Hypotrophy in a child 1 year of age. Intrauterine hypotrophy. Internal causes of malnutrition

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 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<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.

Dystrophy in children (hypotrophy) is a chronic eating disorder, one of the main manifestations of which is a gradually developing child. There are mild and severe forms of dystrophy. A clear boundary between these forms is often difficult to determine. A far advanced form of dystrophy is called atrophy.

Etiology and pathogenesis. The reasons for the development of dystrophy in children are very diverse. It can be caused by external and internal factors. The most common cause (external factor) is malnutrition, both quantitatively and qualitatively. A quantitative lack of food is often associated with malnutrition and can be from the first days of a child's life (lack of milk in the mother, the presence of tight or flat and inverted nipples, lethargy). Insufficiently active sucking is more often observed in, as well as those born in and with intracranial. Getting enough food can interfere with all sorts of congenital (non-closure of the upper and solid, etc.). Hypotrophy also develops as a result of a lack or absence of one of the important components of food (for example, protein, vitamins, salts), if their correct ratio is violated. Qualitative errors in nutrition are more common with mixed and artificial feeding. Of great importance are unfavorable environmental conditions (non-compliance with the sanitary and hygienic regime, lack of air, light, etc.), improper care. There are children in whom dystrophy has developed mainly as a result of a lack of appetite under the influence of improper introduction of complementary foods, drugs, and force-feeding. Infections and chronic diseases contribute to the development of dystrophy due to metabolic disorders and the activity of regulatory mechanisms. Under all these circumstances, the food that enters the body does not cover its needs; as a result, the child's own reserves are used up, which leads to depletion. During starvation, the activity of all body systems is perverted, a violation of all types of metabolism develops. Such children have reduced body resistance and they are prone to all kinds of diseases that are difficult for them and often cause death.

Clinic. The main manifestation of dystrophy (hypotrophy) is a decrease in the subcutaneous fat layer, first of all on the abdomen, then on the chest, back, limbs and later on the face. Happens. slowing down and even stopping weight gain, it becomes less than normal.

There are three degrees of malnutrition. Hypotrophy 1 degree characterized by a lag in weight by 10 - 15%, but the child has a normal. There is a decrease in the subcutaneous fat layer on the abdomen and partially on the limbs. The skin color remains normal or somewhat pale, the general condition is not disturbed.

At hypotrophy of the 2nd degree the weight of the child lags behind the norm by 20-30%, there is also a slight lag in growth (by 1-3 cm). The subcutaneous fat layer is reduced everywhere. The child is pale, the tissues are reduced, the skin is going into folds, the muscles are flabby. The general condition is disturbed, it decreases, the mood becomes unstable, the development of static and motor functions worsens or is delayed.

Hypotrophy 3 degrees characterized by a weight loss of more than 30%, severe wasting and stunting. The subcutaneous fat layer is absent, the eyes sink, wrinkles appear on the forehead, the chin is pointed, the face is senile. The muscles are flabby, retracted, the large fontanelle sinks, the conjunctiva and cornea of ​​the eyes are prone to drying out and ulceration, breathing is shallow, slow, weak, muffled. Appetite is reduced, but there is a tendency to diarrhea. Urination is reduced. Hypochromic anemia develops, with a sharp thickening of the blood, the amount also increases. Children are depressed, their voice is aphonic, the development of static and motor skills, speech is delayed.

The diagnosis of dystrophy in children (hypotrophy) is established on the basis of the anamnesis, appearance of the child, clinical examination data, weight, height.

Hypotrophy treatment- complex, taking into account the individual characteristics of the child, the conditions under which the disease developed. In severe forms - symptomatic, pathogenetic and stimulating therapy. It is especially important to properly prescribe nutrition. So, with hypotrophy of the 1st degree, it is necessary first of all to assign a child nutrition based on the weight that he should have according to his age. With a lack of breast milk, the mother is prescribed supplementary feeding with donor milk or mixtures. With artificial feeding, women's milk and mixtures are temporarily prescribed.

With malnutrition of the 2nd degree, women's milk or sour mixtures are prescribed at the rate of 2/3 or% of the amount required for the given age of the child (see). If the child's weight is reduced by 20%, then the total amount of food is calculated on the actual weight. If more than 20%, then the calculation is carried out on the average weight, that is, on the actual plus 20% of it. The lack of food volume is replenished with fruit and vegetable broths, 5% glucose solution,. The number of feedings increases to 7-8 times a day.

After 5-7 days, when the child's condition improves, the amount of food increases, but the calorie content should not exceed 130-150 calories per 1 kg of body weight. If necessary, carry out a correction with proteins, and (carefully) with fats.

Nutrition is especially carefully prescribed for malnutrition of the 3rd degree. The daily calculation of nutrition is carried out on an average weight between the due and actual. In the first days of treatment, regardless of age, only half of the required amount is prescribed and only women's milk. If it is impossible to provide the child with a sufficient amount of human milk, acid mixtures are given. The lack of food volume is replenished by liquid. An increase in the daily amount of food is carried out very carefully, even with a clear trend towards improvement. Caloric intake per actual weight should not exceed 180 calories per 1 kg of body weight. All children with malnutrition need vitamins and. To improve appetite, appoint 1 / 2-1 teaspoon 5 times a day or 1% solution diluted with before feeding, 0.2 g 2 times a day an hour after meals for 7-10 days. The appointment of anabolic hormones is shown (see). Measures to combat dehydration are carried out as in toxic dyspepsia (see Dyspepsia in children). In severe cases, plasma and blood transfusions are recommended.

Prevention. Proper organization of the general regimen and feeding.

Depends on the degree of the disease, reactivity and timeliness of treatment.

At malnutritionI degrees the general condition of the child suffers little. Body weight is reduced by 11-20% due, the mass-growth coefficient is 56-60 (normally more than 60). The fatness index of Chulitskaya reaches 10-15 (normally 20-25). The clinical symptoms of this condition are moderate restlessness, greed for food, decrease in the number of bowel movements, slight pallor of the skin, thinning of the subcutaneous fat in the trunk area. Psychomotor development corresponds to age. Immunological reactivity and food tolerance may be reduced.

HypotrophyII degrees characterized by pronounced changes in all organs and systems. The child lags behind in weight by 21 - 30%, in height by 2 - 4 cm. The Chulitskaya index decreases to 10 - 0, the mass-height coefficient is below 56. Such children have poor appetite, periodically vomiting, unstable stools, sleep is disturbed. There is a lag in psychomotor development: the child does not hold his head well, does not sit, does not stand up, does not walk. Thermoregulation is disturbed. During the day, fluctuations in body temperature of more than one degree are observed. The subcutaneous fat is sharply thinned not only on the abdomen, but also on the trunk and limbs.

The skin is pale, pale gray; dryness and peeling of the skin (signs of polyhypovitaminosis) are noted. Elasticity, tissue turgor and muscle tone decrease. Hair is dull and brittle. Immunological tolerance is sharply reduced, so the somatic pathology proceeds with few symptoms and is atypical.

Almost every child with II degree malnutrition has rickets and (or) anemia.

HypotrophyIII degrees usually develops in children who were born with symptoms of prenatal malnutrition, and premature. The lag in body weight exceeds 30%, in growth - more than 4 cm. The clinical picture is manifested by anorexia, a decrease in thirst, general lethargy, a decrease in interest in the environment, and a lack of active movements. The face is senile, expresses suffering, cheeks are sunken, Bish's lumps are absent. The subcutaneous fat layer is practically absent. The fatness index of Chulitskaya is negative. There is a delay in psychomotor development ( previously acquired skills are lost).

Breathing is superficial, apnea is sometimes noted. Heart sounds are weakened, deaf, there may be a tendency to bradycardia, arterial hypotension. The abdomen is enlarged due to flatulence, the anterior abdominal wall is thinned, loops of the intestines are contoured. Constipation alternates with soapy-lime stools.

Most patients have rickets, anemia, dysbacteriosis, septic course of infections.

Diagnostics. The diagnosis is based on the clinical picture of the disease. All patients have metabolic disorders to varying degrees: hypoproteinemia, hypoalbuminemia, hypoglycemia, hyponatremia and potassium, hypovitaminosis, acidosis, signs of rickets and anemia. Starch, neutral fat, mucus, muscle fibers can be found in the coprogram. Most children have intestinal dysbiosis of varying severity.

Differential Diagnosis

The disease is differentiated in order to determine the causative factor of malnutrition and identify the underlying disease.

Treatment

It is necessary to observe all the principles of complex treatment, depending on the degree of malnutrition.

Treatment of malnutrition of the first degree is carried out at home and is aimed at eliminating alimentary factors that cause starvation. With malnutrition II and III degree, the child is sent to the hospital to identify diseases that contribute to the development of malnutrition, and their treatment. At the same time, great importance is attached to the proper organization of the daily regimen and nutrition, child care.

Children are hospitalized in separate ward-boxes, which are allowed to be visited by a limited number of medical workers (in order to prevent infectious diseases in a child). The room is ventilated, wet cleaning is carried out 2 times a day. The air temperature in the ward is maintained in the range of 25 - 26 °C. Careful care of the skin and visible mucous membranes is carried out. It is necessary to prescribe a general massage and physiotherapy exercises (taking into account the condition of the child).

The general principles for malnutrition are:

1) the use in the nutrition of children of women's milk and adapted lactic acid mixtures ("Lactofidus", etc.), mixtures for feeding children with reduced body weight ("PreNan", "Alfare");

2) increase in the frequency of feeding up to 7 - 8-10 times (according to the degree of malnutrition);

3) weekly calculation of nutrition for, fats and, daily monitoring of the child's condition (keeping a food diary, control weighing, accounting for fluid balance, stool nature) and analysis of the coprogram (1 time in 3-4 days);

4) compliance with the principle of three-phase nutrition: the period of clarification of food tolerance (Table 12.1), the period of transitional and optimal nutrition.

At malnutritionI degrees calculation of nutrition during the period of diet therapy is carried out on the proper body weight. In the second period (transitional nutrition), protein deficiency is corrected (cheese, yolk, acidophilus paste, protein enpit), fat (fat enpit, vegetable oil, cream), carbohydrates (vegetables, fruits, cereals). In the third period, energy demand increases by 20% of the age norm.

At malnutritionII degrees in the first period, careful individual feeding is carried out. The calculation of nutrition for proteins and carbohydrates is carried out on the actual body weight plus 20%, and - on the actual body weight. In the second period, the amount of food corresponds to the daily age requirement. Correction is carried out for proteins, fats and carbohydrates (see earlier). In the third period, the daily energy requirement also increases by 20% compared to the age norm.

At malnutritionIII degrees in the first period, proteins and carbohydrates are calculated based on the proper body weight, and fat - only from the actual one. A larger volume of daily food requirement (75%) is replenished with liquid (vegetable and fruit decoctions, electrolyte solutions). With anorexia, low food tolerance, partial parenteral nutrition is prescribed with amino acid mixtures (polyamine, alvezin new, amikin, levamine, protein hydrolysates). If there are indications, fatty en-pits, solutions with glucose (1 U / 5 g of glucose) are used. The management of the patient in the second and third periods of diet therapy is carried out according to general principles (similar to malnutrition of I and II degrees).

The criteria for the effectiveness of diet therapy, depending on its period, are:

• at the first stage - improvement of emotional tone, daily increase in body weight by 25 - 30 g (the amount of food should correspond to that calculated according to the actual body weight);
• the second stage - in addition to an increase in body weight, appetite normalizes, the condition of the skin and subcutaneous
  fat layer, digestion of food, psychomotor development skills are restored;
• the third stage - body weight is completely restored, psychomotor development, the functional state of organs and systems of the body, immune status are normalized, concomitant deficient conditions (rickets, anemia, hypovitaminosis) are corrected.

Replacement enzyme therapy with pancreatic preparations (creon, panzinorm, mezim-forte) is carried out for all patients with malnutrition (according to the results of the co-program).

Anabolic drugs for malnutrition are used with caution, since in conditions of nutritional deficiency they can cause profound disturbances in protein and other types of metabolism. Retabolil is usually prescribed at a dose of 1 mg per 1 kg of body weight once every 2 to 3 weeks. Carnitine chloride has anabolic properties.

vitamin therapy carried out with a stimulating and substitution purpose (B 1g B 6, A, PP, B 15, B 5, E, etc.). In severe forms of malnutrition, vitamins are prescribed parenterally.

In order to stimulate the reduced defenses of the body (with II and III degrees of malnutrition), preference should be given to passive immunotherapy. In such cases, native plasma, plasma enriched with specific antibodies (antistaphylococcal, antipseudomonal, etc.), immunoglobulins are prescribed. During the period of re-convalescence, non-specific immunostimulants(methyluracil, apilac, adaptogens, etc.).

To correct intestinal dysbiosis, courses of biological preparations (bifidumbacterin, bifikol, bactisubtil, etc.) and prebiotics (hilak-forte, duphalac, etc.) are prescribed. Rickets and iron deficiency anemia are being treated. The removal of a child from hypotrophy of the I degree takes 1 month, and from the II and III degrees - up to 3-5 months.

Forecast. With malnutrition, the prognosis depends on its cause, the presence of concomitant diseases, the age of the child, environmental conditions, and the severity of the condition.

With alimentary malnutrition of the first degree, the prognosis is usually favorable. Hypotrophy II and III degrees can lead in the future to disruption of the formation of the nervous and endocrine systems.

Prevention. Preventive measures include timely treatment of pathology in a pregnant woman, preservation of natural feeding with the rational introduction of complementary foods in children at the age of 1, monitoring of the main anthropometric indicators in children who are formula-fed, treatment of diseases accompanied by diarrhea, malabsorption syndrome, etc.

Vaccination is carried out according to an individual plan.

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 regimen 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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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.

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. 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. 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 children encounter various infectious diseases of the kidneys, lungs and other organs, for example, pyelonephritis,.

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 in severe form 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:

• Availability ;
• 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), permanent;
• 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.

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