of the cause of the disease;
• ensuring a balanced diet in accordance with age norms;
• treatment of complications caused by malnutrition.

For each child, an individual set of measures is selected depending on the severity of malnutrition.

Comprehensive treatment should include:

• identifying the cause of malnutrition and, if possible, eliminating it;
• diet therapy, which is the basis for the treatment of malnutrition;
• treatment of existing foci of infection in a child;
• symptomatic therapy;
• proper care of the baby;
• Exercise therapy and massage, physiotherapy.

When choosing a diet, it is important to take into account the degree of dysfunction of the digestive organs and the degree of malnutrition.

diet therapy

Nutrition correction is carried out in several stages:

1. At the first stage, in the process of medical supervision, the possibility of full digestion and assimilation of food in the body is determined. The duration of observation varies from several days with 1 degree of malnutrition to 2 weeks with 3 degrees. The digestibility of food and the presence of bloating, diarrhea or other signs of indigestion are determined.

From the first days of treatment, a reduced amount of food per day is prescribed: with 1 degree of malnutrition, it is equal to 2/3 of the volume due to age, with 2 - ½ volume, with 3 degrees - 1/3 of the age norm of daily volume.

The intervals between feedings are reduced, but the frequency of meals increases: with 1 degree of malnutrition up to 7 times a day, with 2 - up to 8 times, with 3 - up to 10 times.

1. The second stage is called transitional. The purpose of the diet during this period of treatment is to gradually compensate for the deficiency of nutrients, minerals and vitamins necessary to restore health.

Tactics are used to increase the volume of a portion of food and its calorie content, but the number of feedings per day is reduced. With small daily additions of the amount of food, the volume is gradually brought to a full age.

1. The third stage of diet therapy is characterized by enhanced nutrition. It is possible to increase the food load only if the functional ability of the digestive organs is fully restored.

An important condition for diet therapy is the use of easily digestible food. The optimal nutrition is mother's milk. In its absence, milk mixtures are prescribed, the choice of which is made by the doctor.

With severe malnutrition, when the child is unable to eat on his own, or the affected organs of the digestive tract are not able to digest it, the baby is prescribed parenteral nutrition.

At the same time, not only nutrient solutions (glucose solution, protein hydrolysates), but also electrolyte solutions (Trisol, Disol), vitamins are injected intravenously to replenish the body's need for fluids and maintain metabolism.

During treatment (in order to facilitate nutrition control), a special diary records the quantity and quality of the food received, including nutrient mixtures administered intravenously. The nature of the stool and the number of bowel movements per day, the number of urination and the volume of urine excreted are monitored and reflected in the diary.

Repeatedly in a week, the coprogram is examined (the presence of undigested fibers, fatty inclusions is determined in the feces). The child's body weight is monitored weekly, on the basis of which the doctor recalculates the need for nutrients.

The criteria for the effectiveness of diet therapy are:

• improved condition of the baby;
• restoration of skin elasticity;
• normal emotional state of the child;
• the appearance of appetite;
• daily increase in body weight by 25-30 g.

The child must be hospitalized with his mother. It will provide care not only at home, but also in the hospital.

Care

One of the components of the complex treatment of malnutrition is a general strengthening massage.

Care for a child with malnutrition should provide:

• comfortable conditions for the baby at home and in the hospital;
• airing the room at least 2 times a day;
• air temperature should be 24-25 C;
• daily exposure to air;
• conducting special exercises to restore muscle tone;
• massage courses for a beneficial effect on the baby's body.

Medical therapy

Drug therapy for malnutrition may include:

• the appointment of probiotics to correct the imbalance of microflora in the intestine (Bifiliz, Atsilakt, Linex, Probifor, Bifiform, Florin Forte, yogurts, etc.);
• enzyme therapy with a decrease in the ability of the gastrointestinal tract to digest food - the prescribed drugs will compensate for the lack of digestive juices of the stomach, pancreas (gastric juice, Creon, Panzinorm, Festal);
• vitamin therapy - at first, drugs are injected (vitamins B1, B6, C), and after normalization of the condition, vitamin-mineral complexes are prescribed orally;
• stimulating therapy that improves metabolic processes: Dibazol, ginseng, Pentoxifylline improve blood flow and provide delivery of oxygen and nutrients to tissues.

If any complications are detected in a child, symptomatic therapy is carried out.

With anemia, iron preparations are prescribed (Totem, Sorbifer, etc.). In the case of a hemoglobin index below 70 g / l, red blood cells can be transfused.

The appointment of immunoglobulin will increase the protective capabilities of the body and protect the baby from infection.

If signs of rickets are detected, a course of treatment with vitamin D plus UVR is carried out in a physical room.

Forecast

Timely treatment of mild to moderate malnutrition will provide a favorable prognosis for the life of the baby. With a severe degree of malnutrition, a lethal outcome is possible in 30-50% of cases.

Prevention

To prevent intrauterine malnutrition, measures should be taken during the period of bearing a child:

• elimination of factors of adverse effect on the fetus;
• regular observation of a woman by a gynecologist and timely screening studies;
• proper nutrition of a pregnant woman;
• timely correction of the pathology of pregnancy;
• strict observance of the pregnant regimen of the day.

For the prevention of postnatal malnutrition, it is necessary:

• regular observation of the child by a pediatrician and anthropometry;
• breastfeeding a baby;
• balanced nutrition of a woman during lactation;
• correct and timely introduction of complementary foods;
• ensuring competent care of the newborn;
• treatment of any disease of the baby as prescribed by the pediatrician.

Summary for parents

Hypotrophy in a baby at an early age is not just a lag in body weight of 10% or more. This disease leads to a lag in mental development, speech. Progressive malnutrition leads to exhaustion and poses a threat to the life of the baby.

The birth of a child is an event of extreme importance. It is necessary to prepare for it and follow all medical recommendations during the period of gestation. These measures will help to avoid the development of malnutrition in the womb.

After the birth of a baby, breastfeeding, proper care of the newborn, regular monitoring of the baby's developmental indicators (physical and mental) will make it possible to prevent the development of acquired malnutrition.

In the event of the occurrence of this serious disease in a child, only timely full-fledged treatment will help restore the health of the crumbs.

Hypotrophy in children is starvation, quantitative or qualitative, as a result of which significant changes occur in the body. Qualitative starvation is possible with improper artificial feeding, lack of essential nutrients and vitamins, quantitative - with incorrect calculation of caloric content or lack of food resources.

Hypotrophy can be the result of acute diseases or the result of a chronic inflammatory process. Wrong actions of parents - lack of regimen, poor care, unsanitary conditions, lack of fresh air - also lead to this condition.

What does a normally developing baby look like?

Signs of normotrophic:

• healthy look
• The skin is pink, velvety, elastic
• A lively look, activity, studies the world around with interest
• Regular increase in weight and height
• Timely mental development
• Proper functioning of organs and systems
• High resistance to adverse environmental factors, including infectious ones
• Rarely cries

In medicine, this concept is used only in children under 2 years of age. According to WHO, malnutrition is not ubiquitous:

• in developed countries, its percentage is less than 10,
• and in developing countries - more than 20.

According to scientific studies, this deficiency condition occurs approximately equally in boys and girls. Severe cases of malnutrition are observed in 10-12 percent of cases, with rickets in a fifth of children, and anemia in a tenth. Half of the children with this pathology are born in the cold season.

Causes and development

The causes of malnutrition in children are diverse. The main factor causing intrauterine malnutrition is toxicosis of the first and second half of pregnancy. Other causes of congenital malnutrition are as follows:

• pregnancy before the age of 20 or after 40 years
• bad habits of the expectant mother, poor nutrition
• chronic diseases of the mother (endocrine pathologies, heart defects, and so on)
• chronic stress
• work of the mother during pregnancy in hazardous production (noise, vibration, chemistry)
• placental pathology (improper attachment, early aging, one umbilical artery instead of two, and other placental circulation disorders)
• multiple pregnancy
• metabolic disorders in the fetus of a hereditary nature
• genetic mutations and intrauterine anomalies

Causes of acquired malnutrition

Internal- caused by pathologies of the body that disrupt food intake and digestion, absorption of nutrients and metabolism:

• congenital malformations
• CNS lesions
• immunodeficiency
• endocrine diseases
• metabolic disorders

In the group of endogenous factors, food allergies and three hereditary diseases that occur with malabsorption syndrome, one of the common causes of malnutrition in children, should be singled out separately:

• cystic fibrosis - disruption of the external secretion glands, affected by the gastrointestinal tract, respiratory system
• celiac disease - gluten intolerance, changes in the work of the intestines in a child begin from the moment gluten-containing foods are introduced into the diet - barley groats, semolina, wheat porridge, rye groats, oatmeal
• lactase deficiency - the digestibility of milk is impaired (lack of lactase).

According to scientific studies, malabsorption syndrome provokes malnutrition twice as often as nutritional deficiencies. This syndrome is characterized primarily by a violation of the chair: it becomes plentiful, watery, frequent, frothy.

External- due to the wrong actions of parents and an unfavorable environment:

All exogenous factors in the development of malnutrition cause stress in the child. It has been proven that light stress increases the need for energy by 20%, and for protein - by 50-80%, moderate - by 20-40% and 100-150%, strong - by 40-70 and 150-200%, respectively.

Symptoms

Signs and symptoms of intrauterine malnutrition in a child:

• body weight below the norm by 15% or more (see below the table of the dependence of weight on the height of the child)
• growth is less by 2-4 cm
• the child is lethargic, muscle tone is low
• congenital reflexes are weak
• thermoregulation is impaired - the child freezes or overheats faster and stronger than normal
• in the future, the initial weight is slowly restored
• umbilical wound does not heal well

Acquired malnutrition is characterized by common features in the form of clinical syndromes.

• Insufficient fatness: the child is thin, but the proportions of the body are not violated.
• Trophic disorders (malnutrition of body tissues): the subcutaneous fat layer is thinned (first on the abdomen, then on the limbs, in severe cases and on the face), the weight is insufficient, body proportions are disturbed, the skin is dry, elasticity is reduced.
• Changes in the functioning of the nervous system: depressed mood, decreased muscle tone, weakened reflexes, psychomotor development is delayed, and in severe cases, acquired skills even disappear.
• Decreased perception of food: appetite worsens up to its complete absence, frequent regurgitation, vomiting, stool disorders appear, the secretion of digestive enzymes is inhibited.
• Reduced immunity: the child begins to get sick often, chronic infectious and inflammatory diseases develop, possibly toxic and bacterial damage to the blood, the body suffers from general dysbacteriosis.

Degrees of malnutrition in children

Hypotrophy of the 1st degree is sometimes practically not noticeable. Only an attentive doctor on examination can identify it, and even then he will first conduct a differential diagnosis and find out if a body weight deficit of 11-20% is a feature of the child's physique. Thin and tall children are usually so due to hereditary characteristics. Therefore, a new mother should not be afraid if her active, cheerful, well-nourished child is not as plump as other children.

Hypotrophy of the 1st degree in children is characterized by a slight decrease in appetite, anxiety, sleep disturbance. The surface of the skin is practically not changed, but its elasticity is reduced, the appearance may be pale. The child looks thin only in the abdomen. Muscle tone is normal or slightly reduced. Sometimes they show signs of rickets, anemia. Children get sick more often than their well-fed peers. Stool changes are insignificant: a tendency to constipation or vice versa.

Hypotrophy of the 2nd degree in children is manifested by a mass deficit of 20-30% and growth retardation (about 2-4 cm). Mom can find cold hands and feet in a child, he can often spit up, refuse to eat, be lethargic, inactive, sad. Such children lag behind in mental and motor development, sleep poorly. Their skin is dry, pale, flaky, easily folded, inelastic. The child looks thin in the abdomen and limbs, and the contours of the ribs are visible. The stool fluctuates greatly from constipation to diarrhea. These kids get sick every quarter.

Sometimes doctors see malnutrition even in a healthy child who looks too thin. But if the growth corresponds to age, he is active, mobile and happy, then the lack of subcutaneous fat is explained by the individual characteristics and high mobility of the baby.

With hypotrophy of the 3rd degree, growth retardation is 7-10 cm, weight deficit is ≥ 30%. The child is drowsy, indifferent, tearful, acquired skills are lost. The subcutaneous fat is thinned everywhere, pale gray, dry skin fits the baby's bones. There is muscle atrophy, cold extremities. Eyes and lips dry, cracks around the mouth. A child often has a chronic infection in the form of pneumonia, pyelonephritis.

Diagnostics

Differential Diagnosis

As mentioned above, the doctor first needs to figure out whether malnutrition is an individual feature of the body. In this case, no changes in the work of the body will be observed.
In other cases, it is necessary to conduct a differential diagnosis of the pathology that led to malnutrition: congenital malformations, diseases of the gastrointestinal tract or the endocrine system, lesions of the central nervous system, infections.

Treatment

The main directions of treatment of malnutrition in children are as follows:

• Identification of the cause of malnutrition, its elimination
• Proper care: daily routine, walks (3 hours daily, if outside ≥5˚), gymnastics and professional massage, bathing in warm baths (38 degrees) in the evening
• Organization of proper nutrition, balanced in proteins, fats and carbohydrates, as well as vitamins and microelements (diet therapy)
• Medical treatment

Treatment of congenital malnutrition consists in maintaining a constant body temperature in the child and establishing breastfeeding.

Nutrition for children with malnutrition

Diet therapy for malnutrition is divided into three stages.

The main directions of drug therapy

• Replacement therapy with pancreatic enzymes; drugs that increase the secretion of gastric enzymes
• The use of immunomodulators
• Treatment of intestinal dysbacteriosis
• vitamin therapy
• Symptomatic therapy: correction of individual disorders (iron deficiency, irritability, stimulant drugs)
• In severe forms of malnutrition - anabolic drugs - drugs that promote the formation of building protein in the body for muscles and internal organs.

Treatment of malnutrition requires an individual approach. It is more correct to say that children are nursed, not treated. Vaccinations for hypotrophy of the 1st degree are carried out according to the general schedule, for hypotrophy of the 2nd and 3rd degrees - on an individual basis.

Study of the causes and symptoms of malnutrition in children

In one of the somatic hospitals, 40 case histories of children diagnosed with hypertrophy (19 boys and 21 girls aged 1-3 years) were analyzed. The conclusions were obtained as a result of the analysis of specially designed questionnaires: most often, children with malnutrition were born from a pregnancy that proceeded with pathologies, with heredity for gastrointestinal pathologies and allergic diseases, with intrauterine growth retardation.

Prevention of malnutrition in children

Prevention of both intrauterine and acquired malnutrition begins with the struggle for the health of the woman and for the preservation of long-term breastfeeding.

The following areas of prevention are tracking the main anthropometric indicators (height, weight), monitoring the nutrition of children.

An important point is the timely detection and treatment of childhood diseases, congenital and hereditary pathologies, proper child care, and prevention of the influence of external factors in the development of malnutrition.

It should be remembered:

• Mother's milk is the best and irreplaceable food for a baby up to a year old.
• At 6 months, the menu should be expanded with plant foods (see how to properly introduce complementary foods to a child). Also, do not transfer the child to adult food too early. Weaning from breastfeeding up to 6 months of the child is a crime against the baby, if there are problems with lactation, the child does not have enough milk, you must first apply it to the breast and only then supplement it.
• Variety in nutrition is not different types of cereals and pasta throughout the day. A complete diet consists in a balanced combination of proteins (animal, vegetable), carbohydrates (complex and simple), fats (animal and vegetable), that is, vegetables, fruits, meat, dairy products must be included in the diet.
• As for meat - after a year it must be present in the child's diet - this is an indispensable product, there can be no talk of any vegetarianism, only meat contains the compounds necessary for growth, they are not produced in the body in the amount that is needed for full development and health.
• Important!!! There are no safe drugs "just" to reduce or increase a child's appetite.

Table of dependence of weight on height in children under 4 years old

Very strong deviations in the weight of the child are not due to reduced appetite or some individual characteristics of the body - this is usually due to an unrecognized disease or lack of good nutrition in the child. A monotonous diet, nutrition that does not meet age-related needs - leads to a painful lack of body weight. The weight of the child should be controlled not so much by age as by the growth of the baby. Below is a table of the dependence of the height and weight of the baby (girls and boys) from birth to 4 years:

• Norm is the interval between GREEN and BLUE weight value (25-75 centiles).
• Weight loss- between YELLOW and GREEN figure (10-25 centiles), however, it may be a variant of the norm or a slight tendency to reduce body weight in relation to height.
• Weight gain- between BLUE and YELLOW number (75-90 centiles) is both normal and indicates a trend towards weight gain.
• Increased or reduced body weight- between RED and YELLOW number indicates both low body weight (3-10th centile) and increased (90-97th centile). This may indicate both the presence of the disease and the characteristics of the child. Such indicators require a thorough diagnosis of the child.
• Painful weight loss or gain- per RED border (>97 or<3 центиля). Ребенок с таким весом нуждается в установлении причины гипотрофии или ожирения и корректировки питания и назначения лечения, массажа и пр. , поскольку это является проявлением какого-либо заболевания и опасно негармоничным развитием органов, систем организма, снижению сопротивляемости к инфекциям и негативным факторам окружающей среды.

Dystrophy in children (hypotrophy) is a chronic eating disorder, one of the main manifestations of which is a gradually developing child. There are mild and severe forms of dystrophy. A clear boundary between these forms is often difficult to determine. A far advanced form of dystrophy is called atrophy.

Etiology and pathogenesis. The reasons for the development of dystrophy in children are very diverse. It can be caused by external and internal factors. The most common cause (external factor) is malnutrition, both quantitatively and qualitatively. A quantitative lack of food is often associated with malnutrition and can be from the first days of a child's life (lack of milk in the mother, the presence of tight or flat and inverted nipples, lethargy). Insufficiently active sucking is more often observed in, as well as those born in and with intracranial. Getting enough food can interfere with all sorts of congenital (non-closure of the upper and solid, etc.). Hypotrophy also develops as a result of a lack or absence of one of the important components of food (for example, protein, vitamins, salts), if their correct ratio is violated. Qualitative errors in nutrition are more common with mixed and artificial feeding. Of great importance are unfavorable environmental conditions (non-compliance with the sanitary and hygienic regime, lack of air, light, etc.), improper care. There are children in whom dystrophy has developed mainly as a result of a lack of appetite under the influence of improper introduction of complementary foods, drugs, and force-feeding. Infections and chronic diseases contribute to the development of dystrophy due to metabolic disorders and the activity of regulatory mechanisms. Under all these circumstances, the food that enters the body does not cover its needs; as a result, the child's own reserves are used up, which leads to depletion. During starvation, the activity of all body systems is perverted, a violation of all types of metabolism develops. Such children have reduced body resistance and they are prone to all kinds of diseases that are difficult for them and often cause death.

Clinic. The main manifestation of dystrophy (hypotrophy) is a decrease in the subcutaneous fat layer, first of all on the abdomen, then on the chest, back, limbs and later on the face. Happens. slowing down and even stopping weight gain, it becomes less than normal.

There are three degrees of malnutrition. Hypotrophy 1 degree characterized by a lag in weight by 10 - 15%, but the child has a normal. There is a decrease in the subcutaneous fat layer on the abdomen and partially on the limbs. The skin color remains normal or somewhat pale, the general condition is not disturbed.

At hypotrophy of the 2nd degree the weight of the child lags behind the norm by 20-30%, there is also a slight lag in growth (by 1-3 cm). The subcutaneous fat layer is reduced everywhere. The child is pale, the tissues are reduced, the skin is going into folds, the muscles are flabby. The general condition is disturbed, it decreases, the mood becomes unstable, the development of static and motor functions worsens or is delayed.

Hypotrophy 3 degrees characterized by a weight loss of more than 30%, severe wasting and stunting. The subcutaneous fat layer is absent, the eyes sink, wrinkles appear on the forehead, the chin is pointed, the face is senile. The muscles are flabby, retracted, the large fontanelle sinks, the conjunctiva and cornea of ​​the eyes are prone to drying out and ulceration, breathing is shallow, slow, weak, muffled. Appetite is reduced, but there is a tendency to diarrhea. Urination is reduced. Hypochromic anemia develops, with a sharp thickening of the blood, the amount also increases. Children are depressed, their voice is aphonic, the development of static and motor skills, speech is delayed.

The diagnosis of dystrophy in children (hypotrophy) is established on the basis of the anamnesis, appearance of the child, clinical examination data, weight, height.

Hypotrophy treatment- complex, taking into account the individual characteristics of the child, the conditions under which the disease developed. In severe forms - symptomatic, pathogenetic and stimulating therapy. It is especially important to properly prescribe nutrition. So, with hypotrophy of the 1st degree, it is necessary first of all to assign a child nutrition based on the weight that he should have according to his age. With a lack of breast milk, the mother is prescribed supplementary feeding with donor milk or mixtures. With artificial feeding, women's milk and mixtures are temporarily prescribed.

With malnutrition of the 2nd degree, women's milk or sour mixtures are prescribed at the rate of 2/3 or% of the amount required for the given age of the child (see). If the child's weight is reduced by 20%, then the total amount of food is calculated on the actual weight. If more than 20%, then the calculation is carried out on the average weight, that is, on the actual plus 20% of it. The lack of food volume is replenished with fruit and vegetable broths, 5% glucose solution,. The number of feedings increases to 7-8 times a day.

After 5-7 days, when the child's condition improves, the amount of food increases, but the calorie content should not exceed 130-150 calories per 1 kg of body weight. If necessary, carry out a correction with proteins, and (carefully) with fats.

Nutrition is especially carefully prescribed for malnutrition of the 3rd degree. The daily calculation of nutrition is carried out on an average weight between the due and actual. In the first days of treatment, regardless of age, only half of the required amount is prescribed and only women's milk. If it is impossible to provide the child with a sufficient amount of human milk, acid mixtures are given. The lack of food volume is replenished by liquid. An increase in the daily amount of food is carried out very carefully, even with a clear trend towards improvement. Caloric intake per actual weight should not exceed 180 calories per 1 kg of body weight. All children with malnutrition need vitamins and. To improve appetite, appoint 1 / 2-1 teaspoon 5 times a day or 1% solution diluted with before feeding, 0.2 g 2 times a day an hour after meals for 7-10 days. The appointment of anabolic hormones is shown (see). Measures to combat dehydration are carried out as in toxic dyspepsia (see Dyspepsia in children). In severe cases, plasma and blood transfusions are recommended.

Prevention. Proper organization of the general regimen and feeding.

Depends on the degree of the disease, reactivity and timeliness of treatment.

Hypotrophy in children is a chronic underweight. Starting from the stage of intrauterine development, for each age of the child there are standards for height and weight, deviations from which in one direction or another indicate a change in nutrition. Overweight in children - paratrophy is no better than malnutrition. The issue of an increase in the number of overweight children is very acute in world medical practice due to the fact that an increase in protein nutrition leads to rapid weight gain in a child of the first year of life. In the future, they risk getting metabolic syndrome.

If the causes of overweight lie in overeating (alimentary factor), then underweight is more often associated not with the fact that the child does not eat enough, but with absorption problems.

Since 1961, WHO has introduced the term "protein-energy malnutrition", but in Russia the lack of physical development, especially in newborns and young children, is referred to as malnutrition. The problem is aggravated by the fact that a long-term deficiency of a number of nutritional components, such as proteins, polyunsaturated fats, iron, microelements, leads to a violation of the child's mental abilities.

Depending on the time of occurrence, malnutrition is divided into prenatal and postnatal. Prenatal (prenatal) or congenital malnutrition is nothing more than intrauterine growth retardation syndrome (IUGR). It develops when there is a violation of the blood supply to the fetus through the uterus and placenta (fetoplacental insufficiency).

If the indicators of fetal development lag behind the standards by 14 days, they speak of 1 degree of developmental delay, 3-4 weeks - 2 degree and more than a month - 3 degree.

There are 3 options for expressing delayed fetal development:

• The hypotrophic variant is characterized by the body length corresponding to the gestational age and the circumference of the head, chest and abdomen below normal;
• The hypoplastic variant reflects the proportional, but reduced parameters of the child;
• With a dysplastic variant, malformations and deformities of the fetus are observed.

Postnatal (postpartum) malnutrition is divided into degrees in accordance with the lack of body weight. At 1 degree, the lack of body weight is 10-20%;

• At 2 degrees - 20-30%;
• At 3 degrees over 30%.

The actual weight of the child is compared with the weight, the calculation of which is carried out according to the tables of normal monthly weight gain. For example, body weight at birth 3700g, at the age of 3 months 5300g. According to the table, the child should gain 600 g + 800 g + 800 g in 3 months, a total of 2200 g. The normal body weight at 3 months for this child should be 5900 g.

The mass deficit is 5900–5300, that is, 600 g, which corresponds to 10% according to the proportion formula:

• 5900 – 100%;
• 600 - 10%, therefore, the child has hypotrophy of the 1st degree.

The reasons

The causes of prenatal and postnatal malnutrition are different. The following causes are characteristic of the fetal IUGR syndrome:

• maternal factor- diseases of the cardiovascular, broncho-pulmonary, urinary systems, smoking, alcoholism, drug use, malnutrition, insulin-dependent diabetes mellitus, multiple pregnancy, history of infertility and abortion, taking certain medications, chronic stress and other neuropsychic overload, transferred rubella, syphilis,.
• Placental causes associated with pathology of the placenta. Perhaps its underdevelopment, inflammation, low attachment, premature detachment, early aging. In recent years, antiphospholipid syndrome, that is, the formation of blood clots in the vessels of the placenta, has been attributed here.

• Socio-biological factors are also considered as the causes of congenital malnutrition. Occurs in young primiparous aged 15-17 years, in single women who give birth without a husband, in those who live in the highlands;
• Hereditary causes are associated with chromosomal and gene abnormalities.

All these reasons directly or indirectly impair uteroplacental blood flow, which disrupts the nutrition of the fetus and hypotrophy of newborns of varying severity.

Hypotrophy in young children is based on other causes:

• Exogenous - direct lack of basic food ingredients, malnutrition and problems that disrupt eating. For example, swallowing problems due to disorders of the nervous system or malformations of the face and jaws;
• Endogenous - there are 3 groups:
• Problems with digestion, absorption and retention of food eaten;
• A child’s disease when he needs increased nutrition (prematurity, chronic diseases of the pulmonary system, microbial and viral infections;
• Received from birth problems in metabolism.

With malnutrition in children, metabolism progressively worsens, which ultimately leads to stress, due to acidosis, and cell destruction.

Liver function suffers, humoral immunity decreases. The breakdown of adipose tissue destabilizes the cell membrane. The body rebuilds metabolic processes in order to direct energy to the brain. The entire digestive system suffers, the mucosa atrophies, the production of enzymes decreases, motility changes, local immunity decreases.

Symptoms

Symptoms of malnutrition in newborns depend on the variant of IUGR. It should be noted that even in modernly equipped perinatal centers, the mortality of newborns in the first 7 days of life in the case of a pronounced syndrome, despite the treatment, reaches 35%.

Children who have undergone IUGR have symptoms such as:

• Lagging behind in physical development (60%);
• Delayed psychomotor development (40%);
• Cerebral palsy;
• (12%).

The symptoms are less pronounced in the hypotrophic variant, the prognosis is more favorable, but the susceptibility to infectious diseases and pneumonia remains high in early childhood, especially up to a year.

The study of the long-term consequences of congenital malnutrition of newborns revealed symptoms of a decrease in intelligence at school age, neurological disorders, a tendency to develop hypertension, coronary heart disease, and diabetes mellitus.

1 degree

With hypotrophy of the 1st degree, the child has minor symptoms, confirming that the diet has been disturbed. The fat layer from the anterior abdominal wall disappears, skin turgor and muscle elasticity decrease, regurgitation is observed, sleep is disturbed, anxiety and fatigue are noted. At the same time, there is no lag in growth and deviations in mental development. The child is prone to frequent colds.

2 degree

When nutrition is disturbed at level 2, the following symptoms appear. Fat disappears from the whole body, except for the cheeks, skin and muscles are flabby, joints and bones are visible, the child has reduced or no appetite, irregular stools, undigested food in the feces. Due to beriberi, the growth of hair, nails, seizures in the corners of the mouth are disturbed, the child quickly overheats or cools down, frequent and prolonged colds, often naughty, restless.

3 degree

The 3rd degree of malnutrition in a child is the most severe, if it is not treated, he will die. The main symptoms include the disappearance of fat from the cheeks of the child, atrophy of the skin and muscles, disruption of the heart and breathing, decreased pressure, stunting, mental retardation, refusal to eat.

Pediatricians in practice use the calculation of the fatness index for newborns and children under one year old. Such a calculation is easy to do yourself. Measure the circumference of the shoulder, thigh and lower leg, find the sum, subtract the height of the child from it. Normally, in a child up to a year old, the index is 25–30 cm. With hypotrophy of the 1st degree, it is reduced to 10–15 cm, with the 2nd - below 10 cm.

Treatment

Fetal IUGR should be treated during pregnancy. The goal of treatment is to improve uteroplacental blood flow. For this, Curantil, Actovegin, vitamin and mineral complexes, including vitamins - antioxidants, are used. Treatment includes proper nutrition, fresh fruits and vegetables in sufficient quantities, protein diet, dairy products.

In some cases, depending on the severity of the condition of the fetus and the prognosis, the question of the advisability of maintaining pregnancy is decided.

It is not difficult to restore nutrition with 1 degree of malnutrition. In the children's clinic, they will make the necessary calculation of the amount of breast milk per day and one feeding. In case of hypogalactia, suitable breast milk substitutes will be prescribed, they will recommend the introduction of juices, cottage cheese. The frequency of feeding in such children should be increased to 7-8 per day.

Babies over one year old include cereals, fruits and vegetables in the diet. The appointment of drugs with 1 degree of malnutrition is not required.

Grade 2 requires the need to adjust diet and feeding, balance nutrition, prescribe medication that can be performed both at home and in the hospital.

Diet and nutrition should be age appropriate, the regime changes. Portions are reduced, but the frequency of eating becomes more frequent. Treatment is carried out with biological stimulants, digestive enzymes, vitamin and mineral complexes.

Just adjusting your diet is not enough. The baby receives complex infusion therapy and parenteral and enteral feeding through a tube.

Treatment of the 3rd degree of malnutrition is aimed at maintaining and correcting the vital functions of the body and includes transfusion of blood, plasma, glucose, the introduction of enzymes and hormones.

There is a fight against dehydration, electrolyte imbalance, acid-base balance. The tube feeding diet includes a specially designed milk-protein mixture, devoid of lactose, but with the addition of fats, including PUFAs (Alfare). When removed from a serious condition, rickets and anemia begin to be treated. In the future, a diet appropriate for age is drawn up. During the period of convalescence, treatment with non-specific immunomodulators is carried out.

Prevention

Prevention has always been and remains preferable and more economical than cure. Prevention of malnutrition in children consists in adequate breastfeeding, the timely introduction of supplementary feeding and complementary foods, and proper care of the baby.

Oddly enough, but prevention should begin from the childhood of future parents. A balanced diet, physical education and sports, work and rest regimen, sleep, avoidance of stress, rejection of bad habits, timely sanitation of foci of infection, personal and intimate hygiene, planned pregnancy and conducting it under the supervision of a specialist in compliance with all recommendations - effective prevention of complications and the birth of a healthy child.

Very often in children there is a pathological malnutrition, which is accompanied by a small increase in body weight compared to the norm in relation to age and height. If this gap is more than 10%, malnutrition is diagnosed, which most often manifests itself before 3 years.

In pediatrics, this disease is considered as an independent type of dystrophy. Since malnutrition in young children is accompanied by very serious disorders in the body (failure of metabolic processes, decreased immunity, lag in speech and psychomotor development), it is important to identify the disease in a timely manner and begin treatment.

Correctly identified causes of malnutrition will help doctors prescribe the best treatment in each case. Factors of the prenatal or postnatal period can lead to a pathological malnutrition of a child.

Intrauterine malnutrition:

• unfavorable conditions for the normal development of the fetus during its gestation (bad habits of a woman, malnutrition, non-compliance with the daily regimen, environmental and industrial hazards);
• somatic diseases of the expectant mother (diabetes mellitus, nephropathy, heart disease, hypertension) and her nervous breakdowns, constant depression;
• pregnancy pathologies (, toxicosis, premature birth, placental insufficiency);
• intrauterine infection of the fetus, its hypoxia.

Extrauterine malnutrition:

• congenital malformations up to chromosomal abnormalities;
• fermentopathy (, lactase deficiency);
• immunodeficiency;
• constitutional anomaly;
• protein-energy deficiency due to poor or unbalanced nutrition (underfeeding, sucking difficulties with flat or inverted nipples in the mother, hypogalactia, insufficient amount of milk formula, abundant regurgitation, micronutrient deficiency);
• poor nutrition of a nursing mother;
• some diseases of the newborn do not allow him to actively suckle, which means - to eat fully: cleft palate, congenital heart disease, cleft lip, birth trauma, perinatal encephalopathy, cerebral palsy, pyloric stenosis, alcohol syndrome;
• frequent SARS, intestinal infections, tuberculosis;
• unfavorable sanitary and hygienic conditions: poor child care, rare exposure to the air, rare bathing, insufficient sleep.

All these causes of childhood malnutrition are closely interrelated, have a direct impact on each other, thus forming a vicious circle that accelerates the progression of the disease.

For example, due to malnutrition, malnutrition begins to develop, while frequent infectious diseases contribute to its strengthening, which, in turn, leads to malnutrition and weight loss by the child.

Classification

There is a special classification of malnutrition in children, depending on the lack of body weight:

1. Hypotrophy of the 1st degree is usually detected in newborns (in 20% of all infants), which is diagnosed if the child's lag in weight is 10–20% less than the age norm, but growth rates are absolutely normal. Parents should not worry about such a diagnosis: with timely care and treatment, the baby recovers in weight, especially when breastfeeding.
2. Hypotrophy of the 2nd degree (average) is a decrease in weight by 20–30%, as well as a noticeable lag in growth (by about 2–3 cm).
3. Hypotrophy of the 3rd degree (severe) is characterized by a lack of mass, exceeding 30% of the age norm, and a significant lag in growth.

The above three degrees of malnutrition suggest different symptoms and treatments.

Symptoms of childhood malnutrition

Usually, the symptoms of malnutrition in newborns are determined already in the hospital. If the disease is acquired, and not congenital, attentive parents, according to some signs, even at home will be able to understand that their child is sick. Symptoms depend on the form of the disease.

I degree

• satisfactory state of health;
• neuropsychic development is quite consistent with age;
• loss of appetite, but within moderate limits;
• pale skin;
• reduced tissue turgor;
• thinning of the subcutaneous fat layer (this process begins with the abdomen).

II degree

• impaired activity of the child (excitation, lethargy, lag in motor development);
• poor appetite;
• pallor, peeling, flabbiness of the skin;
• decreased muscle tone;
• loss of tissue turgor and elasticity;
• disappearance of the subcutaneous fat layer on the abdomen and limbs;
• dyspnea;
• tachycardia;
• frequent otitis, pneumonia, pyelonephritis.

III degree

• severe exhaustion;
• atrophy of the subcutaneous fat layer on the entire body of the child;
• lethargy;
• lack of response to banal stimuli in the form of sound, light and even pain;
• a sharp lag in growth;
• neuropsychic underdevelopment;
• pale gray skin;
• dryness and pallor of the mucous membranes;
• muscles atrophy;
• loss of tissue turgor;
• retraction of the fontanel, eyeballs;
• sharpening of facial features;
• cracks in the corners of the mouth;
• violation of thermoregulation;
• frequent regurgitation, vomiting, diarrhea, candidal stomatitis (thrush);
• alopecia (baldness);
• hypothermia, hypoglycemia or may develop;
• infrequent urination.

If malnutrition is detected in a child, an in-depth examination is carried out to clarify the causes of the disease and appropriate treatment. For this, consultations of children's specialists are appointed - a neurologist, a cardiologist, a gastroenterologist, a geneticist, an infectious disease specialist.

Various diagnostic studies are carried out (ECG, ultrasound, EchoCG, EEG, coprogram, biochemical blood test). Based on the data obtained, therapy is already prescribed.

Treatment of the disease

On an outpatient basis, treatment of malnutrition of the I degree in young children is carried out, inpatient - II and III degrees. The main activities are aimed at:

• normalization of nutrition;
• diet therapy (gradual increase in calorie content and volume of food consumed by the child + fractional, frequent feeding);
• compliance with the regime of the day;
• organization of proper child care;
• correction of metabolic disorders;
• drug therapy (enzymes, vitamins, adaptogens, anabolic hormones);
• in the presence of a severe form of the disease, intravenous administration of glucose, protein hydrolysates, vitamins, saline solutions is prescribed;
• massage with elements of exercise therapy.

With timely treatment of the disease of I and II degrees, the prognosis is favorable, but with hypotrophy of the III degree, a lethal outcome is noted in 50% of cases.

Prevention methods

Prevention of malnutrition in children involves a weekly examination by a pediatrician, constant anthropometry and nutritional correction. You need to think about the prevention of such a terrible disease even while carrying a baby:

• observe the daily routine;
• eat on time;
• correct pathologies;
• exclude all adverse factors.

After the birth of the crumbs, an important role is played by:

• high quality and balanced;
• timely and correct introduction of complementary foods;
• body weight control;
• rational, competent care of the newborn;
• treatment of any, even spontaneously occurring concomitant diseases.

Having heard such a diagnosis as malnutrition, parents should not give up. If the child is provided with normal conditions for the regimen, care and nutrition, quick and effective treatment of possible infections, severe forms can be avoided.