Causes of malnutrition in children. Prevention and therapy of malnutrition in children. Syndrome of digestive disorders and impaired food tolerance

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 (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 central nervous system that develops 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 is a malnutrition that refers to dystrophy and is characterized by a decrease in tissue trophism, growth and body weight of the child. With malnutrition, metabolic processes are disturbed, which lead to a lag in the physical development of children.

Depending on the time of occurrence, congenital and acquired forms of malnutrition are distinguished, and the overall frequency of occurrence varies between 3–5% of all childhood diseases.

How to determine the degree of malnutrition?

The degrees of malnutrition mean how severe the symptoms are and how much weight loss there is in relation to the height of the child. So, for example, a born child is diagnosed with "hypotrophy of the 1st degree" in newborns if he was born at a gestational age of more than 38 weeks, has a body weight of 2800 g or less, and a body length of less than 50 cm. If the child has an acquired form of malnutrition , then they calculate the so-called "weight loss index" or fatness index according to Chulitskaya (Professor of the Department of the University of Physical Culture, St. Petersburg).

ICH (Chulitskaya fatness index) is the sum of the circumference of the shoulder, thigh and lower leg, from which the length of the child's body is taken away. Calculations are carried out in centimeters, and in normal children under the age of one year, this figure is 25-30 cm. If children develop malnutrition, then this index decreases to 10-15 cm, which indicates the presence of malnutrition 1 degree.

The body weight deficit is also calculated using a formula that all pediatricians have. The table contains weight indicators, which should be added monthly:

• 1 month after birth - 600 g.
• 2 and 3 months - 800 g each.
• 4 month - 750 g.

The calculation of the fifth and all subsequent months is equal to the previous weight minus 50 g.

When measuring the degree of malnutrition, the actual weight of the child is compared and the one that is calculated according to the table according to age. For example, a baby was born with a weight of 3500 g, and at the age of 2 months it weighs 4000 g. The actual weight should be 3500 + 600 + 800 = 4900 g. The deficit is 900 g, which is 18% as a percentage:

4900 g - 100%

X \u003d (900 x 100) / 4900 \u003d 18%

• Hypotrophy of the 1st degree - is placed with a weight deficit of 10% to 20%.
• Hypotrophy of the 2nd degree - is placed with a weight deficit of 20% to 30%.
• Hypotrophy of the 3rd degree - is placed with a weight deficit of 30% or more.

Signs of 1st degree of malnutrition

Each degree of malnutrition has its own clinical picture, signs and characteristic symptoms, by which it is also possible to determine the stage of development of the disease.

Signs characteristic of hypotrophy of the 1st degree are as follows:

• IUCH is 10-15 cm.
• The subcutaneous fat layer disappears on the abdomen.
• Skin folds are flabby and straighten out slowly.
• The elasticity of soft tissues is reduced.
• Muscles become sluggish.
• Body weight below normal weight by 10-20%.
• There is no stunting.
• The child's well-being does not suffer and the psyche is not disturbed.
• The child often suffers from infectious and other diseases.
• There is a slight indigestion (regurgitation).
• Irritability and sleep disturbance appear.
• The child becomes restless and gets tired quickly.

Treatment of this degree of malnutrition is not difficult, and weight can be normalized when the regime is restored (the entire amount of food is divided into 7-8 meals) and the diet. The diet is dominated by carbohydrates, cereals, fruits, vegetables.

Signs of the 2nd degree of the disease

Hypotrophy of the 2nd degree is characterized by the following symptoms and signs:

• HI becomes less than 10 and goes to zero.
• The fat layer is absent on almost the entire area of ​​the body.
• Sagging and sagging appear on the skin.
• Joints and bones are clearly visible.
• There is a decrease or lack of appetite.
• Vomiting, nausea and frequent regurgitation of food.
• Irregular and unstable stools, and there are remnants of undigested food in the stool.
• Signs of beriberi are dry hair, brittle and thinning nails, cracks in the corners of the mouth.
• The weight deficit reaches 20-30%.
• Growth is retarded.
• Symptoms of the nervous system - lethargy, anxiety, fatigue, loudness, irritability, sleep disturbance.
• Violation of the process of thermoregulation (the child quickly overheats and cools).
• Infectious diseases the baby gets sick often and for a long time.

Treatment of this degree of malnutrition can be carried out both at home and in a hospital. For treatment, increase the number of feedings and reduce portions of food. Of the drugs prescribed biostimulants, vitamins, minerals, enzymes.

Signs of the 3rd degree of malnutrition in children

This degree is considered severe, since all the symptoms only worsen, and without timely treatment lead to death in children. To all the above signs, signs of a violation of the activity of all organs and systems are added:

• The weight deficit is 30% or more.
• Growth retardation.
• Absence of subcutaneous fat.
• There are violations of the heart rhythm and work of the heart.
• Respiratory failure.
• Mental retardation.
• Muscle atrophy and wrinkling of the skin.
• Anorexia symptoms.
• Violation of thermoregulation and decrease in pressure.

Treatment of this degree of malnutrition should be carried out only in a hospital, since the work of metabolic processes and the activity of all organs and systems are disrupted. Drug treatment includes intravenous transfusion of blood, plasma, glucose solution, hormones, as well as treatment with enzymes, vitamins, microelement compounds.

Hypotrophy is a disease that is diagnosed in children from 0 to 2 years of age. Also, malnutrition can be congenital and manifest itself in a child during intrauterine life. The disease is characterized by an eating disorder, which leads to a lack of body weight of the baby. In this case, the diagnosis is made only if the weight of the child is below normal for his age by 10% or more.

You should not make a diagnosis on your own and try to supplement the child - this is the task of specialists

Causes of the disease

We have already found out that malnutrition in children can be congenital, as well as acquired. What are the main causes of this disease?

Congenital pathology is most often diagnosed in cases of malnutrition of a pregnant woman. Newfangled diets, on which future mothers sit, pose a danger to the fetus. In addition, the baby may suffer if a pregnant woman is diagnosed with placental insufficiency, somatic diseases, and toxicosis.

At risk are women who decide to bear a child at an advanced age or at a young age, as well as if the father and mother are in a related marriage. Often, congenital malnutrition accompanies the development of children with chromosomal mutations, for example, Down syndrome.

Acquired malnutrition can be provoked by several factors. Let's consider each of them separately:

• Underfeeding, and it can be both quantitative and qualitative. In the first case, the child does not receive the required amount of nutrition, in the second case, he is fed with a low-calorie mixture.
• Infectious diseases in young children, as well as their consequences. This is sepsis, constantly recurring diseases of the upper respiratory tract or gastrointestinal tract.
• Developmental defects. Atresia of the biliary tract, heart disease, kidney disease, central nervous system, and other diseases.
• Malabsorption syndrome is a chronic disorder of food digestion processes. As a rule, patients with cystic fibrosis, lactase deficiency, celiac disease or food allergies are at risk (we recommend reading:).

How is the disease diagnosed?

Hypotrophy in children is usually classified as mild, moderately severe, or critical. These three degrees of malnutrition can be diagnosed in newborns and older children.

Degree 1

At first glance, the baby feels satisfactory. If you examine it more closely, you can find a decrease in skin elasticity, a low subcutaneous fat layer on the abdomen. According to the parents, the child's appetite is reduced, weight is growing slowly. Objectively, the doctor notes that body weight is 10-20% lower than normal. A decrease in the level of digestive enzymes can be detected, while the body temperature is normal and the development of motor functions is within the normal range (we recommend reading:).

Degree 2

The child is depressed, his activity is reduced, his appetite is disturbed. The skin is pale, dry, inelastic, weak muscle tone. The subcutaneous fat layer is noticeably reduced on the abdomen, arms and legs, but on the face it is normal. The temperature fluctuates during the day within one degree, which indicates a disorder of thermoregulation. The baby almost does not grow weight (it is 20-30% less than the norm), tachycardia, muffled heart tones may be noted. These symptoms are not the only ones: the child begins to lag behind in development - he lacks the strength to catch up with his peers.

Degree 3

This is the most severe degree of malnutrition, it is diagnosed when the child's general condition is significantly impaired. The baby does not have a subcutaneous fat layer - on the stomach, arms and legs, on the face. The child resembles a skeleton covered with skin. His weight does not increase and may even decrease.

The mood of the baby changes - from lethargy and apathy, he goes into the stage of irritability and tearfulness. Body temperature drops, hands and feet are cold (see also:). Breathing is shallow, heart sounds are muffled, arrhythmia is manifested. The child is constantly spitting up, he has frequent loose stools, urination in small portions. Weight below normal by more than 30%.

Chair with hypotrophy

The classification of stool in malnutrition serves as an additional way to diagnose this disease. The changes are quite pronounced, so we will talk about them separately. The most characteristic types of stool:

• Hungry. Very scanty, dense, dry, almost colorless. In some children, the "hungry" stool becomes green, patches of mucus are noticeable in it, and the smell is putrid, unpleasant. Such a chair often occurs against the background of the development of dysbacteriosis.
• Mealy. This type of stool is usually thin, greenish, with mucus impurities. During a coprological examination, a lot of fiber, starch, neutral fat, mucus and leukocytes are found.
• Protein. The stool is hard, dry, crumbly. The study revealed lime and magnesium salts.

Complications

Hypotrophy is a dangerous condition for a baby. If this disease is not treated, lack of body weight can provoke the development of concomitant serious diseases. The second and third stages often give complications and are accompanied by:

• inflammation of the lungs;
• developmental delay, including mental;
• inflammation of the large and small intestines;
• rickets;

• anemia
• inflammation of the middle ear;
• the development of dysbacteriosis;
• violation of the enzymatic activity of the body.

Treatment

Treatment of malnutrition can be divided into four components. Each of them is important, but the effectiveness will be low if not used in combination:

• The first thing to do is to identify the cause of the disease and eliminate it.
• The next step is to establish proper care for the child. It is important to walk with him at least three hours a day (however, at a temperature not lower than 5 ° C), regularly massage, baths with warm water (about 38 ° C).
• Optimize the nutrition of a small patient. It is important that the baby receives the necessary amount of proteins, fats, carbohydrates.
• If necessary, use drug therapy.

Also, treatment can be conditionally divided into stages. Each of them requires a thoughtful approach and careful adherence to the doctor's advice:

• stage of adaptation;
• interim period;
• stage of enhanced nutrition.

Child care during recovery

Children with 1 and 2 degrees of malnutrition should be massaged regularly. All exercises must be performed by laying the child on his back, then turning over on his stomach. One of the conditions for the massage is the preparation of the room: a recognized expert in pediatrics, Dr. Komarovsky, notes that the room must be ventilated, and the air temperature is about 22˚С.

The simplest massage techniques:

• stroking hands and feet;
• spreading the arms to the sides and crossing them on the chest;
• massage of the abdomen with circular movements;
• flexion and extension of arms and legs;
• turning over on the stomach;
• the child should reflexively try to crawl, for this you need to put your palm under his heels and lightly press;
• foot massage.

There are other massage techniques that can be used depending on the condition of the child, as well as his age. With caution, massage is performed for those children who have been diagnosed with the 3rd degree of the disease. Stroking should be the main elements of such a massage.

Food

Diet therapy is the main method of treating malnutrition in both newborns and older children. It is necessary to organize a diet in compliance with the recommendations of a doctor. If you feed the baby immediately with the amount of food that is shown to him at this age, you can aggravate the condition, cause vomiting, indigestion, and weakness. We will outline the basic principles for calculating the number of feedings and the daily amount of food - they are unchanged for each stage of the disease.

This period is intended for a smooth transition from a critical state to the process of normalizing weight and setting appetite. Its duration and principles may vary and depend on factors such as the degree of the disease.

With 1 degree of malnutrition, the adaptation period is usually 1-3 days. On the first day, the child can eat 2/3 of the total diet. The number of feedings should not exceed 6-7 times a day. Regardless of the age of the baby, it should be fed only with mother's milk or a mixture.

The second degree of malnutrition implies a longer period of adaptation - up to seven days. The first day is very important - the total amount of the mixture on this day should be within ½ - 2/3 of the norm. In this case, you need to use a mixture intended for children younger than the patient by 2 months. The entire period of adaptation is necessary to gradually increase the number of feedings per day - by one or two. Since it is desirable to treat a baby with 2 degrees of malnutrition in a hospital, the child should receive a 5% glucose solution or glucose-salt preparations through a gastric tube. At the moment of reaching the calculated daily amount of nutrition, the patient proceeds to the next stage - intermediate or reparative.

During the treatment of the third degree of malnutrition, the adaptation period should be even longer - from 10 days to 2 weeks. On the first day, the volume of food eaten should be half the norm, and the number of feedings should be ten. Every day you need to increase the amount of food per day by 100 ml. During the adaptation period, it is necessary to gradually switch to 8 meals a day. This stage can be considered passed when the amount of food eaten per day will be equal to 1/5 of the child's body weight.

Stage 2 and 3 of therapeutic nutrition

At the second (reparation) stage, the amount of daily food is finally brought to the required norm, according to the weight and age of the child. In addition, special therapeutic mixtures are introduced into the diet.

The third stage involves enhanced high-calorie nutrition. At a rate of 100-120 kilocalories per day, the baby should receive 200. In order to achieve this goal, you can use high-protein mixtures, as well as add cereals from buckwheat, rice and corn to the diet.

Medical therapy

Drug treatment includes vitamin therapy - vitamins C, B12, B6, B1, A, folic acid are prescribed. To improve digestion, enzymes are prescribed: pancreatin, festal, creon, mexase (see also:). Also, the doctor may recommend hormonal and non-hormonal drugs with an anabolic effect. Of particular note are medicines containing L-carnitine, for example, Elkar (more in the article:). This drug is indicated for children with underweight, malnutrition - it stimulates appetite, increases overall tone.

If the baby has a severe form of malnutrition, he will be given a dropper with albumin, glucose, and special nutrition. Also, such patients are infused with blood, plasma, and hormonal preparations are prescribed.

Often this disease is accompanied by intestinal dysbacteriosis, then the doctor will recommend special preparations with beneficial bacteria that will help improve the functioning of the intestines. In addition, it is required to correct the functional disorders of the nervous system, so children are prescribed soothing herbal preparations, valerian, motherwort. Herbs in the form of tincture are given orally, and also added to bath water.

Forecast

The first and second stages of the disease respond well to treatment if the cause that led to the deficiency of body weight is identified. Proper nutrition, adequate child care will allow you to get the first results in a month. The prognosis for children diagnosed with the third stage of malnutrition is not so rosy. A lethal outcome is observed in 30-50% of cases, while the rest of the patients with the third stage of malnutrition may well have a history of quite serious diseases.

Prevention

Prevention of malnutrition is to eliminate the possible causes that can lead to such a condition. A pregnant woman should eat right, undergo examinations in a timely manner and give up bad habits. After the baby is born, you should follow the doctor's standard recommendations - breastfeed the newborn or formula if breastfeeding is not possible. It is also important to go outside with the baby every day, treat possible foci of infection in a timely manner, and keep chronic diseases under control.

Nutrition should be balanced: from six months, vegetable food is introduced into the baby's menu, closer to a year - meat, fish, eggs. It is important to observe the drinking regimen and make sure that the child drinks not only formula or breast milk, but also water, various teas, compotes. An infant should be shown to the pediatrician every month and control weighings and measurements of physical indicators should be carried out. At the first sign of a lag in weight or height, the cause of such deviations should be found and eliminated. Subject to all these recommendations, the likelihood of developing malnutrition will be minimized.

The body is reduced by 11-20% due, the mass-growth coefficient is 56-60 (normally more than 60). The fatness index of Chulitskaya reaches 10-15 (normally 20-25). The clinical symptoms of this condition are moderate restlessness, greed for food, decrease in the number of bowel movements, slight pallor of the skin, thinning of the subcutaneous fat in the trunk area. Psychomotor development corresponds to age. immunological reactivity and Tolerance, -i; and. 1. The ability of the organism to endure the unfavorable influence of some. factors. Lat. tolerance - patience. 2. The state of the body's immune system, in which it cannot synthesize antibodies in response to the introduction of a certain. antigen, but retains immune reactivity to other antigens; used in organ and tissue transplants. 3. Decrease in the effectiveness of drugs when they are used repeatedly. Syn: addiction.

HypotrophyII degree characterized by pronounced changes in all organs and systems. The child lags behind in weight by 21 - 30%, in height by 2 - 4 cm. The Chulitskaya index decreases to 10 - 0, the mass-height coefficient is below 56. Such children have poor appetite, periodically vomiting, unstable stools, and sleep disturbance. There is a lag in psychomotor development: the child does not hold his head well, does not sit, does not stand up, does not walk. Thermoregulation is disturbed. During the day, fluctuations in body temperature of more than one degree are observed. The subcutaneous fat is sharply thinned not only on the abdomen, but also on the trunk and limbs.

The skin is pale, pale gray; dryness and peeling of the skin (signs of polyhypovitaminosis) are noted. Reduced elasticity, turgor of tissues and muscles. (!LANG:Hair, pl. (sing. hair, -a; m.). Horny threads on the skin of mammals and humans, forming a hairline that protects the body from mechanical damage and heat loss; from keratin, are derivatives of the epidermis, but the hair follicles that give rise to V. are immersed in the dermis of the skin and are usually associated with the sebaceous glands, the life expectancy of V. in humans is about 2-4 years, then instead of the fallen out after 50-90 days appear new; V. contain pigments that determine their color, which changes over time due to depigmentation (graying) depending on age and individual characteristics.Diseases: alopecia, hypertrichosis, hirsutism, dermatoses, carbuncle, sycosis, trichophytosis, acne, favus , folliculitis, furuncle.

Almost every child with II degree malnutrition has rickets and (or) anemia.

HypotrophyIII degree usually develops in children who were born with symptoms of prenatal malnutrition, and premature. The lag in body weight exceeds 30%, in growth - more than 4 cm. The clinical picture is manifested by anorexia, a decrease in thirst, general lethargy, a decrease in interest in the environment, and a lack of active movements. The face is senile, expresses suffering, cheeks are sunken, Bish's lumps are absent. The subcutaneous fat layer is practically absent. The fatness index of Chulitskaya is negative. There is a delay in psychomotor development (previously acquired ones are lost).

Breathing shallow, sometimes noted Temporary or irreversible cessation of breathing with a decrease in the excitability of the respiratory center or its damage. From Greek. dpnoia - lack of breath.

Most patients have rickets, anemia, dysbacteriosis, septic course of infections.

Diagnostics.(!LANG:Diagnosis, -a; m. A brief medical report on the disease and the patient's condition, made on the basis of an anamnesis and a comprehensive examination. From Greek - recognition, diagnosis, -i; g. 1. A set of techniques and methods 2. Dialysis, m. excretion of toxic substances from the body with the introduction of a dialyzing solution into the abdominal cavity.

Differential Diagnosis

The disease is differentiated in order to determine the causative factor of malnutrition and identify the underlying disease.

Treatment

It is necessary to observe all the principles of complex treatment, depending on the degree of malnutrition.

Treatment of hypotrophy of the first degree is carried out at home and is aimed at eliminating alimentary factors that cause. With malnutrition II and III degree, the child is sent to the hospital to identify diseases that contribute to the development of malnutrition, and their treatment. At the same time, great importance is attached to the proper organization of the daily regimen and nutrition, child care.

Children are hospitalized in separate ward-boxes, which are allowed to be visited by a limited number of medical workers (in order to prevent infectious diseases in a child). The room is ventilated, wet cleaning is carried out 2 times a day. Temperature, -s; and. Physiol. An indicator of the thermal state of the human and animal organism, reflecting the ratio of heat production and heat transfer processes. Lat. temperatura from temperatio - the correct ratio, the normal state.

The general principles for malnutrition are:

1) the use in the nutrition of children of women's milk and adapted lactic acid mixtures ("Lactofidus", etc.), mixtures for feeding children with reduced body weight ("PreNan", "Alfare");

2) increase in the frequency of feeding up to 7 - 8-10 times (according to the degree of malnutrition);

3) weekly calculation of nutrition for, fats and, daily monitoring of the child's condition (keeping a food diary, control weighing, accounting for fluid balance, stool nature) and analysis of the coprogram (1 time in 3-4 days);

4) compliance with the principle of three-phase nutrition: the period of clarification of food tolerance (Table 12.1), the period of transitional and optimal nutrition.

At malnutritionI degree the calculation of nutrition during the period of diet therapy is carried out on the proper body weight. In the second period (transitional nutrition), protein deficiency is corrected (cheese, yolk, acidophilus paste, protein enpit), fat (fat enpit, vegetable oil, cream), carbohydrates (vegetables, fruits, cereals). In the third period, energy demand increases by 20% of the age norm.

At malnutritionII degree in the first period, careful individual feeding is carried out. The calculation of nutrition for proteins and carbohydrates is carried out on the actual body weight plus 20%, and - on the actual body weight. In the second period, the amount of food corresponds to the daily age requirement. Correction is carried out for proteins, fats and carbohydrates (see earlier). In the third period, the daily energy requirement also increases by 20% compared to the age norm.

At malnutritionIII degree in the first period, proteins and carbohydrates are calculated based on the proper body weight, and fat - only from the actual one. A larger volume of daily food requirement (75%) is replenished with liquid (vegetable and fruit decoctions, electrolyte solutions). With anorexia, low food tolerance, partial parenteral nutrition with amino acid mixtures (polyamine, new alvezin, amikin, levamine, protein hydrolysates) is prescribed. If there are indications, fatty en-pits, solutions with glucose (1 U / 5 g of glucose) are used. The management of the patient in the second and third period of diet therapy is carried out according to general principles (similar to malnutrition of I and II degrees).

The criteria for the effectiveness of diet therapy, depending on its period, are:

• at the first stage - improvement of emotional tone, daily increase in body weight by 25 - 30 g (the amount of food should correspond to that calculated according to the actual body weight);
• the second stage - in addition to an increase in body weight, appetite normalizes, the condition of the skin and subcutaneous
  fat layer, digestion of food, psychomotor development skills are restored;
• the third stage - body weight is completely restored, psychomotor development, the functional state of organs and systems of the body, immune status are normalized, concomitant deficient conditions (rickets, anemia, hypovitaminosis) are corrected.

Replacement enzyme therapy with pancreatic drugs Specialized organs or a group of cells that synthesize and secrete substances - secrets. Depending on the place of secretion, there are endocrine glands (endocrine), which do not have special excretory ducts and secrete the substances they produce - hormones - directly into the blood or lymph, and external secretion glands (exocrine), which have excretory ducts through which the secret is excreted either on the surface of the body (sweat, lacrimal, milk), or in hollow organs (for example, in the gastrointestinal tract and genitourinary system).

Anabolic drugs for malnutrition are used with caution, since in conditions of nutritional deficiency they can cause profound disturbances in protein and other types of metabolism. Retabolil is usually prescribed at a dose of 1 mg per 1 kg of body weight once every 2 to 3 weeks. Carnitine chloride has anabolic properties.

Vitamin therapy. Treatment and prevention of vitamin deficiency and many other diseases with the help of vitamins. From vitamin and therapy. vitamins, -ov; pl. (unit vitamin, -a; m.). Low molecular weight organic substances, which are indispensable nutrients for humans and animals, are coenzymes, that is, components of enzymes, which means that they are directly involved in all metabolic processes, o From lat. vita - life; the term was proposed in 1912 by the Polish scientist K. funk.

In order to stimulate the reduced defenses of the body (with II and III degrees of malnutrition), preference should be given to passive immunotherapy. In such cases, native plasma, plasma enriched with specific antibodies (antistaphylococcal, antipseudomonal, etc.), immunoglobulins are prescribed. During the period of re-convalescence, non-specific Immunostimulators, -ov; pl. (unit immunostimulant, -a; m.). A group of immunodrugs that stimulate or normalize the body's immune responses, immunotherapy, and; and. Method of treatment inf. and some other diseases through immunization.

To correct intestinal dysbiosis, courses of biological preparations (bifidumbacterin, bifikol, bactisubtil, etc.) and prebiotics (hilak-forte, duphalac, etc.) are prescribed. Rickets and iron deficiency anemia are being treated. The removal of a child from hypotrophy of the I degree takes 1 month, and from the II and III degrees - up to 3-5 months.

Forecast. With malnutrition, the prognosis depends on its cause, the presence of concomitant diseases, the age of the child, environmental conditions, and the severity of the condition.

With alimentary malnutrition of the first degree, the prognosis is usually favorable. Hypotrophy II and III degrees can lead in the future to disruption of the formation of the nervous and endocrine systems.

Prevention. Preventive measures include the timely treatment of pathology in a pregnant woman, the preservation of natural feeding with the rational introduction of complementary foods in children at 1 year of age, monitoring of the main anthropometric indicators in children who are bottle-fed, treatment of diseases accompanied by diarrhea, malabsorption syndrome, etc.

Vaccination. A form of active immunization, the use of vaccines for the specific prevention of various infectious diseases in humans and animals.