What is malnutrition in newborns. Hypotrophy in children. Physiological weight loss in newborns

Word of Greek origin; "hypo" - "below, under" and "trophe" - "food". Hypotrophy is a chronic eating disorder. The basis of the disease is the depletion of the body. This term is used only in relation to the child of the first years of life. From this article you will learn what degrees of malnutrition exist in children. We will also tell you all about the causes of malnutrition in children, the treatment of malnutrition in a child and the preventive measures that you can take to protect your baby from the disease.

Causes of malnutrition in children

Hypotrophy is a chronic eating disorder, accompanied by a violation of the trophic function of the body, digestion, metabolism, dysfunction of various organs and systems with a delay in physical, motor-static and neuropsychic development.

There are congenital malnutrition or prenatal, in the development of which factors that act unfavorably during uterine development play a role, and acquired malnutrition (postnatal), which develops in children born with normal weight and body length. This form of malnutrition in infants and young children can develop as a result of exposure to a number of adverse factors.

Etiology of malnutrition

There are three main factors: alimentary, infectious, constitutional.

Alimentary factor in the development of dystrophy, it can manifest itself as quantitative or qualitative starvation, defects in the organization of the child's nutrition.

Quantitative fasting, as the name itself shows, there is a condition when the child receives insufficient breathing volume and the energy value of food. Currently, in children of the first months of life, malnutrition can develop due to hypogalactia, with difficulties in breastfeeding the mother (“tight” breast of the mother, flat and inverted nipple), sluggish sucking, errors in feeding technique, with early transfer of the child, artificial feeding, due to untimely introduction of complementary foods, "habitual" regurgitation and vomiting.

Quality fasting occurs when an incorrect ratio of individual ingredients (proteins, fats and carbohydrates) is observed in the child’s food, due to the inferiority of the qualitative composition of breast milk, monotonous feeding with the introduction of complementary foods (especially cereals), with a deficiency of proteins and fats, a deficiency of vitamins and minerals (untimely and insufficient introduction of vegetable and fruit juices, vegetable complementary foods).

In recent years, toxic factors have been important in the etiology of malnutrition - these are food contamination with salts of heavy metals (lead, arsenic), pesticides that react with sulfhydryl groups of protein molecules, inhibit protein synthesis, and cause inhibition of enzymatic activity. Toxic factors cause variants of dystrophy with primary metabolic disorders in the cell. Hypotrophy can be caused by hypervitaminosis A and D.

infectious factor- acute and chronic gastrointestinal infections (salmonellosis, coli infection, dysentery, etc.), chronic infections (tuberculosis, syphilis, dysentery), frequent acute respiratory viral infections, pyelonephritis and urinary tract infection, HIV infection. In infections, toxins, metabolic products lead to a violation of intracellular metabolism, the development of hypovitaminosis (qualitative starvation also occurs), and a decrease in appetite (quantitative starvation also appears).

constitutional factor in the etiology of malnutrition, these are congenital anomalies of the gastrointestinal tract, congenital heart defects, immunodeficiency states, enzymopathies (a group of diseases caused by hereditary metabolic defects), diseases of the endocrine system, perinatal encephalopathies of various origins. Congenital anomalies of the gastrointestinal tract include: dolichosigma, Hirschsprung's disease, atresia of the bile ducts, pylorospasm, congenital defects: splitting of the hard palate, non-closure of the upper lip. Diseases of the endocrine system include adrenogenital syndrome, hypothyroidism, diabetes mellitus, pituitary dwarfism.

With constitutional factors in the development of malnutrition, insufficient digestion of food is observed in terms of both quantity and quality due to a violation of the functional properties of body cells.

At present, malnutrition at birth as a manifestation of intrauterine growth retardation is of independent importance in the etiology of malnutrition.

Hypotrophy pathogenesis

A lack of food or a qualitative change in it leads to a violation of the processes of assimilation (intracavitary hydrolysis, membrane digestion and absorption are disturbed), to a distortion of enzymatic reactions, to malnutrition of vital organs, and above all the central nervous system. Due to dysfunction of the central nervous system, dysfunction of the subcortical areas of the brain occurs, which leads to aggravation of trophic disorders. Thus, the main pathogenetic link of malnutrition is intracellular starvation. With insufficient nutrition, the body begins to use its depots to maintain the basal metabolism and the specific dynamic action of food. First of all, the glycogen depot begins to be utilized, however, it is restored by switching to the consumption of energy fat, therefore, first of all, a decrease in fat depot is observed. With a longer exposure to a harmful factor on the body, the fat depot is used up and glycogen cannot be replenished in the absence of fat, the glycogen depot gradually decreases, and then the body begins to use its own proteins. With a protein deficiency in the child's diet, there is an increase in protein-energy deficiency, growth retardation due to a decrease in the synthesis of liver somatomedins, aggravation of enzyme disorders and damage to immunological mechanisms, aggravation of weight loss, atrophic processes.

With protein deficiency, atrophy of the thymus and lymphoid tissue, a decrease in the number of T-lymphocytes, a violation of the bactericidal and phagocytic function of neutrophils are observed. The content of immunoglobulins in blood serum decreases, especially IgM and IgA. Violation of cellular, weakening of humoral immunity cause a high frequency and severe course of bacterial and other infections in patients with malnutrition, the development of septic and toxic-septic conditions in them. Simultaneously with the consumption of glycogen and protein depot, the body gradually utilizes the vitamin depot, which leads to the development of hypo- or beriberi.

With the consumption of endogenous proteins, a violation of the functions of the endocrine glands occurs: a decrease in the function of the thyroid gland (decrease in the level of basal metabolism), the pituitary gland (growth disturbance), and the insular apparatus of the pancreas. As a result of metabolic shifts, the acid-base balance is disturbed, metabolic acidosis and endogenous toxicosis develop.

Under conditions of violation of enzymatic processes in the body, a decrease in the activity of many enzymes in the blood and cells, tissues, lipid peroxidation is enhanced. Lipid peroxides have a toxic effect on the body of a sick child, damage the membranes of cells and their organelles. As a result, destabilization of cell membranes develops, their barrier function worsens, a change in the constancy of the internal environment of the body enhances the dysfunction of organs and systems. In most children with malnutrition, there is a violation of the intestinal biocenosis, most often caused by Proteus microbes, Klebsiella and their associations with hemolytic Escherichia coli, fungi of the genus Candida.

Causes of malnutrition in a newborn

Among the reasons are improper feeding, especially in infants of the first six months of life, poor-quality care for them, constant violations of the daily routine or lack of a daily routine as such, frequent illnesses of the baby (acute infectious diseases, chronic infections, acute gastrointestinal diseases, etc.). P.)

Among the causes in the first place are infectious and nutritional factors, then anomalies of the gastrointestinal tract, hereditary metabolic disorders.

The cause of malnutrition in a child: congenital factors

Hypotrophy in young girls and boys can be congenital (intrauterine), due to the impact on the fetus of various factors, accompanied by circulatory disorders in the placenta, intrauterine infection of the fetus:

• diseases and occupational hazards in the mother during pregnancy,
• gestosis and toxicosis,
• malnutrition,
• smoking and alcohol consumption during pregnancy,
• mother's age is over 35 and under 20 years old.

Cause of malnutrition in a child: feeding

When breastfeeding, the most common cause is malnutrition, due to a lack of milk from the mother or due to sluggish suckling at the breast. The reason for the development of malnutrition during artificial feeding may be a violation of the balance of nutrition in terms of calorie content or chemical composition of food. For example, with one-sided milk feeding (kefir, milk), the baby receives an excess of proteins and salts and a lack of carbohydrates. At the same time, the baby is constipated, the stool becomes clay and fetid. The predominant feeding of children with cereals in diluted milk causes the so-called mealy eating disorder associated with an excess of carbohydrates and a lack of proteins and salts (the stool becomes liquid).

With the disease, the function of the digestive organs decreases, changes occur in protein, fat, carbohydrate, water-salt and vitamin metabolism, anemia develops, immunity changes and various infections accumulate.

The reason why hypotrophy occurs in a child:

1. Sometimes muscle hypotrophy occurs in healthy babies who lead a sedentary lifestyle, with limited mobility in the postoperative period or severe somatic pathology.
2. Muscle atrophy accompanies flaccid paralysis, in particular, arising from the paralytic form of poliomyelitis. The causes of muscle atrophy lie in hereditary degenerative diseases of the muscular system, chronic infections, metabolic disorders, disorders of the trophic functions of the nervous system, prolonged use of glucocorticoids, etc. Local muscle atrophy can form with prolonged immobility associated with diseases of the joints, damage to tendons, nerves, or the muscles themselves.

There are three degrees of malnutrition - I, II, III.

Hypotrophy of the 1st degree in babies is marked by a lag in weight of no more than 20%; there is no lag in growth. The subcutaneous fat layer is preserved everywhere, however, it is somewhat thinned on the trunk and limbs. The elasticity of the skin is slightly lower than that of a healthy baby. The skin and visible mucous membranes may be slightly pale. The general condition does not suffer.

Hypotrophy of the 2nd degree in children there is a lag in weight from 20 to 40%; there is also a lag in growth - up to 3 cm. The skin is dry, inelastic, easily gathers into thin folds, and these folds are poorly straightened. The subcutaneous fat layer is largely thinned on the trunk, buttocks and limbs. Weight loss becomes noticeable on the face. Muscles also become thinner, their tone is disturbed. If the baby had any motor skills by this time, they may disappear. Appetite can be sharply reduced or, conversely, very well expressed.

A child with III degree hypertrophy is characterized by a very significant lag in weight - by 40% and more; also significantly stunted. The subcutaneous fat layer of the baby is absent everywhere, this layer is also absent on the face, which is why the latter takes on the appearance of an senile face - the eyes sink (because the fat in the eye sockets disappears), wrinkles form on the forehead and cheeks, cheekbones stand out, the chin is sharpened, resulting in a face takes on a triangular shape. Often you can see the expression of suffering on the face.

Clinical signs of malnutrition: the baby's skin completely loses elasticity, becomes dry, flaky; over time, trophic disorders appear on the skin - ulcers form on the back of the head, buttocks and in other places. On the trunk and limbs the skin hangs in folds. The muscular system also undergoes significant changes: the muscles become thin and flabby, however, their tone is increased. The tummy can be sharply swollen due to intestinal atony and flatulence, or, on the contrary, drawn in.

Hypotrophy treatment

The treatment is complex. Very important: high-quality care for the baby by the mother, strict observance of the daily routine, proper nutrition, appropriate for age, proper upbringing. It is necessary to eliminate the factor and cause that led to the disease as soon as possible. If necessary, therapy is carried out to increase appetite. Of great importance is the speedy restoration of the normal functioning of all organs and systems. In some cases, the doctor resorts to stimulation therapy. If malnutrition in a baby arose due to improper feeding, due to serious violations of the rules for the introduction of complementary foods, due to monotonous nutrition, the doctor makes adjustments to baby food.

Caring for a child during treatment for malnutrition

Patients with hypotrophy of the first degree are treated at home under the supervision of a district pediatrician without changing the usual regimen corresponding to their age.

Treatment of malnutrition in children of II and III degrees is carried out in a hospital with a mandatory organization of a sparing regimen: the child should be protected from all unnecessary stimuli (light, sound, etc.) It is desirable to keep the child in a box with the creation of an optimal microclimate (air temperature 27-30 ° C , humidity 60-70%, frequent airing); the mother is hospitalized with the child. During walks, the child should be held in his arms, make sure that the hands and feet are warm (using heating pads, socks, mittens). An increase in emotional tone should be achieved by gentle treatment of the patient, the use of massage and gymnastics. With malnutrition of the III degree, especially with muscle hypertonicity, massage is carried out with great care and only stroking.

Diet for malnutrition in children

Diet is the basis of rational treatment of dystrophy (primarily malnutrition). Diet therapy for the treatment of malnutrition can be divided into two stages:

• clarification of the tolerance of various foods;
• a gradual increase in the volume of food and correction of its quality until the physiological age norm is reached.

The first stage lasts from 3-4 to 10-12 days, the second - until recovery.

1. "Rejuvenation" of the diet - the use of food products intended for boys and girls of younger age (breast milk, sour-milk adapted mixtures based on protein hydrolysates);
2. Fractional nutrition - frequent feeding (for example, up to 10 times a day for grade III disease) with a decrease in the amount of food at one time;
3. Weekly calculation of the food load by the amount of proteins, fats and carbohydrates with correction in accordance with the increase in body weight;
4. Regular monitoring of the correctness of treatment (keeping a food diary indicating the amount of food, fluids drunk, diuresis and stool characteristics; compiling a "weight curve", scatological examination, etc.)

How is malnutrition treated in children using nutrition calculation?

The calculation of nutrition for malnutrition of the I degree is performed for the proper (age-appropriate) body weight of the child with full satisfaction of his needs for the main components of food, trace elements and vitamins. In case of disease II and III degrees in the first 2-3 days, the volume of food is limited to 1/3 - 1/2 for the required body weight. Subsequently, it is gradually increased to 2/3 - 3/5 of the daily diet of a healthy child. The missing amount of nutrition is replenished with liquid - vegetable and fruit juices, 5% glucose solution. Upon reaching the age-appropriate amount of food, the amount of proteins and carbohydrates is calculated for the required body weight, and fats for the actual one. If the child does not have dyspepsia in the process of increasing the amount of food, and the body weight increases (usually this happens after 1-12 days from the start of treatment), a qualitative correction of nutrition is gradually carried out, all ingredients are calculated on the proper body weight (proteins and fats - 44.5 g/kg, carbohydrates - 1316 g/kg).

Enzyme therapy for the treatment of malnutrition in a child

Enzymes must be prescribed for any degree of the disease, both due to an increase in the nutritional load during treatment, and in connection with a decrease in the activity of the patient's own gastrointestinal enzymes. Enzyme therapy is carried out for a long time, changing drugs: rennet (abomin), pancreatin + bile components + hemicellulase (festal), with a large amount of neutral fat and fatty acids in the coprogram - pancreatin, panzinorm. The use of vitamins, primarily ascorbic acid, pyridoxine and thiamine, is also pathogenetically justified. Stimulant therapy includes alternating courses of royal jelly (apilac), pentoxyl, ginseng and other agents. With the development of an infectious disease, Ig is injected.

Prevention of malnutrition

It is easier to prevent the causes of malnutrition than to treat it later. The preventive measures are as follows:

• organization of proper child care;
• strict observance of the diet;
• timely and sufficient intake of vitamins;
• hardening procedures (hardening with air, sunlight and water);
• proper upbringing of the baby (provides a positive emotional state);
• also ensures the restoration and development of the necessary conditioned reflexes);
• prevention of infectious diseases.

Prevention of malnutrition should be divided into antenatal and postnatal.

1. Antenatal prevention includes family planning, health education of parents, the fight against abortion, treatment of diseases of the expectant mother, especially diseases of the genital area, health care of the pregnant woman [rational nutrition, adherence to the daily routine, walks in the fresh air, transfer to light work (under adverse working conditions) , exclusion of smoking and other bad habits].
2. Postnatal prevention of malnutrition includes natural feeding with its timely correction, compliance with the regimen and rules for caring for the child, proper education, prevention and treatment of infectious and intercurrent diseases, dispensary observation with monthly (up to 1 year) weighing and measuring body length.

Treatment prognosis malnutrition depends primarily on the possibility of eliminating the cause that led to the development of dystrophy, as well as on the presence of concomitant diseases. With primary alimentary and alimentary-infectious dystrophy, the prognosis is quite favorable.

Nutrition for children with malnutrition

The basis of treatment for all forms of malnutrition is the organization of proper nutrition. The complexity of nutrition lies in the fact that their need for essential nutrients and calories is increased, and food tolerance, especially to fats, is reduced. Therefore, the success of treatment depends on an individual approach to each sick child.

Nutrition in the treatment of malnutrition I degree

The first feeding for full-term infants with congenital malnutrition of the 1st degree should be carried out immediately in the delivery room, for premature infants, depending on the degree of prematurity, no later than 12 hours after birth. In between feedings, be sure to give your baby 5% glucose (1/4 of the total amount of food).

The volume of breast milk per feeding for newborns and premature infants with disease of the I degree is 10 ml on the first day, 15-20 ml on the 2nd, 20-30 ml on the 3rd, 5-7th days - 50-90 ml.

Nutrition during the treatment of malnutrition II - III degree

With malnutrition II - III degree, sluggish sucking or refusal to feed, they begin to feed from 1/3-1/2 of the volume needed at this age, gradually increasing the amount of milk to normal.

The daily amount of food for newborns aged 2 to 8 weeks should approximately be 1/5 of the actual body weight, from 2 to 4 months - 1/5 - 1/6, from 4 to 6 months - 1/7, from 6 up to 9 months - 1/8 part.

• In the first months of life, a person suffering from malnutrition is prescribed 7-8 feedings per day, from 3-4 months - 6, from 5 months, if the condition allows - 5. During the first 2-3 months of a baby’s life, breast milk should be provided, and when it absence - adapted mixtures, preferably acidophilic and sour-milk. Protein correction is carried out with cottage cheese, kefir, fat correction - with vegetable oil, introduced into complementary foods. Carbohydrates are corrected with sugar syrup, fruit juices, puree.
• Complementary foods are introduced against the background of positive body weight dynamics in the absence of acute concomitant diseases during the treatment period. It is necessary to carefully observe the principle of gradualness with the introduction of each new type of food. Fruit juices are prescribed at 2 months, fruit puree - from 2.5 months. Juices are administered gradually: at first a few drops, and by 2-3 months their volume is adjusted to 30 ml.
• Children diagnosed with malnutrition and who are breastfed from 3 months can be given egg yolk as a product containing complete protein, fat, mineral salts - calcium, phosphorus, iron, vitamins A, D, B1, B2, PP. You should start with 1/8 of the yolk and gradually increase the serving to half the yolk per day.
• From the age of 4 months, cottage cheese must be included in the diet of a patient with malnutrition. If the child did not receive it at an earlier date for the purpose of correction and treatment, then the input begins with 5 g (half a teaspoon), gradually increasing the dose by 6-7 months to 40 g.
• At the age of 3.5 months with natural and 2.5 months with artificial feeding, if the condition allows, they introduce complementary foods in the form of cereals - starting with 5%, then 8% and finally 10% concentration. It is preferable to use buckwheat, rice flour. About a month after the introduction of porridge, they begin to introduce vegetable puree, starting with 1-3 teaspoons and increasing the portion over 10-12 days to 100-150 g. Canned vegetable purees from various vegetables for baby food can be used for feeding.
• From 4 months of life, vegetable oil should be introduced into the diet of a child with malnutrition (starting with 1 g and increasing the portion by 8-9 months to 5 g), from 5 months - butter (starting from 2 g and increasing the portion to 5 g by 8 months), from 7 - 7.5 months add meat (mainly beef) in pureed form (starting with 5 g and increasing the portion to 30 g per day, and by 9 months - up to 50 g, by the year - up to 60 - 70 g).
• At 7 months, add meat broth (20-30 ml) with white crackers (2-3 g). The broth should be given in the afternoon feeding before the vegetable puree.

Feeding a baby with malnutrition, which has developed against the background of hereditary metabolic disorders, is built taking into account its cause:

• In the treatment of celiac disease, products containing gluten are excluded: wheat flour, semolina, starch;
• The main method of treating a baby with lactose deficiency is the exclusion from the diet of milk (including mother's) and dishes prepared with fresh milk. These children should be given fermented milk products: acidophilic mixtures, kefir, acidophilic milk, low-lactose mixtures;
• In cystic fibrosis, a diet with a restriction of fat and an increase in protein is prescribed. The need for fats should be covered mainly by vegetable oils (corn, sunflower), rich in unsaturated fatty acids.

Now you know everything about the causes, degrees and methods of treating malnutrition in young children.

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.

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, 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, 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.

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 growth 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, being tall and thin is 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 life of the baby, its 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, provided there are no 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?

Hypotrophy of the newborn is discrepancy between his weight and height to normal indicators for this period.

This deviation is considered quite common, most often the disease is diagnosed among patients who abuse bad habits and do not follow their diet.

What do you need to know?

Causes of the disease

In newborns, a lot depends on the weight; weight compliance with the standards is a sign of normal development.

Hypotrophy can be congenital, acquired and mixed, the causes of the disease are different.

Congenital malnutrition often occurs as a result of violations provoked by various complications of the course of pregnancy:

• intrauterine infection;
• pathology of the umbilical cord and implants;
• acute diseases, exacerbations of chronic;
• propensity to miscarriage;
• polyhydramnios;
• toxicosis.

The lifestyle of a pregnant woman also plays an important role:

• malnutrition;
• stress;
• physical exercise;
• work in hazardous industries;
• smoking, drug, alcohol abuse.

Under the influence of the above factors, the supply of nutrients and oxygen to the fetus from the mother is disrupted, as a result of which malnutrition develops.

Improper feeding, diseases of the gastrointestinal tract - all these factors lead to poor absorption of carbohydrates, fats, proteins, energy valuable substances.

With mixed form diseases, social, infectious or alimentary consequences are added to negative intrauterine factors.

In children with acquired malnutrition lack of weight is not associated with malformations and heredity, their general condition is quite encouraging, mental and physical development corresponds to the gestational age.

Infants with congenital disorders are considered more vulnerable in terms of survival and further mental development.

Symptoms and signs

In appearance, children with intrauterine dystrophy can be divided into two groups, the first one is underweight children with no or slight stunting, to the second- developmental delay affects not only weight and height, but also head circumference.

Children from the second group practically no different from premature babies, the presence of malnutrition is determined after familiarization with their gestational age.

This type of pathology has received the designation hypostatura or hypoplastic type.

The aggravating factors of pregnancy, which provoked developmental delay in this case, appear in the second trimester of pregnancy.

In newborns with underweight and growth retardation, but with a normal head circumference, the disease manifests itself in the form of physical imbalances, the signs may resemble those of hydrocephalus.

With intrauterine hypotrophy various lesions of the skin can occur from barely noticeable dryness to severe wrinkling up to the effect of parchment.

Pathology can be local and widespread, most often the inner surface of the feet and palms is affected.

Dry skin all over body is considered a severe case of malnutrition, regardless of the correspondence of its weight and growth to the gestational age, in this case we are not talking about patients with ichthyosis.

Degrees of the disease

Three degrees of malnutrition:

1. I (light) degree- lag in weight 10-20% of the norm, growth is normal.
2. II (medium) degree- deviation from the norm of weight - 20-30%, height - 2-3 cm.
3. III (severe) degree- weight lag is 30%, deviations in growth are significant.

What causes the disease

Speaking of complications, it is also necessary to mention the degree of the disease, hypotrophy of the 1st degree practically does not affect the development of the child.

Due to insufficient weight, there may be an increased tendency to hypothermia, but with breastfeeding and proper care, it is easy to gain weight.

With hypotrophy of the second and third degree the situation is more complicated, it must be taken into account that due to a lack of nutrients, the formation of internal organs is disrupted, incl. nervous system, which can lead to negative consequences.

The cause of mental abnormalities (oligophrenia, imbecility) of children of alcoholics and drug addicts is chronic intoxication of the mother's body, as well as a deficiency of substances necessary for development.

Complications

Complications of malnutrition are not always encountered, in some newborns, the adaptation process proceeds without any difficulty.

In others, growth retardation is accompanied by violations of life-important functions provoked by complications during pregnancy.

The most common complication poor nutrition in late pregnancy is hypoxia.

Prolonged hypoxia is accompanied by clouding of the amniotic fluid and skin, as a result of which the membranes and the umbilical cord acquire a yellow-green tint.

This pathology has a definition - Clifford syndrome (placental dysfunction). Most often, the pathology occurs in post-term fetuses, however, the syndrome is diagnosed only in 20% of infants born after the term.

In most cases, these babies develop severe forms of respiratory distress, sometimes there are signs of liver enlargement, heart enlargement.

Breathing problems can occur even after successful resuscitation.

Another common complication is pneumothorax., which develops due to rupture of the alveoli.

Pathology usually develops in the first hours after birth and manifests itself in the form of a sudden deterioration in the functioning of the respiratory system, in some cases even the disappearance of heart sounds is diagnosed.

Treatment

Treatment of malnutrition involves an integrated approach

Within the framework of which diet therapy, medication and vitamins are provided.

For older children, massage, physiotherapy exercises, physiotherapy are provided.

Which doctor should I contact?

The most important role in the treatment of the disease is played by diet therapy, which depends on the severity of the disease and appointed individually by a pediatrician.

Parents should follow his recommendations as closely as possible.

How is malnutrition treated?

With malnutrition of the first degree, treatment at home is allowed, daily the baby should receive the same amount of food as newborns with normal weight, the number of meals increased from 6 to 7 times.

Sugar can be added to milk and cereals when they are included in the diet.

The child additionally receives enzymes and vitamins prescribed by the doctor.

The main difficulty in feeding a newborn with malnutrition is that the baby needs an increased amount of nutrients.

At the same time, the resistance of the child's gastrointestinal tract to stress is reduced, enhanced nutrition can provoke indigestion, which can further aggravate the situation.

Newborns with the second and third degree of malnutrition temporarily placed in a hospital, in which the body adapts to normal food intake, in severe cases, nutrient solutions are administered intravenously.

As part of therapy, the number of meals is increased and its volume is reduced.

Treatment also includes drug therapy., within the framework of which vitamins, enzymes, metabolic stimulants are prescribed, the next stage, the babies begin to be given skim milk, subsequently the diet is supplemented with cereals and sugar, cream and butter.

With effective treatment, children's appetite normalizes, positive emotions appear, the condition of the skin and soft tissues improves, weight increases daily by 20-25 g, digestion improves, mental and physical skills are restored.

Do you need special care and nutrition?

When treating malnutrition, it is necessary to establish whether the baby is sick with something else.

In the presence of other diseases, therapy begins with their elimination.

An important role in this case is played by cleanliness of the room which must be constantly maintained.

special care must be taken when preparing food.

Prevention

To prevent the development of intrauterine malnutrition it is necessary to exclude all harmful effects on the body, it is recommended to avoid stress, adhere to a healthy lifestyle, eat right, take vitamins

An infant should be fed an appropriate amount of food for its age, it is recommended to visit the pediatrician regularly for weighing.

A woman should pay great attention to her diet, during and after pregnancy.

With congenital pathology and genetic mutations, metabolism and digestion are different, therefore you must strictly adhere to the diet prescribed by the doctor.

Summing up

Hypotrophy in newborns is quite common, women are at risk, abusing bad habits, not watching their diet.

The severity of the disease is determined by the lag in the weight and height of the child from the norm.

Treatment involves a special diet, which is prescribed individually by a doctor.

To prevent the development of the disease It is recommended to lead a correct lifestyle, monitor nutrition.

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- chronic malnutrition, accompanied by an insufficient increase in body weight of the child in relation to his height and age. Hypotrophy in children is expressed by a child's lag in weight, growth retardation, lag in psychomotor development, underdevelopment of the subcutaneous fat layer, and a decrease in skin turgor. Diagnosis of malnutrition in children is based on examination data and analysis of anthropometric indicators of the child's physical development. Treatment of malnutrition in children involves changing the regimen, diet and caloric intake of the child and the nursing mother; if necessary, parenteral correction of metabolic disorders.

General information

Hypotrophy in children is a lack of body weight due to a violation of assimilation or insufficient intake of nutrients in the child's body. In pediatrics, malnutrition, paratrophy and hypostatura are considered as independent types of chronic eating disorders in children - dystrophy. Hypotrophy is the most common and significant variant of dystrophy, to which children of the first 3 years of life are especially susceptible. The prevalence of malnutrition in children in different countries of the world, depending on the level of their socio-economic development, ranges from 2-7 to 30%.

Hypotrophy in a child is said to be when the body weight lags by more than 10% compared to the age norm. Hypotrophy in children is accompanied by serious disturbances in metabolic processes, decreased immunity, and a lag in psychomotor and speech development.

Causes of malnutrition in children

A variety of prenatal and postnatal factors can lead to chronic malnutrition.

Intrauterine malnutrition in children is associated with adverse conditions that disrupt the normal development of the fetus. In the prenatal period, pathology of pregnancy (toxicosis, preeclampsia, fetoplacental insufficiency, premature birth), somatic diseases of the pregnant woman (diabetes mellitus, nephropathy, pyelonephritis, heart defects, hypertension, etc.), nervous stress, bad habits, malnutrition of women, industrial and environmental hazards, intrauterine infection and fetal hypoxia.

Extrauterine malnutrition in young children may be due to endogenous and exogenous causes. The causes of the endogenous order include chromosomal abnormalities and congenital malformations, fermentopathy (celiac disease, disaccharidase lactase deficiency, malabsorption syndrome, etc.), immunodeficiency states, constitutional abnormalities (diathesis).

Exogenous factors leading to malnutrition in children are divided into alimentary, infectious and social. Alimentary influences are associated with protein-energy deficiency due to insufficient or unbalanced nutrition. Hypotrophy in a child may be the result of constant underfeeding associated with difficulty sucking with an irregular shape of the mother's nipples (flat or inverted nipples), hypogalactia, insufficient amount of milk formula, profuse regurgitation, qualitatively malnutrition (microelement deficiency), poor nutrition of a nursing mother, etc. The same group of reasons should include diseases of the newborn itself, which do not allow him to actively suck and receive the necessary amount of food: cleft lip and palate (cleft lip, cleft palate), congenital heart defects, birth trauma, perinatal encephalopathy, pyloric stenosis, cerebral palsy, alcohol fetal syndrome etc.

Children suffering from frequent acute respiratory viral infections, intestinal infections, pneumonia, tuberculosis, etc. are prone to the development of acquired malnutrition. An important role in the occurrence of malnutrition in children belongs to unfavorable sanitary and hygienic conditions - poor child care, insufficient exposure to fresh air, rare bathing, insufficient sleep .

Classification of malnutrition in children

Thus, according to the time of occurrence, intrauterine (prenatal, congenital), postnatal (acquired) and mixed malnutrition in children are distinguished. The development of congenital malnutrition is based on a violation of the uteroplacental circulation, fetal hypoxia and, as a result, a violation of trophic processes leading to intrauterine growth retardation. In the pathogenesis of acquired malnutrition in children, the leading role belongs to protein-energy deficiency due to malnutrition, disturbances in the processes of food digestion or absorption of nutrients. At the same time, the energy costs of a growing organism are not compensated by food coming from outside. With a mixed form of malnutrition in children, alimentary, infectious or social influences join the adverse factors that acted in the prenatal period after birth.

According to the severity of underweight in children, hypotrophy of I (mild), II (medium) and III (severe) degrees is distinguished. Hypotrophy of the 1st degree is said when a child lags behind in weight by 10-20% of the age norm with normal growth. Hypotrophy of the II degree in children is characterized by a decrease in weight by 20-30% and a growth lag of 2-3 cm. With hypotrophy of the III degree, the body weight deficit exceeds 30% of the due age, there is a significant lag in growth.

During malnutrition in children, the initial period, the stages of progression, stabilization and convalescence are distinguished.

Symptoms of malnutrition in children

With malnutrition of the first degree, the condition of the children is satisfactory; neuropsychic development corresponds to age; there may be a mild decrease in appetite. A close examination reveals pallor of the skin, a decrease in tissue turgor, thinning of the thickness of the subcutaneous fat layer on the abdomen.

Hypotrophy of the II degree in children is accompanied by a violation of the child's activity (excitation or lethargy, lag in motor development), poor appetite. The skin is pale, scaly, flabby. There is a decrease in muscle tone, elasticity and tissue turgor. The skin easily gathers into folds, which are then poorly straightened. The subcutaneous fat layer disappears on the abdomen, trunk and limbs; on the face - saved. Children often present with shortness of breath, hypotension, and tachycardia. Children with II degree malnutrition often suffer from intercurrent diseases - otitis media, pneumonia, pyelonephritis.

Hypotrophy III degree in children is characterized by a sharp depletion: the subcutaneous fat layer atrophies throughout the body and on the face. The child is lethargic, adynamic; practically does not react to stimuli (sound, light, pain); sharply lags behind in growth and neuropsychic development. The skin is pale gray, the mucous membranes are dry and pale; the muscle is atrophic, tissue turgor is completely lost. Exhaustion and dehydration lead to retraction of the eyeballs and fontanel, sharpening of facial features, the formation of cracks in the corners of the mouth, and impaired thermoregulation. Children are prone to regurgitation, vomiting, diarrhea, decreased urination. In children with hypotrophy of the III degree, conjunctivitis, candidal stomatitis (thrush), glossitis, alopecia, atelectasis in the lungs, congestive pneumonia, rickets, anemia are often noted. In the terminal stage of malnutrition, children develop hypothermia, bradycardia, and hypoglycemia.

Diagnosis of malnutrition in children

Intrauterine fetal malnutrition, as a rule, is detected during ultrasound screening of pregnant women. In the process of obstetric ultrasound, the dimensions of the head, length and estimated weight of the fetus are determined. With a delay in intrauterine development of the fetus, the obstetrician-gynecologist sends the pregnant woman to the hospital to clarify the causes of malnutrition.

In newborns, the presence of malnutrition can be detected by a neonatologist immediately after birth. Acquired malnutrition is detected, a study of the coprogram and feces for dysbacteriosis, a biochemical blood test, etc.).

Treatment of malnutrition in children

Treatment of postnatal malnutrition of the 1st degree in children is carried out on an outpatient basis, malnutrition of the II and III degrees - in a hospital. The main measures include the elimination of the causes of malnutrition, diet therapy, the organization of proper care, and the correction of metabolic disorders.

Diet therapy for malnutrition in children is implemented in 2 stages: clarification of food tolerance (from 3-4 to 10-12 days) and a gradual increase in the volume and calorie content of food to the physiological age norm. The implementation of diet therapy for malnutrition in children is based on fractional frequent feeding of the child, weekly calculation of the food load, regular monitoring and correction of treatment. Feeding children with weakened sucking or swallowing reflexes is carried out through a tube.

Drug therapy for malnutrition in children includes the appointment of enzymes, vitamins, adaptogens, anabolic hormones. With severe malnutrition, children are given intravenous administration of protein hydrolysates, glucose, saline solutions, and vitamins. With malnutrition in children, massage with elements of exercise therapy, UVI is useful.

Forecast and prevention of malnutrition in children

With timely treatment of hypotrophy of I and II degrees, the prognosis for the life of children is favorable; with malnutrition III degree mortality reaches 30-50%. To prevent the progression of malnutrition and possible complications, children should be examined weekly by a pediatrician with anthropometry and nutrition correction.

Prevention of prenatal fetal malnutrition should include adherence to the regimen of the day and nutrition of the expectant mother, correction of the pathology of pregnancy, exclusion of the impact on the fetus of various adverse factors. After the birth of a child, the quality of nutrition of a nursing mother, the timely introduction of complementary foods, the control of the dynamics of an increase in the body weight of a child, the organization of rational care for a newborn, and the elimination of concomitant diseases in children become important.

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

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

Factors provoking malnutrition

Internal causes of disturbed trophism of body tissues:

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

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

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

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

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

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

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

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

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

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

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

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

Stages of the disease

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

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

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

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

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

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

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

Removal of a child from a pathological state

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

Hypotrophy of the 1st degree is characterized by:

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

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

Grade 2 is characterized by aggravation of all existing violations:

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

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

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

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

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