Hypotrophy 1. Hypotrophy. Do you need special care and nutrition

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.

Hypotrophy in children is a type of dystrophy - systematic violation of the diet.

This problem is especially acute in regions with a low level of socio-economic development, however, individual cases also occur in developed countries. Here we are talking about dysfunctional families with low material wealth.

What are the symptoms of anorexia in children? Learn about it from ours.

Concept and characteristics

Hypotrophy occurs when there is a systematic malnutrition.

Pathology may be caused by quantitative starvation, when the child does not have enough food, or quality, when the baby, consuming a sufficient amount of food, does not receive enough vitamins and nutrients necessary for its development.

Qualitative malnutrition develops, for example, with the wrong choice for feeding the baby, improper and late introduction of complementary foods. Quantitative malnutrition occurs with a low-calorie diet, insufficient food intake.

With hypotrophy, there is lagging behind normal growth and weight recognized for a particular age group. A slight lag is not considered a pathology, it may be an individual feature of the child's physique.

The presence of the disease can be said in the case when the shortfall in height and body weight exceeds 10% of the established norm.

In this case all organs and systems of the child's body are affected, because, without receiving enough nutrients, they cannot fully perform their functions. Violated not only the physical development of the child, but also mental, intellectual.

Disease classification

There are 3 degrees of development of malnutrition in a child:

Hypotrophy may be congenital or acquired.

The congenital form of the pathology develops even in the prenatal period of a child's life, due to the difficult course of pregnancy, the threat of its interruption, and the unhealthy lifestyle of the expectant mother.

Acquired malnutrition develops after the baby is born as a result of insufficient (or improper) feeding, the presence of certain infectious diseases, anomalies in the development of internal organs, and a violation of their functionality.

Causes of development and risk groups

Congenital malnutrition in children occurs due to such adverse moments as:

The reasons for the development of acquired malnutrition are much more numerous:

Symptoms and clinical picture

At newborn babies the most common form of congenital malnutrition.

It is characterized by the following set of features:

• the weight and height of the child are significantly behind the norm. Weight reduced by 15% or more, height - by 2 cm or more., over time, the height and weight of the child increase slightly, the gains are significantly below the norm;
• lethargy, decreased muscle tone;
• congenital reflexes are weakened;
• there is a violation of thermoregulation (the baby freezes or, conversely, overheats under normal temperature conditions);
• the umbilical wound does not heal for a long period of time, even if the rules for caring for it are observed.

Acquired form of pathology, occurring in older children, appears as:

• thinness. Subcutaneously - the fat layer is thinned, but the normal proportions of the body are preserved. This symptom is characteristic of mild malnutrition;
• malnutrition of body tissues. Wherein subcutaneous fat atrophies becomes more invisible. Initially, it occurs in the abdomen, then throughout the body, in especially severe cases - on the face. The proportions of the body are violated;
• disorders of the nervous system(decrease in reflexes and muscle tone, depressed mood, delays in intellectual development). In a severe course of the disease, the child not only does not develop new skills, but also loses those that were acquired earlier;
• disorders of the digestive system(lack of appetite, frequent vomiting, decreased function of the organs that secrete digestive enzymes, and, as a result, a violation of the digestive processes);
• decrease in the protective functions of the body. Baby the most prone to disease bacterial and viral nature.

Complications and consequences

With pronounced malnutrition, there is a significant weakening of the body, its inability to withstand all kinds of diseases, including can be very serious(pneumonia, sepsis, and others), which can lead to a significant deterioration in the child's condition, and even death.

In addition, the intellectual development of the baby is disturbed, there are problems in learning, there are times when the child even forgot the skills that he had previously.

How does food allergy manifest in children? find out right now.

Diagnostics

To establish the disease and determine its degree, the doctor conducts a survey of the patient (or his parents).

During the survey establishes the nature of the child's nutrition(quantity and quality), living conditions of the baby, features of hygienic care for him, lifestyle and daily routine, whether the child takes medication.

In the process of visual examination, the doctor assesses the baby's physique, the condition of his skin, hair, nails, determines muscle tone, and monitors the child's behavior.

Necessary and laboratory research:

• general analysis of blood and urine;
• analysis of feces for the content of undigested fatty elements;
• study of the immune system;
• Ultrasound of the digestive tract.

Treatment Methods

What is the treatment of malnutrition in children?

The choice of one or another therapeutic method depends on the form of the disease, its degree, as well as on the characteristics of the baby's body.

Often these methods are used in combination, which allows you to achieve more effective and faster results.

To identify gluten allergy in a child, you will find on our website.

Medicines

Patient appoint:

• enzyme preparations containing pancreatic enzymes;
• immunomodulators;
• means for eliminating dysbacteriosis;
• vitamin preparations;
• means to eliminate the secondary symptoms of the disease, when there are violations of the internal organs.

In emergency cases, anabolics are prescribed - drugs necessary for the formation of protein, which is the most important building block for all human tissues and organs.

Food

Therapeutic nutrition for children with signs of malnutrition is carried out in 3 stages:

UFO

Treatment of malnutrition with UV irradiation has stimulating effect on the whole body in general, including the digestive system.

As a result of such an impact, metabolic processes in the child’s body are normalized, nutrients are better absorbed, various kinds of problems in the work of the digestive tract (disturbance of stool, vomiting) become less pronounced, in a child increased appetite.

However, this method is not recommended for severely weakened children with severe malnutrition.

Massage

A properly selected set of massage movements helps to strengthen the baby's muscle tissue, helps restore its tone, and normalize reflexes.

It is important to remember that all movements should be as gentle as possible(stroking), all kinds of pressure, rubbing, and other intense movements should be avoided.

It is necessary to massage (stroke) the arms and legs of the child, not forgetting the hands and feet, back and tummy, chest. 3-4 strokes of each area are enough.

No treatment methods will give the expected effect if you do not create a baby normal living conditions at home.

It is important to monitor the hygiene of the child, the regimen of his day (sleep and wakefulness), spend time with the baby on the street (quiet walks, sleep in the fresh air are recommended), please him with positive emotions.

Forecast

With timely and adequate therapy, the prognosis is usually good.

The presence of secondary diseases, disorders of the internal organs, as well as the small age of the patient reduce the chances of a successful recovery.

Prevention

It is necessary to follow the rules to prevent the development of malnutrition in a child from the moment of his conception. In particular, the expectant mother should pay attention to her health, nutrition, give up excessive physical exertion, bad habits.

After the baby is born, he needs create the right conditions accommodation, provide hygienic care, proper and nutritious food.

Some children are extremely thin, which can be simple feature of their physique.

However, if the lag in terms of height and weight is significant, we are talking about pathology.

It can be caused by various factors, both perinatal and postnatal.

Symptoms of the disease manifest themselves in different ways, depending on the form and degree of pathology. Hypotrophy needs timely and comprehensive treatment, in this case, the chance of recovery is very high.

What weight and height should the child have? Dr. Komarovsky will tell in this video:

We kindly ask you not to self-medicate. Sign up to see a doctor!

There is nothing worse for parents than the illness of their child. And when a baby is sick, still inexperienced parents often cannot cope with it in time, because they do not know the main symptoms of diseases and what they can lead to. This article will focus on such a pathological condition as malnutrition, which is often found in infants.

What is hypotrophy? Types of malnutrition and the main danger.

Hypotrophy is a chronic nutritional disorder in a child, which is characterized by an energy and / or qualitative lack of nutrients, which leads to a lack of body weight of the baby, impaired physical and intellectual development, pathological changes in all organs and systems. The disease affects mainly children under 3 years of age. In different countries, the frequency of malnutrition varies from 2 to 30%, depending on the economic and social development of the country.

There are two types of malnutrition:

• congenital;
• acquired.

Congenital or intrauterine malnutrition is a malnutrition that occurs even in the period of intrauterine development of the child.

The main causes of congenital fetal malnutrition:

• insufficiency of uteroplacental circulation;
• chronic fetal hypoxia;
• chromosomal and genomic mutations;
• pathology of pregnancy;
• constitutional features of the mother's body (small stature, body weight, age);
• mother's bad habits;
• malnutrition in pregnant women.

Acquired malnutrition is a chronic eating disorder of a child, which is characterized by a slowdown or cessation of the growth of the baby's body weight, a violation of normal body proportions, thinning and disappearance of subcutaneous fatty tissue, a violation of the digestive processes, a decrease in the body's resistance to infections, a predisposition to various diseases and a delay in neuropsychic development . It is this type of malnutrition that occurs most often and brings a lot of grief to young parents, therefore, further we will talk about this violation.

Physiological weight loss in newborns

Before you panic due to the fact that the child stopped gaining weight after birth or lost several hundred grams, you need to be aware of such a phenomenon as physiological weight loss in newborns.

It occurs in all babies, regardless of what weight was at birth. The mechanism of this phenomenon is as follows. Before birth, all metabolic processes in the body of the fetus are greatly activated, which provides it with the necessary energy during childbirth and in the first hours of independent life. Also, in the first days of a baby’s life, his body loses more fluid than it consumes (with breathing, feces, evaporation through the skin).

The newborn loses weight until about the 4th day of life, from the 5th day the baby should begin to gain weight again and by the 7-10-14th day his weight should again be the same as at birth, if this does not happen, then you need to look for the cause (such a phenomenon already considered pathological and requires intervention). The rate of weight loss is up to 7% of the original, if more, then this is already a pathology.

Proper care of the child, early breastfeeding, sufficient fluid intake in the child's body, prevents greater weight loss. If physiological weight loss has not occurred, then it is necessary to think about possible reasons. Most often this is due to congenital disorders of the excretory system, due to which fluid accumulates in the child's body.

Etiology of acquired malnutrition

There are many reasons for acquired malnutrition and it is not always possible to establish why the child is not gaining weight.

The main causes of acquired malnutrition:

• nutritional factors (quantitative or qualitative malnutrition of the infant, violation of the feeding regime, the use of low-energy formulas for feeding);
• diseases of the child's digestive tract;
• chronic and acute infectious diseases (pneumonia, SARS, sepsis, intestinal infections, etc.);
• poor child care;
• hereditary diseases;
• congenital malformations;
• anomalies of the constitution (diathesis);
• neuroendocrine diseases.

Clinical signs and degrees of malnutrition

The clinical picture of the disorder is dominated by 4 main syndromes.

1. Syndrome of trophic disorders.

It includes such signs as a lack of mass and / or body length for the age of the child, various violations of body proportions, gradual thinning and disappearance of subcutaneous fatty tissue, the skin becomes dry, inelastic, and the muscles of the child become thinner over time.

2. Syndrome of violation of the state of the central nervous system.

It includes violations of the emotional state (the child cries all the time) and reflex activity (all reflexes weaken). The baby sucks poorly or refuses to breastfeed at all, the muscle tone is reduced, the child moves little, does not roll over, does not hold his head well, etc. The baby’s sleep is disturbed, he does not keep a stable body temperature well.

3. Syndrome of reduced food tolerance.

Over time, the child's appetite decreases until the development of anorexia, he refuses to breastfeed. Disorders of the digestive tract develop (regurgitation, unstable stool, vomiting).

4. Syndrome of reducing the body's resistance (immunological reactivity).

The child becomes prone to frequent inflammatory and infectious diseases.

Depending on the severity of the signs of the disease and weight loss, there are 3 degrees of malnutrition.

Hypotrophy 1 degree:

• weight deficit is 10-20%;
• the child's condition is satisfactory;
• PZhK is moderately thinned only on a stomach;
• tissue turgor is moderately reduced;
• the skin is pale, their elasticity is slightly reduced;
• no growth lag;
• psychomotor development is not disturbed;
• food tolerance is not impaired;
• immunological reactivity is normal.

Hypotrophy 2 degrees:

• body weight deficit 20-30%;
• the condition of the child is moderate;
• The pancreas becomes thinner on the abdomen, limbs and torso;
• tissue turgor is reduced;
• the skin is pale, dry, its elasticity is reduced;
• growth lag is 1-3 cm;
• psychomotor development slows down;
• immunological and food tolerance are reduced.

Hypotrophy 3 degrees:

• weight deficit is more than 30%;
• complete disappearance of PZhK;
• the child's condition is severe;
• tissue turgor is sharply reduced;
• there is no elasticity of the skin, ulcers, cracks appear on the skin;
• growth lags behind by 3-5 cm;
• significant lag in psychomotor development;
• immunological and food tolerance is sharply reduced.

Principles of treatment of malnutrition

Hypotrophy of the 1st degree is treated on an outpatient basis, and 2nd and 3rd degrees - only in a hospital.

The main directions of therapy:

• elimination of the cause of malnutrition;
• diet therapy;
• correction of metabolic disorders;
• organization of proper care;
• therapy for comorbidities.

The basis of the treatment of malnutrition is diet therapy, which has 3 stages: the elimination of the syndrome of reduced food tolerance, the increase in food loads, the complete elimination of malnutrition in a child. A gradual increase in caloric content and volume of food leads to an improvement in the child's condition, he gradually begins to
gain mass. If children have a weakened sucking or swallowing reflex, then they are fed with a probe. The missing volume of fluid is administered intravenously.

In the complex of treatment, doctors prescribe enzymes, vitamins, microelements, preparations for the normalization of intestinal microflora, anabolic hormones.

The prognosis for malnutrition of 1 and 2 degrees with timely access to a doctor and diet therapy started on time is favorable. With malnutrition of the 3rd degree, despite intensive treatment, mortality reaches 20-50%.

To prevent this condition in your baby, it is enough to follow a few recommendations. Regularly visit the district pediatrician to examine the child and take all anthropometric measurements. Adhere to all the principles of proper nutrition for your child, introduce complementary foods and complementary foods on time. It is necessary to control the dynamics of the growth of the child's body weight, organize proper care, and eliminate risk factors for the development of malnutrition.

Thanks

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

Introduction

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

Causes of malnutrition

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

Internal causes of malnutrition

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

External causes of malnutrition

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

Clinical signs and symptoms of malnutrition by degree

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

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

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

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

Hypotrophy of the first degree

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

Symptoms of hypotrophy of the first degree:

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

Hypotrophy of the second degree

Signs of malnutrition of the second degree:

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

Hypotrophy of the third degree

Characteristic signs and symptoms of hypotrophy of the third degree:

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

Options for the course of malnutrition

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

• intrauterine malnutrition;
• hypostatura;
• alimentary insanity.

Intrauterine malnutrition

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

Hypostatura

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

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

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

Kwashiorkor

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

Disorders that contribute to the development of kwashiorkor include:

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

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

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

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

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

Alimentary insanity

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

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

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

Permanent symptoms include:

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

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

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

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

Lack of essential fatty acids

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

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

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

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

Diagnosis of malnutrition

Basic provisions

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

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

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

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

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

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

Laboratory research

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

Instrumental diagnostic methods

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

Hypotrophy treatment

Complex therapy includes:

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

diet therapy

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

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

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

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

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

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

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

The criteria for the effectiveness of dietary therapy are:

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

Care of patients with malnutrition

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

Enzyme therapy

vitamin therapy

Stimulant Therapy

Symptomatic treatment

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

Prevention of the development of malnutrition

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

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

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

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

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

The main causes of malnutrition in children

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

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

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

Internal causes of pathology

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

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

External causes of malnutrition in children

External causes of this pathology include:

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

With malnutrition, 4 main syndromes are detected:

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

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

Hypotrophy 1 degree

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

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

Symptoms of hypotrophy of the 1st degree:

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

Hypotrophy of the 2nd degree

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

Main features:

Hypotrophy of the 3rd degree

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

Characteristic signs of pathology:

Options for the course of pathology

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

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

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

intrauterine course

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

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

Hypostatura

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

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

Most often, hypostatus is provoked by:

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

Kwashiorkor

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

The development of kwashiorkor is promoted by:

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

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

Alimentary insanity

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

Conclusion

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