Treatment of malnutrition in children. Hypotrophy (1,2,3 degrees). Removal of a child from a pathological state

Word of Greek origin; "hypo" - "below, under" and "trophe" - "food". Hypotrophy is a chronic eating disorder. The basis of the disease is the depletion of the body. This term is used only in relation to the child of the first years of life. From this article you will learn what degrees of malnutrition exist in children. We will also tell you all about the causes of malnutrition in children, the treatment of malnutrition in a child and the preventive measures that you can take to protect your baby from the disease.

Causes of malnutrition in children

Hypotrophy is a chronic eating disorder, accompanied by a violation of the trophic function of the body, digestion, metabolism, dysfunction of various organs and systems with a delay in physical, motor-static and neuropsychic development.

There are congenital malnutrition or prenatal, in the development of which factors that act unfavorably during uterine development play a role, and acquired malnutrition (postnatal), which develops in children born with normal weight and body length. This form of malnutrition in infants and young children can develop as a result of exposure to a number of adverse factors.

Etiology of malnutrition

There are three main factors: alimentary, infectious, constitutional.

Alimentary factor in the development of dystrophy, it can manifest itself as quantitative or qualitative starvation, defects in the organization of the child's nutrition.

Quantitative fasting, as the name itself shows, there is a condition when the child receives insufficient breathing volume and the energy value of food. At present, in children of the first months of life, malnutrition can develop due to hypogalactia, with difficulties in breastfeeding the mother (“tight” breast of the mother, flat and inverted nipple), sluggish sucking, errors in feeding technique, with an early transfer of the child, artificial feeding, due to untimely introduction of complementary foods, "habitual" regurgitation and vomiting.

Quality fasting occurs when an incorrect ratio of individual ingredients (proteins, fats and carbohydrates) is observed in the child’s food, due to the inferiority of the qualitative composition of breast milk, monotonous feeding with the introduction of complementary foods (especially cereals), with a deficiency of proteins and fats, a deficiency of vitamins and minerals (untimely and insufficient introduction of vegetable and fruit juices, vegetable complementary foods).

In recent years, toxic factors have been important in the etiology of malnutrition - these are food contamination with salts of heavy metals (lead, arsenic), pesticides that react with sulfhydryl groups of protein molecules, inhibit protein synthesis, and cause inhibition of enzymatic activity. Toxic factors cause variants of dystrophy with primary metabolic disorders in the cell. Hypotrophy can be caused by hypervitaminosis A and D.

infectious factor- acute and chronic gastrointestinal infections (salmonellosis, coli infection, dysentery, etc.), chronic infections (tuberculosis, syphilis, dysentery), frequent acute respiratory viral infections, pyelonephritis and urinary tract infection, HIV infection. In infections, toxins, metabolic products lead to a violation of intracellular metabolism, the development of hypovitaminosis (qualitative starvation also occurs), and a decrease in appetite (quantitative starvation also appears).

constitutional factor in the etiology of malnutrition, these are congenital anomalies of the gastrointestinal tract, congenital heart defects, immunodeficiency states, enzymopathies (a group of diseases caused by hereditary metabolic defects), diseases of the endocrine system, perinatal encephalopathies of various origins. Congenital anomalies of the gastrointestinal tract include: dolichosigmoid, Hirschsprung's disease, atresia of the bile ducts, pylorospasm, congenital defects: splitting of the hard palate, non-closure of the upper lip. Diseases of the endocrine system include adrenogenital syndrome, hypothyroidism, diabetes mellitus, pituitary dwarfism.

With constitutional factors in the development of malnutrition, insufficient digestion of food is observed in terms of both quantity and quality due to a violation of the functional properties of body cells.

At present, malnutrition at birth as a manifestation of intrauterine growth retardation is of independent importance in the etiology of malnutrition.

Hypotrophy pathogenesis

A lack of food or a qualitative change in it leads to a disruption in the processes of assimilation (intracavitary hydrolysis, membrane digestion and absorption are disturbed), to a distortion of enzymatic reactions, to malnutrition of vital organs, and above all the central nervous system. Due to dysfunction of the central nervous system, dysfunction of the subcortical areas of the brain occurs, which leads to aggravation of trophic disorders. Thus, the main pathogenetic link of malnutrition is intracellular starvation. With insufficient nutrition, the body begins to use its depots to maintain the basal metabolism and the specific dynamic action of food. First of all, the glycogen depot begins to be utilized, however, it is restored by switching to the consumption of energy fat, therefore, first of all, a decrease in fat depot is observed. With a longer exposure to a harmful factor on the body, the fat depot is used up and glycogen cannot be replenished in the absence of fat, the glycogen depot gradually decreases, and then the body begins to use its own proteins. With a protein deficiency in the child's diet, there is an increase in protein-energy deficiency, growth retardation due to a decrease in the synthesis of liver somatomedins, aggravation of enzyme disorders and damage to immunological mechanisms, aggravation of weight loss, atrophic processes.

With protein deficiency, atrophy of the thymus and lymphoid tissue, a decrease in the number of T-lymphocytes, a violation of the bactericidal and phagocytic function of neutrophils are observed. The content of immunoglobulins in blood serum decreases, especially IgM and IgA. Violation of cellular, weakening of humoral immunity cause a high frequency and severe course of bacterial and other infections in patients with malnutrition, the development of septic and toxic-septic conditions in them. Simultaneously with the consumption of glycogen and protein depot, the body gradually utilizes the vitamin depot, which leads to the development of hypo- or beriberi.

With the consumption of endogenous proteins, a violation of the functions of the endocrine glands occurs: a decrease in the function of the thyroid gland (decrease in the level of basal metabolism), the pituitary gland (growth disturbance), and the insular apparatus of the pancreas. As a result of metabolic shifts, the acid-base balance is disturbed, metabolic acidosis and endogenous toxicosis develop.

Under conditions of violation of enzymatic processes in the body, a decrease in the activity of many enzymes in the blood and cells, tissues, lipid peroxidation is enhanced. Lipid peroxides have a toxic effect on the body of a sick child, damage the membranes of cells and their organelles. As a result, destabilization of cell membranes develops, their barrier function worsens, a change in the constancy of the internal environment of the body enhances the dysfunction of organs and systems. In most children with malnutrition, there is a violation of the intestinal biocenosis, most often caused by Proteus microbes, Klebsiella and their associations with hemolytic Escherichia coli, fungi of the genus Candida.

Causes of malnutrition in a newborn

Among the reasons are improper feeding, especially in infants of the first six months of life, poor-quality care for them, constant violations of the daily routine or lack of a daily routine as such, frequent illnesses of the baby (acute infectious diseases, chronic infections, acute gastrointestinal diseases, etc.). P.)

Among the causes in the first place are infectious and nutritional factors, then anomalies of the gastrointestinal tract, hereditary metabolic disorders.

The cause of malnutrition in a child: congenital factors

Hypotrophy in little girls and boys can be congenital (intrauterine), due to the impact on the fetus of various factors, accompanied by circulatory disorders in the placenta, intrauterine infection of the fetus:

• diseases and occupational hazards in the mother during pregnancy,
• gestosis and toxicosis,
• malnutrition,
• smoking and alcohol consumption during pregnancy,
• mother's age is over 35 and under 20 years old.

Cause of malnutrition in a child: feeding

When breastfeeding, the most common cause is malnutrition, due to a lack of milk from the mother or due to sluggish suckling at the breast. The reason for the development of malnutrition during artificial feeding may be a violation of the balance of nutrition in terms of calorie content or chemical composition of food. For example, with one-sided milk feeding (kefir, milk), the baby receives an excess of proteins and salts and a lack of carbohydrates. At the same time, the baby is constipated, the stool becomes clay and fetid. The predominant feeding of children with cereals in diluted milk causes the so-called mealy eating disorder associated with an excess of carbohydrates and a lack of proteins and salts (the stool becomes liquid).

With the disease, the function of the digestive organs decreases, changes occur in protein, fat, carbohydrate, water-salt and vitamin metabolism, anemia develops, immunity changes and various infections accumulate.

The reason why hypotrophy occurs in a child:

1. Sometimes muscle hypotrophy occurs in healthy babies who lead a sedentary lifestyle, with limited mobility in the postoperative period or severe somatic pathology.
2. Muscle atrophy accompanies flaccid paralysis, in particular, arising from the paralytic form of poliomyelitis. The causes of muscle atrophy lie in hereditary degenerative diseases of the muscular system, chronic infections, metabolic disorders, disorders of the trophic functions of the nervous system, prolonged use of glucocorticoids, etc. Local muscle atrophy can form with prolonged immobility associated with diseases of the joints, damage to tendons, nerves, or the muscles themselves.

There are three degrees of malnutrition - I, II, III.

Hypotrophy of the 1st degree in babies is marked by a lag in weight of no more than 20%; there is no lag in growth. The subcutaneous fat layer is preserved everywhere, however, it is somewhat thinned on the trunk and limbs. The elasticity of the skin is slightly lower than that of a healthy baby. The skin and visible mucous membranes may be slightly pale. The general condition does not suffer.

Hypotrophy of the 2nd degree in children there is a lag in weight from 20 to 40%; there is also a lag in growth - up to 3 cm. The skin is dry, inelastic, easily gathers into thin folds, and these folds are poorly straightened. The subcutaneous fat layer is largely thinned on the trunk, buttocks and limbs. Weight loss becomes noticeable on the face. Muscles also become thinner, their tone is disturbed. If the baby had any motor skills by this time, they may disappear. Appetite can be sharply reduced or, conversely, very well expressed.

A child with III degree hypertrophy is characterized by a very significant lag in weight - by 40% and more; also significantly stunted. The subcutaneous fat layer in the baby is absent everywhere, this layer is also absent on the face, which is why the latter takes on the appearance of an senile face - the eyes sink (because the fat in the eye sockets disappears), wrinkles form on the forehead and cheeks, cheekbones stand out, the chin is sharpened, resulting in a face takes on a triangular shape. Often you can see the expression of suffering on the face.

Clinical signs of malnutrition: the baby's skin completely loses elasticity, becomes dry, flaky; over time, trophic disorders appear on the skin - ulcers form on the back of the head, buttocks and in other places. On the trunk and limbs the skin hangs in folds. The muscular system also undergoes significant changes: the muscles become thin and flabby, however, their tone is increased. The tummy can be sharply swollen due to intestinal atony and flatulence, or, on the contrary, drawn in.

Hypotrophy treatment

The treatment is complex. Very important: high-quality care for the baby by the mother, strict observance of the daily routine, proper nutrition, appropriate for age, proper upbringing. It is necessary to eliminate the factor and cause that led to the disease as soon as possible. If necessary, therapy is carried out to increase appetite. Of great importance is the speedy restoration of the normal functioning of all organs and systems. In some cases, the doctor resorts to stimulation therapy. If malnutrition in a baby arose due to improper feeding, due to serious violations of the rules for the introduction of complementary foods, due to monotonous nutrition, the doctor makes adjustments to baby food.

Caring for a child during treatment for malnutrition

Patients with hypotrophy of the first degree are treated at home under the supervision of a district pediatrician without changing the usual regimen corresponding to their age.

Treatment of malnutrition in children of II and III degrees is carried out in a hospital with a mandatory organization of a sparing regimen: the child should be protected from all unnecessary stimuli (light, sound, etc.) It is desirable to keep the child in a box with the creation of an optimal microclimate (air temperature 27-30 ° C , humidity 60-70%, frequent airing); the mother is hospitalized with the child. During walks, the child should be held in his arms, make sure that the hands and feet are warm (using heating pads, socks, mittens). An increase in emotional tone should be achieved by gentle treatment of the patient, the use of massage and gymnastics. With malnutrition of the III degree, especially with muscle hypertonicity, massage is carried out with great care and only stroking.

Diet for malnutrition in children

Diet is the basis of rational treatment of dystrophy (primarily malnutrition). Diet therapy for the treatment of malnutrition can be divided into two stages:

• clarification of the tolerance of various foods;
• a gradual increase in the volume of food and correction of its quality until the physiological age norm is reached.

The first stage lasts from 3-4 to 10-12 days, the second - until recovery.

1. "Rejuvenation" of the diet - the use of food products intended for boys and girls of younger age (breast milk, sour-milk adapted mixtures based on protein hydrolysates);
2. Fractional nutrition - frequent feeding (for example, up to 10 times a day for grade III disease) with a decrease in the amount of food at one time;
3. Weekly calculation of the food load by the amount of proteins, fats and carbohydrates with correction in accordance with the increase in body weight;
4. Regular monitoring of the correctness of treatment (keeping a food diary indicating the amount of food, fluids drunk, diuresis and stool characteristics; compiling a "weight curve", scatological examination, etc.)

How is malnutrition treated in children using nutrition calculation?

The calculation of nutrition for malnutrition of the I degree is performed for the proper (age-appropriate) body weight of the child with full satisfaction of his needs for the main components of food, trace elements and vitamins. In case of disease II and III degrees in the first 2-3 days, the volume of food is limited to 1/3 - 1/2 for the required body weight. Subsequently, it is gradually increased to 2/3 - 3/5 of the daily diet of a healthy child. The missing amount of nutrition is replenished with liquid - vegetable and fruit juices, 5% glucose solution. Upon reaching the age-appropriate amount of food, the amount of proteins and carbohydrates is calculated for the required body weight, and fats for the actual one. If the child does not have dyspepsia in the process of increasing the amount of food, and the body weight increases (usually this happens after 1-12 days from the start of treatment), a qualitative correction of nutrition is gradually carried out, all ingredients are calculated on the proper body weight (proteins and fats - 44.5 g/kg, carbohydrates - 1316 g/kg).

Enzyme therapy for the treatment of malnutrition in a child

Enzymes must be prescribed for any degree of the disease, both due to an increase in the nutritional load during treatment, and in connection with a decrease in the activity of the patient's own gastrointestinal enzymes. Enzyme therapy is carried out for a long time, changing drugs: rennet (abomin), pancreatin + bile components + hemicellulase (festal), with a large amount of neutral fat and fatty acids in the coprogram - pancreatin, panzinorm. The use of vitamins, primarily ascorbic acid, pyridoxine and thiamine, is also pathogenetically justified. Stimulant therapy includes alternating courses of royal jelly (apilac), pentoxyl, ginseng and other agents. With the development of an infectious disease, Ig is injected.

Prevention of malnutrition

It is easier to prevent the causes of malnutrition than to treat it later. The preventive measures are as follows:

• organization of proper child care;
• strict observance of the diet;
• timely and sufficient intake of vitamins;
• hardening procedures (hardening with air, sunlight and water);
• proper upbringing of the baby (provides a positive emotional state);
• also ensures the restoration and development of the necessary conditioned reflexes);
• prevention of infectious diseases.

Prevention of malnutrition should be divided into antenatal and postnatal.

1. Antenatal prevention includes family planning, health education of parents, the fight against abortion, treatment of diseases of the expectant mother, especially diseases of the genital area, health care of the pregnant woman [rational nutrition, daily routine, outdoor walks, transfer to light work (under adverse working conditions) , exclusion of smoking and other bad habits].
2. Postnatal prevention of malnutrition includes natural feeding with its timely correction, compliance with the regimen and rules for caring for the child, proper education, prevention and treatment of infectious and intercurrent diseases, dispensary observation with monthly (up to 1 year) weighing and measuring body length.

Treatment prognosis malnutrition depends primarily on the possibility of eliminating the cause that led to the development of dystrophy, as well as on the presence of concomitant diseases. With primary alimentary and alimentary-infectious dystrophy, the prognosis is quite favorable.

Nutrition for children with malnutrition

The basis of treatment for all forms of malnutrition is the organization of proper nutrition. The complexity of nutrition lies in the fact that their need for essential nutrients and calories is increased, and food tolerance, especially to fats, is reduced. Therefore, the success of treatment depends on an individual approach to each sick child.

Nutrition in the treatment of malnutrition I degree

The first feeding for full-term infants with congenital malnutrition of the 1st degree should be carried out immediately in the delivery room, for premature infants, depending on the degree of prematurity, no later than 12 hours after birth. In between feedings, be sure to give your baby 5% glucose (1/4 of the total amount of food).

The volume of breast milk per feeding for newborns and premature infants with disease of the I degree is 10 ml on the first day, 15-20 ml on the 2nd, 20-30 ml on the 3rd, 5-7th days - 50-90 ml.

Nutrition during the treatment of malnutrition II - III degree

With malnutrition II - III degree, sluggish sucking or refusal to feed, they begin to feed from 1/3-1/2 of the volume needed at this age, gradually increasing the amount of milk to normal.

The daily amount of food for newborns aged 2 to 8 weeks should approximately be 1/5 of the actual body weight, from 2 to 4 months - 1/5 - 1/6, from 4 to 6 months - 1/7, from 6 up to 9 months - 1/8 part.

• In the first months of life, a person suffering from malnutrition is prescribed 7-8 feedings per day, from 3-4 months - 6, from 5 months, if the condition allows - 5. During the first 2-3 months of a baby’s life, breast milk should be provided, and when it absence - adapted mixtures, preferably acidophilic and sour-milk. Protein correction is carried out with cottage cheese, kefir, fat correction - with vegetable oil, introduced into complementary foods. Carbohydrates are corrected with sugar syrup, fruit juices, purees.
• Complementary foods are introduced against the background of positive body weight dynamics in the absence of acute concomitant diseases during the treatment period. It is necessary to carefully observe the principle of gradualness with the introduction of each new type of food. Fruit juices are prescribed at 2 months, fruit puree - from 2.5 months. Juices are administered gradually: at first a few drops, and by 2-3 months their volume is adjusted to 30 ml.
• Children diagnosed with malnutrition and who are breastfed from 3 months old can be given egg yolk as a product containing complete protein, fat, mineral salts - calcium, phosphorus, iron, vitamins A, D, B1, B2, PP. You should start with 1/8 of the yolk and gradually increase the serving to half the yolk per day.
• From the age of 4 months, cottage cheese must be included in the diet of a patient with malnutrition. If the child did not receive it at an earlier date for the purpose of correction and treatment, then the input begins with 5 g (half a teaspoon), gradually increasing the dose by 6-7 months to 40 g.
• At the age of 3.5 months with natural and 2.5 months with artificial feeding, if the condition allows, complementary foods are introduced in the form of cereals - starting with 5%, then 8% and finally 10% concentration. It is preferable to use buckwheat, rice flour. Approximately one month after the introduction of porridge, they begin to introduce vegetable puree, starting with 1-3 teaspoons and increasing the portion within 10-12 days to 100-150 g. Canned vegetable purees from various vegetables for baby food can be used for feeding.
• From 4 months of life, vegetable oil should be introduced into the diet of a child with malnutrition (starting with 1 g and increasing the portion by 8-9 months to 5 g), from 5 months - butter (starting from 2 g and increasing the portion to 5 g by 8 months), from 7 - 7.5 months add meat (mainly beef) in pureed form (starting with 5 g and increasing the portion to 30 g per day, and by 9 months - up to 50 g, by the year - up to 60 - 70 g).
• At 7 months, add meat broth (20-30 ml) with white crackers (2-3 g). The broth should be given in the afternoon feeding before the vegetable puree.

Feeding a baby with malnutrition, which has developed against the background of hereditary metabolic disorders, is built taking into account its cause:

• In the treatment of celiac disease, products containing gluten are excluded: wheat flour, semolina, starch;
• The main method of treating a baby with lactose deficiency is the exclusion from the diet of milk (including mother's) and dishes prepared with fresh milk. These children should be given fermented milk products: acidophilic mixtures, kefir, acidophilic milk, low-lactose mixtures;
• In cystic fibrosis, a diet with a restriction of fat and an increase in protein is prescribed. The need for fats should be covered mainly by vegetable oils (corn, sunflower), rich in unsaturated fatty acids.

Now you know everything about the causes, degrees and methods of treating malnutrition in young children.

This condition is observed in children at an early age. The most common cause of malnutrition is lack of protein in the diet, as well as low nutritional and energy value of products.

Hypotrophy is the most common type of dystrophy, which affects children in the first 2-3 years of life. High mortality among children of this age in the past has been associated with malnutrition. Now, thanks to an increase in the social standard of living and the emergence of effective drugs, cases of malnutrition have become a rarity.

If we consider the problem of hunger globally, then it still remains relevant in many countries of the world, where it is a mass disease. The prevalence of this phenomenon varies in different countries from 2 to 30% and directly depends on the social and economic condition of the population.

From the moment of birth, children are rapidly gaining body weight, along with it all the internal organs and bone tissue of the skeleton grow. In the early years Nutrition plays an important role in the development of a child. If the diet is poor or nutrition is insufficient, then the child shows signs of changes in the functioning of internal organs and systems. Lack of weight affects the functioning of the digestive organs, which leads to problems with the absorption of vitamins and nutrients. A lack of weight of more than 10% in comparison with the norm is a reason to talk about malnutrition.

CAUSES

The development of malnutrition is influenced by many reasons, in addition, this condition can be accompanied by other diseases.

With insufficient intake of nutrients into the body, they speak of the exogenous origin of the syndrome. In the event that the body is not able to absorb a sufficient amount of food, they indicate the endogenous nature of malnutrition.

Exogenous causes of malnutrition:

• underfeeding or overfeeding;
• unbalanced diet (alimentary factors);
• acute infectious processes;
• low social status of the family;
• wrong mode.

Endogenous causes of malnutrition:

• malformations of the digestive organs and other systems;
• endocrine pathologies;
• neuroendocrine diseases;
• metabolic diseases;
• congenital enzymopathies;
• malabsorption in the intestine;
• chromosomal abnormalities.

CLASSIFICATION

Hypotrophy is systematized in several directions.

Classification of malnutrition depending on the period of occurrence:

• congenital(prenatal, or intrauterine). At the heart of its development is a pathological change in utero-placental metabolism. Intrauterine malnutrition causes oxygen starvation of the fetus, metabolic disorders and entails a delay in the development of the child.
• Acquired(postnatal). Of primary importance is the protein and energy deficiency caused by poor nutrition, pathological disorders in the process of digestion and absorption. The child does not compensate for the energy costs for growth and development, which should come with nutrients.
• mixed the form indicates the accession to congenital factors, infectious, social and alimentary causes after the birth of the child.

Classification of malnutrition according to the severity of underweight:

• I degree - easy;
• II degree - medium;
• III degree - severe.

The division of malnutrition into degrees of severity is necessary for a correct assessment of the child's condition and for planning therapeutic measures.

SYMPTOMS

Symptoms depend on the severity of the syndrome:

• I degree. Signs of lagging behind the optimal body weight are at the level of 10-20%. There is a slight loss of subcutaneous fat in the abdomen. The general condition of the child is satisfactory. noted loss of appetite, pallor, decreased muscle tone and sleep disturbance.
• II degree. Has a pronounced symptomatic picture. The lack of growth is 2-4 cm, and the deficit of weight is in the range of 20-30%. The child has weakness and apathy, dry skin, its peeling and some swelling. Microcirculation is disturbed, and a thin layer of subcutaneous tissue is concentrated only in the face area. These symptoms are accompanied by nausea, vomiting, and loose stools. When listening to the heart, muffled tones and are noted. Respiratory function is disturbed and pressure decreases.
• III degree. A weight deficit of more than 30% is fraught with developmental delay and serious conditions. There is a high risk of anorexia. In addition, the child loses previously acquired skills. His skin integument is pale, dry, subcutaneous tissue is absent. Muscle atrophy is observed, symptoms of dehydration occur, cardiac activity decreases, and body temperature drops below normal.

DIAGNOSTICS

When diagnosing malnutrition, several important points must be considered. One of the indicators of probable deviations are changes in the work of organs and systems.

Clinical signs for the detection of malnutrition:

• trophic changes;
• thinning of the fat layer under the skin;
• indigestion;
• metabolic change;
• disturbances in the work of the central nervous system.

One of the main criteria is the thickness of the subcutaneous fat layer: the smaller it is, the more pronounced hypotrophy.

Differentiation of the syndrome is made with diseases, the symptoms of which are manifested by a decrease in body weight, small stature and a lag in the physical development of the child. These include nanism, or growth hormone deficiency. With this disease, there are no trophic changes, the subcutaneous tissue is not thinned, and the size of the organs corresponds to the size of the body.

The nature of feces is one of the signs of the severity of the pathological condition. Insufficient protein in the child's diet leads to the fact that to compensate for its deficiency, the body uses internal reserves in the form of its own muscle tissue and fat layer. One of the metabolic products in this case is ammonia, which gives the urine a characteristic odor. With the help of laboratory blood tests, it is possible to detect a decrease in the number of red blood cells and hemoglobin, a lack of vitamins, trace elements, and abnormalities in the liver.

In case of complications from the internal organs, such methods of instrumental diagnostics as an electrocardiogram of the heart and an electroencephalogram of the brain are used.

Ultrasound examination is used in the examination of internal organs and to detect intrauterine malnutrition during pregnancy based on anthropometric indicators.

When making a diagnosis, the doctor assesses the living conditions, the social and material condition of the family, and also interviews parents for genetic pathologies. As a rule, the diagnosis of malnutrition is not difficult, problems can arise when identifying the causes of this condition.

TREATMENT

Treatment of malnutrition is a whole range of measures aimed at eliminating its root cause and restoring the normal functioning of the body. Treatment of mild malnutrition is carried out on an outpatient basis, for treatment of moderate and severe degrees, hospitalization is necessary.

Therapeutic measures for malnutrition:

• elimination or regulation of the etiological factor;
• diet therapy;
• elimination of chronic foci of infection;
• organization of a rational regime;
• compliance with the rules of child care;
• prescribing medications;
• vitamin therapy, the use of enzymes (symptomatic treatment);
• massage, physiotherapy.

Diet therapy deserves special attention. It is carried out in two stages: at the first, food tolerance is clarified, and then there is an increase in the volume of food and its calorie content to the required standards. Meals are frequent and fractional - 7-10 meals a day in small portions.

In severe cases of malnutrition, when the child is not able to eat independently, feeding is done through a tube. If the gastrointestinal tract is not able to take food due to any internal damage, parenteral nutrition is used, which consists in the intravenous administration of nutrient solutions, electrolytes and minerals. When cases of intrauterine fetal hypotrophy are detected, the nutrition of the expectant mother is corrected.

In children, drug treatment of malnutrition is aimed at maintaining the normal functioning of the body in children and depends on the complications that have arisen.

A decrease in the functional activity of the digestive organs requires the appointment of enzymatic preparations to replace the deficiency of gastric juice and pancreatic enzymes. Perhaps the appointment of immunomodulators, probiotics and antibiotics. Symptomatic therapy is aimed at treating anemia, reducing excitability and prescribing stimulant drugs.

An essential component of treatment is vitamin therapy. First, B vitamins and vitamin C are administered intramuscularly, and then they are transferred to their enteral use. Later, a course of taking multivitamin preparations is prescribed.

COMPLICATIONS

Considering the possible negative consequences of malnutrition, it is necessary to take into account the stage of development of the disease. So, the mild severity of malnutrition does not affect the health of the child. Being underweight can lead to tendency to hypothermia, but with proper care and good nutrition, these factors are easily leveled.

Serious complications are often associated with a predisposition to infectious processes and the development of comorbidities.

Complications of malnutrition:

• protracted colds and viral diseases;
• chronic fetal hypoxia;
• newborns;
• hemorrhagic disease of the newborn;
• inflammation of the large and small intestines (enterocolitis);
• blood poisoning ();
• vitamin D deficiency ();
• anemia;
• pneumonia;
• inflammation of the middle ear;
• mental retardation.

PREVENTION

Preventive measures are relevant from the moment of pregnancy. They include the proper nutrition of a woman, adherence to the regimen, as well as the exclusion of any negative effects on the fetus.

After the baby is born, special attention should be paid to nutritional quality of a nursing mother. It is necessary to monitor the weight of the child monthly and introduce complementary foods in a timely manner. Natural feeding with mother's breast milk is a priority, as it contains all the necessary substances for the normal development of the baby. With a shortage of mother's milk, the child is supplemented with specially selected artificial mixtures.

To prevent the development of malnutrition will help constant monitoring of the child's health for the development of infectious diseases, and diseases of the gastrointestinal tract. Walking in the fresh air, sun exposure and hardening are also effective measures to prevent malnutrition.

PROGNOSIS FOR RECOVERY

The prognosis for malnutrition depends on the factors that caused the exhaustion of the child, as well as on the nature of feeding, concomitant diseases and age.

With mild to moderate malnutrition favorable prognosis. In severe cases mortality reaches 30%. The outcome of the disease depends on how effectively it is possible to avoid secondary infection. Prolonged malnutrition is dangerous for the development of mental retardation in the future in infants.

A child's chances of recovery in severe cases depend on their age. Concomitant malformations significantly worsen the prognosis, improve - a prosperous environment and full-fledged home care after a stay in a hospital.

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Treatment of malnutrition should be aimed at eliminating the primary disease, as well as secondary infections, otherwise it cannot be effective.

Treatment of sick children with malnutrition should be comprehensive. It includes: identifying the cause and eliminating it; diet therapy, organization of rational care, regimen; massage and gymnastics; identification and treatment of foci of infection and other concomitant diseases; enzyme therapy, vitamin therapy, stimulating therapy; symptomatic therapy.

Treatment of malnutrition in children involves changing the regimen, diet and caloric intake of the child and the nursing mother; if necessary, parenteral correction of metabolic disorders.

The basis of the correct treatment of malnutrition is diet therapy. It should be noted that both an insufficient amount of food ingredients and their excess adversely affect the condition of a child with malnutrition. Based on many years of experience in treating children with this disease, representatives of different schools have developed the following tactics for diet therapy.

The implementation of diet therapy for malnutrition in children is based on fractional frequent feeding of the child, weekly calculation of the food load, regular monitoring and correction of treatment.

With malnutrition of the first degree, food tolerance is quite high. Children tolerate nutritional stress well, so they can receive food that is appropriate for their age. Proteins, fats and carbohydrates are calculated per 1 kg of proper weight.

In the treatment of children with malnutrition of the II degree, two periods are distinguished: pre-reparation and reparation period. The pre-reparation period for malnutrition of the II degree is usually 7-10 days. During this period, the patient's tolerance to food is determined. From food, the patient receives either human milk or products that replace it (cow's milk, sour milk formulas, adapted milk formulas).

The daily volume of food is reduced to 2/3 of the required volume. The missing water is replenished with a liquid (boiled water, tea, 5% glucose solution, etc.). The child during this period (in its first days) receives food in 8 doses, that is, every 2.5 hours. Subsequently, with good food tolerance (no vomiting, regurgitation, diarrhea), the volume of food can be increased by 100-150 ml of the daily ration for each subsequent day. With an excess in volume of 2/3 of the daily food ration, the child begins to be fed after 3 hours, i.e. 7 times. After the child begins to cope with the proper amount of food, we can assume that the pre-reparation period is over.

In the period of reparation, nutrition is corrected, complementary foods are introduced according to general rules. At first, carbohydrates and proteins are prescribed for 1 kg of the required weight, and fats for approximately the required weight.

In the treatment of children with III degree hypotrophy, two periods are also distinguished: pre-reparation and reparation period. Since food tolerance in hypotrophy of the III degree is much lower compared to hypotrophy of the II degree, the food load is carried out even more carefully. The pre-reparation period lasts 14-20 days or more. On the first day, nutrition can be calculated based on the energy spent by the child on the main metabolism (65-70 kcal per 1 kg of actual body weight). This is approximately U 2 part of the required daily amount of food.

A child with hypotrophy of the III degree is given food in the form of expressed breast milk (or its substitutes) in 10 doses, that is, every 2 hours, observing a 6-hour night break. Subsequently, with normal tolerance of this volume of food every 2 days, it can be increased by 100-150 ml. The end of the pre-reparation period can be judged on the basis of the good tolerance of women's milk or its substitutes in a volume normal for a given age. In the period of reparation with malnutrition of the III degree, the tactics are similar to those for malnutrition of the II degree.

In the period of determining food tolerance, enzyme therapy is widely used. For this purpose, a 1% solution of diluted hydrochloric acid, pepsin, abomin, natural gastric juice, festal are used. With a high content of neutral fat and fatty acids in the coprogram of patients, pancreatin is prescribed.

Vitamin therapy in the treatment of patients with malnutrition is used for both replacement and stimulating purposes. In the first days of treatment of the disease, vitamins are administered parenterally, then given orally: ascorbic acid 50-100 mg, vitamins B 1 25-50 mg, B 6 50-100 mg per day, then alternating courses of vitamin treatment are carried out. minami A, PP, B 15, B 5, E, folic acid, vitamin B 1 2 in age doses.

Stimulant therapy is a mandatory part of the treatment of malnutrition in children. It consists in prescribing alternating courses of treatment with apilac, dibazol, pantocrine, ginseng and other means. In severe malnutrition, especially when combined with diseases of an infectious nature, y-globulin is administered, a 10% solution of albumin, protein, plasma is administered intravenously, blood is transfused.

In the treatment of malnutrition II and III degrees in children, the appointment of anabolic steroid hormones is indicated: nerabol (daily inside at 0.1-0.3 mg / kg), retabolil (1 mg / kg once every 2-3 weeks) .

Symptomatic therapy depends on the clinical picture of malnutrition. In the treatment of anemia, it is advisable to use iron preparations, blood transfusions from the mother (if the blood is compatible by group and Rh factor and there is no history of hepatitis). In the case of a combination of malnutrition with rickets, after the end of the period of clarification of food tolerance, therapeutic doses of vitamin D are prescribed (with mandatory control according to the Sulkovich reaction!). Therapy of symptomatic malnutrition, in addition to diet therapy, should be aimed at treating the underlying disease.

Sick children with malnutrition of the 1st degree in the absence of severe concomitant diseases can be treated at home, children with malnutrition of the 2nd and 3rd degrees - in a hospital. The patient should be in a bright, spacious, well-ventilated room; the ambient air temperature should be at least 24-25 ° C and not higher than 26-27 ° C, since a child with severe degrees of malnutrition is easily overcooled and overheated.

It is important to create a positive emotional tone in the child, to pick it up more often. A positive effect is provided by warm baths (water temperature 38 ° C), which can be carried out daily. Mandatory components of the treatment are massage and gymnastics.

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, profuse regurgitation, micronutrient deficiency);
• poor nutrition of a nursing mother;
• some diseases of the newborn do not allow him to actively suck, and therefore - 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;
• decreased 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.

When 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.

Hypotrophy is a chronic malnutrition in babies, which is accompanied by a constant underweight in relation to the age and height of the infant. Often, malnutrition in children affects not only the insufficient development of muscle mass, but also psychomotor aspects, growth retardation, general lagging behind peers, and also causes a violation of skin turgor due to insufficient buildup of the subcutaneous fat layer.

Underweight (hypotrophy) in infants usually has 2 causes. Nutrients may enter the child's body in insufficient quantities for proper development or simply not be absorbed.

In medical practice, malnutrition is distinguished as an independent type of violation of physiological development, a subspecies of dystrophy. As a rule, small children under the age of one year are susceptible to such a violation, but sometimes the condition persists up to 3 years, due to the peculiarities of the social status of the parents.

Degrees of malnutrition in children and symptoms of the disorder

First degree

The disease is characterized by a slight decrease in appetite, accompanied by sleep disturbance and frequent anxiety. The baby's skin usually remains practically unchanged, but has reduced elasticity and a pale appearance. Thinness is visible only in the abdomen, while muscle tone can be normal (sometimes slightly reduced).

In some cases, 1 degree of malnutrition in young children may be accompanied by anemia or rickets. There is also a general decrease in the functioning of the immune system, from which babies get sick more often, look less well-fed in comparison with their peers. Some children may have indigestion leading to diarrhea or constipation.

Often, the 1st degree of violation remains almost imperceptible to parents, and only an experienced doctor can identify it with a thorough examination and diagnosis, during which he must find out if the thinness of the baby is a feature of his physique and a hereditary factor.

For some children, height and thinness are inherited from their parents, so a slender young mother should not worry that her baby does not look as well-fed as the rest, if at the same time he is active, cheerful and eats well.

Second degree

It is characterized by a lack of weight in children in the amount of 20-30%, as well as a lag in growth of the baby, on average by 3-4 cm. also the lack of warmth of the arms and legs.

With hypotrophy of the 2nd degree in newborns, there is a developmental delay not only in motor, but also mental, poor sleep, pallor and dry skin, frequent peeling of the epidermis. Baby's skin is not elastic, it easily gathers into folds.

Thinness is strongly pronounced and affects not only the abdomen, but also the limbs, while the contours of the ribs are clearly visible in the baby. Children with this form of disorder are very often sick and have unstable stools.

Third degree

Babies with this form of impairment are severely stunted, on average up to 10 cm, and have a weight deficit of more than 30%. The state is characterized by severe weakness, an indifferent attitude on the part of the child to almost everything, tearfulness, drowsiness, as well as the rapid loss of many acquired skills.

The thinning of the subcutaneous fatty tissue is clearly expressed throughout the body of the child, there is a strong atrophy of the muscles, dry skin, cold extremities. The color of the skin is pale with a grayish tint. The lips and eyes of the baby are dry, cracks are observed around the mouth. Often in children there are various infectious diseases of the kidneys, lungs and other organs, for example, pyelonephritis, pneumonia.

Types of malnutrition

Violation in young children is divided into 2 types.

Congenital malnutrition

Otherwise, the condition is called prenatal developmental delay, which begins even in the prenatal period. There are 5 main causes of congenital disorders:

• Maternal. This group includes insufficient and malnutrition of the expectant mother during pregnancy, her very young or, conversely, old age. Previously appeared stillborn children or miscarriages, the presence of serious chronic diseases, alcoholism, smoking or drug use, as well as severe preeclampsia in the second half of pregnancy can lead to the appearance of a baby with malnutrition.
• Paternal. Caused by hereditary causes on the paternal side.
• Placental. The appearance of hypotrophy of any degree in a newborn can also be affected by poor patency of the vessels of the placenta, their narrowing, anomalies in the location of the placenta, its presentation or partial detachment. Vascular thrombosis, heart attacks, fibrosis of the placenta can also affect the appearance of the disorder.
• Socio-biological factors. Insufficient material support for the expectant mother, her adolescence, as well as work in hazardous and chemically hazardous industries, the presence of penetrating radiation.
• Other factors. Mutations at the genetic and chromosomal level, the presence of congenital malformations, multiple pregnancy, premature birth.

Acquired malnutrition

The causes of such developmental disorders are divided into two types: endogenous and exogenous.

Endogenous factors include:

• the presence of diathesis in infancy;
• anomalies of the constitution in babies up to a year;
• immunodeficiency, both primary and secondary;
• congenital malformations, such as perinatal encephalopathy, pyloric stenosis, bronchopulmonary dysplasia, Hirschsprung's disease, "short bowel" syndrome, disorders in the cardiovascular system;
• endocrine disorders, in particular, hypothyroidism, adrenogenital syndrome, pituitary dwarfism;
• the presence of malabsorption syndrome, disaccharidase deficiency, cystic fibrosis;
• anomalies of the metabolic process of hereditary etiology, for example, galactosemia, fructosemia, Niemann-Pick or Tay-Sachs disease.

• diseases caused by infections, for example, sepsis, pyelonephritis, intestinal disorders caused by bacteria (salmonellosis, dysentery, colienteritis), persistent dysbacteriosis;
• improper upbringing, non-compliance with the daily routine. These include improper care for a baby under the age of one year, poor sanitary conditions, malnutrition;
• nutritional factors such as underfeeding of the infant (qualitative or quantitative) with natural feeding can be observed with a flat nipple in the mother. Underfeeding due to a "tight" breast, in this case, the baby cannot suck out the required amount of milk. Vomiting or constant spitting up;
• toxic causes, for example, poisoning, various degrees and forms of hypervitaminosis, feeding with low-quality milk formula or animal milk from the moment of birth (it is not absorbed by the body of the newborn).

Diagnostics

To accurately establish the diagnosis of malnutrition in babies, a set of studies is carried out, which includes:

• Collection of anamnesis. The features of the baby's life, his nutrition, regimen, the presence of possible congenital diseases, medication, living conditions, care, as well as diseases of the parents that can be transmitted to the child at the genetic level are clarified.
• Careful inspection, during which the condition of the baby's hair and skin, his oral cavity, and nails is determined. The child's behavior, mobility, existing muscle tone, general appearance are assessed.
• Body mass index calculation and comparing it with the norms of development based on the weight of the baby at birth and his age at the time of the diagnosis. The thickness of the subcutaneous fat layer is also determined.
• Conducting laboratory research baby blood and urine tests.
• Complete immunological examination.
• Breath tests.
• Ultrasound of internal organs.
• ECG.
• Blood sampling for a complete biochemical analysis.
• The study of feces child for the presence of dysbacteriosis and the amount of undigested fat.

Intrauterine malnutrition can be detected even during pregnancy during the next ultrasound, in which the doctor determines the size of the fetus and the estimated weight.

If developmental disorders are detected, the expectant mother is sent to a hospital for a full examination and taking the necessary measures.

In newborns, existing malnutrition can be determined by a neonatologist during an examination immediately after the birth of the baby. Acquired developmental disorder is usually detected by a pediatrician during a routine examination and the necessary measurements of height and weight. In this case, the doctor, in addition to conducting research, usually appoints consultations of other specialists, which helps to accurately establish the diagnosis and degree of malnutrition.

Treatment

Therapy for malnutrition is carried out depending on the degree of the disease. Postnatal malnutrition of the 1st degree is treated on an ordinary outpatient basis at home with mandatory strict adherence to all doctor's prescriptions.

The second and third degrees require inpatient treatment, where specialists can constantly assess the baby's condition and the results of the treatment, which is aimed at eliminating the existing causes of malnutrition, organizing good care for the baby, and correcting metabolic abnormalities.

The basis of the treatment of malnutrition is a special diet therapy, which is carried out in 2 stages. First, possible food intolerances in the infant are analyzed, after which the doctor prescribes a certain balanced diet with a gradual increase in food portions and its calorie content.

The basis of diet therapy for malnutrition is fractional nutrition in small portions with a short period of time. The serving size is increased weekly, taking into account the necessary nutritional load during regular monitoring and examinations. In the course of therapy, adjustments are made to the treatment.

Weakened babies who cannot swallow or suck on their own are fed through a special tube.

Medical treatment is also carried out, in which the baby is prescribed vitamins, enzymes, taking anabolic hormones, adaptogens. In cases of a particularly serious condition of children with malnutrition, they are given intravenous infusions of special protein hydrolysates, saline solutions, glucose and essential vitamins.

To strengthen muscle tone, kids are given exercise therapy and UVR, as well as a course of special massage.

Lifestyle of children with malnutrition

During the treatment of the child, parents must strictly comply with all the doctor's instructions. The main factors for the successful cure of the crumbs are the establishment of the correct regimen not only for feeding, but also for playing, sleeping and walking.

With proper care and good nutrition, in the absence of metabolic disorders and other congenital (acquired or chronic) diseases, babies quickly gain weight and are quite capable of catching up with the parameters of their healthy peers.

It is important to prevent the appearance of malnutrition in infants and it lies in the correct behavior of the future mother during the bearing of the crumbs. Registration at a polyclinic (special center or private clinic) should take place in the early stages of pregnancy, already during the first month.

It is important to pass all the scheduled examinations and studies on time, not to miss scheduled appointments and consultations of specialists. A special moment in the prevention of malnutrition in a child is the nutrition of the expectant mother, it must be balanced, provide the body with all the necessary substances not only for its existence, but also for the development of the fetus.

Timely examination allows you to identify the existing violation in time and take the necessary measures to eliminate it even before the birth of the crumbs.

How to recognize malnutrition in a child?

Hypotrophy of the newborn is discrepancy between his weight and height to normal indicators for this period.

This deviation is considered quite common, most often the disease is diagnosed among patients who abuse bad habits and do not follow their diet.

What do you need to know?

Causes of the disease

In newborns, a lot depends on the weight; weight compliance with the standards is a sign of normal development.

Hypotrophy can be congenital, acquired and mixed, the causes of the disease are different.

Congenital malnutrition often occurs as a result of violations provoked by various complications of the course of pregnancy:

• intrauterine infection;
• pathology of the umbilical cord and implants;
• acute diseases, exacerbations of chronic;
• propensity to miscarriage;
• polyhydramnios;
• toxicosis.

The lifestyle of a pregnant woman also plays an important role:

• malnutrition;
• stress;
• physical exercise;
• work in hazardous industries;
• smoking, drug, alcohol abuse.

Under the influence of the above factors, the supply of nutrients and oxygen to the fetus from the mother is disrupted, as a result of which malnutrition develops.

Improper feeding, diseases of the gastrointestinal tract - all these factors lead to poor absorption of carbohydrates, fats, proteins, energy-rich substances.

With mixed form diseases, social, infectious or alimentary consequences are added to negative intrauterine factors.

In children with acquired malnutrition lack of weight is not associated with malformations and heredity, their general condition is quite encouraging, mental and physical development corresponds to the gestational age.

Infants with congenital disorders are considered more vulnerable in terms of survival and further mental development.

Symptoms and signs

In appearance, children with intrauterine dystrophy can be divided into two groups, the first one is underweight children with no or slight stunting, to the second- developmental delay affects not only weight and height, but also head circumference.

Children from the second group practically no different from premature babies, the presence of malnutrition is determined after familiarization with their gestational age.

This type of pathology has received the designation hypostatura or hypoplastic type.

The aggravating factors of pregnancy, which provoked developmental delay in this case, appear in the second trimester of pregnancy.

In newborns with underweight and growth retardation, but with a normal head circumference, the disease manifests itself in the form of physical imbalances, the signs may resemble those of hydrocephalus.

With intrauterine hypotrophy various lesions of the skin can occur from barely noticeable dryness to severe wrinkling up to the effect of parchment.

Pathology can be local and widespread, most often the inner surface of the feet and palms is affected.

Dry skin all over body is considered a severe case of malnutrition, regardless of the correspondence of its weight and growth to the gestational age, in this case we are not talking about patients with ichthyosis.

Degrees of the disease

Three degrees of malnutrition:

1. I (light) degree- lag in weight 10-20% of the norm, growth is normal.
2. II (medium) degree- deviation from the norm of weight - 20-30%, height - 2-3 cm.
3. III (severe) degree- weight lag is 30%, deviations in growth are significant.

What causes the disease

Speaking of complications, it is also necessary to mention the degree of the disease, hypotrophy of the 1st degree practically does not affect the development of the child.

Due to insufficient weight, there may be an increased tendency to hypothermia, but with breastfeeding and proper care, it is easy to gain weight.

With hypotrophy of the second and third degree the situation is more complicated, it must be taken into account that due to a lack of nutrients, the formation of internal organs is disrupted, incl. nervous system, which can lead to negative consequences.

The cause of mental deviations (oligophrenia, imbecility) of children of alcoholics and drug addicts is chronic intoxication of the mother's body, as well as a deficiency of substances necessary for development.

Complications

Complications of malnutrition are not always encountered, in some newborns, the adaptation process proceeds without any difficulties.

In others, growth retardation is accompanied by violations of life-important functions provoked by complications during pregnancy.

The most common complication poor nutrition in late pregnancy is hypoxia.

Prolonged hypoxia is accompanied by clouding of the amniotic fluid and skin, as a result of which the membranes and the umbilical cord acquire a yellow-green tint.

This pathology has a definition - Clifford syndrome (placental dysfunction). Most often, the pathology occurs in post-term fetuses, however, the syndrome is diagnosed only in 20% of infants born after the term.

In most cases, these babies develop severe forms of respiratory distress, sometimes there are signs of liver enlargement, heart enlargement.

Breathing problems can occur even after successful resuscitation.

Another common complication is pneumothorax., which develops due to rupture of the alveoli.

Pathology usually develops in the first hours after birth and manifests itself in the form of a sudden deterioration in the functioning of the respiratory system, in some cases even the disappearance of heart sounds is diagnosed.

Treatment

Treatment of malnutrition involves an integrated approach

Within the framework of which diet therapy, medication and vitamins are provided.

For older children, massage, physiotherapy exercises, physiotherapy are provided.

Which doctor should I contact?

The most important role in the treatment of the disease is played by diet therapy, which depends on the severity of the disease and appointed individually by a pediatrician.

Parents should follow his recommendations as closely as possible.

How is malnutrition treated?

With malnutrition of the first degree, treatment at home is allowed, daily the baby should receive the same amount of food as newborns with normal weight, the number of meals increased from 6 to 7 times.

Sugar can be added to milk and cereals when they are included in the diet.

The child additionally receives enzymes and vitamins prescribed by the doctor.

The main difficulty in feeding a newborn with malnutrition is that the baby needs an increased amount of nutrients.

At the same time, the resistance of the child's gastrointestinal tract to stress is reduced, enhanced nutrition can provoke indigestion, which can further aggravate the situation.

Newborns with the second and third degree of malnutrition temporarily placed in a hospital, in which the body adapts to normal food intake, in severe cases, nutrient solutions are administered intravenously.

As part of therapy, the number of meals is increased and its volume is reduced.

Treatment also includes drug therapy., within the framework of which vitamins, enzymes, metabolic stimulants are prescribed, the next stage, the babies begin to be given skim milk, subsequently the diet is supplemented with cereals and sugar, cream and butter.

With effective treatment, children's appetite normalizes, positive emotions appear, the condition of the skin and soft tissues improves, weight increases daily by 20-25 g, digestion improves, mental and physical skills are restored.

Do you need special care and nutrition?

When treating malnutrition, it is necessary to establish whether the baby is sick with something else.

In the presence of other diseases, therapy begins with their elimination.

An important role in this case is played by cleanliness of the room which must be constantly maintained.

special care must be taken when preparing food.

Prevention

To prevent the development of intrauterine malnutrition it is necessary to exclude all harmful effects on the body, it is recommended to avoid stress, adhere to a healthy lifestyle, eat right, take vitamins

An infant should be fed an appropriate amount of food for its age, it is recommended to visit the pediatrician regularly for weighing.

A woman should pay great attention to her diet, during and after pregnancy.

With congenital pathology and genetic mutations, metabolism and digestion are different, therefore you must strictly adhere to the diet prescribed by the doctor.

Summing up

Hypotrophy in newborns is quite common, women are at risk, abusing bad habits, not watching their diet.

The severity of the disease is determined by the lag in the weight and height of the child from the norm.

Treatment involves a special diet, which is prescribed individually by a doctor.

To prevent the development of the disease It is recommended to lead a correct lifestyle, monitor nutrition.

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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. 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;
• 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 ();
• 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 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 ();
• conjunctivitis;
• 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

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. Optimal nutrition is. 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.

It is examined repeatedly in a week (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

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 0 С;
• 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 B 1, B 6, 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;
• 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;
• balanced nutrition of a woman during lactation;
• 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.