congenital malnutrition. Methods for determining three degrees of malnutrition. Endogenous causes of malnutrition

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, abundant regurgitation, micronutrient deficiency);
• poor nutrition of a nursing mother;
• some diseases of the newborn do not allow him to actively suckle, which means - to eat fully: cleft palate, congenital heart disease, cleft lip, birth trauma, perinatal encephalopathy, cerebral palsy, pyloric stenosis, alcohol syndrome;
• frequent SARS, intestinal infections, tuberculosis;
• unfavorable sanitary and hygienic conditions: poor child care, rare exposure to the air, rare bathing, insufficient sleep.

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

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

Classification

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

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

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

Symptoms of childhood malnutrition

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

I degree

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

II degree

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

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

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

Treatment of the disease

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

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

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

Prevention methods

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

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

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

• high quality and balanced;
• 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.

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.

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

Causes of the disease

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

Intrauterine malnutrition:

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

Extrauterine malnutrition:

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

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

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

Classification

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

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

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

Symptoms of childhood malnutrition

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

I degree

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

II degree

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

III degree

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

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

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

Treatment of the disease

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

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

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

Prevention methods

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

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

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

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

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

Hypotrophy is a chronic malnutrition in babies, which is accompanied by a constant underweight in relation to the age and height of the infant. Often, malnutrition in children affects not only the insufficient development of muscle mass, but also psychomotor aspects, growth retardation, general lagging behind peers, and also causes a violation of skin turgor due to insufficient buildup of the subcutaneous fat layer. Underweight (hypotrophy) in infants usually has 2 causes. Nutrients may enter the child's body in insufficient quantities for proper development or simply not be absorbed. In medical practice, malnutrition is distinguished as an independent type of violation of physiological development, a subspecies of dystrophy. As a rule, small children under the age of one year are susceptible to such a violation, but sometimes the condition persists up to 3 years, due to the peculiarities of the social status of the parents.

Degrees of malnutrition in children and symptoms of the disorder

First degree

The disease is characterized by a slight decrease in appetite, accompanied by sleep disturbance and frequent anxiety. The baby's skin usually remains practically unchanged, but has reduced elasticity and a pale appearance. Thinness is visible only in the abdomen, while muscle tone can be normal (sometimes slightly reduced). In some cases, 1 degree of malnutrition in young children may be accompanied by anemia or rickets. There is also a general decrease in the functioning of the immune system, from which babies get sick more often, look less well-fed in comparison with their peers. Some children may have indigestion leading to diarrhea or constipation.
Often, the 1st degree of violation remains almost imperceptible to parents, and only an experienced doctor can identify it with a thorough examination and diagnosis, during which he must find out if the thinness of the baby is a feature of his physique and a hereditary factor. For some children, height and thinness are inherited from their parents, so a slender young mother should not worry that her baby does not look as well-fed as the rest, if at the same time he is active, cheerful and eats well.

Second degree

It is characterized by a lack of weight in children in the amount of 20-30%, as well as a lag in growth of the baby, on average by 3-4 cm. also the lack of warmth of the arms and legs. With malnutrition of the 2nd degree in newborns, there is a developmental delay not only in motor, but also mental, poor sleep, pallor and dry skin, frequent peeling of the epidermis. Baby's skin is not elastic, it easily gathers into folds. Thinness is strongly pronounced and affects not only the abdomen, but also the limbs, while the contours of the ribs are clearly visible in the baby. Children with this form of disorder are very often sick and have unstable stools.

Third degree

Babies with this form of impairment are severely stunted, on average up to 10 cm, and have a weight deficit of more than 30%. The state is characterized by severe weakness, an indifferent attitude on the part of the child to almost everything, tearfulness, drowsiness, as well as the rapid loss of many acquired skills. The thinning of the subcutaneous fatty tissue is clearly expressed throughout the body of the child, there is a strong atrophy of the muscles, dry skin, cold extremities. The color of the skin is pale with a grayish tinge. The lips and eyes of the baby are dry, cracks are observed around the mouth. Often in children there are various infectious diseases of the kidneys, lungs and other organs, for example, pyelonephritis, pneumonia.

Types of malnutrition

Violation in young children is divided into 2 types.

Congenital malnutrition

Otherwise, the condition is called prenatal developmental delay, which begins even in the prenatal period. There are 5 main causes of congenital disorders:

• Maternal. This group includes insufficient and malnutrition of the expectant mother during pregnancy, her very young or, conversely, old age. Previously appeared stillborn children or miscarriages, the presence of serious chronic diseases, alcoholism, smoking or drug use, as well as severe preeclampsia in the second half of pregnancy can lead to the appearance of a baby with malnutrition.
• Paternal. Caused by hereditary causes on the paternal side.
• Placental. The appearance of hypotrophy of any degree in a newborn can also be affected by poor patency of the vessels of the placenta, their narrowing, anomalies in the location of the placenta, its presentation or partial detachment. Vascular thrombosis, heart attacks, fibrosis of the placenta can also affect the appearance of the disorder.
• Socio-biological factors. Insufficient material support for the expectant mother, her adolescence, as well as work in hazardous and chemically hazardous industries, the presence of penetrating radiation.
• Other factors. Mutations at the genetic and chromosomal level, the presence of congenital malformations, multiple pregnancy, premature birth.

Acquired malnutrition

The causes of such developmental disorders are divided into two types: endogenous and exogenous. Endogenous factors include:

• the presence of diathesis in infancy;
• anomalies of the constitution in babies up to a year;
• immunodeficiency, both primary and secondary;
• congenital malformations, such as perinatal encephalopathy, pyloric stenosis, bronchopulmonary dysplasia, Hirschsprung's disease, "short bowel" syndrome, disorders in the cardiovascular system;
• endocrine disorders, in particular, hypothyroidism, adrenogenital syndrome, pituitary dwarfism;
• the presence of malabsorption syndrome, disaccharidase deficiency, cystic fibrosis;
• anomalies of the metabolic process of hereditary etiology, for example, galactosemia, fructosemia, Niemann-Pick or Tay-Sachs disease.

• diseases caused by infections, for example, sepsis, pyelonephritis, intestinal disorders caused by bacteria (salmonellosis, dysentery, colienteritis), persistent dysbacteriosis;
• improper upbringing, non-compliance with the daily routine. These include improper care for a baby under the age of one year, poor sanitary conditions, malnutrition;
• nutritional factors such as underfeeding of the infant (qualitative or quantitative) with natural feeding can be observed with a flat nipple in the mother. Underfeeding due to a "tight" breast, in this case, the baby cannot suck out the required amount of milk. Vomiting or constant spitting up;
• toxic causes, for example, poisoning, various degrees and forms of hypervitaminosis, feeding with low-quality milk formula or animal milk from the moment of birth (it is not absorbed by the body of the newborn).

Diagnostics

To accurately establish the diagnosis of malnutrition in babies, a set of studies is carried out, which includes:

• Collection of anamnesis. The features of the baby's life, his nutrition, regimen, the presence of possible congenital diseases, medication, living conditions, care, as well as diseases of the parents that can be transmitted to the child at the genetic level are clarified.
• Careful inspection, during which the condition of the baby's hair and skin, his oral cavity, and nails is determined. The child's behavior, mobility, existing muscle tone, general appearance are assessed.
• Body mass index calculation and comparing it with the norms of development based on the weight of the baby at birth and his age at the time of the diagnosis. The thickness of the subcutaneous fat layer is also determined.
• Conducting laboratory research baby blood and urine tests.
• Complete immunological examination.
• Breath tests.
• Ultrasound of internal organs.
• ECG.
• Blood sampling for a complete biochemical analysis.
• The study of feces child for the presence of dysbacteriosis and the amount of undigested fat.

Intrauterine malnutrition can be detected even during pregnancy during the next ultrasound, in which the doctor determines the size of the fetus and the estimated weight. If developmental disorders are detected, the expectant mother is sent to a hospital for a full examination and taking the necessary measures. In newborns, existing malnutrition can be determined by a neonatologist during an examination immediately after the birth of the baby. Acquired developmental disorder is usually detected by a pediatrician during a routine examination and the necessary measurements of height and weight. In this case, the doctor, in addition to conducting research, usually appoints consultations of other specialists, which helps to accurately establish the diagnosis and degree of malnutrition.

Treatment

Therapy for malnutrition is carried out depending on the degree of the disease. Postnatal malnutrition of the 1st degree is treated under normal outpatient conditions at home with mandatory strict adherence to all doctor's prescriptions. The second and third degrees require inpatient treatment, where specialists can constantly assess the baby's condition and the results of the treatment, which is aimed at eliminating the existing causes of malnutrition, organizing good care for the baby, and correcting metabolic abnormalities. The basis of the treatment of malnutrition is a special diet therapy, which is carried out in 2 stages. First, possible food intolerances in the infant are analyzed, after which the doctor prescribes a certain balanced diet with a gradual increase in food portions and its calorie content. The basis of diet therapy for malnutrition is fractional nutrition in small portions with a short period of time. The serving size is increased weekly, taking into account the necessary nutritional load during regular monitoring and examinations. In the course of therapy, adjustments are made to the treatment. Weakened babies who cannot swallow or suck on their own are fed through a special tube. Medical treatment is also carried out, in which the baby is prescribed vitamins, enzymes, taking anabolic hormones, adaptogens. In cases of a particularly serious condition of children with malnutrition, they are given intravenous infusions of special protein hydrolysates, saline solutions, glucose and essential vitamins. To strengthen muscle tone, kids are given exercise therapy and UVR, as well as a course of special massage.

Lifestyle of children with malnutrition

During the treatment of the child, parents must strictly comply with all the doctor's instructions. The main factors for the successful cure of the crumbs are the establishment of the correct regimen not only for feeding, but also for playing, sleeping and walking. With proper care and good nutrition, in the absence of metabolic disorders and other congenital (acquired or chronic) diseases, babies quickly gain weight and are quite capable of catching up with the parameters of their healthy peers. It is important to prevent the appearance of malnutrition in infants and it lies in the correct behavior of the expectant mother during the bearing of the crumbs. Registration at a polyclinic (special center or private clinic) should take place in the early stages of pregnancy, already during the first month. It is important to pass all the scheduled examinations and studies on time, not to miss scheduled appointments and consultations of specialists. A special moment in the prevention of malnutrition in a child is the nutrition of the expectant mother, it must be balanced, provide the body with all the necessary substances not only for its existence, but also for the development of the fetus. Timely examination allows you to identify the existing violation in time and take the necessary measures to eliminate it even before the birth of the crumbs.

How to recognize malnutrition in a child?

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

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

Why does fetal hypotrophy develop?

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

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

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

How is malnutrition diagnosed in newborns?

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

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

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

Symptoms of malnutrition in children

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

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

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

Treatment of malnutrition in children

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

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

What does a normally developing baby look like?

Signs of normotrophic:

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

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

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

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

Causes and development

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

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

Causes of acquired malnutrition

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

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

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

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

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

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

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

Symptoms

Signs and symptoms of intrauterine malnutrition in a child:

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

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

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

Degrees of malnutrition in children

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

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

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

Diagnostics

Differential Diagnosis

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

Treatment

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

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

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

The main directions of drug therapy

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

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

Study of the causes and symptoms of malnutrition in children

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

Prevention of malnutrition in children

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

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

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

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

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

Hypotrophy in children is a chronic underweight. Starting from the stage of intrauterine development, for each age of the child there are standards for height and weight, deviations from which in one direction or another indicate a change in nutrition. Overweight in children - paratrophy is no better than malnutrition. The issue of an increase in the number of overweight children is very acute in world medical practice due to the fact that an increase in protein nutrition leads to rapid weight gain in a child of the first year of life. In the future, they risk getting metabolic syndrome.

If the causes of overweight lie in overeating (alimentary factor), then underweight is more often associated not with the fact that the child does not eat enough, but with absorption problems.

Since 1961, WHO has introduced the term "protein-energy malnutrition", but in Russia the lack of physical development, especially in newborns and young children, is referred to as malnutrition. The problem is aggravated by the fact that a long-term deficiency of a number of nutritional components, such as proteins, polyunsaturated fats, iron, microelements, leads to a violation of the child's mental abilities.

Depending on the time of occurrence, malnutrition is divided into prenatal and postnatal. Prenatal (prenatal) or congenital malnutrition is nothing more than intrauterine growth retardation syndrome (IUGR). It develops when there is a violation of the blood supply to the fetus through the uterus and placenta (fetoplacental insufficiency).

If the indicators of fetal development lag behind the standards by 14 days, they speak of 1 degree of developmental delay, 3-4 weeks - 2 degree and more than a month - 3 degree.

There are 3 options for expressing delayed fetal development:

• The hypotrophic variant is characterized by the body length corresponding to the gestational age and the circumference of the head, chest and abdomen below normal;
• The hypoplastic variant reflects the proportional, but reduced parameters of the child;
• With a dysplastic variant, malformations and deformities of the fetus are observed.

Postnatal (postpartum) malnutrition is divided into degrees in accordance with the lack of body weight. At 1 degree, the lack of body weight is 10-20%;

• At 2 degrees - 20-30%;
• At 3 degrees over 30%.

The actual weight of the child is compared with the weight, the calculation of which is carried out according to the tables of normal monthly weight gain. For example, body weight at birth 3700g, at the age of 3 months 5300g. According to the table, the child should gain 600 g + 800 g + 800 g in 3 months, a total of 2200 g. The normal body weight at 3 months for this child should be 5900 g.

The mass deficit is 5900–5300, that is, 600 g, which corresponds to 10% according to the proportion formula:

• 5900 – 100%;
• 600 - 10%, therefore, the child has hypotrophy of the 1st degree.

The reasons

The causes of prenatal and postnatal malnutrition are different. The following causes are characteristic of the fetal IUGR syndrome:

• maternal factor- diseases of the cardiovascular, broncho-pulmonary, urinary systems, smoking, alcoholism, drug use, malnutrition, insulin-dependent diabetes mellitus, multiple pregnancy, history of infertility and abortion, taking certain medications, chronic stress and other neuropsychic overload, transferred rubella, syphilis,.
• Placental causes associated with pathology of the placenta. Perhaps its underdevelopment, inflammation, low attachment, premature detachment, early aging. In recent years, antiphospholipid syndrome, that is, the formation of blood clots in the vessels of the placenta, has been attributed here.

• Socio-biological factors are also considered as the causes of congenital malnutrition. Occurs in young primiparous aged 15-17 years, in single women who give birth without a husband, in those who live in the highlands;
• Hereditary causes are associated with chromosomal and gene abnormalities.

All these reasons directly or indirectly impair uteroplacental blood flow, which disrupts the nutrition of the fetus and hypotrophy of newborns of varying severity.

Hypotrophy in young children is based on other causes:

• Exogenous - direct lack of basic food ingredients, malnutrition and problems that disrupt eating. For example, swallowing problems due to disorders of the nervous system or malformations of the face and jaws;
• Endogenous - there are 3 groups:
• Problems with digestion, absorption and retention of food eaten;
• A child’s disease when he needs increased nutrition (prematurity, chronic diseases of the pulmonary system, microbial and viral infections;
• Received from birth problems in metabolism.

With malnutrition in children, metabolism progressively worsens, which ultimately leads to stress, due to acidosis, and cell destruction.

Liver function suffers, humoral immunity decreases. The breakdown of adipose tissue destabilizes the cell membrane. The body rebuilds metabolic processes in order to direct energy to the brain. The entire digestive system suffers, the mucosa atrophies, the production of enzymes decreases, motility changes, local immunity decreases.

Symptoms

Symptoms of malnutrition in newborns depend on the variant of IUGR. It should be noted that even in modernly equipped perinatal centers, the mortality of newborns in the first 7 days of life in the case of a pronounced syndrome, despite the treatment, reaches 35%.

Children who have undergone IUGR have symptoms such as:

• Lagging behind in physical development (60%);
• Delayed psychomotor development (40%);
• Cerebral palsy;
• (12%).

The symptoms are less pronounced in the hypotrophic variant, the prognosis is more favorable, but the susceptibility to infectious diseases and pneumonia remains high in early childhood, especially up to a year.

The study of the long-term consequences of congenital malnutrition of newborns revealed symptoms of a decrease in intelligence at school age, neurological disorders, a tendency to develop hypertension, coronary heart disease, and diabetes mellitus.

1 degree

With hypotrophy of the 1st degree, the child has minor symptoms, confirming that the diet has been disturbed. The fat layer from the anterior abdominal wall disappears, skin turgor and muscle elasticity decrease, regurgitation is observed, sleep is disturbed, anxiety and fatigue are noted. At the same time, there is no lag in growth and deviations in mental development. The child is prone to frequent colds.

2 degree

When nutrition is disturbed at level 2, the following symptoms appear. Fat disappears from the whole body, except for the cheeks, skin and muscles are flabby, joints and bones are visible, the child has reduced or no appetite, irregular stools, undigested food in the feces. Due to beriberi, the growth of hair, nails, seizures in the corners of the mouth are disturbed, the child quickly overheats or cools down, frequent and prolonged colds, often naughty, restless.

3 degree

The 3rd degree of malnutrition in a child is the most severe, if it is not treated, he will die. The main symptoms include the disappearance of fat from the cheeks of the child, atrophy of the skin and muscles, disruption of the heart and breathing, decreased pressure, stunting, mental retardation, refusal to eat.

Pediatricians in practice use the calculation of the fatness index for newborns and children under one year old. Such a calculation is easy to do yourself. Measure the circumference of the shoulder, thigh and lower leg, find the sum, subtract the height of the child from it. Normally, in a child up to a year old, the index is 25–30 cm. With hypotrophy of the 1st degree, it is reduced to 10–15 cm, with the 2nd - below 10 cm.

Treatment

Fetal IUGR should be treated during pregnancy. The goal of treatment is to improve uteroplacental blood flow. For this, Curantil, Actovegin, vitamin and mineral complexes, including vitamins - antioxidants, are used. Treatment includes proper nutrition, fresh fruits and vegetables in sufficient quantities, protein diet, dairy products.

In some cases, depending on the severity of the condition of the fetus and the prognosis, the question of the advisability of maintaining pregnancy is decided.

It is not difficult to restore nutrition with 1 degree of malnutrition. In the children's clinic, they will make the necessary calculation of the amount of breast milk per day and one feeding. In case of hypogalactia, suitable breast milk substitutes will be prescribed, they will recommend the introduction of juices, cottage cheese. The frequency of feeding in such children should be increased to 7-8 per day.

Babies over one year old include cereals, fruits and vegetables in the diet. The appointment of drugs with 1 degree of malnutrition is not required.

Grade 2 requires the need to adjust diet and feeding, balance nutrition, prescribe medication that can be performed both at home and in the hospital.

Diet and nutrition should be age appropriate, the regime changes. Portions are reduced, but the frequency of eating becomes more frequent. Treatment is carried out with biological stimulants, digestive enzymes, vitamin and mineral complexes.

Just adjusting your diet is not enough. The baby receives complex infusion therapy and parenteral and enteral feeding through a tube.

Treatment of the 3rd degree of malnutrition is aimed at maintaining and correcting the vital functions of the body and includes transfusion of blood, plasma, glucose, the introduction of enzymes and hormones.

There is a fight against dehydration, electrolyte imbalance, acid-base balance. The tube feeding diet includes a specially designed milk-protein mixture, devoid of lactose, but with the addition of fats, including PUFAs (Alfare). When removed from a serious condition, rickets and anemia begin to be treated. In the future, a diet appropriate for age is drawn up. During the period of convalescence, treatment with non-specific immunomodulators is carried out.

Prevention

Prevention has always been and remains preferable and more economical than cure. Prevention of malnutrition in children consists in adequate breastfeeding, the timely introduction of supplementary feeding and complementary foods, and proper care of the baby.

Oddly enough, but prevention should begin from the childhood of future parents. A balanced diet, physical education and sports, work and rest regimen, sleep, avoidance of stress, rejection of bad habits, timely sanitation of foci of infection, personal and intimate hygiene, planned pregnancy and conducting it under the supervision of a specialist in compliance with all recommendations - effective prevention of complications and the birth of a healthy child.

Hypotrophy in children is a diagnosis associated with malnutrition of the child, which is accompanied by insufficient weight gain in accordance with age and height. Most often occurs in babies under the age of three years, can be observed in newborns. This condition is dangerous because it entails other serious disruptions in the body, up to a lag in mental development. Therefore, it is important to know about this disease, its symptoms, in order to detect its manifestations in time.

About malnutrition in young children can be said with a lack of body weight of 10% of the age norm or more. Depending on the neglect of the disease, there are three degrees of it.

The first degree is usually invisible, it can be skipped, taking it as a feature of the physique. Or vice versa, the baby can really be thin by nature, so the doctor can identify hypotrophy of the 1st degree in children. Its symptoms include:

• loss of appetite;
• sleep disorders;
• anxiety;
• possible decrease in muscle tone;
• pallor of the skin and a decrease in its elasticity;
• the child may look thin in the abdomen;
• rarely - signs of anemia or rickets.

Hypotrophy of the 2nd degree in children will already be noticeable to parents on the following grounds:

• weight deficit from 20 to 30%;
• growth retardation (3-4 cm);
• bad sleep;
• lethargy, lethargy;
• poor appetite, frequent regurgitation;
• stool disorders - constipation and diarrhea;
• cold extremities;
• poor skin condition: pallor, peeling and dryness;
• pronounced thinness of the body;
• lag in psychomotor development;
• possible tachycardia and shortness of breath;
• frequent colds.

With the third degree of the disease, the child's condition becomes almost critical:

• weight deficit of more than 30%;
• lag in growth of 8-10 cm;
• the bones are covered with leather;
• gray, dry skin;
• drowsiness, tearfulness, apathy;
• in infants - sinking of the fontanel;
• loss of previously acquired skills;
• muscles atrophy;
• mental underdevelopment;
• chronic infections (pyelonephritis, pneumonia) are possible;
• cracks in the corners of the lips;
• stool disorders, frequent vomiting.

Types of malnutrition

In addition to the degrees of development, malnutrition is divided according to the time of onset of the disease into intrauterine (congenital) and acquired.

Congenital malnutrition

This type of pathology is also called intrauterine, and develops during the period of gestation by the mother. Reasons for this type:

• toxicosis in the mother in the first and second trimester of pregnancy;
• fetoplacental insufficiency,;
• bad habits of a pregnant woman, poor nutrition;
• chronic diseases of the expectant mother (cardiac, endocrine, diabetes mellitus, pyelonephritis, etc.);
• stress;
• genetic abnormalities of the fetus;
• mother's work in hazardous production during pregnancy;
• problems with the placenta;
• — fetal hypoxia —;
• intrauterine infection.

You can determine intrauterine disease after birth by the following symptoms: too low weight and height, violation of thermoregulation, decreased muscle tone, slow healing of the umbilical wound, weak expression of reflexes.

Acquired malnutrition

The causes of this type of pathology can be divided into external and internal. Internal causes include various diseases and pathologies in a child, including congenital (metabolic disorders, endocrine diseases, immunodeficiency, malformations, food allergies, lactase deficiency, celiac disease, cystic fibrosis), birth injuries, cerebral palsy. Also, children who often suffer from infectious diseases (ARI, intestinal infections) may be prone to the development of malnutrition.

External causes do not depend on the state of health of the child, but are caused by an environment unfavorable for development, incorrect actions of parents:

• inadequate feeding (breast milk or formula);
• improper grip of the nipple during breastfeeding and, as a result, a lack of milk;
• poor nutrition of a nursing mother;
• unbalanced diet;
• too low-calorie food;
• late introduction of complementary foods;
• excess of the norm of taken vitamins (especially A and D);
• taking certain medications;
• poisoning;
• lack of parental attention, walks in the fresh air;
• lack of activities with the child in the form of massage and gymnastics, rare bathing, poor sleep.

Diagnostics

Suspecting malnutrition, the pediatrician will diagnose and prescribe a series of tests. So, the baby will be examined to determine the condition of his skin, nails and hair, muscle tone, thickness of the subcutaneous fat layer. The doctor will interview the parents about the child's usual condition: how he eats, sleeps, behaves, how he is looked after. The congenital diseases discussed above will be important: their presence can help confirm the diagnosis of the child.

In addition, it will be necessary to pass tests and undergo research:

• general urine and blood tests;
• stool analysis;
• blood chemistry;
• Ultrasound of the abdominal organs;
• examination of the heart using an electrocardiogram, echocardiography;
• electroencephalogram - examination of the brain.

You may also need to consult a number of pediatric doctors of a narrow profile: a neurologist, a cardiologist, a gastroenterologist, a geneticist, etc.

Treatment of malnutrition in children

When establishing an accurate diagnosis, the doctor will prescribe treatment, which includes:

• elimination of the cause that caused malnutrition;
• establishing proper nutrition of the child, following a certain diet;
• ensuring proper care from parents;
• drug therapy (vitamins, immunomodulators, probiotics, drugs to improve the production of stomach enzymes);
• massage, ultraviolet irradiation can be prescribed.

The diet for this diagnosis is as follows:

1. At first, for 2 days to 2 weeks, the baby is fed food intended for younger babies. The calculated norm of food is divided into 9-10 receptions.
2. Then the food is brought to the age norm according to the weight of the patient, special mixtures are added.
3. The next stage includes an increase in the calorie content of food consumed, nutrition should be enhanced.

As for intrauterine pathology, for treatment, first of all, breastfeeding is established so that the baby receives enough nutrients, and they also monitor his body temperature and maintain it at the right level.

Lifestyle of children with malnutrition

When diagnosing this disease or suspecting its occurrence due to some factors, you need to adhere to a certain lifestyle. In addition to a balanced diet with sufficient (and sometimes increased) calories, the necessary amount of vitamins and microelements, the parents of such a child must provide him with the necessary care and adherence to the daily routine: daily walks (at least 3 hours), therapeutic massage, gymnastics, nightly bathing.

The prevention of pathology is of great importance. And it should begin even before the birth of the child,. A pregnant woman should eat properly, fully and balanced, follow the doctor's prescriptions regarding the use of vitamin complexes. After the baby is born, you need to monitor his nutrition, be sure to try to establish breastfeeding, which provides him with everything necessary for normal growth and development.

It is necessary to monitor the height and weight of the child, visit a pediatrician to monitor these indicators and regular examinations of the baby. After 6 months, complementary foods must be introduced into the child's diet in accordance with the standards and recommendations of the WHO. The baby's diet should include a variety of healthy foods: cereals, meat, vegetables and fruits, dairy and sour-milk products.

How to recognize malnutrition

Parents should closely monitor the condition of their child and notice all changes in his behavior, eating and other habits, and general condition.

Disturbance of appetite and sleep, too much weight loss, skin problems, lethargy and apathy - all these signs should alert.

If you suspect an insufficient set of weight and height, you must definitely show the child to the pediatrician. Do not ignore monthly trips to the clinic for weighing and examination: this is how a doctor with many years of experience will be able to recognize an incipient disease that young parents may miss.

Video: complementary foods and norms for the growth and weight of a child as part of the prevention and diagnosis of malnutrition

Proper nutrition of the child plays a very important role in the process of his growth and development. Therefore, for the prevention of malnutrition, it will be useful to learn the basic rules for introducing complementary foods for the smallest, which in the future will provide the basis for proper eating habits.

Also pay attention to this short video, which clearly demonstrates the norms of height and weight of babies depending on age. Such data will also help you find out if everything is in order with the child, and also not to panic too much if your child does not fall into the standard parameters of hospital tables.

It is very important to observe the normal development of your baby from its very birth, so as not to miss the alarming bells of the onset of any disease. Knowing more about such a pathology as malnutrition, you will carefully consider his condition and provide the baby with proper care and proper diet. If you had to face such an unpleasant problem, please share your experience in the comments. Tell us what doctors advised and prescribed for you, how you coped with the disease. And may your children always be healthy!