Treatment of malnutrition. Causes and signs of protein-energy deficiency, malnutrition, in children. What causes the disease

Often, young children have insufficient weight gain for their age and height. Chronic weight gain of 10% or more that is missing in a baby is called malnutrition.

This pathologically disturbed nutrition is an independent disease - a kind of dystrophy. More often it is observed in babies of the first 3 years of life, causes serious changes in the body, so it is so important to identify and treat it in time.

Hypotrophy is also accompanied by a slowdown in growth, psychomotor development. due to insufficient intake of food or problems with the absorption of nutrients in the baby's body.

Classification

Depending on the period of development of malnutrition, there are:

1. Congenital, or occurring in utero (prenatal), malnutrition, which develops as a result of oxygen starvation of the fetus, with a delay in its development.
2. Acquired malnutrition (postnatal), arising as a result of a protein-energy deficiency in the body that is not compensated by the calorie content and composition of food. Deficiency may be due to an unbalanced composition of food, a violation of its digestion or absorption of nutrients.
3. Mixed malnutrition, during the development of which additional postnatal causes (alimentary or social order) are added to the factors of the prenatal stage.

According to the severity, malnutrition is distinguished:

• 1 (mild) degree: the weight deficit is 10-20% of the norm by age, and the growth of the baby is normal;
• 2 (medium) degree: weight is reduced by 20-30%, and height - by 2-3 cm from the average age norm;
• 3 (severe) degree: the weight deficit exceeds 30% of the due against the background of a pronounced lag in growth.

During malnutrition in children, periods are distinguished:

• elementary;
• progression;
• stabilization;
• recovery or convalescence.

Causes of malnutrition

Preeclampsia and placental dysfunction can lead to intrauterine hypotrophy of the fetus.

Hypotrophy of a child can be caused by many factors of the prenatal and postnatal stages of its development.

Intrauterine malnutrition may be associated with:

1. Pathology of pregnancy:

• toxicosis;
• preeclampsia;
• fetoplacental insufficiency;
• premature birth;
• fetal hypoxia;
• intrauterine infection.

1. Factors unfavorable for the development of the fetus:

• bad habits in a pregnant woman;
• stressful situations or frequent depression;
• non-compliance with the daily routine during pregnancy;
• unfavorable environment;
• industrial hazards.

1. The presence of a serious pathology in the expectant mother:

• heart defects;
• diabetes;
• chronic pyelonephritis;
• hypertension;
• nephropathy.

Acquired malnutrition in a child can be caused by endogenous or exogenous causes.

Endogenous causes include:

• congenital anomalies of development (including chromosomal);
• enzymatic deficiency, including malabsorption syndrome, lactase deficiency, celiac disease, etc.;
• constitutional anomalies ();
• immunodeficiency state.

Among the exogenous factors that cause malnutrition, there are alimentary, infectious and social factors.

1. Alimentary factors are unbalanced or insufficient food, the consumption of which causes a protein and energy deficiency. Alimentary factors include:

• regular malnutrition associated with impaired sucking (due to inverted or flat nipples of the mother's breast);
• lack of nutrition with or a decrease in the volume of milk mixtures;
• profuse regurgitation in the baby;
• poor-quality composition of milk with insufficient nutrition of the mother;
• infant diseases that impede the process of sucking and proper nutrition: pyloric stenosis, cleft lip, cleft palate, cerebral palsy, congenital heart defects, etc.

1. Infectious factors that can lead to malnutrition:

• intestinal group of infections;
• severe pneumonia;
• frequently occurring respiratory diseases;
• tuberculosis, etc.

1. Social factors play an important role in the appearance of malnutrition. These include:

• insufficient financial support for the family;
• unsanitary conditions and errors in caring for the baby (lack of walks in the air, non-compliance with the daily routine, insufficient sleep, etc.).

If there are several reasons for hypotrophy, then the disease progresses at an accelerated pace, since they complement each other. Insufficient nutrition reduces immunity, contributes to the occurrence of an infectious pathology, which provokes weight loss and increases malnutrition. A vicious circle is formed, and malnutrition is rapidly increasing.

Symptoms

Manifestations of malnutrition depend on the severity of the process. Doctors determine the congenital form of the disease already at the first examination of the baby. Postnatal malnutrition is diagnosed in the process of monitoring the development of the baby according to characteristic features.

With a mild degree of the disease, the general condition of the crumbs does not suffer. In neuropsychic development, the child does not lag behind. There may be some loss of appetite. From objective data, the following manifestations can be detected:

• pale skin;
• tissue elasticity is reduced;
• the subcutaneous fat layer in the abdomen is thinned.

Children with moderate malnutrition are characterized by reduced activity. Lethargy can be replaced by excitement. Characterized by a lag in the development of motor skills. Appetite is greatly reduced. Flaky, flabby, pale skin. Muscle tone is reduced. Due to the deterioration of elasticity, skin folds are easily formed, cracking down with difficulty.

The subcutaneous fat layer is preserved only on the face, and is completely absent in other parts of the body. Respiration and heart rate are quickened, blood pressure is reduced. Children often develop somatic diseases - pyelonephritis, pneumonia, otitis, etc.

With severe malnutrition, the subcutaneous fat layer in children disappears not only on the trunk and limbs, but also on the face. The child lags far behind both in physical and neuropsychic development. Growth is significantly reduced, muscles are atrophic, tissue density and elasticity are completely lost.

The baby is lethargic, almost motionless. There is no reaction to external stimuli - not only to light, sound, but even to pain. It is obvious that the child is emaciated. Babies have a sunken large fontanel. The skin is pale, has a grayish tint.

Pallor and dryness of the mucous membranes, cracked lips, sharpened facial features, sunken eyes are expressed. Thermoregulation is broken. Babies spit up (or vomit), are prone to diarrhea, and urinate infrequently.

For children with severe malnutrition, the following diseases are characteristic:

• fungal infection of the oral mucosa ();
• conjunctivitis;
• pneumonia (inflammation of the lungs);
• rickets;
• alopecia (hair loss), etc.

In the terminal stage, the temperature drops sharply, the heart rate slows down, and the blood sugar level drops.

Diagnostics

Intrauterine malnutrition can be detected during an ultrasound screening examination of pregnant women. The measured dimensions of the fetal head, body length and the calculation of the estimated weight of the fetus make it possible to assess its development in accordance with the gestational age, to identify intrauterine maturation delay.

A pregnant woman is hospitalized in order to identify the cause that caused fetal hypotrophy. Congenital malnutrition is diagnosed by a neonatologist (pediatrician of the maternity ward, specialist in newborns) at the first examination of a born baby.

Acquired malnutrition is detected by a pediatrician when observing a child based on controlled anthropometric data: height, weight, chest circumference, head, abdomen, hips and shoulders. The thickness of the skin-fat fold in different parts of the body is also determined.

If malnutrition is detected, a deeper examination is prescribed to identify its cause:

• consultations of pediatric specialists (cardiologist, neuropathologist, geneticist, gastroenterologist, endocrinologist);
• laboratory methods: blood test (clinical and biochemical method), urinalysis, feces for dysbacteriosis, coprogram;
• hardware research: ECG, ultrasound, echocardiography, electroencephalography, etc.

Treatment

Treatment of children with mild (1st) degree malnutrition can be carried out at home in the absence of concomitant pathology and a minimized risk of complications. When diagnosing moderate and severe malnutrition (2nd or 3rd degree), the child is hospitalized.

Complex therapy is prescribed, the purpose of which is:

• elimination of the cause of the disease;
• ensuring a balanced diet in accordance with age norms;
• treatment of complications caused by malnutrition.

For each child, an individual set of measures is selected depending on the severity of malnutrition.

Comprehensive treatment should include:

• identifying the cause of malnutrition and, if possible, eliminating it;
• diet therapy, which is the basis for the treatment of malnutrition;
• treatment of existing foci of infection in a child;
• symptomatic therapy;
• proper care of the baby;
• Exercise therapy and massage, physiotherapy.

When choosing a diet, it is important to take into account the degree of dysfunction of the digestive organs and the degree of malnutrition.

diet therapy

Nutrition correction is carried out in several stages:

1. At the first stage, in the process of medical supervision, the possibility of full digestion and assimilation of food in the body is determined. The duration of observation varies from several days with 1 degree of malnutrition to 2 weeks with 3 degrees. The digestibility of food and the presence of bloating, diarrhea or other signs of indigestion are determined.

From the first days of treatment, a reduced amount of food per day is prescribed: with 1 degree of malnutrition, it is equal to 2/3 of the volume due to age, with 2 - ½ volume, with 3 degrees - 1/3 of the age norm of daily volume.

The intervals between feedings are reduced, but the frequency of meals increases: with 1 degree of malnutrition up to 7 times a day, with 2 - up to 8 times, with 3 - up to 10 times.

1. The second stage is called transitional. The purpose of the diet during this period of treatment is to gradually compensate for the deficiency of nutrients, minerals and vitamins necessary to restore health.

Tactics are used to increase the volume of a portion of food and its calorie content, but the number of feedings per day is reduced. With small daily additions of the amount of food, the volume is gradually brought to a full age.

1. The third stage of diet therapy is characterized by enhanced nutrition. It is possible to increase the food load only if the functional ability of the digestive organs is fully restored.

An important condition for diet therapy is the use of easily digestible food. Optimal nutrition is. In its absence, milk mixtures are prescribed, the choice of which is made by the doctor.

With severe malnutrition, when the child is unable to eat on his own, or the affected organs of the digestive tract are not able to digest it, the baby is prescribed parenteral nutrition.

At the same time, not only nutrient solutions (glucose solution, protein hydrolysates), but also electrolyte solutions (Trisol, Disol), vitamins are injected intravenously to replenish the body's need for fluids and maintain metabolism.

During treatment (in order to facilitate nutritional control), a special diary records the quantity and quality of the food received, including nutritional mixtures administered intravenously. The nature of the stool and the number of bowel movements per day, the number of urination and the volume of urine excreted are monitored and reflected in the diary.

It is examined repeatedly in a week (the presence of undigested fibers, fatty inclusions is determined in the feces). The child's body weight is monitored weekly, on the basis of which the doctor recalculates the need for nutrients.

The criteria for the effectiveness of diet therapy are:

• improved condition of the baby;
• restoration of skin elasticity;
• normal emotional state of the child;
• the appearance of appetite;
• daily increase in body weight by 25-30 g.

The child must be hospitalized with his mother. It will provide care not only at home, but also in the hospital.

Care

Care for a child with malnutrition should provide:

• comfortable conditions for the baby at home and in the hospital;
• airing the room at least 2 times a day;
• air temperature should be 24-25 0 С;
• daily exposure to air;
• conducting special exercises to restore muscle tone;
• massage courses for a beneficial effect on the baby's body.

Medical therapy

Drug therapy for malnutrition may include:

• the appointment of probiotics to correct the imbalance of microflora in the intestine (Bifiliz, Atsilakt, Linex, Probifor, Bifiform, Florin Forte, yogurts, etc.);
• enzyme therapy with a decrease in the ability of the gastrointestinal tract to digest food - the prescribed drugs will compensate for the lack of digestive juices of the stomach, pancreas (gastric juice, Creon, Panzinorm, Festal);
• vitamin therapy - at first, drugs are injected (vitamins B 1, B 6, C), and after normalization of the condition, vitamin-mineral complexes are prescribed orally;
• stimulating therapy that improves metabolic processes: Dibazol, ginseng, Pentoxifylline improve blood flow and provide delivery of oxygen and nutrients to tissues.

If any complications are detected in a child, symptomatic therapy is carried out.

With anemia, iron preparations are prescribed (Totem, Sorbifer, etc.). In the case of a hemoglobin index below 70 g / l, red blood cells can be transfused.

The appointment of immunoglobulin will increase the protective capabilities of the body and protect the baby from infection.

If signs of rickets are detected, a course of treatment with vitamin D plus UVR is carried out in a physical room.

Forecast

Timely treatment of mild to moderate malnutrition will provide a favorable prognosis for the life of the baby. With a severe degree of malnutrition, a lethal outcome is possible in 30-50% of cases.

Prevention

To prevent intrauterine malnutrition, measures should be taken during the period of bearing a child:

• elimination of factors of adverse effect on the fetus;
• regular observation of a woman by a gynecologist and timely screening studies;
• timely correction of the pathology of pregnancy;
• strict observance of the pregnant regimen of the day.

For the prevention of postnatal malnutrition, it is necessary:

• regular observation of the child by a pediatrician and anthropometry;
• balanced nutrition of a woman during lactation;
• ensuring competent care of the newborn;
• treatment of any disease of the baby as prescribed by the pediatrician.

Summary for parents

Hypotrophy in a baby at an early age is not just a lag in body weight of 10% or more. This disease leads to a lag in mental development, speech. Progressive malnutrition leads to exhaustion and poses a threat to the life of the baby.

The birth of a child is an event of extreme importance. It is necessary to prepare for it and follow all medical recommendations during the period of gestation. These measures will help to avoid the development of malnutrition in the womb.

After the birth of a baby, breastfeeding, proper care of the newborn, regular monitoring of the baby's developmental indicators (physical and mental) will make it possible to prevent the development of acquired malnutrition.

In the event of the occurrence of this serious disease in a child, only timely full-fledged treatment will help restore the health of the crumbs.

Hypotrophy in children is a pathological violation of weight gain, which affects the overall development (physical and psychological). There is also a decrease in skin turgor and growth retardation. As medical practice shows, such an ailment occurs in children under 2 years of age.

Etiology

Hypotrophy in young children can be accompanied by various diseases or develop as an independent disease. The most common etiological factors include the following:

• unbalanced diet;
• underfeeding or overfeeding a child;
• improperly selected mixtures;
• viral or infectious diseases;
• endocrine diseases;
• hereditary pathologies;
• disorders in the digestive tract - incomplete absorption of nutrients;
• genetic predisposition of the fetus.

Hypotrophy at an early age can also develop in a child when eating poor-quality baby food. It should also be noted that malnutrition in newborns can develop both with artificial and breastfeeding. That is why it is very important for the mother herself to eat right and, in general, take good care of her health.

There are also perinatal etiological factors in the development of fetal hypotrophy:

• malnutrition during pregnancy (intrauterine malnutrition);
• chronic illnesses of the mother both before pregnancy and during childbearing;
• alcohol abuse, smoking;
• frequent stress, nervous strain.

In the same subgroup, you can add features of the constitution of the mother herself. If the weight of a pregnant woman is not more than 45 kg, and the height is not more than 150 cm, there is a risk of developing fetal malnutrition.

Symptoms

The clinical picture of fetal hypotrophy manifests itself in the form of a malfunction of several systems at once. First of all, symptoms in the gastrointestinal tract appear:

• bloating;
• refusal to eat, poor appetite;
• nausea and vomiting;
• drastic weight loss.

As the disease progresses, the clinical picture is supplemented by the following symptoms:

• bad sleep;
• impaired coordination of movements;
• decreased muscle tone;
• sudden mood swings in a child;
• emotional unstable background.

Also, against the background of such a clinical picture in young children, the protective functions of the body are sharply reduced. Therefore, a child up to a year becomes easily vulnerable to any infections and viral pathological processes.

Classification

According to the international classification, there are such types of malnutrition:

• intrauterine (perinatal or congenital form);
• postnatal (acquired form);
• mixed type.

According to the degree of development, malnutrition in children can occur in the following forms:

• light;
• average;
• heavy.

Hypotrophy of the fetus of the 1st degree does not pose a significant threat to the health of the child. In this case, the deviation from the required weight is no more than 10–15% even with normal growth for this age.

The second degree means a deviation in mass up to 30% and a lag in growth of 3-5 cm.

With malnutrition of the third degree, there are significant deviations in weight - from 30% or more, a significant lag in growth. At this stage of development of the pathological process, malnutrition in a child may be accompanied by other diseases. The most common ailments are:

As practice shows, fetal malnutrition in the third stage almost always leads to the development of rickets.

Diagnostics

If during pregnancy a woman undergoes a timely examination, then fetal hypotrophy will be detected at an early stage of development. If such a pathology is suspected, the pregnant woman is sent for an ultrasound examination and screening is done.

As for already newborn children or toddlers, pathological deviations in development will certainly be noticeable by a pediatrician during examination.

Diagnostic measures for suspected malnutrition in a child include the following activities:

• measurement of the circumference of the head, abdomen;
• measurement of the thickness of the skin and fat.

It is also obligatory to consult with medical specialists of other profiles:

• geneticist;
• cardiologist;
• neurologist;
• endocrinologist.

Depending on the age of the child, instrumental diagnostics may be needed:

• coprogram.

Only on the basis of the tests obtained, the doctor can finally establish the diagnosis and prescribe the correct course of treatment.

Treatment

Treatment of the disease depends on the type of disease and the stage of development of the disease. If we are talking about intrauterine malnutrition (during pregnancy), then therapy is primarily aimed at the expectant mother herself. Treatment may include the following activities:

• balanced diet;
• taking drugs to eliminate pathology;
• taking enzymes to improve digestion.

In most cases, if the pathology is detected in the second or third trimester of pregnancy, the treatment takes place in a hospital.

Treatment of children (newborns and up to a year) also takes place in a hospital. So that the child does not develop muscle hypotrophy, bed rest is prescribed. Comprehensive therapy includes the following:

• food according to a special diet;
• taking vitamin preparations;
• courses of special massage and exercise therapy;
• biological additives.

In addition, it is very important how the child will be looked after. According to official statistics, malnutrition in children and during pregnancy is most often observed in socially disadvantaged families.

Diet

The diet is prescribed only by the attending physician based on the individual characteristics of the patient and the stage of development of the disease:

• in the first degree - meals at least 7 times a day;
• in the second degree - 8 times a day;
• at the third - 10 times a day.

As for the list of products, they are chosen based on what the patient's digestive system can digest.

Prevention

Preventive methods are especially important during pregnancy. It is very important for a future mother to eat fully and in a timely manner, since the health of the baby depends on it. Also, during pregnancy, a woman should be regularly examined for the timely detection of pathology.

Today, the best prevention of malnutrition in newborns is careful planning of pregnancy.

For newborns, preventive measures are as follows:

• the nutrition of the baby should be complete and only of the best quality;
• weight gain and height increase should be constantly monitored;
• the child should be examined by a pediatrician in a timely manner;
• complementary foods should be introduced gradually starting with small doses;
• foods should have all the necessary vitamins and minerals.

With the above symptoms, you should immediately consult a doctor and in no case self-medicate. Delay, in this case, can result in a child's disability or death.

Forecast

Hypotrophy in a child at the first or second stage responds well to treatment and practically does not cause complications. As for the pathological process at the third stage of development, a lethal outcome is observed in 30–50% of all cases.

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Answer only if you have proven medical knowledge

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

General information

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

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

Causes of malnutrition in children

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

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

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

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

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

Classification of malnutrition in children

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

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

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

Symptoms of malnutrition in children

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

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

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

Diagnosis of malnutrition in children

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

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

Treatment of malnutrition in children

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

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

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.

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 through 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.

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

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

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Concept and characteristics

Hypotrophy occurs when there is a systematic malnutrition.

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

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

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

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

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

Disease classification

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

Hypotrophy may be congenital or acquired.

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

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

Causes of development and risk groups

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

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

Symptoms and clinical picture

At newborn babies the most common form of congenital malnutrition.

It is characterized by the following set of features:

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

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

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

Complications and consequences

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

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

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Diagnostics

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

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

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

Necessary and laboratory research:

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

Treatment Methods

What is the treatment of malnutrition in children?

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

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

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Medicines

Patient appoint:

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

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

Food

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

UFO

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

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

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

Massage

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

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

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

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

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

Forecast

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

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

Prevention

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

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

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

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

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

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

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