Hypotrophy in young children treatment. Methods for determining three degrees of malnutrition. Biochemical studies reveal

Hypotrophy- an eating disorder of a young child, which is characterized by a stop or slowdown in the growth of body weight, progressive thinning of the subcutaneous tissue, disturbances in body proportions, disorders of the digestive and metabolic functions, a decrease in specific and nonspecific defenses of the body, a tendency to develop other diseases, a delay in physical and neurological -mental development.

Cause and pathogenesis of malnutrition

Clinical manifestations of malnutrition

Hypotrophy I degree is rarely diagnosed

Hypotrophy II degree

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

Hypotrophy III degree (atrophy, insanity)

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

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

Prenatal malnutrition

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

Hypostatura

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

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

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

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

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

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

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

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

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.

It is extremely common to observe malnutrition in children, accompanied by a slight increase in body weight in relation to height and age. When this gap exceeds 10%, hypotrophy is diagnosed.

Hypotrophy (protein-energy malnutrition (PEM)) is a spectrum of conditions caused by various levels of protein and calorie deficiency and is characterized by insufficient body weight in relation to height.

Hypostatura is described as one of the variants of PEI, in which an interconnected deficit is established, both in body weight and in height.

The causes of malnutrition can be divided into two groups:

• exogenous (associated with external factors);
• endogenous (internal causes).

The mechanism of the onset of the disease and the development of its manifestations (pathogenesis)

In pathogenesis, the following pathophysiological phases are distinguished:

1. 1st phase - hungry excitement. The consumption of reserve reserves of carbohydrates provides the body's energy needs, the metabolism of amino acids weakens, and the excretion of nitrogen decreases.
2. 2nd phase - the phase in which the metabolism switches to the breakdown of fat, the basal metabolism decreases, the synthesis of vital proteins is still preserved due to the breakdown of other body proteins.
3. The 3rd phase is irreversible: the splitting of the “internal” protein is carried out to cover energy goals, changes occur in the structure of mitochondria (organelles that are the energy base of cells) with a violation of their regulatory mechanisms.

Symptoms

Clinical manifestations of malnutrition are grouped into several syndromes.

Trophic disorder syndrome

Lack of tissue nutrition, which caused structural changes in tissues and cell death:

• flat or negative curve of body weight in dynamics;
• deficiency of body weight, to a lesser extent - body length;
• the proportionality of the physique is violated;
• trophic disorders of the skin and skin appendages: decreased elasticity, flabbiness, dryness, with cachexia (extreme exhaustion of the body) - a symptom of a "pouch" (a narrow mouth opening with deep wrinkles around it), dull nature of nails and hair, alopecia (baldness);
• the subcutaneous fat layer is consistently thinning - on the body, abdomen, limbs, face;
• muscle hypotorphy and increasing;
• decrease in tissue elasticity.

Syndrome of digestive disorders and impaired food tolerance

• appetite decreases up to anorexia;
• increasing dyspeptic disorders - regurgitation, unstable stools, irregular defecation, alternating;
• enzymatic and secretory gastrointestinal tract are weakened.

CNS dysfunction syndrome

• disturbed emotional tone (scream, cry) and neuro-reflex excitability;
• involuntary muscle contraction;
• hyporeflexia (decreased reflexes);
• lag of psycho-emotional development;
• thermoregulation and sleep are disturbed.

Syndrome of impaired hematopoiesis and immunobiological reactivity

• deficiency of iron and other micro and macro elements, vitamins (iron deficiency anemia, rickets, etc.);
• frequent infectious and inflammatory diseases, their course is erased and atypical;
• develop toxic-septic conditions, dysbiocenosis of natural microbiological niches;
• signs of secondary immunodeficiency.

Weakened nonspecific resistance.

Depending on the deficiency of body weight, three degrees of malnutrition are distinguished: at degree 1, the insufficiency is 11–20% of the due value, at degree 2 - 21–30%, at degree 3 - a deficiency of more than 30% of the due body weight. In clinical practice, malnutrition of the 1st degree prevails, mainly associated with temporary alimentary disorders, less often the 2nd degree is observed, the development of which is associated with a complex of etiological factors, mainly endogenous. III degree or cachexia with irreversible organ system consequences and subsequent death is a rare condition.

Fetal hypotraphy

Fetal hypotrophy is a delay in intrauterine development of the child.

There are three options for the development of pathology:

1. Hypotrophic. There is a malnutrition of all systems and organs, characterized by slow development of the fetus, which does not correspond to the gestational age.
2. Hypoplastic. It is characterized by a delay in the maturation of all organs in combination with a lag in the overall development of the fetus. This means that at birth, tissues and organs are not sufficiently formed and their functions are not fully performed.
3. Dysplastic. There is uneven development of some organs. For example, the liver, heart develop in accordance with the gestational age, and other organs have a lag in maturation.

Diagnosis of malnutrition in children

Diagnosis is based on anthropometric data (a method of measuring the human body and its parts): a lack of body weight and a slowdown in growth rates relative to proper values.

In the blood test, anemia is detected, with malnutrition of the 3rd degree - absolute lymphopenia (decrease in lymphocytes), slowing down the ESR.

Biochemical examination reveals:

• hypoalbuminemia (decrease in albumin, a substance that is an integral part of blood plasma);
• dysproteinemia (imbalance between blood protein fractions);
• hypoglycemia (decrease in glucose concentration);
• hypocholesterolemia (decrease in cholesterol);
• dyslipilemia (impaired lipid balance).

In the analysis of urine - leukocyturia, ketone bodies, an excess amount of ammonia. B - signs of impaired intestinal digestion.

How is the treatment carried out?

Children with grade 1 malnutrition are treated on an outpatient basis when the social environment is favorable. At the 2nd - 3rd degree, therapy is carried out only in a hospital (first in the intensive care unit, then in the general somatic unit).

All children need a therapeutic and protective regime: sufficient sleep in calm conditions, regular ventilation of the room, access to sunlight, wet cleaning twice a day. The temperature in the room is maintained at 25 - 26 ° C. Walks, therapeutic exercises, massage, bathing - daily; skin and visible mucous membranes are carefully cared for (moisturizing creams, emulsions, vitamin masks).

Diet therapy is the basis of treatment, and is carried out in 3 stages. The basis is the rejuvenation of the diet (“step back”), that is, they use foods that are typical for an earlier age group.

When a child is breastfed, it is unacceptable to exclude a single drop of mother's milk from the diet of a patient with malnutrition.

Organization of diet therapy

In the complex treatment of children, enzyme replacement therapy is used, taking into account the coprogram, as well as vitamin D3, iron preparations, vitamins of groups B, C, PP, A and E. Probiotic preparations based on bifido- and lactobacilli are prescribed to correct microbiocenosis disorders. At the 3rd degree of malnutrition, antimycotic agents are used to prevent candidal lesions of the intestine.

The use of anabolic drugs is carried out with caution, since, under the condition of a deficiency of nutrients, their use can lead to profound disorders of protein and other types of metabolism.

Conclusion

The prognosis is favorable for PEU of the 1st and 2nd degree. With the 3rd degree of malnutrition, despite the ongoing treatment, mortality is 20 - 50% of cases.

Hypotrophy (Greek hypo - low, and trophe - nutrition) is akin to dystrophy, it is also expressed in the lack of physical development of children, but in addition it leads to serious metabolic disorders in the body. In the first months of life, the baby's bone and muscle tissues grow rapidly, and the total body weight gained to a sufficient degree indicates its harmonious development.

If the body weight is insufficient, then failures in the child's life support system will not keep you waiting. The lack of vitamins and microelements will not allow the full development of the child's body, but it is especially dangerous for him to have a deficiency of protein - the building material of cells, as well as a lack of calories - energy for metabolic processes in the body. The pathological process can also start from malnutrition, and as a result of some kind of disease or harmful factor leading to incomplete absorption of food.

Factors provoking malnutrition

Internal causes of disturbed trophism of body tissues:

1. Functional failures in the digestive system: they do not allow you to fully absorb the nutrients necessary for the baby. This can happen both in the gastrointestinal tract (gastrointestinal tract), and at the cellular level in the very substance of the tissue. Violation of metabolic processes in the cell leads to the depletion of its energy reserves, and upon reaching a critical value, the cell may die.

2. Encephalopathy of the fetus at different stages of intrauterine development, which in turn leads to the fact that the central nervous system that develops with deviations can cause dysfunction of any internal organ.

3. Immature lung tissue. Blood, unsaturated with oxygen, cannot carry it to the tissues sufficiently, which slows down the metabolism and hinders the full development of the whole organism.

4. Congenital pathology of the gastrointestinal tract, leading to systematic constipation or vomiting (for example, Hirschsprung's disease).

5. Syndrome of "shortened gut" - the consequences of abdominal surgery.

6. Failures of the immune system of a hereditary nature, weakening the body's defenses.

7. Disrupted work of the endocrine system. For example, diseases of the thyroid gland lead to a slowdown in both growth and metabolic processes in the body, and abnormalities in the pituitary gland cause pituitary dwarfism - insufficient production of growth hormone.

8. Hereditary diseases associated with metabolic disorders. An example is galactosemia - intolerance to milk and any dairy products or fructosemia, which causes a similar attitude of the child's body to fructose contained in both vegetables and fruits.

External factors cause malnutrition much less frequently. If their impact is prolonged, then in the future they can affect not only the growth and physical development of the child, but also the general condition of his body and the performance of organs. These include:

1. Chronic malnutrition due to the characteristics of the mother's breasts or the small amount of milk she has, in addition, the child himself may not have a fully developed lower jaw or a shortened frenulum of the edge of the tongue. An illiterate use of ready-made formulas for feeding babies or untimely introduction of complementary foods can play a large role in underfeeding.

2. Reduced immunity of the baby, provoked by any infection (bacterial, viral) at different stages of pregnancy or the life of the child. The presence of pyelonephritis, infections of the urinary system and damage to the intestinal mucosa significantly slow down the development of the body, because it spends a lot of vital energy on fighting the pathogens of these diseases (up to half of the total costs).

3. Exposure to toxic substances, including drugs, and an overdose of vitamins (especially A and D).

Stages of the disease

For better control over the general condition of the child with malnutrition and the appointment of adequate treatment, the disease is usually divided into degrees. Such a division is purely conditional, because the course of the disease is continuous and it is difficult to draw a clear line between the stages. In newborns, hypotrophy of the 1st degree is diagnosed if he was born on the dates following the 38th week with a weight not exceeding 2800 g, while having a body length of less than 50 cm.

If the disease is acquired at some stage of a child's life, then to determine its degree, it is necessary to calculate the fatness index (BFI), introduced by Professor Chulitskaya and adopted by domestic medicine. The method is based on measuring (in centimeters) the circumference of the shoulder at two points, the thigh and lower leg, and summing up these results, and then subtracting the height of the baby from the resulting amount. Up to a year, a fully developing baby should have an IUCH index of at least 20 cm.

To give a detailed description of each degree of the disease, it is necessary to consider malnutrition syndromes (the entire set of symptoms of the affected organ). There are several of them:

1. Violation of the trophism of organ tissues due to the slow flow of metabolic processes in the body. This leads to a decrease in the total body weight, including the subcutaneous fat layer, as well as to lethargy and flabbiness of the skin.

2. Dysfunction of the digestive organs, while the entire gastrointestinal tract suffers: the stomach does not produce enough pepsin and acid, and the intestines do not have enough enzymes to process food. Therefore, with malnutrition, the presence of stool disorder and flatulence is quite understandable.

3. Functional failures in the work of the central nervous system of the child, which is expressed in his hyperexcitability, sleep disturbance, apathy and a decrease in muscle tone.

4. Impaired hematopoietic process, expressed in anemia, and to a large extent, a decrease in the protective functions of the immune system. Such children are susceptible to many infectious diseases, the leading symptoms of which are atypical and blurred.

Removal of a child from a pathological state

How do doctors determine the degree of malnutrition? First of all, according to the body weight deficit for the corresponding age of the child (all pediatricians have a correspondence table) and the Chulitskaya index.

Hypotrophy of the 1st degree is characterized by:

• the presence of a weight deficit of 10% - 20% of the original;
• IUCH varies between 10 and 15 cm;
• thinning of the fat layer on the abdomen and loss of elasticity of the skin;
• rapid fatigue and restless sleep;
• the presence of irritability;
• satisfactory general condition of the baby.

Treatment is carried out at home and involves fractional meals (8 times a day). Food should be easily digestible, preference is given to cereals, fresh fruits and vegetables.

Grade 2 is characterized by aggravation of all existing violations:

• the presence of a weight deficit of 20% - 30% of the original;
• IA varies between 1 and 10 cm;
• complete absence of fat on the abdomen and chest, dryness and pallor of the skin;
• degradation of muscle mass on the limbs and weakness of the entire muscle corset;
• markedly impaired thermoregulation;
• the appearance of dysbacteriosis;
• delayed closure of the small and large fontanel;
• nervousness and capriciousness;
• susceptibility to frequent infectious diseases, protracted nature.

Treatment can be carried out at home, but it is still better to give preference to the hospital if possible. The principle of fractional nutrition is used, but portions are reduced in volume. Nutrition should be easily digestible, in addition, a course of biostimulants is prescribed, a vitamin-mineral complex and enzymes are taken to improve digestion.

With malnutrition of the third degree, there is already a complete clinic of the disease. The condition of the child is very serious, and in the absence of necessary measures, a fatal outcome is also possible. The complexity of the situation lies also in the fact that the effectiveness of the measures taken to remove the child from this situation is low. Even in appearance, it is clear how exhausted his body is:

• the presence of a weight deficit of more than 30% of the original;
• VA is zero or will be negative;
• the absence of a fatty layer on the whole body, even on the face, and the skin is so thin that it resembles the dried skin of a mummy;
• the skin fold released by the fingers does not straighten out for a long time, sunken cheeks and protruding cheekbones are visible on the face;
• the thermoregulation center in the brain does not function, and the body temperature changes abruptly;
• a clear lack of iron leads to "jamming" in the corners of the lips, and a lack of vitamins (primarily A and C) - to bleeding and atrophy of the gum tissue;
• the appearance of symptoms of osteoporosis, expressed in the softness of the cranial bones;
• due to a sharp decrease in the protective forces, the baby very often and for a long time suffers from infectious diseases (inflammatory processes of the middle ear or kidneys, often pneumonia);
• overexcitation of the central nervous system, followed by apathy for everything.

Treatment of malnutrition of the 3rd degree is carried out only in stationary conditions, since all types of metabolic processes, functions of organs and systems are completely disrupted in the body. These babies need an intravenous infusion of glucose and a transfusion of blood or its plasma. Course treatment with hormones, maintenance therapy with enzymes, as well as the intake of necessary vitamins and trace elements are prescribed.

Hypotrophy in a simplified form is a chronic malnutrition. This pathology is most often found in children at an early age. A child with malnutrition is far behind in growth and weight gain.

From the very first day of life, children rapidly gain weight. Everything grows in them: bones of the skeleton, muscle tissues, internal organs. If the kids do not receive sufficient amounts of food, or the diet is not made correctly, then this will very quickly affect the development of the body and the work of its various systems and organs.

Doctors say that the main reason for the development of malnutrition is a lack of protein in food and insufficient calorie intake.

The main causes of malnutrition in children

This pathology can develop under the influence of internal and external factors. Besides, malnutrition can be primary or secondary.

• Primary malnutrition in children develops against the background of malnutrition.
• Secondary malnutrition in children appears against the background of internal diseases, in which the absorption of nutrients from food is disturbed or even becomes impossible.

Internal factors that cause malnutrition in newborns include diseases of the internal organs associated with digestion. Simply put, due to these diseases, nutrients are not fully absorbed. It is worth noting that these are not necessarily diseases of the digestive system. These may be changes at the level of tissues and cells, manifested in the violation of metabolic processes. Because of them, the energy reserves in the cells are depleted, which leads to their death.

Internal causes of pathology

The most common internal causes of malnutrition in young children are:

Doctors say that internal factors that cause malnutrition in children are much more common than external ones. But this does not mean that the latter should not be taken into account. In order for malnutrition to occur under the influence of external factors, they must affect the child's body for a long time. This means that pathology can manifest itself not only in a lack of weight and height, but also in more serious violations that will certainly manifest themselves in the future.

External causes of malnutrition in children

External causes of this pathology include:

The symptoms of this pathology are mainly determined by the lack of nutrients in the baby's body. In second place are the symptoms of diseases that cause disturbances in the work of various organs. Doctors divide all symptoms into separate syndromes, combining a set of signs that occur when a disease of a particular organ or system occurs.

With malnutrition, 4 main syndromes are detected:

As a rule, each small patient with malnutrition manifests only one syndrome.

Doctors distinguish 3 degrees of malnutrition. This separation helps doctors more accurately determine the condition of the child and choose the right treatment. The levels change. At each stage of the pathology, additional symptoms appear in young patients.

Hypotrophy 1 degree

In children, it is manifested by a decrease in subcutaneous fat. This is due to the fact that the body, with a lack of nutrition, tries to compensate for energy costs due to subcutaneous fat, which is the best energy storage. Fat from the subcutaneous tissue enters the blood, where it is processed into the energy necessary for normal life.

First, fat disappears in the abdomen, and then from other parts of the body. Assessment of the state of adipose tissue is carried out using various methods. In recent years, doctors have given preference to the Chulitskaya index, based on measuring the circumferences of the shoulders, hips and legs.

Symptoms of hypotrophy of the 1st degree:

• Decreased muscle tone and elasticity of the skin.
• The growth of the child does not lag behind age indicators.
• Body weight lags behind the norm by 20%.
• Feeling within normal limits.
• The child gets tired quickly.
• The child does not sleep well and becomes irritable.

Hypotrophy of the 2nd degree

The initial symptoms are the same as in the 1st degree of pathology. The main difference lies in the deepening of the old symptoms and the appearance of new ones.

Main features:

Hypotrophy of the 3rd degree

At this stage of the disease, clinical manifestations become especially acute. There are violations in the work of all organs and systems. It is very difficult for doctors to get a small patient out of this condition. The severity of primary pathologies determines the possibility of further recovery. The most severe malnutrition of the 3rd degree is tolerated by newborns.

Characteristic signs of pathology:

Options for the course of pathology

Lack of mass and growth retardation can be observed in a baby at all stages of its development. At the same time, at each stage, the pathology has its own characteristics.

Depending on the period in which the pathology develops, doctors distinguish 4 variants of its course:

1. Intrauterine flow.
2. Hypostatura.
3. Kvishiorkor.
4. Alimentary insanity.

intrauterine course

Pathology develops when the child is still in the womb. Doctors distinguish 3 options for intrauterine malnutrition:

1. Hypotrophic. All organs of the fetus do not receive enough nutrients. Because of this, the child grows very slowly.
2. Hypoplastic. With this variant of the pathology, along with a delay in the overall development of the fetus, there is a violation in the maturation of organs.
3. Dysplastic. Different organs develop unevenly. Some of them correspond to the terms of pregnancy, while others do not.

Hypostatura

We are talking about a uniform lag of a newborn child in height and body weight from their peers.

Hypostatura is a secondary pathology that develops on the basis of diseases of the internal organs. It can manifest itself not only in newborns, but also in adolescents.

Most often, hypostatus is provoked by:

• Heart disease and circulatory disorders.
• Encephalopathy complicated by endocrine disorders.
• bronchopulmonary dysplasia. This pathology appears even in the period of intrauterine development and manifests itself in the insufficient development of the lung tissue, due to which the newborn does not receive enough oxygen during breathing.

Kwashiorkor

With this variant of the course of malnutrition, the body receives protein food in insufficient quantities or is not at all able to absorb protein products.

The development of kwashiorkor is promoted by:

• Long-term digestive problems, manifested by unstable stools.
• Problems with the liver.
• Diseases of the kidneys.
• Burns and significant blood loss.
• Some infectious diseases.

The lack of protein leads to disturbances in the work of the central nervous system. The child becomes lethargic, falls asleep at the first opportunity, does not want to eat. He may develop edema due to a lack of albumin and globulin in the blood. His muscle mass is rapidly declining.

Alimentary insanity

This course of malnutrition is most often detected in school-age children. This condition is characterized by a lack of proteins and calories. Alimentary insanity is accompanied by the following symptoms:

Conclusion

Hypotrophy in children is a rather dangerous disease. The prognosis of recovery depends on what causes the pathology. The earlier the disease is detected, the less damage it will cause to the health of the child.