Hypotrophy in children - causes, diagnosis, treatment. Hypotrophy in children: diagnosis and treatment Causes of congenital malnutrition

- 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 suckle 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.

Dystrophy(Greek dys - disorder, trophe - nutrition) develops mainly in young children and is characterized by impaired absorption of nutrients by body tissues. There are the following types of dystrophies: 1) dystrophy with a lack of body weight (hypotrophy); 2) dystrophy with body weight corresponding to height or some excess of mass over length (paratrophy); 3) dystrophy with overweight (obesity) (Table 1).

Hypotrophy(Greek hypo - under, below trophe - nutrition) - a chronic eating disorder with a lack of body weight. This is a pathophysiological reaction of a young child, accompanied by a violation of the metabolic and trophic functions of the body and characterized by a decrease in food tolerance and immunobiological reactivity. According to WHO, malnutrition (malnutrition) is diagnosed in 20-30% or more of young children.

Etiology: According to the time of occurrence, congenital (prenatal) and acquired (postnatal) malnutrition are distinguished (Table 1). The causes, clinic and treatment of intrauterine growth retardation are discussed above in the section "Antenatal malnutrition".

There are 2 groups of acquired malnutrition according to etiology - exogenous and endogenous (Table 1). With careful collection of anamnesis data, a mixed etiology of malnutrition in a child is often established. With exogenous causes, primary malnutrition is diagnosed, with endogenous causes - secondary (symptomatic).

Exogenous causes of malnutrition:

1. Nutritional factors- Quantitative underfeeding in case of hypogalactia in the mother or feeding difficulties on the part of the mother or child, or qualitative underfeeding (use of an age-inappropriate mixture, late introduction of complementary foods).

2. Infectious factors- intrauterine infections, infectious diseases of the gastrointestinal tract, repeated acute respiratory viral infections, sepsis.

3. Toxic factors- the use of low-quality milk mixtures with an expired shelf life, hypervitaminosis A and D, drug poisoning.

4. Disadvantages of care, regime, education.

Endogenous causes of malnutrition:

1. Perinatal encephalopathy of various origins.

2. Bronchopulmonary dysplasia.

3. Congenital malformations of the gastrointestinal tract, cardiovascular system, kidneys, liver, brain and spinal cord.

4. Primary malabsorption syndrome (deficiency of lactase, sucrose, maltase, cystic fibrosis, exudative enteropathy) or secondary (intolerance to cow's milk proteins, "short gut" syndrome after extensive bowel resections, secondary disaccharidase deficiency).

5. Hereditary immunodeficiency states.

6. Hereditary metabolic disorders.

7. Endocrine diseases (hypothyroidism, adrenogenital syndrome).

8. Anomalies of the constitution.

Pathogenesis:

With malnutrition, the utilization of nutrients (primarily proteins) is impaired both in the intestine and in tissues. In all patients, the excretion of nitrogenous products in the urine increases with a violation of the ratio between urea nitrogen and total urine nitrogen. A decrease in the enzymatic activity of the stomach, intestines, pancreas is characteristic, and the level of deficiency corresponds to the severity of malnutrition. Therefore, a nutritional load that is adequate for a healthy child can cause acute indigestion in a patient with II-III degree malnutrition. With malnutrition, the functions of the liver, heart, kidneys, lungs, immune, endocrine, and central nervous systems are disrupted.

Of the metabolic disorders, the most typical are: hypoproteinemia, hypoalbuminemia, aminoaciduria, a tendency to hypoglycemia, acidosis, hypokalemia and hypokalemia, hypocalcemia and hypophosphamenia.

Classification:

According to the severity, three degrees of malnutrition are distinguished: I, II, W: (Table 1). The diagnosis indicates the etiology, time of onset, period of the disease, comorbidity, complications. It is necessary to distinguish between primary and secondary (symptomatic) malnutrition. Primary malnutrition can be the main or concomitant diagnosis and is usually the result of undernutrition.

Secondary malnutrition- complication of the underlying disease. Diagnosis

malnutrition is competent in children up to 2-3 years of age.

Clinical picture:

All clinical symptoms of malnutrition in children for the following groups of syndromes:

1. Trophic_disorder syndrome- thinning of the subcutaneous fat layer, lack of body weight and disproportionate physique (Chulitskaya and Erisman indices are reduced), a flat weight gain curve, trophic skin changes, muscle thinning, decreased tissue turgor, signs of polyhypovitaminosis.

2. Syndrome of reduced food tolerance- loss of appetite up to anorexia, development of dyspeptic disorders (regurgitation, vomiting, unstable stool), decrease in secretory and enzymatic functions of the gastrointestinal tract.

3. CNS dysfunction syndrome- violation of emotional tone and behavior; low activity, the predominance of negative emotions, sleep disturbance and thermoregulation, delayed psychomotor development, muscle hypo-, dystonia.

4. Syndrome of decreased immunobiological reactivity- a tendency to frequent infections - inflammatory diseases, their erased and atypical course, the development of toxic-septic conditions, dysbiocenoses, secondary immunodeficiency states, a decrease in nonspecific resistance.

Hypotrophy I degree characterized by thinning of the subcutaneous fat layer in all parts of the body and especially on the abdomen. The fatness index of Chulitskaya is reduced to 10-15. Tissue turgor and muscle tone are reduced, the fat fold is flabby. Characterized by pallor of the bones and mucous membranes, a decrease in firmness and elasticity of the skin. The growth of the child does not lag behind the norm. The body weight deficit is 10-20%. The weight gain curve is flattened. The child's health is not disturbed. Psychomotor development corresponds to age. The child is restless, does not sleep well. Immunological reactivity is not broken.

Hypotrophy II degree. The subcutaneous fat layer is absent on the abdomen, chest, sharply thinned on the limbs, preserved on the face. Severe pallor, dryness, decreased elasticity of the skin. The fatness index of Chulitskaya is 0-10. Reduced tissue turgor (a skin fold hangs down on the inner surface of the thighs) and muscle tone. Active rickets in children is manifested by muscle hypotension, symptoms of osteoporosis, osteomalacia and hypoplasia. The body weight deficit is 20-30% (in relation to height), there is a lag in growth. The body weight gain curve is flat. Appetite is reduced. Food tolerance is reduced. Often regurgitation and vomiting are observed. Characterized by weakness and irritability, the child is indifferent to the environment. Sleep is restless. The child loses already acquired motor skills and abilities. Thermoregulation is impaired, and the child quickly cools or overheats.

Most children develop various diseases (otitis media, pneumonia, pyelonephritis), which are asymptomatic and long-term.

The chair is unstable (often liquefied, undigested, rarely constipation). Significantly reduced acidity of gastric juice, secretion and activity of enzymes of the stomach, pancreas and intestines. Subcompensated intestinal dysbacteriosis develops.

Hypotrophy III degree(marasmus, atrophy). Primary malnutrition of the III degree is characterized by an extreme degree of exhaustion: the external child resembles a skeleton covered with skin. The subcutaneous fat layer is absent. The skin is pale gray, dry. Extremities are cold. Skin folds do not straighten out, as there is no elasticity of the skin. Characterized by thrush, stomatitis. The forehead is covered with wrinkles, the chin is pointed, the cheeks are sunken. The abdomen is distended, distended, or bowel loops are contoured. The chair is unstable.

Body temperature is often lowered. The patient quickly cools on examination, easily overheats. Against the background of a sharp decrease in immunological reactivity, various

foci of infection that are asymptomatic. Significantly reduced muscle mass. The weight gain curve is negative. The body weight deficit exceeds 30% in children of appropriate height. The Chulitskaya index is negative. The child is severely retarded. With secondary malnutrition of the III degree, the clinical picture is less severe than with primary ones, they are easier to treat if the underlying disease is identified and there is an opportunity to actively influence it.

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Introduction

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

Causes of malnutrition

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

Internal causes of malnutrition

• Encephalopathy that occurs in the fetus during pregnancy. Here we are talking about the fact that during the period of intrauterine development in the fetus, the normal activity of the central nervous system is disturbed, with a secondary disruption of the work of all internal organs and systems.
• Underdevelopment of lung tissue. Insufficient 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 disrupted.
• Hereditary diseases of the immune system, leading to a decrease in the body's defenses, inability to fight infection.
• Some endocrine diseases. Hypothyroidism is a disease of the thyroid gland, in which growth and metabolic processes in the body slow down. Pituitary dwarfism is a disease of the central organ of the endocrine system, as a result of which a sufficient amount of growth hormone is not produced.
• Metabolic diseases that are inherited. For example, galactosemia (intolerance to milk and dairy products), fructosemia is a similar disease in which the child's body does not absorb the fructose contained in vegetables and fruits. Rarer hereditary pathologies related to metabolic disorders include: leucinosis, Niemann-Pick disease, Tay-Sachs and others.

External causes of malnutrition

• Firstly, the quantitative underfeeding of the baby occurs due to the underdevelopment of the female breast (flat nipple, inverted nipple) or lack of female milk. On the part of the child, the cause may be: an underdeveloped lower jaw, constant vomiting, a short frenulum at the lower edge of the tongue.
• Secondly, insufficient feeding 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

Key points

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

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

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

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

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

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

Laboratory research

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

Instrumental diagnostic methods

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

Hypotrophy treatment

Complex therapy includes:

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

diet therapy

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

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

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

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

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

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

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

The criteria for the effectiveness of dietary therapy are:

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

Care of patients with malnutrition

• The conditions for staying in the wards should be as comfortable as possible, and are as follows: the lighting complied with all regulatory standards, 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.

Treatment of malnutrition should be aimed at eliminating the primary disease, as well as secondary infections, otherwise it cannot be effective.

Treatment of sick children with malnutrition should be comprehensive. It includes: identifying the cause and eliminating it; diet therapy, organization of rational care, regimen; massage and gymnastics; identification and treatment of foci of infection and other concomitant diseases; enzyme therapy, vitamin therapy, stimulating therapy; symptomatic therapy.

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.

The basis of the correct treatment of malnutrition is diet therapy. It should be noted that both an insufficient amount of food ingredients and their excess adversely affect the condition of a child with malnutrition. Based on many years of experience in treating children with this disease, representatives of different schools have developed the following tactics for diet therapy.

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.

With malnutrition of the first degree, food tolerance is quite high. Children tolerate nutritional stress well, so they can receive food that is appropriate for their age. Proteins, fats and carbohydrates are calculated per 1 kg of proper weight.

In the treatment of children with malnutrition of the II degree, two periods are distinguished: pre-reparation and reparation period. The pre-reparation period for malnutrition of the II degree is usually 7-10 days. During this period, the patient's tolerance to food is determined. From food, the patient receives either human milk or products that replace it (cow's milk, sour milk formulas, adapted milk formulas).

The daily volume of food is reduced to 2/3 of the required volume. The missing water is replenished with a liquid (boiled water, tea, 5% glucose solution, etc.). The child during this period (in its first days) receives food in 8 doses, that is, every 2.5 hours. Subsequently, with good food tolerance (no vomiting, regurgitation, diarrhea), the volume of food can be increased by 100-150 ml of the daily ration for each subsequent day. With an excess in volume of 2/3 of the daily food ration, the child begins to be fed after 3 hours, i.e. 7 times. After the child begins to cope with the proper amount of food, we can assume that the pre-reparation period is over.

In the period of reparation, nutrition is corrected, complementary foods are introduced according to general rules. At first, carbohydrates and proteins are prescribed for 1 kg of the required weight, and fats for approximately the required weight.

In the treatment of children with III degree hypotrophy, two periods are also distinguished: pre-reparation and reparation period. Since food tolerance in hypotrophy of the III degree is much lower compared to hypotrophy of the II degree, the food load is carried out even more carefully. The pre-reparation period lasts 14-20 days or more. On the first day, nutrition can be calculated based on the energy spent by the child on the main metabolism (65-70 kcal per 1 kg of actual body weight). This is approximately U 2 part of the required daily amount of food.

A child with hypotrophy of the III degree is given food in the form of expressed breast milk (or its substitutes) in 10 doses, that is, every 2 hours, observing a 6-hour night break. Subsequently, with normal tolerance of this volume of food every 2 days, it can be increased by 100-150 ml. The end of the pre-reparation period can be judged on the basis of the good tolerance of women's milk or its substitutes in a volume normal for a given age. In the period of reparation with malnutrition of the III degree, the tactics are similar to those for malnutrition of the II degree.

In the period of determining food tolerance, enzyme therapy is widely used. For this purpose, a 1% solution of diluted hydrochloric acid, pepsin, abomin, natural gastric juice, festal are used. With a high content of neutral fat and fatty acids in the coprogram of patients, pancreatin is prescribed.

Vitamin therapy in the treatment of patients with malnutrition is used for both replacement and stimulating purposes. In the first days of treatment of the disease, vitamins are administered parenterally, then given orally: ascorbic acid 50-100 mg, vitamins B 1 25-50 mg, B 6 50-100 mg per day, then alternating courses of vitamin treatment are carried out. minami A, PP, B 15, B 5, E, folic acid, vitamin B 1 2 in age doses.

Stimulant therapy is a mandatory part of the treatment of malnutrition in children. It consists in prescribing alternating courses of treatment with apilac, dibazol, pantocrine, ginseng and other means. In severe malnutrition, especially when combined with diseases of an infectious nature, γ-globulin is administered, a 10% solution of albumin, protein, plasma is administered intravenously, blood is transfused.

In the treatment of malnutrition II and III degrees in children, the appointment of anabolic steroid hormones is indicated: nerabol (daily inside at 0.1-0.3 mg / kg), retabolil (1 mg / kg once every 2-3 weeks) .

Symptomatic therapy depends on the clinical picture of malnutrition. In the treatment of anemia, it is advisable to use iron preparations, blood transfusions from the mother (if the blood is compatible by group and Rh factor and there is no history of hepatitis). In the case of a combination of malnutrition with rickets, after the end of the period of clarification of food tolerance, therapeutic doses of vitamin D are prescribed (with mandatory control according to the Sulkovich reaction!). Therapy of symptomatic malnutrition, in addition to diet therapy, should be aimed at treating the underlying disease.

Sick children with malnutrition of the 1st degree in the absence of severe concomitant diseases can be treated at home, children with malnutrition of the 2nd and 3rd degrees - in a hospital. The patient should be in a bright, spacious, well-ventilated room; the ambient air temperature should be at least 24-25 ° C and not higher than 26-27 ° C, since a child with severe malnutrition is easily overcooled and overheated.

It is important to create a positive emotional tone in the child, to pick it up more often. A positive effect is provided by warm baths (water temperature 38 ° C), which can be carried out daily. Mandatory components of the treatment are massage and gymnastics.

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

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

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

Classification

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

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

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

Symptoms of childhood malnutrition

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

I degree

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

II degree

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

III degree

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

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

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

Treatment of the disease

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

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

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

Prevention methods

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

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

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

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

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

Hypotrophy is a chronic malnutrition in babies, which is accompanied by a constant underweight in relation to the age and height of the infant. Often, malnutrition in children affects not only the insufficient development of muscle mass, but also psychomotor aspects, growth retardation, general lagging behind peers, and also causes a violation of skin turgor due to insufficient buildup of the subcutaneous fat layer.

Underweight (hypotrophy) in infants usually has 2 causes. Nutrients may enter the child's body in insufficient quantities for proper development or simply not be absorbed.

In medical practice, malnutrition is distinguished as an independent type of violation of physiological development, a subspecies of dystrophy. As a rule, small children under the age of one year are susceptible to such a violation, but sometimes the condition persists up to 3 years, due to the peculiarities of the social status of the parents.

Degrees of malnutrition in children and symptoms of the disorder

First degree

The disease is characterized by a slight decrease in appetite, accompanied by sleep disturbance and frequent anxiety. The baby's skin usually remains practically unchanged, but has reduced elasticity and a pale appearance. Thinness is visible only in the abdomen, while muscle tone can be normal (sometimes slightly reduced).

In some cases, 1 degree of malnutrition in young children may be accompanied by anemia or rickets. There is also a general decrease in the functioning of the immune system, from which babies get sick more often, look less well-fed in comparison with their peers. Some children may have indigestion leading to diarrhea or constipation.

Often, the 1st degree of violation remains almost imperceptible to parents, and only an experienced doctor can identify it with a thorough examination and diagnosis, during which he must find out if the thinness of the baby is a feature of his physique and a hereditary factor.

For some children, height and thinness are inherited from their parents, so a slender young mother should not worry that her baby does not look as well-fed as the rest, if at the same time he is active, cheerful and eats well.

Second degree

It is characterized by a lack of weight in children in the amount of 20-30%, as well as a lag in growth of the baby, on average by 3-4 cm. also the lack of warmth of the arms and legs.

With malnutrition of the 2nd degree in newborns, there is a developmental delay not only in motor, but also mental, poor sleep, pallor and dry skin, frequent peeling of the epidermis. Baby's skin is not elastic, it easily gathers into folds.

Thinness is strongly pronounced and affects not only the abdomen, but also the limbs, while the contours of the ribs are clearly visible in the baby. Children with this form of disorder are very often sick and have unstable stools.

Third degree

Babies with this form of impairment are severely stunted, on average up to 10 cm, and have a weight deficit of more than 30%. The state is characterized by severe weakness, an indifferent attitude on the part of the child to almost everything, tearfulness, drowsiness, as well as the rapid loss of many acquired skills.

The thinning of the subcutaneous fatty tissue is clearly expressed throughout the body of the child, there is a strong atrophy of the muscles, dry skin, cold extremities. The color of the skin is pale with a grayish tint. The lips and eyes of the baby are dry, cracks are observed around the mouth. Often in children there are various infectious diseases of the kidneys, lungs and other organs, for example, pyelonephritis, pneumonia.

Types of malnutrition

Violation in young children is divided into 2 types.

Congenital malnutrition

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

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

Acquired malnutrition

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

Endogenous factors include:

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

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

Diagnostics

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

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

Intrauterine malnutrition can be detected even during pregnancy during the next ultrasound, in which the doctor determines the size of the fetus and the estimated weight.

If developmental disorders are detected, the expectant mother is sent to a hospital for a full examination and taking the necessary measures.

In newborns, existing malnutrition can be determined by a neonatologist during an examination immediately after the birth of the baby. Acquired developmental disorder is usually detected by a pediatrician during a routine examination and the necessary measurements of height and weight. In this case, the doctor, in addition to conducting research, usually appoints consultations of other specialists, which helps to accurately establish the diagnosis and degree of malnutrition.

Treatment

Therapy for malnutrition is carried out depending on the degree of the disease. Postnatal malnutrition of the 1st degree is treated under normal outpatient conditions at home with mandatory strict adherence to all doctor's prescriptions.

The second and third degrees require inpatient treatment, where specialists can constantly assess the baby's condition and the results of the treatment, which is aimed at eliminating the existing causes of malnutrition, organizing good care for the baby, and correcting metabolic abnormalities.

The basis of the treatment of malnutrition is a special diet therapy, which is carried out in 2 stages. First, possible food intolerances in the infant are analyzed, after which the doctor prescribes a certain balanced diet with a gradual increase in food portions and its calorie content.

The basis of diet therapy for malnutrition is fractional nutrition in small portions with a short period of time. The serving size is increased weekly, taking into account the necessary nutritional load during regular monitoring and examinations. In the course of therapy, adjustments are made to the treatment.

Weakened babies who cannot swallow or suck on their own are fed through a special tube.

Medical treatment is also carried out, in which the baby is prescribed vitamins, enzymes, taking anabolic hormones, adaptogens. In cases of a particularly serious condition of children with malnutrition, they are given intravenous infusions of special protein hydrolysates, saline solutions, glucose and essential vitamins.

To strengthen muscle tone, kids are given exercise therapy and UVR, as well as a course of special massage.

Lifestyle of children with malnutrition

During the treatment of the child, parents must strictly comply with all the doctor's instructions. The main factors for the successful cure of the crumbs are the establishment of the correct regimen not only for feeding, but also for playing, sleeping and walking.

With proper care and good nutrition, in the absence of metabolic disorders and other congenital (acquired or chronic) diseases, babies quickly gain weight and are quite capable of catching up with the parameters of their healthy peers.

It is important to prevent the appearance of malnutrition in infants and it lies in the correct behavior of the expectant mother during the bearing of the crumbs. Registration at a polyclinic (special center or private clinic) should take place in the early stages of pregnancy, already during the first month.

It is important to pass all the scheduled examinations and studies on time, not to miss scheduled appointments and consultations of specialists. A special moment in the prevention of malnutrition in a child is the nutrition of the expectant mother, it must be balanced, provide the body with all the necessary substances not only for its existence, but also for the development of the fetus.

Timely examination allows you to identify the existing violation in time and take the necessary measures to eliminate it even before the birth of the crumbs.

How to recognize malnutrition in a child?

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-rich 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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