Cause of acquired malnutrition in children. Hypotrophy in young children: the main symptoms. Why does fetal hypotrophy develop?

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Introduction

From birth, the child begins to significantly gain in body weight, all his organs grow, including the bones of the skeleton. If the baby is not properly fed and cared for, the first signs of malnutrition will immediately begin to appear in the form of a disruption in the functioning of various organs and systems. Most often, malnutrition develops due to a lack of protein and calories in the diet. With the initial lag in body weight, disturbances from the gastrointestinal tract begin, which leads to a violation of the absorption of nutrients. As a rule, children also suffer from a lack of vitamins and trace elements in their diet.

Causes of malnutrition

Internal factors include diseases of various internal organs involved in digestion, that is, nutrients, under the influence of any reasons, cannot be absorbed by the body. Here, for example, it is appropriate to say that the violation can be both at the level of the gastrointestinal tract, and at the tissue and cellular level. In this case, various metabolic disorders occur in the cell itself. Cellular energy reserves gradually decrease. In the case of their complete depletion, the natural process of cell death begins.

Internal causes of malnutrition

• Encephalopathy that occurs in the fetus during pregnancy. Here we are talking about the fact that during the period of intrauterine development in the fetus, the normal activity of the central nervous system is disturbed, with a secondary disruption of the work of all internal organs and systems.
• Underdevelopment of lung tissue. Insufficient enrichment of blood with oxygen leads to metabolic disorders in the body, and slows down the development of organs and systems.
• Congenital pathology of the gastrointestinal tract - when such phenomena as constipation or vomiting are constantly present (with Hirschsprung's disease, dolichosigmoid, impaired location of the pancreas).
• Frequent abdominal operations that lead to "short bowel" syndrome. The natural physiological process of food digestion is disrupted.
• Hereditary diseases of the immune system, leading to a decrease in the body's defenses, inability to fight infection.
• Some endocrine diseases. Hypothyroidism is a disease of the thyroid gland, in which growth and metabolic processes in the body slow down. Pituitary dwarfism is a disease of the central organ of the endocrine system, as a result of which a sufficient amount of growth hormone is not produced.
• Metabolic diseases that are inherited. For example, galactosemia (intolerance to milk and dairy products), fructosemia is a similar disease in which the child's body does not absorb the fructose contained in vegetables and fruits. Rarer hereditary pathologies related to metabolic disorders include: leucinosis, Niemann-Pick disease, Tay-Sachs and others.

External causes of malnutrition

• Firstly, the quantitative underfeeding of the baby occurs due to the underdevelopment of the female breast (flat nipple, inverted nipple) or lack of female milk. On the part of the child, the cause may be: an underdeveloped lower jaw, constant vomiting, a short frenulum at the lower edge of the tongue.
• Secondly, insufficient feeding of the mother with high-quality breast milk, or improper use of the nutrient mixture, late introduction of supplementary feeding or complementary foods to the child, insufficient intake of all the necessary and useful ingredients in the baby's diet also leads to chronic malnutrition and the development of malnutrition.

Clinical signs and symptoms of malnutrition by degree

With malnutrition, there are several main syndromes:
1. The first of these is a syndrome in which the trophic function of organs and tissues is disturbed. Here we are talking about the fact that metabolic processes in the organs and tissues of the body slow down, body weight drops, the subcutaneous fat layer becomes much thinner, the skin becomes lethargic and flabby.
2. Another important syndrome is a syndrome in which there is a violation of digestive functions. The entire digestive tract is affected. Less hydrochloric acid and pepsin are produced in the stomach, and there are not enough enzymes in the intestines to process the food bolus.
The main symptoms of the syndrome of digestive disorders are:

• stool disorder, which can manifest itself both in the form of constipation and diarrhea;
• the chair becomes unformed, shines;
• with a more detailed examination of the stool, I find in it undigested food residues.

In each individual case, more than one of the above syndromes may be expressed. The manifestations of malnutrition also depend on the predominance of the lack of any component of food. For example, during protein starvation, symptoms of hematopoiesis and a decrease in the body's defenses prevail.

There are three degrees of malnutrition. This separation is necessary for the convenience of assessing the general condition of the child and for planning the amount of treatment. But in reality, the degrees of malnutrition are stages of the same process, following one after another.

Hypotrophy of the first degree

Initially, fat reserves disappear in the abdomen, then in other places. The degree of depletion of the subcutaneous fat layer is assessed by different methods. The most practical, and at the same time informative method, is the Chulitskaya index. This method is based on measuring the circumference of the shoulder in two different places, then the hips and lower legs, and the child's height is subtracted from the resulting amount. The norm for a child up to a year is 20-25 cm. Another method is to measure the skin fold in four different places: on the abdomen to the left of the navel, on the shoulder, in the area of ​​​​the shoulder blades, and finally, on the thigh from the outside. With normal growth and development of the child, the skin fold is approximately 2-2.5 cm. In the first degree of malnutrition, the Chulitskaya index is 10-15 centimeters, and the skin fold slightly decreases.

Symptoms of hypotrophy of the first degree:

• Fat folds are flabby, muscle tone is reduced, elasticity and firmness of the skin is lost.
• The growth of the child initially corresponds to age norms.
• Body weight is reduced from approximately 11% to 20% of the original.
• General health is normal. There is rapid fatigue.
• There are no disorders of the central nervous system. Sleep disturbing, intermittent.
• The child is a little irritable, may spit up the food he has eaten.

Hypotrophy of the second degree

Signs of malnutrition of the second degree:

• The subcutaneous fat layer is very thin on the legs, arms, and may be absent on the abdomen or chest.
• The Chulitskaya index decreases, and varies from one to ten centimeters.
• The skin is pale, dry.
• The skin is flabby, easily shifts into folds.
• Hair and nails become brittle.
• Muscle mass on the limbs decreases, body weight decreases by about twenty to thirty percent, and stunting is also noted.
• Thermoregulation is disturbed, such children quickly freeze, or also quickly overheat.
• There is a high risk of exacerbation of chronic infections (pyelonephritis, otitis media, pneumonia).
• Violation of resistance to the food taken. In connection with trophic disorders of the villi and the intestinal mucosa, digestion is disturbed, in particular the absorption of nutrients. Dysbacteriosis appears, that is, pathogenic bacterial flora predominates. Children appear: increased gas formation, bloating and discomfort in the abdomen. Frequent constipation or diarrhea, often alternating one after another.
• Decreased muscle tone. Due to the significantly reduced muscle tone, the abdomen protrudes outward, and the impression of a frog's abdomen is created.
• The lack of vitamin D and calcium in the body leads to additional development of muscle weakness, the development of symptoms of osteoporosis (washing out of calcium from the bones). At the same time, the bones of the skull become soft, the large and small fontanelles remain open for quite a long time.
• From the side of the central nervous system, a number of pathological disorders similar to those in the first degree of malnutrition are also revealed. Children are restless, cannot fall asleep, often act up. Then the characteristic symptoms of overexcitation of the central nervous system are gradually replaced by lethargy and apathy towards the outside world.

Hypotrophy of the third degree

Characteristic signs and symptoms of hypotrophy of the third degree:

• By appearance, you can immediately determine that there is a chronic lack of nutrition. The subcutaneous fat layer is absent in almost all places, including the face. The skin is dry, pale and so thin that the child looks like a mummy.
• When you try to form a skin fold with your fingers, there is practically no resistance of healthy skin. The elasticity of the skin is so reduced that the fold does not straighten out for a long time after releasing the fingers. Deep wrinkles form all over the body.
• Muscle mass and body weight as a whole are so small that the fatness index according to Chulitskaya is not determined, or is negative. The overall weight loss is 30% or more of normal values.
• On the face, the retraction of the cheeks is visible, the cheekbones protrude forward, the sharpening of the chin is pronounced.
• Manifestations of lack of vital trace elements and vitamins are clearly expressed.
• Lack of iron affects the appearance of cracks in the corners of the mouth (jamming), as well as anemia.
• The lack of vitamins A and C manifests itself in the form of appearance on the mucous membranes: bleeding and atrophy (death, reduction in size) of the gums, stomatitis in the form of small whitish rashes.
• The abdomen is greatly distended due to the weakness of the muscles that support it.
• Body temperature often jumps up and down due to the fact that the thermoregulation center in the brain does not work.
• Immunity is sharply reduced. You can detect signs of sluggish chronic infections. Inflammation of the middle ear - otitis, inflammation of the kidneys - pyelonephritis, pneumonia - pneumonia.
• The child's growth lags behind the average.

Options for the course of malnutrition

Depending on the period of development of hypotrophic manifestations, there are four variants of the course of hypotrophy:

• intrauterine malnutrition;
• hypostatura;
• alimentary insanity.

Intrauterine malnutrition

There are several options for the development of intrauterine malnutrition:
1. Hypotrophic- when the nutrition of all organs and systems is disturbed, the fetus develops very slowly, and does not correspond to the gestational age.
2. Hypoplastic- this variant of development means that along with insufficient general development of the fetal organism, there is also some lag in the maturation and development of all organs. Here we are talking about the fact that organs and tissues at birth are not sufficiently formed, and do not fully perform their functions.
3. Dysplastic the variant of the course of malnutrition is characterized by uneven development of individual organs. Some, such as the heart, liver, develop normally, corresponding to the gestational age, while others, on the contrary, lag behind in their development, or develop asymmetrically.

Hypostatura

The only difference from true malnutrition is that the skin and subcutaneous fat layer do not undergo strong changes.

Hypostatura, as one of the variants of the course of malnutrition, occurs secondarily in chronic diseases of some internal organs. The development of hypostature is usually associated with transitional periods of growth and development of the child. One of these periods falls on the first six months of a child's life. At the same time, they begin to gradually add food products, milk formulas to mother's milk - in other words, to supplement the child. The appearance of this pathology in the second year of life is associated primarily with congenital chronic diseases. Here are the most common ones:

• Congenital malformations of the cardiovascular system. Violation of blood circulation leads to insufficient flow of oxygen and nutrients to organs and tissues.
• Encephalopathies in combination with endocrine disorders also have an extremely adverse effect on the metabolism in the body, delaying development and growth.
• Bronchopulmonary dysplasia is a disturbed development of the lung tissue during the period of intrauterine development of the fetus. In this case, there are serious complications associated with breathing and the delivery of oxygen to the blood.

Kwashiorkor

In addition, there are specific disorders in which the body receives less, does not synthesize or does not absorb protein foods at all.

Disorders that contribute to the development of kwashiorkor include:

• Long-term indigestion, manifested by persistent unstable stools - in other words, the child has chronic diarrhea.
• In diseases of the liver, its protein-forming function is disrupted.
• Kidney disease, accompanied by increased loss of protein along with urine.
• Burns, excessive blood loss, infectious diseases.

In addition to the constant symptoms, children with kwashiorkor have other signs of the disease that occur with varying frequency.

Common symptoms are:
1. Color change, softening of thinning and, eventually, hair loss on the head. Hair becomes lighter, and in later manifestations of the disease, or in older children, discolored or even gray strands of hair are found.
2. Dermatitis is an inflammation of the superficial layers of the skin. Redness, itching, cracks appear on the skin. Subsequently, the skin in the affected areas exfoliates, and traces remain in this place in the form of light spots.

Rare symptoms include:
1. Dermatosis - red-brown spots of a rounded shape.
2. Hepatomegaly is an abnormal enlargement of the liver. The liver tissue is replaced by adipose and connective tissue. The liver is not able to form enzymes and other active substances necessary for the normal function of the whole organism.
3. Kidney dysfunction. The filtration capacity is reduced. In the blood, harmful metabolic products accumulate.
4. Stool disorders are permanent. The child has persistent diarrhea. The feces are shiny and smell unpleasant.

Summing up the material presented, we can say with confidence that kwashiorkor is a disease that is extremely rare in countries with a temperate climate. Countries located in this geographic latitude have a developed social status and standard of living, so the possibility of malnutrition and a deficiency in the diet of proteins and calories is practically excluded.

Alimentary insanity

To establish the cause and make an accurate diagnosis, find out:

• From the history of the onset of the disease, they learn what the body weight of the child was even before the first signs of malnutrition appeared.
• The socio-economic situation in which the child's family is located.
• If possible, find out the daily diet.
• Whether there is vomiting or chronic diarrhea, and how often it occurs.
• Is this child taking any medications? For example, anorexigenic, which suppress appetite, or diuretics, which remove many useful nutrients from the body, including protein.
• Are there any disorders of the central nervous system: stressful situations, alcohol or drug addiction.
• In adolescence, in particular in girls, starting from the age of 12, they find out the presence and evaluate the regularity, frequency and duration of the menstrual cycle.

Among all the symptoms that appear with alimentary insanity, permanent and rare symptoms are distinguished.

Permanent symptoms include:

• weight loss reaches up to 60% of normal, age-appropriate;
• decrease in the thickness of the subcutaneous fat layer;
• reduction in the mass of muscle fibers;
• the limbs of the patient become very thin;
• many wrinkles appear on the face, the skin fits all the facial bones and it seems as if this is the face of an old man.

• Diarrhea is chronic. The chair is liquid, shines, with an unpleasant smell.
• Thinning and clarification of hair, which eventually begin to fall out.
• Exacerbation of chronic infections is a very frequent companion of an organism weakened by malnutrition.
• Thrush is a fungal disease that affects the mucous membranes of the mouth, vagina and urethra. They are manifested by whitish discharge, itching and discomfort in these places.
• Symptoms of multivitamin deficiency, depending on the lack of certain vitamins and minerals.

• Eye changes are manifested by inflammation of the eyelids, the formation of new small vessels on the cornea. Grayish plaques appear in the inner corners of the eyes (lack of vitamin A).
• In the oral cavity, inflammatory changes in the mucous membrane and gums are observed. The tongue increases in size (due to a lack of vitamin B 12).
• The heart is enlarged. Insufficient strength of cardiac impulses leads to stagnation of blood in the veins, swelling of the lower extremities appears.
• Weakness of the muscles of the anterior abdominal wall causes a sagging, protruding abdomen. The liver protrudes beyond the lower edge of the right hypochondrium.
• Explicit neurological disorders are manifested in nervousness, increased irritability, muscle weakness, and a decrease in tendon reflexes.

• Memory worsens, mental and cognitive abilities, including working capacity, decrease.
• Decreased visual acuity. A lack of vitamin A causes a decrease in vision at dusk.
• The sharpness of taste sensations is also reduced.
• A lack of vitamin C leads to increased capillary fragility. Small punctate hemorrhages can be seen on the skin after a slight pinch.

Lack of essential fatty acids

In most cases, this variant of malnutrition appears in infants who lack the nutrition of mother's milk. Cow's milk and other milk mixtures do not contain essential fatty acids in the amount necessary for the energy and plastic costs of a young organism. Depending on the deficiency of one or another fatty acid, the symptoms of the disease will differ slightly from each other.

With a lack of linoleic acid, the following symptoms appear:

• Dryness of the skin with exfoliation of the superficial stratum corneum.
• Wound healing continues for a long period.
• Thrombocytopenia - a reduced number of platelets (blood cells responsible for its clotting) in the blood. The lack of platelets leads to increased fragility of small vessels, with accidental minor domestic injuries of the skin, bleeding lengthens. Insignificant tweaks cause the appearance of many small-point hemorrhages.
• Prolonged loose stools (diarrhea).
• Periodic exacerbations of infectious diseases (for example, skin or lungs).

• numbness and paresthesia (tingling sensation) of the lower and upper extremities;
• general muscle weakness;
• visual impairment.

Diagnosis of malnutrition

Key points

Detection of important clinical signs in all major systems involved in the pathological process. This includes the following violations:

• fatness disorders - manifested in the form of thinning of the subcutaneous fat layer and trophic changes;
• digestive disorders - include changes in food resistance;
• metabolic disorders: protein, fat, carbohydrate, mineral, vitamin;
• functional disorders of the central nervous system.

The second point that should not escape the attention of doctors is the differentiation of pathological changes that occur during malnutrition, with other similar diseases, with a decrease in height, body weight, and overall physical development of children.

Symptoms of children with hypostatura are very similar to a disease such as nanism. This is a pathology of the central endocrine organs (hypothalamus and pituitary gland), in which growth hormone, somatotropin, is not produced. With this disease, unlike hypostatura, there are no pathological changes in the form of thinning of the subcutaneous fat layer and other trophic disorders. All organs develop evenly, although they are reduced in size.

Assessment of the child's condition and determination of the degree of pathological changes is also determined by the nature of the feces. Initially, with malnutrition, the stool is scanty, colorless, with a characteristic fetid odor. In the future, violations of the functional ability to process food through the gastrointestinal tract lead to the fact that the stool becomes plentiful, shiny, it contains the remains of undigested food, muscle fibers. Infection with pathogenic bacteria of the intestinal mucosa entails dysbacteriosis (diarrhea, bloating and discomfort in the abdomen).

Due to insufficient intake of protein, the body uses internal reserves (from muscles, adipose tissue), the metabolic products of which are excreted by the kidneys in the form of ammonia. The urine of such patients has the smell of ammonia.

Laboratory research

In biochemical analyzes, signs of impaired liver function, lack of vitamins and trace elements can be detected.

Instrumental diagnostic methods

Ultrasound is used when the borders of the heart are enlarged, the liver is enlarged, or there are other pathological changes in the abdominal cavity.
If necessary, or in doubtful cases, the attending physician prescribes the appropriate instrumental diagnostic method at his discretion.
Diagnosis of malnutrition and the degree of pathological changes is not an easy task, and requires a lot of patience, care and experience from the doctor.

Hypotrophy treatment

Complex therapy includes:

• Determination of the cause that caused malnutrition, simultaneously with an attempt to regulate and eliminate it.
• Diet therapy, which is selected individually in each specific case, and also depends on the degree of pathological disorders in the body.
• Detection of chronic foci of infection that contribute to the development of malnutrition, as well as their active treatment.
• Symptomatic treatment, which includes the use of multivitamin and enzyme preparations.
• Appropriate regimen with proper care and educational activities.
• Periodic courses of massage and therapeutic exercises.

diet therapy

• 2/3 for hypotrophics of the first degree.
• 1/2 for hypotrophics of the second degree.
• 1/3 for hypotrophics of the third degree.

3. The third period in diet therapy is the stage of enhanced food intake. Only after complete restoration of the functional activity of the gastrointestinal tract, the patient can increase the load of food.
In the third period, intensive feeding is continued, however, with a restriction of protein intake, since the increased intake of protein products is not fully absorbed by the body.
During each stage of diet therapy, the stool is periodically checked for the content of residual dietary fiber and fat (coprogram).

Other, no less important conditions when prescribing a diet are:
1. Reducing the periods between feedings. And the frequency of feeding itself increases several times a day, and is:

• with hypotrophy of the first degree - seven times a day;
• in the second degree - eight times a day;
• in the third degree - ten times a day.

3. Maintaining adequate periodic nutritional control. For this purpose, special diaries are kept, where the amount of food eaten is noted. Systematic control is simultaneously performed for stool, diuresis (number and frequency of urination). If nutrient mixtures are administered intravenously, then their amount is also recorded in the diary.

4. Fecal samples are taken several times a week for the presence of undigested dietary fiber and fatty inclusions.

5. Every week, the child is weighed, and additional calculations are made to calculate the required amount of nutrients (proteins, fats and carbohydrates).

The criteria for the effectiveness of dietary therapy are:

• normalization of the condition and elasticity of the skin;
• improving the appetite and emotional state of the child;
• daily weight gain, an average of 25-30 grams.

Care of patients with malnutrition

• The conditions for staying in the wards should be as comfortable as possible, and are as follows: the lighting complied with all regulatory standards, airing was carried out twice a day, the air temperature was optimal, within 24-25 degrees Celsius.
• Daily walks in the fresh air serve both as hardening and as a prevention of upper respiratory tract infections (congestive pneumonia).
• Periodic gymnastic exercises and massage courses will help restore reduced muscle tone, and will have a beneficial effect on the general condition of the body.

Enzyme therapy

vitamin therapy

Stimulant Therapy

Symptomatic treatment

• With anemia, iron preparations (sorbifer, totem) are prescribed. If a child has a very low hemoglobin value (below 70 g/l), he is prescribed a red blood cell transfusion.
• With rickets, vitamin D is prescribed, as well as preventive courses of physiotherapy. For this purpose, irradiation with ultraviolet rays using a special quartz lamp is used.

Prevention of the development of malnutrition

• The child must be completely healthy.
• Eat food according to the age of the child.
• Complementary foods are introduced gradually, and before breastfeeding. The child eats with a small spoon.
• The change of one type of feeding is replaced by one type of complementary foods.
• The food you eat should be rich in vitamins and essential minerals.

Summing up the above material, it should be noted that the prognosis for the development of malnutrition depends primarily on the causes that participated in the occurrence of this pathological condition. The conditions of the external and internal environment, the nature of feeding, as well as the age of the patient - all this plays a big role in the development of malnutrition. With alimentary insufficiency, the outcome of the disease is usually favorable.

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 nutrition, 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 the symptoms into separate syndromes, combining a set of signs that occur when a particular organ or system is ill.

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 at the expense of 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.

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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In order to develop, he needs a complete one. If a growing organism receives few nutrients, then growth slows down.

The body directs nutrients to those systems that are vital. The rest either stop developing or develop very slowly. In infancy, developmental delays are a guarantee of disability in adulthood.

Dystrophy, or, as it is also called, hypotrophy, is the very condition that develops with insufficient. Now we will find out what malnutrition is, how it develops and whether it is possible to avoid the negative consequences of malnutrition in infants.

What is malnutrition and how often does it occur in children

Hypotrophy is a rare phenomenon in developed countries. According to the World Health Organization, for every hundred babies, there are seven to eight babies with malnutrition.

In developing countries, this figure is much higher - as many as twenty babies out of every hundred suffer from malnutrition. Hypotrophy can only be diagnosed in babies under two years of age; upon reaching this age, the body begins to develop differently.

In simple terms, malnutrition is the consequences of starvation. It doesn't matter who - the mother or the baby. Mother's milk is the only complete food for an infant, and if the mother eats poorly, the child will suffer more than her.

Hypotrophy is a condition that develops when there is a lack of nutrients in the body. There are quantitative and qualitative shortages. Quantitative - this is when food is scarce.

Qualitative develops in the case of improperly selected artificial. Mother's milk in sufficient quantities cannot lead to a quality shortage.

Classification and reasons

Hypotrophy is intrauterine and acquired. Intrauterine malnutrition develops when the baby's mother suffers severe toxicosis in the first and second trimesters. As for the degrees, there is a special classification that determines the severity of malnutrition in a baby.

Hypotrophy 1 (mild) degree can be diagnosed in children. At the same time, growth occurs normally, the baby does not gain up to 10% of the norm in weight.

Hypotrophy of the second (medium) degree- the condition is more severe. In this case, the weight deficit is already from 20 to 30%. The second degree poses a threat to the development of the baby, and if the lack of weight is not replenished within a month and a half, regressive processes will begin.

Third (severe) degree malnutrition is characterized by a serious deficiency of mass - from 30% and above, as well as an almost complete cessation of growth. The causes of malnutrition are varied - from malformations to the quality of child care.

If a mother eats poorly or has bad habits, all this will affect her child. The baby will be frail and underweight if the mother has serious chronic diseases, such as heart disease or endocrine disorders.

Did you know? No matter how small the arm of a newborn baby may seem, it is so strong that it can support the entire weight of his body. grasp reflex- one of the unconditional and very important reflexes both for a human child and for many young marsupials.

The physiological causes of a quantitative shortage are a sluggish sucking reflex, in which the child cannot drink enough milk, an irregular shape of the nipples and an increased density of the mammary glands.

In addition to the obvious lack of food, the causes of acquired malnutrition are infectious diseases accompanied by intestinal disorders, an environmentally unfavorable environment, and a lack of maternal care.

Maternal care refers to constant attention, physical contact, communication, frequent walks, and sincere affection. The stronger the stress, the higher will be the need for additional nutrition, which should compensate for energy losses.

Clinical manifestations

Congenital malnutrition is diagnosed immediately by external signs - lack of subcutaneous adipose tissue, weak turgor, large folds of skin on the neck, sides and buttocks, which do not straighten out for a long time.

The more the baby's ribs, joints stick out, the shoulder blades are visible under the skin, the more dystrophy is developed in him. Laboratory findings of a dystrophic baby usually show a lack of calcium and potassium in the plasma fluid, a reduced number and platelets, and low blood sugar.

Acquired malnutrition can be diagnosed only some time after the child stays at home with his parents.

As we have already found out, the causes of dystrophy can be not only the inattention of parents, but also physiological factors, therefore, the more often the child is examined by a pediatrician, the lower the possibility of starting malnutrition to a dangerous stage.

Important! In the second degree of malnutrition, the subcutaneous fat layer leaves the entire body, but remains on the face. As long as this fat layer remains, the child can be brought out of the state of exhaustion without consequences.

There are three stages of malnutrition. At first, the baby begins to show signs of anxiety. He becomes more nervous and capricious, begins to noticeably lose weight - the fat layer on the stomach becomes thinner.

Skin circulation at this stage is still stable, so skin color remains normal, but a decrease in appetite will alert any attentive parent. In this case, there is nothing to worry about, breastfeeding and good care will help the baby quickly gain normal weight.

The second stage of malnutrition is characterized by a violation of the activity of the baby. He becomes lethargic, drowsiness increases. Shortness of breath and tachycardia are possible, as well.

Another sign of hypotrophy of the second degree is a lag in growth of two to three centimeters from the norm. The skin of children begins to turn pale and peel off, muscle tone decreases and eating disorders become chronic.
The layer of adipose tissue begins to melt, this is especially noticeable on the abdomen and limbs. Hypotrophy of the third degree is characterized by thinning of the subcutaneous fat layer both on the face and on the whole body.

The color of the skin turns from pale to gray, the folds on the skin do not straighten out. Eyes sink, facial features, on the contrary, become sharper, the baby stops responding to stimuli.

At the last stage of malnutrition, the child develops inflammatory diseases.- , . It is possible, urination, on the contrary, becomes less frequent.

There are several diagnostic methods: instrumental, laboratory and general. With a general diagnosis, the pediatrician draws conclusions about the presence of symptoms of malnutrition based on observations.

He evaluates the baby's fatness (the presence of fat folds on the neck, sides and limbs) and its digestive function. The latter is characterized by the quality of feces - their color, smell and structure. In a child who suffers from dystrophy, feces have a fetid odor, often contain undigested food and even particles of muscle fibers.

At the end, the pediatrician checks the functioning of the central nervous system by observing the child's reaction to external stimuli.

Did you know? There are more bones in the body of a newborn baby than in the body of an adult, by as much as sixty pieces!

Laboratory studies are prescribed starting from the second stage of malnutrition, when the risk of pathological changes in the body increases.

The results of the analyzes differ at different stages of malnutrition, and the best way to show possible violations is a blood test - it gives an idea of ​​the protein balance, immunity stability and possible inflammatory processes.

Instrumental diagnostics is used when malfunctions in the work of internal organs and organ systems are suspected. First of all, the work of the heart is checked - the doctor conducts an electrocardiographic study.

Reinforced feeding will also not be a cure, as the whole body has already suffered. It requires a competent approach to nutrition, vitamin therapy and medical supervision.

Treatment of hypotrophy of the first degree can be carried out at home, after registering with a pediatrician. With the second and third degree of malnutrition, it is necessary to go to the hospital and strictly follow all medical recommendations that relate to the normalization of nutrition, daily routine, drug therapy and therapeutic massages.

Important! Frequent fractional feeding of a child speeds up his recovery, in contrast to plentiful but rare meals. The more severe the degree of exhaustion, the more often you need to feed the baby. For the first stage of the disease, six to seven times a day is enough, for the second- eight-ten and for the third- ten to twelve feedings per day.

This is the main method of treating malnutrition: without it, drug therapy and massages do not make sense. The higher the degree of exhaustion, the more sparing food the doctor will select and prescribe.

First, the degree of damage to the digestive and central nervous systems is checked, because thinning of the subcutaneous fat layer is not the main indicator of the degree of damage to dystrophy.

Product resistance is tested empirically. If the child has reached the age at which complementary foods can be given, it is gradually introduced into the diet and monitored for bloating and disorders. For the treatment of breast-fed children, maternal nutrition is adjusted.

You can not give a lot of food to babies at once. The higher the degree of exhaustion, the smaller portions begin its recovery. At the second stage of diet therapy, special attention is paid to micro- and macroelements entering the body.
At the transitional stage, nutrition in young children should fill the body's need for calories and food volume for accelerated recovery from malnutrition. The child begins to feed less often, but more plentifully.

The last stage is characterized by enhanced feeding. The child is given plenty of food when the functionality of the digestive tract is fully restored.

It is necessary to limit the protein component of food, as the most difficult to digest, but to ensure nutrition - weight at this stage comes very intensively.

Frequent fecal analysis is a prerequisite for monitoring recovery. The amount of undigested dietary fiber and fatty elements show how to adjust the diet.

Did you know? For the first two years of life, the child sleeps unstably, and therefore his parents during this time lose about four and a half thousand hours of good sleep.- this is equal to almost half a year of life.

Medications

Drug therapy includes vitamin therapy, enzyme therapy and therapy that stimulates the body's metabolic processes. Vitamin therapy enriches the body with substances that are lacking more than others - C, B1 and B6.

First, subcutaneous and intramuscular administration of solutions is practiced. After the digestive function returns to normal and the vitamin complexes stop transiting, an enteral intake (through the mouth) is prescribed.

Stimulating therapy is carried out with drugs that enhance immunity (up to immunoglobulin at the most severe stages), increase blood circulation and stimulate oxygen transport to all tissues.

Massage and exercise therapy

Physical therapy is physiotherapy exercises. It, together with massage, is used to improve tissue metabolism, stimulate blood circulation, and accelerate lymph. Physical education strengthens muscles and ligaments and affects the baby's joints - they become flexible and mobile again.

In complex therapy, exercise therapy and massage play the role of a general tonic, normalize metabolic processes and, due to this, restore the excitability of the central nervous system, which begins to transmit normal food reflexes.

Important! Therapeutic exercise is active and passive. Active movements include movements that the baby performs on his own, reacting to stimuli. Passive exercise is performed by the hands of a qualified pediatrician or trained parents.

A woman should stop drinking alcohol, exclude, including passive, be in the fresh air and undergo regular check-ups with a gynecologist.

Did you know? At birth, babies do not have kneecap joints. They just don't need- at this age, children cannot support themselves in an upright position. Finally, the knee joints are formed only six months after birth.

After birth, you need to keep the baby in the best conditions - provide him with breastfeeding or purchase balanced ones if there is no milk. A nursing mother must watch her diet, because everything she eats will turn into food for the baby.

The pediatrician will tell you when you can introduce complementary foods to breast milk, and this should be done gradually, checking the reaction of the child to individual products. In addition to nutrition, you need to ensure that the baby is often exposed to sunlight and fresh air.
These natural factors cause strong young children. Hypotrophy is not a sentence, and with caring care, you can return the baby to normal in a short time. It is necessary to monitor the nutrition of a nursing mother and enrich her diet with vitamin complexes.

Complementary foods should be introduced in accordance with medical prescriptions and observing changes in the well-being of the baby. Knowing the symptoms and signs of malnutrition, you can understand when the baby began to have alarming symptoms and seek help from a pediatrician.

Only competent medical care will save the baby from progressive malnutrition and give him the opportunity to develop correctly.

Very often in children there is a pathological malnutrition, which is accompanied by a small increase in body weight compared to the norm in relation to age and height. If this gap is more than 10%, malnutrition is diagnosed, which most often manifests itself before 3 years.

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

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

Intrauterine malnutrition:

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

Extrauterine malnutrition:

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

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

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

Classification

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

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

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

Symptoms of childhood malnutrition

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

I degree

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

II degree

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

III degree

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

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

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

Treatment of the disease

Outpatient treatment of malnutrition I degree in young children, stationary - II and III degrees. The main activities are aimed at:

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

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

Prevention methods

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

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

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

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

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