Age of development of malnutrition in children. Chronic eating disorders in young children. Do you need special care and nutrition

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

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

Factors provoking malnutrition

Internal causes of disturbed trophism of body tissues:

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

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

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

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

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

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

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

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

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

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

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

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

Stages of the disease

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

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

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

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

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

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

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

Removal of a child from a pathological state

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

Hypotrophy of the 1st degree is characterized by:

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

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

Grade 2 is characterized by aggravation of all existing violations:

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

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

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

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

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

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

Hypotrophy in children is a diagnosis associated with malnutrition of the child, which is accompanied by insufficient weight gain in accordance with age and height. Most often occurs in babies under the age of three years, can be observed in newborns. This condition is dangerous because it entails other serious disruptions in the body, up to a lag in mental development. Therefore, it is important to know about this disease, its symptoms, in order to detect its manifestations in time.

About malnutrition in young children can be said with a lack of body weight of 10% of the age norm or more. Depending on the neglect of the disease, there are three degrees of it.

The first degree is usually invisible, it can be skipped, taking it as a feature of the physique. Or vice versa, the baby can really be thin by nature, so the doctor can identify hypotrophy of the 1st degree in children. Its symptoms include:

• loss of appetite;
• sleep disorders;
• anxiety;
• possible decrease in muscle tone;
• pallor of the skin and a decrease in its elasticity;
• the child may look thin in the abdomen;
• rarely - signs of anemia or rickets.

Hypotrophy of the 2nd degree in children will already be noticeable to parents on the following grounds:

• weight deficit from 20 to 30%;
• growth retardation (3-4 cm);
• bad sleep;
• lethargy, lethargy;
• poor appetite, frequent regurgitation;
• stool disorders - constipation and diarrhea;
• cold extremities;
• poor skin condition: pallor, peeling and dryness;
• pronounced thinness of the body;
• lag in psychomotor development;
• possible tachycardia and shortness of breath;
• frequent colds.

With the third degree of the disease, the child's condition becomes almost critical:

• weight deficit of more than 30%;
• lag in growth of 8-10 cm;
• the bones are covered with leather;
• gray, dry skin;
• drowsiness, tearfulness, apathy;
• in infants - sinking of the fontanel;
• loss of previously acquired skills;
• muscles atrophy;
• mental underdevelopment;
• chronic infections (pyelonephritis, pneumonia) are possible;
• cracks in the corners of the lips;
• stool disorders, frequent vomiting.

Types of malnutrition

In addition to the degrees of development, malnutrition is divided according to the time of onset of the disease into intrauterine (congenital) and acquired.

Congenital malnutrition

This type of pathology is also called intrauterine, and develops during the period of gestation by the mother. Reasons for this type:

• toxicosis in the mother in the first and second trimester of pregnancy;
• fetoplacental insufficiency,;
• bad habits of a pregnant woman, poor nutrition;
• chronic diseases of the expectant mother (cardiac, endocrine, diabetes mellitus, pyelonephritis, etc.);
• stress;
• genetic abnormalities of the fetus;
• mother's work in hazardous production during pregnancy;
• problems with the placenta;
• — fetal hypoxia —;
• intrauterine infection.

You can determine intrauterine disease after birth by the following symptoms: too low weight and height, violation of thermoregulation, decreased muscle tone, slow healing of the umbilical wound, weak expression of reflexes.

Acquired malnutrition

The causes of this type of pathology can be divided into external and internal. Internal causes include various diseases and pathologies in a child, including congenital (metabolic disorders, endocrine diseases, immunodeficiency, malformations, food allergies, lactase deficiency, celiac disease, cystic fibrosis), birth injuries, cerebral palsy. Also, children who often suffer from infectious diseases (ARI, intestinal infections) may be prone to the development of malnutrition.

External causes do not depend on the state of health of the child, but are caused by an environment unfavorable for development, incorrect actions of parents:

• inadequate feeding (breast milk or formula);
• improper grip of the nipple during breastfeeding and, as a result, a lack of milk;
• poor nutrition of a nursing mother;
• unbalanced diet;
• too low-calorie food;
• late introduction of complementary foods;
• excess of the norm of taken vitamins (especially A and D);
• taking certain medications;
• poisoning;
• lack of parental attention, walks in the fresh air;
• lack of activities with the child in the form of massage and gymnastics, rare bathing, poor sleep.

Diagnostics

Suspecting malnutrition, the pediatrician will diagnose and prescribe a series of tests. So, the baby will be examined to determine the condition of his skin, nails and hair, muscle tone, thickness of the subcutaneous fat layer. The doctor will interview the parents about the child's usual condition: how he eats, sleeps, behaves, how he is looked after. The congenital diseases discussed above will be important: their presence can help confirm the diagnosis of the child.

In addition, it will be necessary to pass tests and undergo research:

• general urine and blood tests;
• stool analysis;
• blood chemistry;
• Ultrasound of the abdominal organs;
• examination of the heart using an electrocardiogram, echocardiography;
• electroencephalogram - examination of the brain.

You may also need to consult a number of pediatric doctors of a narrow profile: a neurologist, a cardiologist, a gastroenterologist, a geneticist, etc.

Treatment of malnutrition in children

When establishing an accurate diagnosis, the doctor will prescribe treatment, which includes:

• elimination of the cause that caused malnutrition;
• establishing proper nutrition of the child, following a certain diet;
• ensuring proper care from parents;
• drug therapy (vitamins, immunomodulators, probiotics, drugs to improve the production of stomach enzymes);
• massage, ultraviolet irradiation can be prescribed.

The diet for this diagnosis is as follows:

1. At first, for 2 days to 2 weeks, the baby is fed food intended for younger babies. The calculated norm of food is divided into 9-10 receptions.
2. Then the food is brought to the age norm according to the weight of the patient, special mixtures are added.
3. The next stage includes an increase in the calorie content of food consumed, nutrition should be enhanced.

As for intrauterine pathology, for treatment, first of all, breastfeeding is established so that the baby receives enough nutrients, and they also monitor his body temperature and maintain it at the right level.

Lifestyle of children with malnutrition

When diagnosing this disease or suspecting its occurrence due to some factors, you need to adhere to a certain lifestyle. In addition to a balanced diet with sufficient (and sometimes increased) calories, the necessary amount of vitamins and microelements, the parents of such a child must provide him with the necessary care and adherence to the daily routine: daily walks (at least 3 hours), therapeutic massage, gymnastics, nightly bathing.

The prevention of pathology is of great importance. And it should begin even before the birth of the child,. A pregnant woman should eat properly, fully and balanced, follow the doctor's prescriptions regarding the use of vitamin complexes. After the baby is born, you need to monitor his nutrition, be sure to try to establish breastfeeding, which provides him with everything necessary for normal growth and development.

It is necessary to monitor the height and weight of the child, visit a pediatrician to monitor these indicators and regular examinations of the baby. After 6 months, complementary foods must be introduced into the child's diet in accordance with the standards and recommendations of the WHO. The baby's diet should include a variety of healthy foods: cereals, meat, vegetables and fruits, dairy and sour-milk products.

How to recognize malnutrition

Parents should closely monitor the condition of their child and notice all changes in his behavior, eating and other habits, and general condition.

Disturbance of appetite and sleep, too much weight loss, skin problems, lethargy and apathy - all these signs should alert.

If you suspect an insufficient set of weight and height, you must definitely show the child to the pediatrician. Do not ignore monthly trips to the clinic for weighing and examination: this is how a doctor with many years of experience will be able to recognize an incipient disease that young parents may miss.

Video: complementary foods and norms for the growth and weight of a child as part of the prevention and diagnosis of malnutrition

Proper nutrition of the child plays a very important role in the process of his growth and development. Therefore, for the prevention of malnutrition, it will be useful to learn the basic rules for introducing complementary foods for the smallest, which in the future will provide the basis for proper eating habits.

Also pay attention to this short video, which clearly demonstrates the norms of height and weight of babies depending on age. Such data will also help you find out if everything is in order with the child, and also not to panic too much if your child does not fall into the standard parameters of hospital tables.

It is very important to observe the normal development of your baby from its very birth, so as not to miss the alarming bells of the onset of any disease. Knowing more about such a pathology as malnutrition, you will carefully consider his condition and provide the baby with proper care and proper diet. If you had to face such an unpleasant problem, please share your experience in the comments. Tell us what doctors advised and prescribed for you, how you coped with the disease. And may your children always be healthy!

This condition is observed in children at an early age. The most common cause of malnutrition is lack of protein in the diet, as well as low nutritional and energy value of products.

Hypotrophy is the most common type of dystrophy, which affects children in the first 2-3 years of life. High mortality among children of this age in the past has been associated with malnutrition. Now, thanks to an increase in the social standard of living and the emergence of effective drugs, cases of malnutrition have become a rarity.

If we consider the problem of hunger globally, then it still remains relevant in many countries of the world, where it is a mass disease. The prevalence of this phenomenon varies in different countries from 2 to 30% and directly depends on the social and economic condition of the population.

From the moment of birth, children are rapidly gaining body weight, along with it all the internal organs and bone tissue of the skeleton grow. In the early years Nutrition plays an important role in the development of a child. If the diet is poor or nutrition is insufficient, then the child shows signs of changes in the functioning of internal organs and systems. Lack of weight affects the functioning of the digestive organs, which leads to problems with the absorption of vitamins and nutrients. A lack of weight of more than 10% in comparison with the norm is a reason to talk about malnutrition.

THE REASONS

The development of malnutrition is influenced by many reasons, in addition, this condition can be accompanied by other diseases.

With insufficient intake of nutrients into the body, they speak of the exogenous origin of the syndrome. In the event that the body is not able to absorb a sufficient amount of food, they indicate the endogenous nature of malnutrition.

Exogenous causes of malnutrition:

• underfeeding or overfeeding;
• unbalanced diet (alimentary factors);
• acute infectious processes;
• low social status of the family;
• wrong mode.

Endogenous causes of malnutrition:

• malformations of the digestive organs and other systems;
• endocrine pathologies;
• neuroendocrine diseases;
• metabolic diseases;
• congenital enzymopathies;
• malabsorption in the intestine;
• chromosomal abnormalities.

CLASSIFICATION

Hypotrophy is systematized in several directions.

Classification of malnutrition depending on the period of occurrence:

• congenital(prenatal, or intrauterine). At the heart of its development is a pathological change in utero-placental metabolism. Intrauterine malnutrition causes oxygen starvation of the fetus, metabolic disorders and entails a delay in the development of the child.
• Acquired(postnatal). Of primary importance is the protein and energy deficiency caused by poor nutrition, pathological disorders in the process of digestion and absorption. The child does not compensate for the energy costs for growth and development, which should come with nutrients.
• mixed the form indicates the accession to congenital factors, infectious, social and alimentary causes after the birth of the child.

Classification of malnutrition according to the severity of underweight:

• I degree - easy;
• II degree - medium;
• III degree - severe.

The division of malnutrition into degrees of severity is necessary for a correct assessment of the child's condition and for planning therapeutic measures.

SYMPTOMS

Symptoms depend on the severity of the syndrome:

• I degree. Signs of lagging behind the optimal body weight are at the level of 10-20%. There is a slight loss of subcutaneous fat in the abdomen. The general condition of the child is satisfactory. noted loss of appetite, pallor, decreased muscle tone and sleep disturbance.
• II degree. Has a pronounced symptomatic picture. The lack of growth is 2-4 cm, and the deficit of weight is in the range of 20-30%. The child has weakness and apathy, dry skin, its peeling and some swelling. Microcirculation is disturbed, and a thin layer of subcutaneous tissue is concentrated only in the face area. These symptoms are accompanied by nausea, vomiting, and loose stools. When listening to the heart, muffled tones and are noted. Respiratory function is disturbed and pressure decreases.
• III degree. A weight deficit of more than 30% is fraught with developmental delay and serious conditions. There is a high risk of anorexia. In addition, the child loses previously acquired skills. His skin integument is pale, dry, subcutaneous tissue is absent. Muscle atrophy is observed, symptoms of dehydration occur, cardiac activity decreases, and body temperature drops below normal.

DIAGNOSTICS

When diagnosing malnutrition, several important points must be considered. One of the indicators of probable deviations are changes in the work of organs and systems.

Clinical signs for the detection of malnutrition:

• trophic changes;
• thinning of the fat layer under the skin;
• indigestion;
• metabolic change;
• disturbances in the work of the central nervous system.

One of the main criteria is the thickness of the subcutaneous fat layer: the smaller it is, the more pronounced hypotrophy.

Differentiation of the syndrome is made with diseases, the symptoms of which are manifested by a decrease in body weight, small stature and a lag in the physical development of the child. These include nanism, or growth hormone deficiency. With this disease, there are no trophic changes, the subcutaneous tissue is not thinned, and the size of the organs corresponds to the size of the body.

The nature of feces is one of the signs of the severity of the pathological condition. Insufficient protein in the child's diet leads to the fact that to compensate for its deficiency, the body uses internal reserves in the form of its own muscle tissue and fat layer. One of the metabolic products in this case is ammonia, which gives the urine a characteristic odor. With the help of laboratory blood tests, it is possible to detect a decrease in the number of red blood cells and hemoglobin, a lack of vitamins, trace elements, and abnormalities in the liver.

In case of complications from the internal organs, such methods of instrumental diagnostics as an electrocardiogram of the heart and an electroencephalogram of the brain are used.

Ultrasound examination is used in the examination of internal organs and to detect intrauterine malnutrition during pregnancy based on anthropometric indicators.

When making a diagnosis, the doctor assesses the living conditions, the social and material condition of the family, and also interviews parents for genetic pathologies. As a rule, the diagnosis of malnutrition is not difficult, problems can arise when identifying the causes of this condition.

TREATMENT

Treatment of malnutrition is a whole range of measures aimed at eliminating its root cause and restoring the normal functioning of the body. Treatment of mild malnutrition is carried out on an outpatient basis, for treatment of moderate and severe degrees, hospitalization is necessary.

Therapeutic measures for malnutrition:

• elimination or regulation of the etiological factor;
• diet therapy;
• elimination of chronic foci of infection;
• organization of a rational regime;
• compliance with the rules of child care;
• prescribing medications;
• vitamin therapy, the use of enzymes (symptomatic treatment);
• massage, physiotherapy.

Diet therapy deserves special attention. It is carried out in two stages: at the first, food tolerance is clarified, and then there is an increase in the volume of food and its calorie content to the required standards. Meals are frequent and fractional - 7-10 meals a day in small portions.

In severe cases of malnutrition, when the child is not able to eat independently, feeding is done through a tube. If the gastrointestinal tract is not able to take food due to any internal damage, parenteral nutrition is used, which consists in the intravenous administration of nutrient solutions, electrolytes and minerals. When cases of intrauterine fetal hypotrophy are detected, the nutrition of the expectant mother is corrected.

In children, drug treatment of malnutrition is aimed at maintaining the normal functioning of the body in children and depends on the complications that have arisen.

A decrease in the functional activity of the digestive organs requires the appointment of enzymatic preparations to replace the deficiency of gastric juice and pancreatic enzymes. Perhaps the appointment of immunomodulators, probiotics and antibiotics. Symptomatic therapy is aimed at treating anemia, reducing excitability and prescribing stimulant drugs.

An essential component of treatment is vitamin therapy. First, B vitamins and vitamin C are administered intramuscularly, and then they are transferred to their enteral use. Later, a course of taking multivitamin preparations is prescribed.

COMPLICATIONS

Considering the possible negative consequences of malnutrition, it is necessary to take into account the stage of development of the disease. So, the mild severity of malnutrition does not affect the health of the child. Being underweight can lead to tendency to hypothermia, but with proper care and good nutrition, these factors are easily leveled.

Serious complications are often associated with a predisposition to infectious processes and the development of comorbidities.

Complications of malnutrition:

• protracted colds and viral diseases;
• chronic fetal hypoxia;
• newborns;
• hemorrhagic disease of the newborn;
• inflammation of the large and small intestines (enterocolitis);
• blood poisoning ();
• vitamin D deficiency ();
• anemia;
• pneumonia;
• inflammation of the middle ear;
• mental retardation.

PREVENTION

Preventive measures are relevant from the moment of pregnancy. They include the proper nutrition of a woman, adherence to the regimen, as well as the exclusion of any negative effects on the fetus.

After the baby is born, special attention should be paid to nutritional quality of a nursing mother. It is necessary to monitor the weight of the child monthly and introduce complementary foods in a timely manner. Natural feeding with mother's breast milk is a priority, as it contains all the necessary substances for the normal development of the baby. With a shortage of mother's milk, the child is supplemented with specially selected artificial mixtures.

To prevent the development of malnutrition will help constant monitoring of the child's health for the development of infectious diseases, and diseases of the gastrointestinal tract. Walking in the fresh air, sun exposure and hardening are also effective measures to prevent malnutrition.

PROGNOSIS FOR RECOVERY

The prognosis for malnutrition depends on the factors that caused the exhaustion of the child, as well as on the nature of feeding, concomitant diseases and age.

With mild to moderate malnutrition favorable prognosis. In severe cases mortality reaches 30%. The outcome of the disease depends on how effectively it is possible to avoid secondary infection. Prolonged malnutrition is dangerous for the development of mental retardation in the future in infants.

A child's chances of recovery in severe cases depend on their age. Concomitant malformations significantly worsen the prognosis, improve - a prosperous environment and full-fledged home care after a stay in a hospital.

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

General information

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

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

Causes of malnutrition in children

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

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

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

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

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

Classification of malnutrition in children

Thus, according to the time of occurrence, intrauterine (prenatal, congenital), postnatal (acquired) and mixed malnutrition in children are distinguished. The development of congenital malnutrition is based on a violation of the uteroplacental circulation, fetal hypoxia and, as a result, a violation of trophic processes leading to intrauterine growth retardation. In the pathogenesis of acquired malnutrition in children, the leading role belongs to protein-energy deficiency due to malnutrition, impaired digestion of food 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 body weight deficiency in children, malnutrition 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 hypotrophy II degree often suffer from intercurrent diseases - otitis, 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 stage III hypotrophy, conjunctivitis, candidal stomatitis (thrush), glossitis, alopecia, atelectasis in the lungs, congestive pneumonia, rickets, and 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 hypotrophy 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.