How to determine the degree of malnutrition in a child. Hypotrophy in children: diagnosis and treatment. Syndrome of impaired hematopoiesis and immunobiological reactivity

Hypotrophy is a malnutrition that refers to dystrophy and is characterized by a decrease in tissue trophism, growth and body weight of the child. With malnutrition, metabolic processes are disturbed, which lead to a lag in the physical development of children.

Depending on the time of occurrence, congenital and acquired forms of malnutrition are distinguished, and the overall frequency of occurrence varies between 3–5% of all childhood diseases.

How to determine the degree of malnutrition?

The degrees of malnutrition mean how severe the symptoms are and how much weight loss there is in relation to the height of the child. So, for example, a born child is diagnosed with "hypotrophy of the 1st degree" in newborns if he was born at a gestational age of more than 38 weeks, has a body weight of 2800 g or less, and a body length of less than 50 cm. If the child has an acquired form of malnutrition , then they calculate the so-called "weight loss index" or fatness index according to Chulitskaya (Professor of the Department of the University of Physical Culture, St. Petersburg).

ICH (Chulitskaya fatness index) is the sum of the circumference of the shoulder, thigh and lower leg, from which the length of the child's body is taken away. Calculations are carried out in centimeters, and in normal children under the age of one year, this figure is 25-30 cm. If children develop malnutrition, then this index decreases to 10-15 cm, which indicates the presence of malnutrition 1 degree.

The body weight deficit is also calculated using a formula that all pediatricians have. The table contains weight indicators, which should be added monthly:

• 1 month after birth - 600 g.
• 2 and 3 months - 800 g each.
• 4 month - 750 g.

The calculation of the fifth and all subsequent months is equal to the previous weight minus 50 g.

When measuring the degree of malnutrition, the actual weight of the child is compared and the one that is calculated according to the table according to age. For example, a baby was born with a weight of 3500 g, and at the age of 2 months it weighs 4000 g. The actual weight should be 3500 + 600 + 800 = 4900 g. The deficit is 900 g, which is 18% as a percentage:

4900 g - 100%

X \u003d (900 x 100) / 4900 \u003d 18%

• Hypotrophy of the 1st degree - is placed with a weight deficit of 10% to 20%.
• Hypotrophy of the 2nd degree - is placed with a weight deficit of 20% to 30%.
• Hypotrophy of the 3rd degree - is placed with a weight deficit of 30% or more.

Signs of 1st degree of malnutrition

Each degree of malnutrition has its own clinical picture, signs and characteristic symptoms, by which it is also possible to determine the stage of development of the disease.

Signs characteristic of hypotrophy of the 1st degree are as follows:

• IUCH is 10-15 cm.
• The subcutaneous fat layer disappears on the abdomen.
• Skin folds are flabby and straighten out slowly.
• The elasticity of soft tissues is reduced.
• Muscles become sluggish.
• Body weight below normal weight by 10-20%.
• There is no stunting.
• The child's well-being does not suffer and the psyche is not disturbed.
• The child often suffers from infectious and other diseases.
• There is a slight indigestion (regurgitation).
• Irritability and sleep disturbance appear.
• The child becomes restless and gets tired quickly.

Treatment of this degree of malnutrition is not difficult, and weight can be normalized when the regime is restored (the entire amount of food is divided into 7-8 meals) and the diet. The diet is dominated by carbohydrates, cereals, fruits, vegetables.

Signs of the 2nd degree of the disease

Hypotrophy of the 2nd degree is characterized by the following symptoms and signs:

• HI becomes less than 10 and goes to zero.
• The fat layer is absent on almost the entire area of ​​the body.
• Sagging and sagging appear on the skin.
• Joints and bones are clearly visible.
• There is a decrease or lack of appetite.
• Vomiting, nausea and frequent regurgitation of food.
• Irregular and unstable stools, and there are remnants of undigested food in the stool.
• Signs of beriberi are dry hair, brittle and thinning nails, cracks in the corners of the mouth.
• The weight deficit reaches 20-30%.
• Growth is retarded.
• Symptoms of the nervous system - lethargy, anxiety, fatigue, loudness, irritability, sleep disturbance.
• Violation of the process of thermoregulation (the child quickly overheats and cools).
• Infectious diseases the baby gets sick often and for a long time.

Treatment of this degree of malnutrition can be carried out both at home and in a hospital. For treatment, increase the number of feedings and reduce portions of food. Of the drugs prescribed biostimulants, vitamins, minerals, enzymes.

Signs of the 3rd degree of malnutrition in children

This degree is considered severe, since all the symptoms only worsen, and without timely treatment lead to death in children. To all the above signs, signs of a violation of the activity of all organs and systems are added:

• The weight deficit is 30% or more.
• Growth retardation.
• Absence of subcutaneous fat.
• There are violations of the heart rhythm and work of the heart.
• Respiratory failure.
• Mental retardation.
• Muscle atrophy and wrinkling of the skin.
• Anorexia symptoms.
• Violation of thermoregulation and decrease in pressure.

Treatment of this degree of malnutrition should be carried out only in a hospital, since the work of metabolic processes and the activity of all organs and systems are disrupted. Drug treatment includes intravenous transfusion of blood, plasma, glucose solution, hormones, as well as treatment with enzymes, vitamins, microelement compounds.

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, γ-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 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.

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

Causes of the disease

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

Intrauterine malnutrition:

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

Extrauterine malnutrition:

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

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

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

Classification

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

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

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

Symptoms of childhood malnutrition

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

I degree

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

II degree

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

III degree

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

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

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

Treatment of the disease

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

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

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

Prevention methods

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

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

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

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

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

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 malnutrition 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 tinge. 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 under normal outpatient conditions 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 expectant 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?

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Hypotrophy in children- this is the deviation of the actual body weight from the physiological age norms. This is an alimentary disease, which is characterized by a decrease in the amount or complete absence of the subcutaneous fat layer. In rare cases of hereditary metabolic disorders, malnutrition in children is associated with insufficient muscle mass. Muscular hypotrophy in children is complicated by dysfunctions of internal organs, heart failure and dystrophy subsequently. The classification of malnutrition in children is carried out in accordance with the indicators of the lag in weight gain:

• 1 degree diagnosed with a loss of body weight by 10-20%;
• 2 degree- this is the abandonment of the actual body weight from the physiological age norm by 21-40%;
• 3 degree- loss of more than 42% of normal body weight for age.

Why does fetal hypotrophy develop?

Fetal hypotrophy- this is a condition in which the actual weight of the child in utero is determined below the physiological level corresponding to the gestational age. The main provoking factors:

• toxicosis of pregnancy;
• nephropathy of a pregnant woman;
• a large amount of amniotic fluid;
• infectious diseases of the expectant mother;
• exacerbation of chronic diseases of internal organs;
• nutritional deficiencies in women.

Fetal hypotrophy is diagnosed by ultrasound. After diagnosis, the obstetrician should take measures to eliminate the causes of fetal hypotrophy.

How is malnutrition diagnosed in newborns?

After birth, malnutrition in newborns can be diagnosed at the first examination. The child is weighed and the data of his height and weight are compared. The doctor assesses the condition of the turgor of the skin and the thickness of the subcutaneous fat layer. With deviations from the norm, a diagnosis of underweight is established. In the newborn period, malnutrition in children can develop under the influence of:

• congenital disorders of the development of the digestive system;
• insufficiency of milk in the mother;
• improperly chosen scheme of artificial and mixed feeding;
• enzymatic deficiency;
• lactose intolerance;
• frequent colds and infectious diseases.

When diagnosing, the indicator of body weight gain is of decisive importance.

Symptoms of malnutrition in children

During the diagnosis, the main symptoms of malnutrition in children are distinguished:

• insufficient body weight;
• decrease in physical and mental activity;
• decrease in skin turgor;
• dry mucous membranes and skin;
• reduction in the amount of subcutaneous adipose tissue.

To prescribe the correct method of treatment, the cause of malnutrition should be identified. In newborns, this phenomenon is often associated with nutritional deficiencies or disorders of the gastrointestinal tract.

Treatment of malnutrition in children

Treatment of malnutrition in children begins with the diagnosis and elimination of the causes that form the complex of clinical symptoms. The diet and calorie content of the diet are adjusted. When breastfeeding, attention is paid to the diet of the mother. A high protein intake is recommended. If necessary, the diet of a nursing woman is supplemented with vitamin and mineral complexes. If these measures do not help within 1-2 weeks, then the child is transferred to a mixed type of feeding. The doctor recommends mixtures that are most suitable for the baby in terms of age and type of physiological characteristics. If the malnutrition of newborns is associated with lactose intolerance, then breastfeeding is completely replaced with artificial one using mixtures without milk protein.

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Hypotrophy in children is starvation, quantitative or qualitative, as a result of which significant changes occur in the body. Qualitative starvation is possible with improper artificial feeding, lack of essential nutrients and vitamins, quantitative - with incorrect calculation of caloric content or lack of food resources. Hypotrophy can be the result of acute diseases or the result of a chronic inflammatory process. Wrong actions of parents - lack of regimen, poor care, unsanitary conditions, lack of fresh air - also lead to this condition.

What does a normally developing baby look like?

Signs of normotrophic:

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

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

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

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

Causes and development

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

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

Causes of acquired malnutrition

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

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

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

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

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

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

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

Symptoms

Signs and symptoms of intrauterine malnutrition in a child:

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

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

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

Degrees of malnutrition in children

Hypotrophy of the 1st degree is sometimes practically not noticeable. Only an attentive doctor on examination can identify it, and even then he will first conduct a differential diagnosis and find out if a body weight deficit of 11-20% is a feature of the child's physique. Thin and tall children are usually so due to hereditary characteristics. Therefore, a new mother should not be afraid if her active, cheerful, well-nourished child is not as plump as other children. Hypotrophy of the 1st degree in children is characterized by a slight decrease in appetite, anxiety, sleep disturbance. The surface of the skin is practically not changed, but its elasticity is reduced, the appearance may be pale. The child looks thin only in the abdomen. Muscle tone is normal or slightly reduced. Sometimes they show signs of rickets, anemia. Children get sick more often than their well-fed peers. Stool changes are insignificant: a tendency to constipation or vice versa. Hypotrophy of the 2nd degree in children is manifested by a mass deficit of 20-30% and growth retardation (about 2-4 cm). Mom can find cold hands and feet in a child, he can often spit up, refuse to eat, be lethargic, inactive, sad. Such children lag behind in mental and motor development, sleep poorly. Their skin is dry, pale, flaky, easily folded, inelastic. The child looks thin in the abdomen and limbs, and the contours of the ribs are visible. The stool fluctuates greatly from constipation to diarrhea. These kids get sick every quarter.

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

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

Diagnostics

Differential Diagnosis

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

Treatment

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

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

Treatment of congenital malnutrition consists in maintaining a constant body temperature in the child and establishing breastfeeding. Nutrition of children with malnutrition Diet therapy for malnutrition is divided into three stages.

The main directions of drug therapy

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

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

Study of the causes and symptoms of malnutrition in children

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

Prevention of malnutrition in children

Prevention of both intrauterine and acquired malnutrition begins with the struggle for the health of the woman and for the preservation of long-term breastfeeding. The following areas of prevention are tracking the main anthropometric indicators (height, weight), monitoring the nutrition of children. An important point is the timely detection and treatment of childhood diseases, congenital and hereditary pathologies, proper child care, and prevention of the influence of external factors in the development of malnutrition. It should be remembered:

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

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

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

• Norm is the interval between GREEN and BLUE weight value (25-75 centiles).
• Weight loss- between YELLOW and GREEN figure (10-25 centiles), however, it may be a variant of the norm or a slight tendency to reduce body weight in relation to height.
• Weight gain- between BLUE and YELLOW number (75-90 centiles) is both normal and indicates a trend towards weight gain.
• Increased or reduced body weight- between RED and YELLOW number indicates both low body weight (3-10th centile) and increased (90-97th centile). This may indicate both the presence of the disease and the characteristics of the child. Such indicators require a thorough diagnosis of the child.
• Painful weight loss or gain- per RED border (>97 or
  

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. Currently, 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 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: dolichosigma, 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 young 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 regime: 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, adherence to the daily routine, walks in the fresh air, 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, puree.
• 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.

- chronic malnutrition, accompanied by an insufficient increase in body weight of the child in relation to his height and age. Hypotrophy in children is expressed by a child's lag in weight, growth retardation, lag in psychomotor development, underdevelopment of the subcutaneous fat layer, and a decrease in skin turgor. Diagnosis of malnutrition in children is based on examination data and analysis of anthropometric indicators of the child's physical development. 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.

General information

Hypotrophy in children is a lack of body weight due to a violation of assimilation or insufficient intake of nutrients in the child's body. In pediatrics, malnutrition, paratrophy and hypostatura are considered as independent types of chronic eating disorders in children - dystrophy. Hypotrophy is the most common and significant variant of dystrophy, to which children of the first 3 years of life are especially susceptible. The prevalence of malnutrition in children in different countries of the world, depending on the level of their socio-economic development, ranges from 2-7 to 30%.

Hypotrophy in a child is said to be when the body weight lags by more than 10% compared to the age norm. Hypotrophy in children is accompanied by serious disturbances in metabolic processes, decreased immunity, and a lag in psychomotor and speech development.

Causes of malnutrition in children

A variety of prenatal and postnatal factors can lead to chronic malnutrition.

Intrauterine malnutrition in children is associated with adverse conditions that disrupt the normal development of the fetus. In the prenatal period, pathology of pregnancy (toxicosis, preeclampsia, fetoplacental insufficiency, premature birth), somatic diseases of the pregnant woman (diabetes mellitus, nephropathy, pyelonephritis, heart defects, hypertension, etc.), nervous stress, bad habits, malnutrition of women, industrial and environmental hazards, intrauterine infection and fetal hypoxia.

Extrauterine malnutrition in young children may be due to endogenous and exogenous causes. The causes of the endogenous order include chromosomal abnormalities and congenital malformations, fermentopathy (celiac disease, disaccharidase lactase deficiency, malabsorption syndrome, etc.), immunodeficiency states, constitutional abnormalities (diathesis).

Exogenous factors leading to malnutrition in children are divided into alimentary, infectious and social. Alimentary influences are associated with protein-energy deficiency due to insufficient or unbalanced nutrition. Hypotrophy in a child may be the result of constant underfeeding associated with difficulty sucking with an irregular shape of the mother's nipples (flat or inverted nipples), hypogalactia, insufficient amount of milk formula, profuse regurgitation, qualitatively malnutrition (microelement deficiency), poor nutrition of a nursing mother, etc. The same group of reasons should include diseases of the newborn itself, which do not allow him to actively suckle and receive the necessary amount of food: cleft lip and palate (cleft lip, cleft palate), congenital heart defects, birth trauma, perinatal encephalopathy, pyloric stenosis, cerebral palsy, alcohol fetal syndrome etc.

Children suffering from frequent acute respiratory viral infections, intestinal infections, pneumonia, tuberculosis, etc. are prone to the development of acquired malnutrition. An important role in the occurrence of malnutrition in children belongs to unfavorable sanitary and hygienic conditions - poor child care, insufficient exposure to fresh air, rare bathing, insufficient sleep .

Classification of malnutrition in children

Thus, according to the time of occurrence, intrauterine (prenatal, congenital), postnatal (acquired) and mixed malnutrition in children are distinguished. The development of congenital malnutrition is based on a violation of the uteroplacental circulation, fetal hypoxia and, as a result, a violation of trophic processes leading to intrauterine growth retardation. In the pathogenesis of acquired malnutrition in children, the leading role belongs to protein-energy deficiency due to malnutrition, disturbances in the processes of food digestion or absorption of nutrients. At the same time, the energy costs of a growing organism are not compensated by food coming from outside. With a mixed form of malnutrition in children, alimentary, infectious or social influences join the adverse factors that acted in the prenatal period after birth.

According to the severity of underweight in children, hypotrophy of I (mild), II (medium) and III (severe) degrees is distinguished. Hypotrophy of the 1st degree is said when a child lags behind in weight by 10-20% of the age norm with normal growth. Hypotrophy of the II degree in children is characterized by a decrease in weight by 20-30% and a growth lag of 2-3 cm. With hypotrophy of the III degree, the body weight deficit exceeds 30% of the due age, there is a significant lag in growth.

During malnutrition in children, the initial period, the stages of progression, stabilization and convalescence are distinguished.

Symptoms of malnutrition in children

With malnutrition of the first degree, the condition of the children is satisfactory; neuropsychic development corresponds to age; there may be a mild decrease in appetite. A close examination reveals pallor of the skin, a decrease in tissue turgor, thinning of the thickness of the subcutaneous fat layer on the abdomen.

Hypotrophy of the II degree in children is accompanied by a violation of the child's activity (excitation or lethargy, lag in motor development), poor appetite. The skin is pale, scaly, flabby. There is a decrease in muscle tone, elasticity and tissue turgor. The skin easily gathers into folds, which are then poorly straightened. The subcutaneous fat layer disappears on the abdomen, trunk and limbs; on the face - saved. Children often present with shortness of breath, hypotension, and tachycardia. Children with II degree malnutrition often suffer from intercurrent diseases - otitis media, pneumonia, pyelonephritis.

Hypotrophy III degree in children is characterized by a sharp depletion: the subcutaneous fat layer atrophies throughout the body and on the face. The child is lethargic, adynamic; practically does not react to stimuli (sound, light, pain); sharply lags behind in growth and neuropsychic development. The skin is pale gray, the mucous membranes are dry and pale; the muscle is atrophic, tissue turgor is completely lost. Exhaustion and dehydration lead to retraction of the eyeballs and fontanel, sharpening of facial features, the formation of cracks in the corners of the mouth, and impaired thermoregulation. Children are prone to regurgitation, vomiting, diarrhea, decreased urination. In children with hypotrophy of the III degree, conjunctivitis, candidal stomatitis (thrush), glossitis, alopecia, atelectasis in the lungs, congestive pneumonia, rickets, anemia are often noted. In the terminal stage of malnutrition, children develop hypothermia, bradycardia, and hypoglycemia.

Diagnosis of malnutrition in children

Intrauterine fetal malnutrition, as a rule, is detected during ultrasound screening of pregnant women. In the process of obstetric ultrasound, the dimensions of the head, length and estimated weight of the fetus are determined. With a delay in intrauterine development of the fetus, the obstetrician-gynecologist sends the pregnant woman to the hospital to clarify the causes of malnutrition.

In newborns, the presence of malnutrition can be detected by a neonatologist immediately after birth. Acquired malnutrition is detected, a study of the coprogram and feces for dysbacteriosis, a biochemical blood test, etc.).

Treatment of malnutrition in children

Treatment of postnatal malnutrition of the 1st degree in children is carried out on an outpatient basis, malnutrition of the II and III degrees - in a hospital. The main measures include the elimination of the causes of malnutrition, diet therapy, the organization of proper care, and the correction of metabolic disorders.

Diet therapy for malnutrition in children is implemented in 2 stages: clarification of food tolerance (from 3-4 to 10-12 days) and a gradual increase in the volume and calorie content of food to the physiological age norm. 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. Feeding children with weakened sucking or swallowing reflexes is carried out through a probe.

Drug therapy for malnutrition in children includes the appointment of enzymes, vitamins, adaptogens, anabolic hormones. With severe malnutrition, children are given intravenous administration of protein hydrolysates, glucose, saline solutions, and vitamins. With malnutrition in children, massage with elements of exercise therapy, UVI is useful.

Forecast and prevention of malnutrition in children

With timely treatment of hypotrophy of I and II degrees, the prognosis for the life of children is favorable; with malnutrition III degree mortality reaches 30-50%. To prevent the progression of malnutrition and possible complications, children should be examined weekly by a pediatrician with anthropometry and nutrition correction.

Prevention of prenatal fetal malnutrition should include adherence to the regimen of the day and nutrition of the expectant mother, correction of the pathology of pregnancy, exclusion of the impact on the fetus of various adverse factors. After the birth of a child, the quality of nutrition of a nursing mother, the timely introduction of complementary foods, the control of the dynamics of an increase in the body weight of a child, the organization of rational care for a newborn, and the elimination of concomitant diseases in children become important.