Signs of malnutrition in a child. Chronic eating disorders in young children. There are three options for the development of pathology

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 (we recommend reading:).

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 (we recommend reading:).

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. Body temperature drops, hands and feet are cold (see also:). 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%.

Chair with hypotrophy

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;

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

Treatment

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.

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

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.

Food

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.

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.

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.

Stage 2 and 3 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 (see also:). Also, the doctor may recommend hormonal and non-hormonal drugs with an anabolic effect. Of particular note are medicines containing L-carnitine, for example, Elkar (more in the article:). 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 intestines. 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.

Forecast

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.

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, profuse 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.

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 strongly 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 child's age, various violations of body proportions, gradual thinning and disappearance of subcutaneous fatty tissue, the skin becomes dry, inelastic, and the child's muscles 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, trace elements, 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 local pediatrician to examine the child and carry out 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- an eating disorder of a young child, which is characterized by a stop or slowdown in the growth of body weight, progressive thinning of the subcutaneous tissue, disturbances in body proportions, disorders of the digestive and metabolic functions, a decrease in specific and nonspecific defenses of the body, a tendency to develop other diseases, a delay in physical and neurological -mental development.

Cause and pathogenesis of malnutrition

Clinical manifestations of malnutrition

Hypotrophy I degree is rarely diagnosed

Hypotrophy II degree

With malnutrition of the II degree, changes occur in the cardiovascular system, respiratory organs, and liver. Polyglandular insufficiency develops. Most children with this form of eating disorder suffer from rickets, and every second child has anemia. There are various violations of protein, fat, carbohydrate, water-electrolyte and vitamin metabolism. The immunological reactivity is sharply reduced. Such children often get sick,. Moreover, these diseases against the background of malnutrition are asymptomatic, atypical; their end is often unfavorable.

Hypotrophy III degree (atrophy, insanity)

Face triangular, wrinkled; the nasolabial fold is deep, the jaws and cheekbones protrude, the chin is pointed, the cheeks are sunken. It is like the face of an old man ("Voltaire's face"). The thickness of the skin fold at the level of the navel decreases to 0.2 cm (thinned skin), Chulitsky's fatness index is negative, proportionality is sharply distorted. The skin is pale gray, sometimes purple-blue, hangs in folds on the neck and limbs, dry, flaky, in some places there are areas of pigmentation, its elasticity is lost, the skin fold does not straighten out, the tissue turgor is sluggish, muscle tone is reduced, although hypertension is also possible, conjunctiva and oral mucosa are dry. The mouth is large, the lips are scarlet (blood thickening), cracks form in the corners of the mouth (“sparrow's mouth”). The child loses more than 30% of body weight, sharply lags behind in growth (more than 4 cm), psychomotor development.

Breathing is superficial, apnea periodically appears. Heart sounds are weakened or deaf, there is a tendency to bradycardia, blood pressure is reduced. The abdomen is enlarged due to flatulence, the anterior abdominal wall is thinned, loops of the intestines are visible. There is an alternation of constipation with soapy-lime stools. The processes of hydrolysis and absorption are sharply weakened due to hypofermentopathy, which develops as a result of atrophy of the mucous membrane of the small intestine, liver, pancreas and other organs. Most patients have rickets, anemia, bacterial infection (pneumonia, sepsis, otitis media, pyelonephritis, etc.). All types of metabolism are severely impaired; immunological insufficiency, extinction of function and atrophy of organs of regulatory systems (nervous, endocrine), dysbacteriosis of II-III degree are observed. The terminal period is characterized by hypothermia (33-32 ° C), bradycardia (60-40 per 1 min), hypoglycemia; completely indifferent to the environment, the child slowly dies.

Prenatal malnutrition

In children with intrauterine growth retardation, hypotension, decreased physiological reflexes, decreased appetite, impaired thermoregulation, a tendency to hypoglycemia, late falling off of the umbilical residue, sluggish healing of the umbilical wound, prolonged transient jaundice, regurgitation, and unstable stools are observed. The main diagnostic criterion for prenatal malnutrition in full-term newborns should be consider a decrease in the weight-height coefficient below 60. This index is unsuitable for assessing this condition in premature babies. In this case, the following formula is used: the trophic index (IT) is equal to the difference between the length and circumference of the thigh (cm). In preterm infants with a gestational age of 36-37 weeks, in the absence of clinical signs of malnutrition, IT = 0, with malnutrition of I degree, IT is 1 cm, II degree - 2 cm, III degree - C cm or more. Convenient is the method of calculating the body weight deficit of preterm infants according to gestational age: birth weight deficit of 10-20% - I degree, 20-30% - II degree, 30% or more - III degree of malnutrition.

Hypostatura

Treatment of children with malnutrition is a complex problem. Daily it is necessary to take into account the dynamics of body weight, the amount of fluid and food consumed, regurgitation, vomiting, bowel movements.

With hypotrophy of the I degree, the period of clarification of tolerance to food is 1-3 days. It is carried out according to the following scheme. First eliminate the shortcomings of feeding, prescribe food appropriate for age (on the 1st day - 1/2-2/3 of the daily volume, on the 2nd - 2/3-4/5 and on the 3rd day - the full daily volume) . The amount of food that is missing is compensated with liquid (vegetable, fruit, rice and other decoctions, infusions of medicinal plants, digested water). The amount of nutrition is calculated in accordance with a certain body weight, the lack of food of one or another component is corrected by adding protein (cottage cheese, yolk, acidophilic paste, protein enpit), fat (fat enpit, butter, cream), carbohydrates (vegetables, fruits, cereals, refined carbohydrates).

In some cases, in order to improve the processes of digestion, substitution therapy (enzymes) is prescribed. Give ascorbic acid, ergocalciferol, B vitamins through the mouth. In the absence of other diseases, children with grade I malnutrition are treated at home.

Treatment of patients with malnutrition II and III degree is carried out in a hospital. In case of malnutrition of the II degree during the 1st week, 1/2 of the required daily volume of food is prescribed, on the 2nd - 2/3, on the 3rd - the full volume. With hypotrophy of the III degree - On the 1st week - 1/3, 2nd - 1/2, 3rd - 2/3 and 4th - full volume. The frequency of its reception is increased by 1-2 and 2-3 times, respectively. The rest of the daily volume is provided with liquid (vegetable and fruit decoctions, electrolyte solutions, parenteral feeding).

For parenteral nutrition, amino acid mixtures are used (polyamine, Vamin, Alvezin "New", Amikin, Levamine, etc.), 10% glucose solution with insulin (5-8 days, daily or every other day, 5-6 times). Within 2-3 weeks, in doses exceeding physiological by 3-5 times, children are given vitamins (group B, ascorbic acid, vitamin P preparations, ergocalciferol). In order to improve the processes of hydrolysis and absorption in the digestive tract for a period of 2-3 weeks enzyme preparations are prescribed (gastric juice, pancreatin, Pepsidil, festal, panzinorm, abomin, etc.).

In the first days, courses of treatment are carried out with drugs that stimulate metabolism (apilac, pentoxyl, ginseng tincture, pantocrine), and during the recovery period, potent anabolic hormones (methandrostenediol, nerobol, retabolil, etc.) are used.

Prevention of antenatal malnutrition consists in the treatment of toxicosis of pregnant women, the observance of hygienic working conditions, life, nutrition, the exclusion of bad habits, and the like. Natural feeding in combination with the correct regimen and education, periodic determination of the chemical composition of food and body weight dynamics is a prerequisite for excluding the development of postnatal malnutrition.

Prevention of any acute and chronic, acquired, hereditary and congenital disease and early diagnosis is the most important step in the prevention of malnutrition.

Hypotrophy in children is a pathological violation of weight gain, which affects the overall development (physical and psychological). There is also a decrease in skin turgor and growth retardation. As medical practice shows, such an ailment occurs in children under 2 years of age.

Etiology

Hypotrophy in young children can be accompanied by various diseases or develop as an independent disease. The most common etiological factors include the following:

• unbalanced diet;
• underfeeding or overfeeding a child;
• improperly selected mixtures;
• viral or infectious diseases;
• endocrine diseases;
• hereditary pathologies;
• disorders in the digestive tract - incomplete absorption of nutrients;
• genetic predisposition of the fetus.

Hypotrophy at an early age can also develop in a child when eating poor-quality baby food. It should also be noted that malnutrition in newborns can develop both with artificial and breastfeeding. That is why it is very important for the mother herself to eat right and, in general, take good care of her health.

There are also perinatal etiological factors in the development of fetal hypotrophy:

• malnutrition during pregnancy (intrauterine malnutrition);
• chronic illnesses of the mother both before pregnancy and during childbearing;
• alcohol abuse, smoking;
• frequent stress, nervous strain.

In the same subgroup, you can add features of the constitution of the mother herself. If the weight of a pregnant woman is not more than 45 kg, and the height is not more than 150 cm, there is a risk of developing fetal malnutrition.

Symptoms

The clinical picture of fetal hypotrophy manifests itself in the form of a malfunction of several systems at once. First of all, symptoms in the gastrointestinal tract appear:

• bloating;
• refusal to eat, poor appetite;
• nausea and vomiting;
• drastic weight loss.

As the disease progresses, the clinical picture is supplemented by the following symptoms:

• bad sleep;
• impaired coordination of movements;
• decreased muscle tone;
• sudden mood swings in a child;
• emotional unstable background.

Also, against the background of such a clinical picture in young children, the protective functions of the body are sharply reduced. Therefore, a child up to a year becomes easily vulnerable to any infections and viral pathological processes.

Classification

According to the international classification, there are such types of malnutrition:

• intrauterine (perinatal or congenital form);
• postnatal (acquired form);
• mixed type.

According to the degree of development, malnutrition in children can occur in the following forms:

• light;
• average;
• heavy.

Hypotrophy of the fetus of the 1st degree does not pose a significant threat to the health of the child. In this case, the deviation from the required weight is no more than 10–15% even with normal growth for this age.

The second degree means a deviation in mass up to 30% and a lag in growth of 3–5 cm.

With malnutrition of the third degree, there are significant deviations in weight - from 30% or more, a significant lag in growth. At this stage of development of the pathological process, malnutrition in a child may be accompanied by other diseases. The most common ailments are:

As practice shows, fetal malnutrition in the third stage almost always leads to the development of rickets.

Diagnostics

If during pregnancy a woman undergoes a timely examination, then fetal hypotrophy will be detected at an early stage of development. If such a pathology is suspected, the pregnant woman is sent for an ultrasound examination and screening is done.

As for already newborn children or toddlers, pathological deviations in development will certainly be noticeable by a pediatrician during examination.

Diagnostic measures for suspected malnutrition in a child include the following activities:

• measurement of the circumference of the head, abdomen;
• measurement of the thickness of the skin and fat.

It is also obligatory to consult with medical specialists of other profiles:

• geneticist;
• cardiologist;
• neurologist;
• endocrinologist.

Depending on the age of the child, instrumental diagnostics may be needed:

• coprogram.

Only on the basis of the tests obtained, the doctor can finally establish the diagnosis and prescribe the correct course of treatment.

Treatment

Treatment of the disease depends on the type of disease and the stage of development of the disease. If we are talking about intrauterine malnutrition (during pregnancy), then therapy is primarily aimed at the expectant mother herself. Treatment may include the following activities:

• balanced diet;
• taking drugs to eliminate pathology;
• taking enzymes to improve digestion.

In most cases, if the pathology is detected in the second or third trimester of pregnancy, the treatment is inpatient.

Treatment of children (newborns and up to a year) also takes place in a hospital. So that the child does not develop muscle hypotrophy, bed rest is prescribed. Comprehensive therapy includes the following:

• food according to a special diet;
• taking vitamin preparations;
• courses of special massage and exercise therapy;
• biological additives.

In addition, it is very important how the child will be looked after. According to official statistics, malnutrition in children and during pregnancy is most often observed in socially disadvantaged families.

Diet

The diet is prescribed only by the attending physician based on the individual characteristics of the patient and the stage of development of the disease:

• in the first degree - meals at least 7 times a day;
• in the second degree - 8 times a day;
• at the third - 10 times a day.

As for the list of products, they are chosen based on what the patient's digestive system can digest.

Prevention

Preventive methods are especially important during pregnancy. It is very important for a future mother to eat fully and in a timely manner, since the health of the baby depends on it. Also, during pregnancy, a woman should be regularly examined for the timely detection of pathology.

Today, the best prevention of malnutrition in newborns is careful planning of pregnancy.

For newborns, preventive measures are as follows:

• the nutrition of the baby should be complete and only of the best quality;
• weight gain and height increase should be constantly monitored;
• the child should be examined by a pediatrician in a timely manner;
• complementary foods should be introduced gradually starting with small doses;
• foods should have all the necessary vitamins and minerals.

With the above symptoms, you should immediately consult a doctor and in no case self-medicate. Delay, in this case, can result in a child's disability or death.

Forecast

Hypotrophy in a child at the first or second stage responds well to treatment and practically does not cause complications. As for the pathological process at the third stage of development, a lethal outcome is observed in 30–50% of all cases.

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