Prevention of malnutrition in young children. Causes and signs of protein-energy deficiency, malnutrition, in children. The main directions of drug therapy

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

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

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

What is malnutrition and how often does it occur in children

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

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

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

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

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

Classification and reasons

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

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

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

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

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

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

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

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

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

Clinical manifestations

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Medications

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

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

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

Massage and exercise therapy

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

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

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

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

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

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

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

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

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

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

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

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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Hypotrophy(Greek hypo - under, below; trophe - nutrition) - a chronic eating disorder with a lack of body weight. In Anglo-American literature, the term malnutrition is used instead of the term malnutrition - malnutrition. The main most common type of malnutrition is protein-energy malnutrition (PKI). As a rule, such children also have a deficiency in the intake of vitamins (hypovitaminosis), as well as microelements. According to

Etiology

There are two groups of malnutrition according to etiology - exogenous and endogenous, although mixed variants are also possible. It is important to remember that weight loss up to the development of malnutrition is a non-specific reaction of a growing organism to a long-term effect of any damaging factor. With any disease, children develop: stagnation in the stomach, inhibition of the activity of enzymes of the gastrointestinal tract, constipation, and sometimes vomiting. This is associated, in particular, with an almost 10-fold increase in the level of somatostatin in sick children, which inhibits anabolic processes. With alimentary reasons, primary malnutrition is diagnosed, with endogenous - secondary (symptomatic).

Exogenous causes of malnutrition

Nutritional factors - quantitative underfeeding in case of hypogalactia in the mother or difficulties in feeding on the part of the mother (flat, inverted nipple, "tight" mammary gland, etc.), the child (regurgitation, vomiting, small lower jaw, "short frenulum" of the tongue and etc.) or high-quality underfeeding (use of an age-inappropriate mixture, late introduction of complementary foods, poverty of the daily ration of animal proteins, fats, vitamins, iron, microelements).

Infectious factors - intrauterine generalized infections (etc.), intranatal infections, toxic-septic conditions, and urinary tract infections, intestinal infections, etc. Especially often the cause of malnutrition is infectious lesions of the gastrointestinal tract, causing morphological changes in the intestinal mucosa (up to atrophy of the villi), inhibition of the activity of disaccharidases (usually lactase), immunopathological damage to the intestinal wall, dysbacteriosis, contributing to prolonged diarrhea, maldigestion, malabsorption. It is believed that for any mild infectious diseases, energy and other nutritional needs increase by 10%, moderate - by 50% of the needs under normal conditions.
ness (BKN). As a rule, such children also have a deficiency in the intake of vitamins (hypovitaminosis), as well as microelements. According to , in developing countries, up to 20-30% or more of young children have protein-calorie or other types of malnutrition.

Toxic factors - the use of expired or low-quality milk formulas during artificial feeding, hypervitaminosis D and A, poisoning, including medicinal ones, etc.

Anorexia as a result of psychogenic and other deprivation, when the child does not receive enough attention, affection, psychogenic stimulation of development, walks, massage and gymnastics.

Endogenous causes of malnutrition

Perinatal encephalopathies of various origins

Congenital malformations of the gastrointestinal tract with complete or partial obstruction and persistent vomiting (pyloric stenosis, annular pancreas, dolichosigma, Hirschsprung's disease, etc.), as well as the cardiovascular system.

Syndrome of "short bowel" after extensive bowel resections.

Hereditary (primary) immunodeficiency states (mainly T-systems) or.

Primary malabsorption and maldigestion (intolerance to lactose, sucrose, glucose, fructose, celiac disease, exudative enteropathy), as well as secondary malabsorption (allergic intolerance to cow or soy milk proteins, enteropathic acrodermatitis, etc.).

Hereditary metabolic anomalies (fructosemia, leucinosis, xanthomatosis, Niemann-Pick and Tay-Sachs diseases, etc.).

Endocrine diseases (adrenogenital syndrome, pituitary dwarfism, etc.).

All clinical symptoms of BKN are divided into the following groups of disorders:

1. Syndrome of trophic disorders - thinning of the subcutaneous fat layer, a flat growth curve and a lack of body weight and a violation of the proportionality of the physique (the indices of L. I. Chulitskaya and F. F. Erisman are reduced), a decrease in tissue turgor and signs of polyhypovitaminosis (A, B, B2 , B6, D, P, PP).

2. Syndrome of digestive disorders - loss of appetite up to anorexia, unstable stool with a tendency to both constipation and dyspepsia, dysbacteriosis, decreased food tolerance, signs of maldigestion in the coprogram.
3. Syndrome of dysfunction of the central nervous system - disorders of emotional tone and behavior, low activity, dominance of negative emotions, sleep disturbances and thermoregulation, lag in the pace of psychomotor development, muscle hypo-, dystonia.

4. Syndrome of impaired hematopoiesis and decreased immunobiological reactivity - anemia, secondary immunodeficiency states, a tendency to an erased, atypical course of frequent infectious and inflammatory diseases. The main reason for the suppression of immunological reactivity in malnutrition is protein metabolism disorders.

Classification

According to the severity, there are three degrees of malnutrition: I, I, III. The diagnosis should indicate the most likely etiology of malnutrition, concomitant diseases, complications. It is necessary to distinguish between primary and secondary
nye (symptomatic) malnutrition. malnutrition can be the main or concomitant diagnosis and is usually the result of undernutrition. Secondary malnutrition is a complication of the underlying disease that must be identified and treated.

Clinical picture

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 10-15. The fat fold is flabby, and muscle tone is reduced. There is some pallor of the skin and mucous membranes, a decrease in firmness and elasticity of the skin. The growth of the child does not lag behind the norm, and body weight is 11-20% below the norm. The weight gain curve is flattened. The general health of the child is satisfactory. Psychomotor development corresponds to age, but he is irritable, restless, easily tired, sleep is disturbed. Has a tendency to vomit.

Hypotrophy II degree

The subcutaneous fat layer is absent on the abdomen, sometimes on the chest, sharply thinned on the limbs, preserved on the face. The fatness index of Chulitskaya is 1-10. The skin is pale with a grayish tinge, dry, easily folds. The transverse folds typical of healthy children on the inner surface of the thighs disappear and flabby longitudinal folds appear, hanging like a bag. The skin is pale, flabby, as if redundant on the buttocks, thighs, although sometimes there are swelling.

As a rule, there are signs of polyhypovitaminosis (marbling, peeling and hyperpigmentation in the folds, fragility of nails and hair, brightness of mucous membranes, seizures in the corners of the mouth, etc.). reduced. Typically, a decrease in the mass of the muscles of the limbs. A decrease in muscle tone leads, in particular, to an increase in the abdomen due to hypotension of the muscles of the anterior abdominal wall, intestinal atony and flatulence.

Body weight is reduced compared to the norm by 20-30% (in relation to length), there is a lag in growth. The body weight gain curve is flat. Appetite is reduced. Food tolerance is reduced. Characterized by weakness and irritability, the child is restless, noisy, whiny or lethargic, indifferent to the environment. The face takes on a worried, adult expression.
zhenie. Sleep is restless. Thermoregulation is impaired and the child quickly cools or overheats, depending on the ambient temperature. Fluctuations in body temperature during the day exceed 1°C.

Many sick children have otitis media, pneumonia, and other infectious processes that are asymptomatic. In particular, the clinical picture of pneumonia is dominated by respiratory failure, intoxication with mild catarrhal phenomena or in their absence and the presence of only a shortened tympanitis in the interscapular regions. Otitis is manifested by some anxiety, sluggish sucking, while even with an otoscopic examination of the tympanic membrane it is weakly expressed. The stool in patients with malnutrition is unstable: constipation is replaced by dyspeptic stool.

Hypotrophy III degree (marasmus, atrophy)

Hypotrophy of the III degree is characterized by an extreme degree of exhaustion: the appearance of the child resembles a skeleton covered with skin. The subcutaneous fat layer is absent on the abdomen, trunk and limbs, sharply thinned or absent on the face. The skin is pale gray, dry, sometimes purple-blue, the limbs are cold. The skin fold does not straighten out, since there is practically no elasticity of the skin (an abundance of wrinkles). The fatness index of Chulitskaya is negative. On the skin and mucous membranes there are manifestations of hypovitaminosis C, A, group B. Thrush, stomatitis are detected. The mouth looks bright, large, with cracks in the corners of the mouth ("sparrow's mouth").
Sometimes there is weeping erythema of the skin. The forehead is covered with wrinkles. The nasolabial fold is deep, the jaws and cheekbones protrude, the chin is pointed, the teeth are thin. Cheeks sink in as Bish's lumps disappear. The child's face resembles the face of an old man ("Voltaire's face"). The abdomen is distended, distended, or bowel loops are contoured. The stool is unstable: more often constipation, alternating with soapy-calcareous stools.

Body temperature is often lowered. There is no difference in temperature in the armpit and in the rectum. The patient quickly cools on examination, easily overheats. The temperature periodically "for no reason" rises to numbers. Due to a sharp decrease in immunological reactivity, otitis media and other foci of infection (, , colienteritis, etc.) are often found, which, as in stage II malnutrition, are asymptomatic. There are hypoplastic and osteomalacia signs of rickets. With severe flatulence, the muscles of the limbs are rigid. There is a sharp decrease in muscle mass.

The curve of weight gain is negative, the patient is losing weight every day. Body weight is 30% or more less than the average in children of the corresponding height. The child sharply lags behind in growth. 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.
Options for the course of malnutrition

Intrauterine malnutrition - currently, according to the International Classification of Diseases, this term has been replaced by intrauterine growth retardation (). There are hypotrophic, hypoplastic and dysplastic variants. In the English literature, instead of the term "hypotrophic variant of IUGR", the term "asymmetric" is used, and the hypoplastic and dysplastic variants are combined with the term "symmetrical IUGR".

Hypostatura (Greek hypo - under, below; statura - growth, size)

More or less uniform lag of the child in height and body weight with a slightly reduced state of fatness and skin turgor. Both indices of L.I. Chulitskaya (fatness and axial) are slightly reduced. This form of chronic eating disorder is typical for children with congenital heart defects, brain malformations, encephalopathies, endocrine pathology, and bronchopulmonary dysplasia (BPD). That this is a form of chronic eating disorder is confirmed by the fact that PBP is reduced, and after active treatment of the underlying disease, for example, surgery for congenital heart disease, the physical development of children is normal. As a rule, children with hypostature have other signs of chronic malnutrition that are characteristic of grade II malnutrition (trophic disorders and moderate signs of polyhypovitaminosis on the skin, dysproteinemia, deterioration in fat absorption in the intestine, low levels of phospholipids, chylomicrons and a-lipoproteins in the blood, aminoaciduria).

It is important to emphasize that the biological age of the child (bone, etc.) corresponds to its length and body weight. Unlike children with hypostature, children with hypoplasty (with constitutional growth retardation) do not have trophic disorders: they have pink velvety skin, there are no symptoms of hypovitaminosis, they have good muscle tone, their neuropsychic development corresponds to age, food tolerance and not violated. After eliminating the cause of hypostatura, children catch up with their peers in terms of physical development. The same situation is with hypoplastics, that is, the phenomenon of “canalization” of growth or homeoresis according to Waddington sets in. These terms denote the ability of an organism to return to a given genetic development program in cases where the traditional dynamics of child growth was disturbed under the influence of either damaging environmental factors or diseases.

Hypostatura is usually a pathology of children in the second half of the year or the second year of life, but, unfortunately, now there are children with hypostature already in the first months of life. These are children with bronchopulmonary dysplasia, severe brain damage due to intrauterine infections, alcoholic fetopathy, "industrial syndrome" of the fetus. Such children are very resistant to therapy and they do not have the phenomenon of "canalization". On the other hand, hypostature must be differentiated from primordial dwarfism (birth weight and length are very low), as well as other forms of growth retardation, which should be read about in the chapter "Endocrine Diseases".

Kwashiorkor

A peculiar variant of the course of malnutrition in young children in tropical countries, due to eating mainly plant foods, with a deficiency of animal proteins. The term is thought to mean "weaned" (usually due to the mother's next pregnancy). At the same time, protein deficiency can also contribute to (or even cause it):

1) a decrease in protein absorption in conditions accompanied by prolonged diarrhea;

2) excessive loss of protein during (), infectious diseases and helminthiases, burns, large blood loss;

3) decreased protein synthesis in chronic liver diseases.

Symptoms

Common symptoms of kwashiorkor are:

1) neuropsychiatric disorders (apathy, lethargy, drowsiness, lethargy, tearfulness, lack of appetite, psychomotor development lag);

2) edema (at the beginning, due to hypoproteinemia, the internal organs “swell”, then edema may appear on the limbs, face, which creates a false impression of the child’s fatness);

3) a decrease in muscle mass, up to muscle atrophy, and a decrease in tissue trophism;

4) lag of physical development (to a greater extent of growth than body weight).

These symptoms are called D. B. Jelliff's tetrad.

Common symptoms: hair changes (lightening, softening - silkiness, straightening, thinning, weakening of the roots, leading to hair loss, hair becomes sparse), (darkening of the skin appears in areas of irritation, but unlike pellagra, in areas not exposed to sunlight, then desquamation of the epithelium occurs in these areas and foci of depigmentation remain, which can be generalized) and signs of hypovitaminosis on the skin, anorexia, moon face, anemia, diarrhea. In older children, the manifestation of kwashiorkor may be a gray strand of hair or
vanishing of normal hair color and discolored ("flag symptom"), changes in nails.

Rare symptoms: layered-pigmented dermatosis (red-brown patches of skin of a rounded shape), hepatomegaly (due to fatty infiltration of the liver), eczematous lesions and skin cracks, ecchymoses and petechiae. All children with kwashiorkor have signs of polyhypovitaminosis (A, B, B2, Bc, D, etc.), kidney function (both filtration and reabsorption) is reduced, hypoproteinemia in blood serum (due to hypoalbuminemia), hypoglycemia ( but the glucose tolerance test has a diabetic type), aminoaciduria, but with a decrease in the excretion of hydroxyproline in relation to creatinine, low activity of liver and pancreatic enzymes.

Characteristic in the analysis of blood is not only anemia, but also lymphocytopenia, increased ESR. In all sick children, it is significantly reduced, which leads to a severe course of infectious diseases. It is especially difficult for them, therefore, in the complex therapy of measles, the expert committee recommends that such children be prescribed vitamin A, which leads to a decrease in mortality. They often have subcutaneous septic ulcers, leading to the formation of deep necrotic ulcers. All patients also have intermittent diarrhea with foul-smelling stools and severe steatorrhea. Often in such children and (for example, ankylostomiasis, etc.).

In conclusion, we emphasize that protein-calorie malnutrition, that is, can also exist in Russia - for example, we observed it in a teenager with chronic active hepatitis.

Insanity alimentary (exhaustion)

It occurs in children of preschool and school age - balanced starvation with a deficit in the daily diet of both protein and calories. The constant symptoms of insanity are a lack of mass (below 60% of the standard body weight for age), wasting of muscles and subcutaneous fat, which makes the hands of patients very thin, and the face "senile". Rare symptoms of marasmus are hair changes, concomitant vitamin deficiency (often a deficiency of vitamins A, group B), zinc deficiency, thrush, diarrhea, recurrent infections.

Trophic status assessment

To assess the trophic status of schoolchildren, you can use the criteria (with some reductions) proposed for adults [Rudman D., 1993]:

Anamnesis. Previous dynamics of body weight.

Typical dietary intake based on retrospective data.

Socio-economic status of the family.

Anorexia, vomiting, diarrhea.
In adolescents, assessment of puberty, in particular in adolescent girls, assessment of menstrual status.

Drug therapy with an assessment of the possible impact on nutritional status (in particular, diuretics, anorexants).

Social adaptation among peers, family, possible signs of psychogenic stress, anorexia, drug addiction and substance abuse, etc.

physical data.

Skin: pallor, scaly, xerosis, follicular hyperkeratosis, pellagrozny, petechiae, ecchymosis, perifollicular hemorrhages.

Hair: dispigmentation, thinning, straightening, weakening of the hair roots, sparse hair.

Head: rapid emaciation of the face (specify from photographs), enlargement of the parotid glands.

Eyes: Bitot's plaques, angular inflammation of the eyelids, xerosis of the conjunctiva and sclera, keratomalacia, corneal vascularization.

Oral cavity: cheilosis, angular stomatitis, glossitis, hunter's glossitis, atrophy of the papillae of the tongue, ulceration of the tongue, loosening of the gums, dentition of the teeth.

Heart: cardiomegaly, signs of energy-dynamic or congestive heart failure.

Abdominal cavity: protruding abdomen, hepatomegaly.

Extremities: obvious decrease in muscle mass, peripheral edema, koilonychia.

Neurological status: weakness, irritability, tearfulness, muscle weakness, calf tenderness, loss of deep tendon reflexes.

Functional indicators: reduced cognitive ability and performance.

Adaptation of vision to the dark, sharpness of taste (reduced).

Fragility of capillaries (increased).

In the presence of the above symptoms and a weight deficit of 20-35% (along the body length), a moderate degree of protein-calorie deficiency, alimentary depletion is diagnosed.

In the etiology of moderate forms of malnutrition in children and adolescents, chronic stress, excessive neuropsychic stress, neuroses leading to excessive emotional arousal, and insufficient sleep can be of decisive importance. In adolescence, girls often limit their diet for aesthetic reasons. Malnutrition is also possible due to family poverty. According to radio and television reports, every fifth conscript to the Russian army
in 1996-1997 had a body mass deficit in length exceeding 20%. Common symptoms of mild protein malnutrition are lethargy, fatigue, weakness, restlessness, irritability, constipation, or loose stools. Undernourished children have a shortened attention span and do poorly in school. Characteristic for such young men and women are pallor of the skin and mucous membranes (deficiency anemia), muscle weakness - the shoulders are lowered, the chest is flattened, but the stomach protrudes (the so-called “tired posture”), “sluggish posture”, frequent respiratory and other infections, some delayed puberty, caries. In the treatment of such children, in addition to the normalization of the diet and a long course of vitamin therapy, an individual approach is required in the recommendations on the daily routine and lifestyle in general.

Essential fatty acid deficiency

Feeding formulas from cow's milk that are not adapted for baby food, malabsorption of fats can lead to a syndrome of insufficiency of linoleic and linolenic acid: dryness and flaking of the skin, alopecia, small gains in body weight and length, poor wound healing, thrombocytopenia, diarrhea, recurrent skin infections, lungs; linolenic acid: numbness, paresthesia, weakness, blurred vision. Treatment: adding vegetable oils to the diet (up to 30% of the need for fat), nucleotides, which are abundant in women's milk and few in cow's milk.

Carnitine deficiency can be hereditary (9 known hereditary anomalies with a violation of its metabolism) or acquired (deep prematurity and prolonged parenteral nutrition, prolonged hypoxia with myocardial damage). Clinically manifested, in addition to malnutrition, repeated vomiting, enlargement of the heart and liver, myopathy, attacks of hypoglycemia, stupor, coma. This disease in the family is often preceded by the sudden death of previous children or their death after episodes of acute encephalopathy, vomiting with the development of a coma. A typical symptom is a specific smell emanating from the child (the smell of sweaty feet, cheese, rancid butter). Treatment with riboflavin (10 mg every 6 hours intravenously) and carnitine chloride (100 mg/kg orally in 4 doses) leads to the normalization of the condition of children.

Deficiencies of vitamins and trace elements are described in other sections of the chapter.

Diagnosis and differential diagnosis

The main criterion for diagnosing malnutrition and establishing its degree is the thickness of the subcutaneous fat layer. The criteria for diagnosis are detailed in Table. 29. The body weight of the child must also be taken into account,
but not in the first place, since with the simultaneous lag of the child in growth (hyposomia, hypostatura), it is rather difficult to establish the true deficiency of body weight.

The chair in a child with malnutrition is more often "hungry"

Hungry stools are scanty, dry, discolored, lumpy, with a putrid, offensive odor. Urine smells like ammonia. A hungry stool quickly turns into a dyspeptic one, which is characterized by a green color, an abundance of mucus, leukocytes, extracellular starch, digestible fiber, fatty acids, neutral fat, and sometimes muscle fibers. At the same time, dyspeptic phenomena are often caused by the ascent of Escherichia coli into the upper intestines and an increase in its motility or infection with its pathogenic strains, dysbacteriosis.

In the differential diagnosis of malnutrition, one must keep in mind all those diseases that can be complicated by chronic malnutrition and are listed in the "Etiology" section.

In a patient with hypostatura, it is necessary to exclude various types of dwarfism - disproportionate (chondrodystrophy, congenital fragility of bones, vitamin D-resistant forms of rickets, severe vitamin D-dependent) and proportional (primordial, pituitary, thyroid, cerebral, cardiac, etc.). We must not forget about constitutional hyposomia (hypoplasty).

In some families, due to various hereditary characteristics of the endocrine system, there is a tendency towards lower growth rates. Such children are proportional: with some lag in growth and body weight, the thickness of the subcutaneous fat layer is normal everywhere, tissue turgor is good, the skin is pink, velvety, without signs of hypovitaminosis. Muscle tone and psychomotor development of children are age appropriate.

It is believed that in a healthy child, the body length can vary within 1.5 s from the arithmetic mean body length of healthy children of the corresponding age. If the length of the child's body goes beyond the specified limits, then they speak of hyper- or hyposomy. Hyposomia within 1.5-2.5 s can be both a variant of the norm and a consequence of a pathological condition. With a child's body length less than the average value minus 3 s, nanism is diagnosed.

Hypotrophy can develop in a child both with normosomy and with hyper- and hyposomia. Therefore, permissible fluctuations in body length in children of the first six months of life are considered 4-5 cm, and later up to 3 years - 5-6 cm; permissible fluctuations in body weight in the first half of the year - 0.8 kg, and later up to 3 years - 1.5 kg (in relation to the arithmetic mean body length of the child).

Treatment

In patients with malnutrition, therapy should be complex and include:

1) identification of the causes of malnutrition and attempts to correct or eliminate them;

2) diet therapy;

3) organization of a rational regimen, care, education, massage and gymnastics;

4) detection and treatment of foci of infection, rickets, anemia and other complications and concomitant diseases;

5) enzyme and vitamin therapy, stimulating and symptomatic treatment.

diet therapy

The basis of rational treatment of patients with malnutrition. The degree of reduction in body weight and appetite does not always correspond to the severity of malnutrition due to damage to the gastrointestinal tract and central nervous system.

Therefore, the fundamental principles of diet therapy for malnutrition are three-phase nutrition:

1) the period of clarification of tolerance to food;

2) transitional period;

3) a period of enhanced (optimal) nutrition.

A large food load, introduced early and abruptly, can cause a breakdown in the patient, dyspepsia due to insufficient capacity of the gastrointestinal tract to utilize nutrients (in the intestine, the total pool of epithelial cells and the rate of restorative proliferation are reduced, the rate of migration of epithelial cells from crypts to the villus is slowed down , reduced activity of intestinal enzymes and absorption rate).

Sometimes a patient with malnutrition, exhaustion with excess nutrition does not have an increase in the weight gain curve, and a decrease in calorie content leads to its increase. During all periods of diet therapy, an increase in the food load should be carried out gradually under the regular control of the coprogram.

The following important principles of diet therapy in patients with malnutrition are:

1) the use of only easily digestible food at the initial stages of treatment (women's milk, and in the absence of its hydrolyzed mixtures (Alfare, Pepti-Junior, etc.) - adapted mixtures, preferably fermented milk: acidophilic "Baby", "Kid", "Lactofidus" , "Biolakt", "Bifilin", etc.), since in patients with malnutrition often
there is intestinal dysbacteriosis, insufficiency of intestinal lactase;

2) more frequent feedings (7 - with hypotrophy of the I degree, 8 - with hypotrophy of the II degree, 10 feedings with hypotrophy of the III degree);

3) adequate systematic monitoring of nutrition (keeping a diary with notes on the amount of food eaten at each feeding), stool, diuresis, the amount of fluid drunk and administered parenterally, salt, etc .; regular, every 5-7 days, calculation of the food load for proteins, fats, carbohydrates; twice a week - coprogram).

The period for determining food tolerance in malnutrition of I degree is usually 1-2 days, II degree - about 3-7 days and III degree - 10-14 days. Sometimes a child does not tolerate lactose or cow's milk proteins well. In these cases, you have to resort to lactose-free mixtures or "vegetable" types of milk.

It is important to remember that from the very first day of treatment, the child should receive the amount of fluid corresponding to the actual weight of his body (see Table 27). The daily volume of the milk mixture used on the first day of treatment is usually given: with malnutrition of the I degree, approximately 2/3, malnutrition of the II degree - '/2 and hypotrophy of the III degree - '/3 of the proper body weight. In this case, the calorie content is: with malnutrition of the I degree - 100-105 kcal / kg per day; II degree - 75-80 kcal / kg per day; III degree - 60 kcal / kg per day, and the amount of protein, respectively - 2 g / kg per day; 1.5 g/kg per day; 0.6-0.7 g / kg per day. It is necessary that from the very first day of treatment the child does not lose body weight, and from the 3-4th day, even with severe degrees of malnutrition, he begins to add 10-20 or more grams per day. The missing amount of fluid is administered enterally in the form of glucose-salt solutions (oralite, rehydron, citroglucosolan, worse - vegetable decoctions, raisin drink, etc.). In the absence of commercial preparations for rehydration, a mixture of 400 ml of 5% glucose solution, 400 ml of isotonic solution, 20 ml of 7% potassium chloride solution, 50 ml of 5% sodium bicarbonate solution can be used. To increase the effectiveness of such a mixture, 100 ml of an amino acid mixture for parenteral nutrition (10% aminone or aminoven, alvesin) can be added to it.

Especially if the child has diarrhea, it must be remembered that all mixtures and solutions given orally have a low osmolarity (approximately 300-340 mOsm / l). Rarely (with severe diarrhea, vomiting, obstruction of the gastrointestinal tract), it is necessary to use parenteral nutrition. At the same time, it must be remembered that the daily amount of potassium (both with enteral and parenteral nutrition) should be 4 mmol / kg (that is, 1-1.5 times higher than normal), and sodium should not be more
more than 2-2.5 mmol / kg, because patients easily retain sodium, and they always have a potassium deficiency. Potassium "additives" give about 2 weeks. Correction of solutions with preparations of calcium, phosphorus, magnesium is also advisable.

Restoring the normal volume of circulating blood, maintaining and correcting disturbed electrolyte metabolism, and stimulating protein synthesis are the tasks of the first two days of therapy for severe malnutrition. With parenteral nutrition, solutions of amino acids (aminoven, etc.) must also be added. During the period of clarification of tolerance to food, gradually (about 10-20 ml per feeding daily) increase the amount of the main mixture, bringing it at the end of the period to the proper amount for the actual body weight (in the first year of life, about 1/5 of the actual weight, but no more 1 l).

Interim period.

At this time, therapeutic formulas are added to the main mixture (up to 1/3 of the total volume), that is, those mixtures in which there are more food ingredients compared to breast milk or adapted mixtures, reduce the number of feedings, bring the volume and ingredients of the food to , which the child would receive for the due body weight. An increase in the food load with proteins, carbohydrates and, last but not least, fats, should be carried out under the control of its calculation (the amount of proteins, fats and carbohydrates per 1 kg of body weight per day in the food eaten) and under the control of coprograms (1 time in 3-4 days ). An increase in the amount of proteins is achieved by adding protein mixtures and products (protein enpit, fat-free kefir, kefir 5, cottage cheese, yolk, etc.); carbohydrates (including sugar syrup, cereals); fat (fat enpit, cream). 100 g of dry protein enpit contains 47.2 g of protein, 13.5 g of fat, 27.9 g of carbohydrates and 415 kcal.

After its correct dilution (15 g per 100 g of water), 100 g of the liquid mixture will respectively contain 7.08 g of proteins, 2.03 g of fats, 4.19 g of carbohydrates and 62.2 kcal. Diluted in the same way, 15% fat enpit will contain in 100 g: proteins - 2.94 g, fats - 5.85 g, carbohydrates - 4.97 g and 83.1 kcal. The criterion for the effectiveness of dietary treatment are: improvement in emotional tone, normalization of appetite, improvement in the condition of the skin and tissue turgor, daily weight gain by 25-30 g, normalization of the L. I. Chulitskaya index (fatness) and restoration of lost psychomotor development skills along with the acquisition of new ones. , improved digestion of food (according to the co-program).

It should be borne in mind that the optimal ratio between food protein and energy for protein utilization at the initial stage is: 1 g of protein per 150 non-protein kilocalories, and therefore, simultaneously with the protein load, it is necessary to increase the amount of carbohydrates, because patients with eating disorders increase the fat load endure badly.

Already in the transitional period, children begin to introduce complementary foods (if it is necessary for their age and they received them before the start of treatment), but cereals and vegetable purees are prepared not on whole, but on half cow's milk or even on vegetable broth to reduce the load of lactose and fats. The load of carbohydrates during the transitional period reaches 14-16 g/kg per day, and after that they begin to increase the load of fats, using whole kefir, bifilin, porridge additives of yolk, vegetable oil, fatty enpit.

During the period of enhanced nutrition, the child receives about 140-160 kcal/kg per day with hypotrophy of the I degree, about 160-180-200 kcal/kg per day for the P-III degree. At the same time, proteins make up 10-15% of calories (in healthy people 7-9%), that is, about 3.5-4 g / kg of body weight. Large amounts of protein are not absorbed, and therefore useless, in addition, they can contribute to metabolic acidosis, hepatomegaly. In the initial period of enhanced protein nutrition, a child may experience transient tubular distal acidosis (in children with constipation, Litwood's syndrome increases), sweating. In this case, a sodium bicarbonate solution is prescribed at a dose of 2-3 mmol / kg per day orally, although it is necessary to think about reducing the protein load.

The main criterion for the effectiveness of diet therapy are: improvement of psychomotor and nutritional status and metabolic indicators, achievement of regular weight gain of 25-30 g / day, and not calculated diet indicators

The above is a scheme for the treatment of patients with malnutrition with the help of a diet. However, for each sick child, an individual approach to diet and its expansion is required, which is carried out under the mandatory control of the coprogram, body weight curves and sugar curves. The body weight curve during the treatment of a patient with malnutrition can be stepped: the rise corresponds to the deposition of nutrients in the tissues (deposition curve), the flat part corresponds to their assimilation (assimilation curve).

Care organization.

Patients with malnutrition I degree in the absence of severe concomitant diseases and complications can be treated at home. Children with malnutrition II and III degree must be placed in a hospital with their mother. The patient should be in a bright, spacious, regularly ventilated room. The air temperature in the ward should not be lower than 24-25 °C, but not higher than 26-27 °C, as the child easily cools down and overheats. In the absence of contraindications to walking (high temperature, otitis media), you should walk several times a day at an air temperature of at least -5 ° C. At lower air temperatures, a walk on the veranda is organized. In autumn and winter, when walking, they put a heating pad at their feet. It is very important to create a positive tone in the child - to take him in your arms more often (prevention of hypostatic pneumonia). Attention should be paid to the prevention of cross-infection - place
the patient in isolated boxes, regularly irradiate the ward or box with a bactericidal lamp. A positive effect on the course of malnutrition is provided by warm baths (water temperature 38 ° C), which, in the absence of contraindications, should be carried out daily. Mandatory in the treatment of children with malnutrition are massage and gymnastics.

Identification of foci of infection and their sanitation is a necessary condition for the successful treatment of patients with malnutrition. To fight the infection, they prescribe (do not use nephro-, hepato- and ototoxic!), physiotherapy, and, if necessary, surgical treatment.

Correction of dysbacteriosis.

Given that almost all patients with malnutrition have dysbacteriosis, it is advisable to provide a course of bifidumbacterin or bificol within 3 weeks in the complex of therapeutic measures.

Enzyme therapy is widely used as a temporary substitution in the treatment of patients with malnutrition, especially during the period of clarification of food tolerance. For this purpose, abomin, gastric juice diluted with water, festal, mezim, etc. are used. If the coprogram shows an abundance of neutral fat and fatty acids, then additionally creon, panzinorm, pancitrate, etc. are prescribed.

Vitamin therapy is an integral part of the treatment of a patient with malnutrition, and vitamins are first administered parenterally, and later - per os. In the first days, vitamins C, B, B6 are used. The initial dose of vitamin B6 is 50 mg per day. The dose and duration of treatment with vitamin B6 is best determined by the reaction of urine to xanthurenic acid (with ferric chloride). A positive reaction indicates a deficiency in the body of vitamin B6. In the 2nd-3rd periods of malnutrition treatment, alternating courses of vitamins A, PP, B15, B5, E, folic acid, B12 are carried out.

Stimulating therapy consists in prescribing alternating courses of apilac, dibazol, pentoxyl, metacil, ginseng, pantocrine and other agents. In severe malnutrition with layering of infection, intravenous immunoglobulin is administered. As a stimulating therapy, you can also use a 20% solution of carnitine chloride, 1 drop per 1 kg of body weight 3 times a day inside (dilute with boiled water). For this purpose, blood and plasma transfusions should not be used, anabolic steroids (Nerobol, Retabolil, etc.), glucocorticoids should not be prescribed.

Symptomatic therapy depends on the clinical picture of malnutrition. In the treatment of anemia, it is advisable to use folic acid, iron preparations (if they are poorly tolerated, iron preparations are administered parenterally), and with hemoglobin less than 70 g / l, erythrocyte mass is transfused or washed. With malnutrition of the first degree in excited children, mild sedatives are prescribed.
All children with malnutrition pathogenetically have and, which manifests itself as symptoms of osteoid tissue hyperplasia only during a period of enhanced nutrition and an increase in body weight gain, therefore, after the end of the period of clarification of food tolerance, UVR is prescribed. Therapy of symptomatic malnutrition, along with diet therapy and other types of treatment, should first of all be directed to the underlying disease.

Treatment of malnutrition in different children should be differentiated. The doctor requires perseverance, an integrated approach to the patient, taking into account his individual characteristics. It is rightly said that patients with malnutrition are not cured, but nursed.

Forecast

It depends primarily on the cause that led to malnutrition, the possibilities of its elimination, the presence of concomitant and complicating diseases, the age of the patient, the nature, care and environmental conditions, the degree of malnutrition. With alimentary and alimentary-infectious malnutrition, the prognosis is usually favorable.

Prevention

Natural, early detection and rational treatment of hypogalactia, proper nutrition with its expansion in accordance with age, sufficient fortification of food, organization of age-appropriate care and regimen, and prevention of rickets are important. Early diagnosis and proper treatment of rickets, anemia, infectious diseases of the respiratory system, gastrointestinal tract, kidneys, and endocrine diseases are of great importance. An important element in the prevention of malnutrition are also measures aimed at antenatal protection of the health of the fetus.

- 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.

Hypotrophy- an eating disorder in a young child, which is characterized by a stop or slowdown in the growth of body weight, progressive thinning of the subcutaneous tissue, body proportions disorders, digestive and metabolic disorders, a decrease in specific and nonspecific body defenses, a tendency to develop other diseases, physical and neurological delay -mental development.

Cause and pathogenesis of malnutrition

Clinical manifestations of malnutrition

Hypotrophy I degree is rarely diagnosed

Hypotrophy II degree

With malnutrition of the II degree, changes occur in the cardiovascular system, respiratory organs, and liver. Polyglandular insufficiency develops. Most children with this form of eating disorder suffer from rickets, and every second child has anemia. There are various violations of protein, fat, carbohydrate, water-electrolyte and vitamin metabolism. The immunological reactivity is sharply reduced. Such children often get sick,. Moreover, these diseases against the background of malnutrition are asymptomatic, atypical; their end is often unfavorable.

Hypotrophy III degree (atrophy, insanity)

Face triangular, wrinkled; the nasolabial fold is deep, the jaws and cheekbones protrude, the chin is pointed, the cheeks are sunken. It is like the face of an old man ("Voltaire's face"). The thickness of the skin fold at the level of the navel decreases to 0.2 cm (thinned skin), Chulitsky's fatness index is negative, proportionality is sharply distorted. The skin is pale gray, sometimes purple-blue, hangs in folds on the neck and limbs, dry, flaky, in some places there are areas of pigmentation, its elasticity is lost, the skin fold does not straighten out, the tissue turgor is sluggish, muscle tone is reduced, although hypertension is also possible, conjunctiva and oral mucosa are dry. The mouth is large, the lips are scarlet (blood thickening), cracks form in the corners of the mouth (“sparrow's mouth”). The child loses more than 30% of body weight, sharply lags behind in growth (more than 4 cm), psychomotor development.

Breathing is superficial, apnea periodically appears. Heart sounds are weakened or deaf, there is a tendency to bradycardia, blood pressure is reduced. The abdomen is enlarged due to flatulence, the anterior abdominal wall is thinned, loops of the intestines are visible. There is an alternation of constipation with soapy-lime stools. The processes of hydrolysis and absorption are sharply weakened due to hypofermentopathy, which develops as a result of atrophy of the mucous membrane of the small intestine, liver, pancreas and other organs. Most patients have rickets, anemia, bacterial infection (pneumonia, sepsis, otitis media, pyelonephritis, etc.). All types of metabolism are severely impaired; immunological insufficiency, extinction of function and atrophy of organs of regulatory systems (nervous, endocrine), dysbacteriosis of II-III degree are observed. The terminal period is characterized by hypothermia (33-32 ° C), bradycardia (60-40 per 1 min), hypoglycemia; completely indifferent to the environment, the child slowly dies.

Prenatal malnutrition

In children with intrauterine growth retardation, hypotension, decreased physiological reflexes, decreased appetite, impaired thermoregulation, tendency to hypoglycemia, late falling off of the umbilical residue, sluggish healing of the umbilical wound, prolonged transient jaundice, regurgitation, and unstable stools are observed. The main diagnostic criterion for prenatal malnutrition in full-term newborns should be consider a decrease in the weight-height coefficient below 60. This index is unsuitable for assessing this condition in premature babies. In this case, the following formula is used: the trophic index (IT) is equal to the difference between the length and circumference of the thigh (cm). In preterm infants with a gestational age of 36-37 weeks, in the absence of clinical signs of malnutrition, IT = 0, with malnutrition of I degree, IT is 1 cm, II degree - 2 cm, III degree - C cm or more. Convenient is the method of calculating the body weight deficit of preterm infants according to gestational age: birth weight deficit of 10-20% - I degree, 20-30% - II degree, 30% or more - III degree of malnutrition.

Hypostatura

Treatment of children with malnutrition is a complex problem. Daily it is necessary to take into account the dynamics of body weight, the amount of fluid and food consumed, regurgitation, vomiting, bowel movements.

With hypotrophy of the I degree, the period of clarification of tolerance to food is 1-3 days. It is carried out according to the following scheme. First eliminate the shortcomings of feeding, prescribe food appropriate for age (on the 1st day - 1/2-2/3 of the daily volume, on the 2nd - 2/3-4/5 and on the 3rd day - the full daily volume) . The amount of food that is missing is compensated with liquid (vegetable, fruit, rice and other decoctions, infusions of medicinal plants, digested water). The amount of nutrition is calculated in accordance with a certain body weight, the lack of food of one or another component is corrected by adding protein (cottage cheese, yolk, acidophilic paste, protein enpit), fat (fat enpit, butter, cream), carbohydrates (vegetables, fruits, cereals, refined carbohydrates).

In some cases, in order to improve the processes of digestion, substitution therapy (enzymes) is prescribed. Give ascorbic acid, ergocalciferol, B vitamins through the mouth. In the absence of other diseases, children with grade I malnutrition are treated at home.

Treatment of patients with malnutrition II and III degree is carried out in a hospital. In case of malnutrition of the II degree during the 1st week, 1/2 of the required daily volume of food is prescribed, on the 2nd - 2/3, on the 3rd - the full volume. With hypotrophy of the III degree - On the 1st week - 1/3, 2nd - 1/2, 3rd - 2/3 and 4th - full volume. The frequency of its reception is increased by 1-2 and 2-3 times, respectively. The rest of the daily volume is provided with liquid (vegetable and fruit decoctions, electrolyte solutions, parenteral feeding).

For parenteral nutrition, amino acid mixtures are used (polyamine, Vamin, Alvezin "New", Amikin, Levamine, etc.), 10% glucose solution with insulin (5-8 days, daily or every other day, 5-6 times). Within 2-3 weeks, in doses exceeding physiological by 3-5 times, children are given vitamins (group B, ascorbic acid, vitamin P preparations, ergocalciferol). In order to improve the processes of hydrolysis and absorption in the digestive tract for a period of 2-3 weeks enzyme preparations are prescribed (gastric juice, pancreatin, Pepsidil, festal, panzinorm, abomin, etc.).

In the first days, courses of treatment are carried out with drugs that stimulate metabolism (apilac, pentoxyl, ginseng tincture, pantocrine), and during the recovery period, potent anabolic hormones (methandrostenediol, nerobol, retabolil, etc.) are used..

Prevention of antenatal malnutrition consists in the treatment of toxicosis of pregnant women, the observance of hygienic working conditions, life, nutrition, the exclusion of bad habits, and the like. Natural feeding in combination with the correct regimen and education, periodic determination of the chemical composition of food and body weight dynamics is a prerequisite for excluding the development of postnatal malnutrition.

Prevention of any acute and chronic, acquired, hereditary and congenital disease and early diagnosis is the most important step in the prevention of malnutrition.