Hypotrophy Komarovsky. Methods for determining three degrees of malnutrition. Exogenous causes of malnutrition

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, microelements, preparations for the normalization of intestinal microflora, anabolic hormones.

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

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

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

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

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

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

THE REASONS

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

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

Exogenous causes of malnutrition:

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

Endogenous causes of malnutrition:

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

CLASSIFICATION

Hypotrophy is systematized in several directions.

Classification of malnutrition depending on the period of occurrence:

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

Classification of malnutrition according to the severity of underweight:

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

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

SYMPTOMS

Symptoms depend on the severity of the syndrome:

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

DIAGNOSTICS

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

Clinical signs for the detection of malnutrition:

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

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

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

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

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

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

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

TREATMENT

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

Therapeutic measures for malnutrition:

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

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

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

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

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

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

COMPLICATIONS

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

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

Complications of malnutrition:

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

PREVENTION

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

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

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

PROGNOSIS FOR RECOVERY

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

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

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

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Hypotrophy in children is a type of dystrophy - systematic violation of the diet.

This problem is especially acute in regions with a low level of socio-economic development, however, individual cases also occur in developed countries. Here we are talking about dysfunctional families with low material wealth.

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Concept and characteristics

Hypotrophy occurs when there is a systematic malnutrition.

Pathology may be caused by quantitative starvation, when the child does not have enough food, or quality, when the baby, consuming a sufficient amount of food, does not receive enough vitamins and nutrients necessary for its development.

Qualitative malnutrition develops, for example, with the wrong choice for feeding the baby, improper and late introduction of complementary foods. Quantitative malnutrition occurs with a low-calorie diet, insufficient food intake.

With hypotrophy, there is lagging behind normal growth and weight recognized for a particular age group. A slight lag is not considered a pathology, it may be an individual feature of the child's physique.

The presence of the disease can be said in the case when the shortfall in height and body weight exceeds 10% of the established norm.

In this case all organs and systems of the child's body are affected, because, without receiving enough nutrients, they cannot fully perform their functions. Violated not only the physical development of the child, but also mental, intellectual.

Disease classification

There are 3 degrees of development of malnutrition in a child:

Hypotrophy may be congenital or acquired.

The congenital form of the pathology develops even in the prenatal period of a child's life, due to the difficult course of pregnancy, the threat of its interruption, and the unhealthy lifestyle of the expectant mother.

Acquired malnutrition develops after the baby is born as a result of insufficient (or improper) feeding, the presence of certain infectious diseases, anomalies in the development of internal organs, and a violation of their functionality.

Causes of development and risk groups

Congenital malnutrition in children occurs due to such adverse moments as:

The reasons for the development of acquired malnutrition are much more numerous:

Symptoms and clinical picture

At newborn babies the most common form of congenital malnutrition.

It is characterized by the following set of features:

• the weight and height of the child are significantly behind the norm. Weight reduced by 15% or more, height - by 2 cm or more., over time, the height and weight of the child increase slightly, the gains are significantly below the norm;
• lethargy, decreased muscle tone;
• congenital reflexes are weakened;
• there is a violation of thermoregulation (the baby freezes or, conversely, overheats under normal temperature conditions);
• the umbilical wound does not heal for a long period of time, even if the rules for caring for it are observed.

Acquired form of pathology, occurring in older children, appears as:

• thinness. Subcutaneously - the fat layer is thinned, but the normal proportions of the body are preserved. This symptom is characteristic of mild malnutrition;
• malnutrition of body tissues. Wherein subcutaneous fat atrophies becomes more invisible. Initially, it occurs in the abdomen, then throughout the body, in especially severe cases - on the face. The proportions of the body are violated;
• disorders of the nervous system(decrease in reflexes and muscle tone, depressed mood, delays in intellectual development). In a severe course of the disease, the child not only does not develop new skills, but also loses those that were acquired earlier;
• disorders of the digestive system(lack of appetite, frequent vomiting, decreased function of the organs that secrete digestive enzymes, and, as a result, a violation of the digestive processes);
• decrease in the protective functions of the body. Baby the most prone to disease bacterial and viral nature.

Complications and consequences

With pronounced malnutrition, there is a significant weakening of the body, its inability to withstand all kinds of diseases, including can be very serious(pneumonia, sepsis, and others), which can lead to a significant deterioration in the child's condition, and even death.

In addition, the intellectual development of the baby is disturbed, there are problems in learning, there are times when the child even forgot the skills that he had previously.

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Diagnostics

To establish the disease and determine its degree, the doctor conducts a survey of the patient (or his parents).

During the survey establishes the nature of the child's nutrition(quantity and quality), living conditions of the baby, features of hygienic care for him, lifestyle and daily routine, whether the child takes medication.

In the process of visual examination, the doctor assesses the baby's physique, the condition of his skin, hair, nails, determines muscle tone, and monitors the child's behavior.

Necessary and laboratory research:

• general analysis of blood and urine;
• analysis of feces for the content of undigested fatty elements;
• study of the immune system;
• Ultrasound of the digestive tract.

Treatment Methods

What is the treatment of malnutrition in children?

The choice of one or another therapeutic method depends on the form of the disease, its degree, as well as on the characteristics of the baby's body.

Often these methods are used in combination, which allows you to achieve more effective and faster results.

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Medicines

Patient appoint:

• enzyme preparations containing pancreatic enzymes;
• immunomodulators;
• means for eliminating dysbacteriosis;
• vitamin preparations;
• means to eliminate the secondary symptoms of the disease, when there are violations of the internal organs.

In emergency cases, anabolics are prescribed - drugs necessary for the formation of protein, which is the most important building block for all human tissues and organs.

Food

Therapeutic nutrition for children with signs of malnutrition is carried out in 3 stages:

UFO

Treatment of malnutrition with UV irradiation has stimulating effect on the whole body in general, including the digestive system.

As a result of such an impact, metabolic processes in the child’s body are normalized, nutrients are better absorbed, various kinds of problems in the work of the digestive tract (disturbance of stool, vomiting) become less pronounced, in a child increased appetite.

However, this method is not recommended for severely weakened children with severe malnutrition.

Massage

A properly selected set of massage movements helps to strengthen the baby's muscle tissue, helps restore its tone, and normalize reflexes.

It is important to remember that all movements should be as gentle as possible(stroking), all kinds of pressure, rubbing, and other intense movements should be avoided.

It is necessary to massage (stroke) the arms and legs of the child, not forgetting the hands and feet, back and tummy, chest. 3-4 strokes of each area are enough.

No treatment methods will give the expected effect if you do not create a baby normal living conditions at home.

It is important to monitor the hygiene of the child, the regime of his day (sleep and wakefulness), spend time with the baby on the street (quiet walks, sleep in the fresh air are recommended), please him with positive emotions.

Forecast

With timely and adequate therapy, the prognosis is usually good.

The presence of secondary diseases, disorders of the internal organs, as well as the small age of the patient reduce the chances of a successful recovery.

Prevention

It is necessary to follow the rules to prevent the development of malnutrition in a child from the moment of his conception. In particular, the expectant mother should pay attention to her health, nutrition, give up excessive physical exertion, bad habits.

After the baby is born, he needs create the right conditions accommodation, provide hygienic care, proper and nutritious food.

Some children are extremely thin, which can be simple feature of their physique.

However, if the lag in terms of height and weight is significant, we are talking about pathology.

It can be caused by various factors, both perinatal and postnatal.

Symptoms of the disease manifest themselves in different ways, depending on the form and degree of pathology. Hypotrophy needs timely and comprehensive treatment, in this case, the chance of recovery is very high.

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Update: December 2018

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
• , 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
• - the digestibility of milk is disturbed (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 nutrition: 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 mass is insufficient, the body proportions are disturbed, the skin is dry, elasticity is reduced.
• Changes in the functioning of the nervous system: depressed mood, decreased muscle tone, weakening of reflexes, psychomotor development is delayed, and in severe cases, acquired skills even disappear.
• Decreased food intake: appetite worsens up to its complete absence, frequent regurgitation, vomiting, stool disorders appear, the secretion of digestive enzymes is inhibited.
• Decreased 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 1 degree in children it 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 2 degrees in children it is manifested by a weight 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 7-10 cm, weight deficit ≥ 30%. The child is drowsy, indifferent, tearful, acquired skills are lost. The subcutaneous fat is thinned everywhere, pale gray, dry skin fits the baby's bones. There is muscle atrophy, cold extremities. Eyes and lips dry, cracks around the mouth. A child often has a chronic infection in the form of pneumonia, pyelonephritis.

Diagnostics

Differential Diagnosis

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

Treatment

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

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

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

Nutrition for children with malnutrition

Diet therapy for malnutrition is divided into three stages.

The main directions of drug therapy

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

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

Study of the causes and symptoms of malnutrition in children

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

Prevention of malnutrition in children

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

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

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

It should be remembered:

• Mother's milk is the best and irreplaceable food for a baby up to a year old.
• At 6 months, the menu should be expanded with plant foods (see). 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 any, 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 question of any vegetarianism, only meat contains the compounds necessary for growth, they are not produced in the body in the amount that is needed for full development and health.
• Important!!! There are no safe drugs "just" to reduce or increase a child's appetite.

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

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

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

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 takes place in a hospital.

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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