Hypotrophy of infants cold bath. Hypotrophy in young children: causes, symptoms, how to feed a child. Options for the course of pathology

Hypotrophy in a simplified form is a chronic malnutrition. This pathology is most often found in children at an early age. A child with malnutrition is far behind in growth and weight gain.

From the very first day of life, children rapidly gain weight. Everything grows in them: bones of the skeleton, muscle tissues, internal organs. If the kids do not receive sufficient amounts of food, or the diet is not made correctly, then this will very quickly affect the development of the body and the work of its various systems and organs.

Doctors say that the main reason for the development of malnutrition is a lack of protein in food and insufficient calorie intake.

The main causes of malnutrition in children

This pathology can develop under the influence of internal and external factors. Besides, malnutrition can be primary or secondary.

• Primary malnutrition in children develops against the background of malnutrition.
• Secondary malnutrition in children appears against the background of internal diseases, in which the absorption of nutrients from food is disturbed or even becomes impossible.

Internal factors that cause malnutrition in newborns include diseases of the internal organs associated with digestion. Simply put, due to these diseases, nutrients are not fully absorbed. It is worth noting that these are not necessarily diseases of the digestive system. These may be changes at the level of tissues and cells, manifested in the violation of metabolic processes. Because of them, the energy reserves in the cells are depleted, which leads to their death.

Internal causes of pathology

The most common internal causes of malnutrition in young children are:

Doctors say that internal factors that cause malnutrition in children are much more common than external ones. But this does not mean that the latter should not be taken into account. In order for malnutrition to occur under the influence of external factors, they must affect the child's body for a long time. This means that pathology can manifest itself not only in a lack of weight and height, but also in more serious violations that will certainly manifest themselves in the future.

External causes of malnutrition in children

External causes of this pathology include:

The symptoms of this pathology are mainly determined by the lack of nutrients in the baby's body. In second place are the symptoms of diseases that cause disturbances in the work of various organs. Doctors divide all symptoms into separate syndromes, combining a set of signs that occur when a disease of a particular organ or system occurs.

With malnutrition, 4 main syndromes are detected:

As a rule, each small patient with malnutrition manifests only one syndrome.

Doctors distinguish 3 degrees of malnutrition. This separation helps doctors more accurately determine the condition of the child and choose the right treatment. The levels change. At each stage of the pathology, additional symptoms appear in young patients.

Hypotrophy 1 degree

In children, it is manifested by a decrease in subcutaneous fat. This is due to the fact that the body, with a lack of nutrition, tries to compensate for energy costs due to subcutaneous fat, which is the best energy storage. Fat from the subcutaneous tissue enters the blood, where it is processed into the energy necessary for normal life.

First, fat disappears in the abdomen, and then from other parts of the body. Assessment of the state of adipose tissue is carried out using various methods. In recent years, doctors have given preference to the Chulitskaya index, based on measuring the circumferences of the shoulders, hips and legs.

Symptoms of hypotrophy of the 1st degree:

• Decreased muscle tone and elasticity of the skin.
• The growth of the child does not lag behind age indicators.
• Body weight lags behind the norm by 20%.
• Feeling within normal limits.
• The child gets tired quickly.
• The child does not sleep well and becomes irritable.

Hypotrophy of the 2nd degree

The initial symptoms are the same as in the 1st degree of pathology. The main difference lies in the deepening of the old symptoms and the appearance of new ones.

Main features:

Hypotrophy of the 3rd degree

At this stage of the disease, clinical manifestations become especially acute. There are violations in the work of all organs and systems. It is very difficult for doctors to get a small patient out of this condition. The severity of primary pathologies determines the possibility of further recovery. The most severe malnutrition of the 3rd degree is tolerated by newborns.

Characteristic signs of pathology:

Options for the course of pathology

Lack of mass and growth retardation can be observed in a baby at all stages of its development. At the same time, at each stage, the pathology has its own characteristics.

Depending on the period in which the pathology develops, doctors distinguish 4 variants of its course:

1. Intrauterine flow.
2. Hypostatura.
3. Kvishiorkor.
4. Alimentary insanity.

intrauterine course

Pathology develops when the child is still in the womb. Doctors distinguish 3 options for intrauterine malnutrition:

1. Hypotrophic. All organs of the fetus do not receive enough nutrients. Because of this, the child grows very slowly.
2. Hypoplastic. With this variant of the pathology, along with a delay in the overall development of the fetus, there is a violation in the maturation of organs.
3. Dysplastic. Different organs develop unevenly. Some of them correspond to the terms of pregnancy, while others do not.

Hypostatura

We are talking about a uniform lag of a newborn child in height and body weight from their peers.

Hypostatura is a secondary pathology that develops on the basis of diseases of the internal organs. It can manifest itself not only in newborns, but also in adolescents.

Most often, hypostatus is provoked by:

• Heart disease and circulatory disorders.
• Encephalopathy complicated by endocrine disorders.
• bronchopulmonary dysplasia. This pathology appears even in the period of intrauterine development and manifests itself in the insufficient development of the lung tissue, due to which the newborn does not receive enough oxygen during breathing.

Kwashiorkor

With this variant of the course of malnutrition, the body receives protein food in insufficient quantities or is not at all able to absorb protein products.

The development of kwashiorkor is promoted by:

• Long-term digestive problems, manifested by unstable stools.
• Problems with the liver.
• Diseases of the kidneys.
• Burns and significant blood loss.
• Some infectious diseases.

The lack of protein leads to disturbances in the work of the central nervous system. The child becomes lethargic, falls asleep at the first opportunity, does not want to eat. He may develop edema due to a lack of albumin and globulin in the blood. His muscle mass is rapidly declining.

Alimentary insanity

This course of malnutrition is most often detected in school-age children. This condition is characterized by a lack of proteins and calories. Alimentary insanity is accompanied by the following symptoms:

Conclusion

Hypotrophy in children is a rather dangerous disease. The prognosis of recovery depends on what causes the pathology. The earlier the disease is detected, the less damage it will cause to the health of the child.

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

Etiology

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

Exogenous causes of malnutrition

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

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

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

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

Endogenous causes of malnutrition

Perinatal encephalopathies of various origins

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

Syndrome of "short bowel" after extensive bowel resections.

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

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

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

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

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

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

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

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

Classification

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

Clinical picture

Hypotrophy I degree

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

Hypotrophy II degree

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

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

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

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

Hypotrophy III degree (marasmus, atrophy)

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

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

The curve of weight gain is negative, the patient is losing weight every day. Body weight is 30% or more less than the average in children of the corresponding height. The child sharply lags behind in growth. With secondary malnutrition of the III degree, the clinical picture is less severe than with primary ones, they are easier to treat if the underlying disease is identified and there is an opportunity to actively influence it.
Options for the course of malnutrition

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

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

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

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

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

Kwashiorkor

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

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

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

3) decreased protein synthesis in chronic liver diseases.

Symptoms

Common symptoms of kwashiorkor are:

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

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

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

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

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

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

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

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

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

Insanity alimentary (exhaustion)

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

Trophic status assessment

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

Anamnesis. Previous dynamics of body weight.

Typical dietary intake based on retrospective data.

Socio-economic status of the family.

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

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

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

physical data.

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

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

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

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

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

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

Abdominal cavity: protruding abdomen, hepatomegaly.

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

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

Functional indicators: reduced cognitive ability and performance.

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

Fragility of capillaries (increased).

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

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

Essential fatty acid deficiency

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

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

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

Diagnosis and differential diagnosis

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

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

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

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

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

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

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

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

Treatment

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

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

2) diet therapy;

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

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

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

diet therapy

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

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

1) the period of clarification of tolerance to food;

2) transitional period;

3) a period of enhanced (optimal) nutrition.

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

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

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

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

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

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

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

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

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

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

Interim period.

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

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

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

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

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

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

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

Care organization.

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

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

Correction of dysbacteriosis.

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

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

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

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

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

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

Forecast

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

Prevention

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

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

Causes of the disease

Correctly identified causes of malnutrition will help doctors prescribe the best treatment in each case. Factors of the prenatal or postnatal period can lead to a pathological malnutrition of a child.

Intrauterine malnutrition:

• unfavorable conditions for the normal development of the fetus during its gestation (bad habits of a woman, malnutrition, non-compliance with the daily regimen, environmental and industrial hazards);
• somatic diseases of the expectant mother (diabetes mellitus, pyelonephritis, nephropathy, heart disease, hypertension) and her nervous breakdowns, constant depression;
• pregnancy pathologies (preeclampsia, toxicosis, premature birth, fetoplacental insufficiency);
• intrauterine infection of the fetus, its hypoxia.

Extrauterine malnutrition:

• congenital malformations up to chromosomal abnormalities;
• fermentopathy (celiac disease, lactase deficiency);
• immunodeficiency;
• constitutional anomaly;
• protein-energy deficiency due to poor or unbalanced nutrition (underfeeding, sucking difficulties with flat or inverted nipples in the mother, hypogalactia, insufficient amount of milk formula, profuse regurgitation, micronutrient deficiency);
• poor nutrition of a nursing mother;
• some diseases of the newborn do not allow him to actively suckle, which means - to eat fully: cleft palate, congenital heart disease, cleft lip, birth trauma, perinatal encephalopathy, cerebral palsy, pyloric stenosis, alcohol syndrome;
• frequent SARS, intestinal infections, pneumonia, tuberculosis;
• unfavorable sanitary and hygienic conditions: poor child care, rare exposure to the air, rare bathing, insufficient sleep.

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

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

Classification

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

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

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

Symptoms of childhood malnutrition

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

I degree

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

II degree

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

III degree

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

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

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

Treatment of the disease

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

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

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

Prevention methods

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

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

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

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

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

Hypotrophy is a chronic malnutrition in babies, which is accompanied by a constant underweight in relation to the age and height of the infant. Often, malnutrition in children affects not only the insufficient development of muscle mass, but also psychomotor aspects, growth retardation, general lagging behind peers, and also causes a violation of skin turgor due to insufficient growth of the subcutaneous fat layer. Underweight (hypotrophy) in infants usually has 2 causes. Nutrients may enter the child's body in insufficient quantities for proper development or simply not be absorbed. In medical practice, malnutrition is distinguished as an independent type of violation of physiological development, a subspecies of dystrophy. As a rule, small children under the age of one year are susceptible to such a violation, but sometimes the condition persists up to 3 years, due to the peculiarities of the social status of the parents.

Degrees of malnutrition in children and symptoms of the disorder

First degree

The disease is characterized by a slight decrease in appetite, accompanied by sleep disturbance and frequent anxiety. The baby's skin usually remains practically unchanged, but has reduced elasticity and a pale appearance. Thinness is visible only in the abdomen, while muscle tone can be normal (sometimes slightly reduced). In some cases, 1 degree of malnutrition in young children may be accompanied by anemia or rickets. There is also a general decrease in the functioning of the immune system, from which babies get sick more often, look less well-fed in comparison with their peers. Some children may have indigestion leading to diarrhea or constipation.
Often, the 1st degree of violation remains almost imperceptible to parents, and only an experienced doctor can identify it with a thorough examination and diagnosis, during which he must find out if the thinness of the baby is a feature of his physique and a hereditary factor. For some children, being tall and thin is inherited from their parents, so a slender young mother should not worry that her baby does not look as well-fed as the rest, if at the same time he is active, cheerful and eats well.

Second degree

It is characterized by a lack of weight in children in the amount of 20-30%, as well as a lag in growth of the baby, on average by 3-4 cm. also the lack of warmth of the arms and legs. With malnutrition of the 2nd degree in newborns, there is a developmental delay not only in motor, but also mental, poor sleep, pallor and dry skin, frequent peeling of the epidermis. Baby's skin is not elastic, it easily gathers into folds. Thinness is strongly pronounced and affects not only the abdomen, but also the limbs, while the contours of the ribs are clearly visible in the baby. Children with this form of disorder are very often sick and have unstable stools.

Third degree

Babies with this form of impairment are severely stunted, on average up to 10 cm, and have a weight deficit of more than 30%. The state is characterized by severe weakness, an indifferent attitude on the part of the child to almost everything, tearfulness, drowsiness, as well as the rapid loss of many acquired skills. The thinning of the subcutaneous fatty tissue is clearly expressed throughout the body of the child, there is a strong atrophy of the muscles, dry skin, cold extremities. The color of the skin is pale with a grayish tinge. The lips and eyes of the baby are dry, cracks are observed around the mouth. Often in children there are various infectious diseases of the kidneys, lungs and other organs, for example, pyelonephritis, pneumonia.

Types of malnutrition

Violation in young children is divided into 2 types.

Congenital malnutrition

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

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

Acquired malnutrition

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

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

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

Diagnostics

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

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

Intrauterine malnutrition can be detected even during pregnancy during the next ultrasound, in which the doctor determines the size of the fetus and the estimated weight. If developmental disorders are detected, the expectant mother is sent to a hospital for a full examination and taking the necessary measures. In newborns, existing malnutrition can be determined by a neonatologist during an examination immediately after the birth of the baby. Acquired developmental disorder is usually detected by a pediatrician during a routine examination and the necessary measurements of height and weight. In this case, the doctor, in addition to conducting research, usually appoints consultations of other specialists, which helps to accurately establish the diagnosis and degree of malnutrition.

Treatment

Therapy for malnutrition is carried out depending on the degree of the disease. Postnatal malnutrition of the 1st degree is treated under normal outpatient conditions at home with mandatory strict adherence to all doctor's prescriptions. The second and third degrees require inpatient treatment, where specialists can constantly assess the baby's condition and the results of the treatment, which is aimed at eliminating the existing causes of malnutrition, organizing good care for the baby, and correcting metabolic abnormalities. The basis of the treatment of malnutrition is a special diet therapy, which is carried out in 2 stages. First, possible food intolerances in the infant are analyzed, after which the doctor prescribes a certain balanced diet with a gradual increase in food portions and its calorie content. The basis of diet therapy for malnutrition is fractional nutrition in small portions with a short period of time. The serving size is increased weekly, taking into account the necessary nutritional load during regular monitoring and examinations. In the course of therapy, adjustments are made to the treatment. Weakened babies who cannot swallow or suck on their own are fed through a special tube. Medical treatment is also carried out, in which the baby is prescribed vitamins, enzymes, taking anabolic hormones, adaptogens. In cases of a particularly serious condition of children with malnutrition, they are given intravenous infusions of special protein hydrolysates, saline solutions, glucose and essential vitamins. To strengthen muscle tone, kids are given exercise therapy and UVR, as well as a course of special massage.

Lifestyle of children with malnutrition

During the treatment of the child, parents must strictly comply with all the doctor's instructions. The main factors for the successful cure of the crumbs are the establishment of the correct regimen not only for feeding, but also for playing, sleeping and walking. With proper care and good nutrition, provided there are no metabolic disorders and other congenital (acquired or chronic) diseases, babies quickly gain weight and are quite capable of catching up with the parameters of their healthy peers. It is important to prevent the appearance of malnutrition in infants and it lies in the correct behavior of the expectant mother during the bearing of the crumbs. Registration at a polyclinic (special center or private clinic) should take place in the early stages of pregnancy, already during the first month. It is important to pass all the scheduled examinations and studies on time, not to miss scheduled appointments and consultations of specialists. A special moment in the prevention of malnutrition in a child is the nutrition of the expectant mother, it must be balanced, provide the body with all the necessary substances not only for its existence, but also for the development of the fetus. Timely examination allows you to identify the existing violation in time and take the necessary measures to eliminate it even before the birth of the crumbs.

How to recognize malnutrition in a child?

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Hypotrophy in children- this is the deviation of the actual body weight from the physiological age norms. This is an alimentary disease, which is characterized by a decrease in the amount or complete absence of the subcutaneous fat layer. In rare cases of hereditary metabolic disorders, malnutrition in children is associated with insufficient muscle mass. Muscular hypotrophy in children is complicated by dysfunctions of internal organs, heart failure and dystrophy subsequently. The classification of malnutrition in children is carried out in accordance with the indicators of the lag in weight gain:

• 1 degree diagnosed with a loss of body weight by 10-20%;
• 2 degree- this is the abandonment of the actual body weight from the physiological age norm by 21-40%;
• 3 degree- loss of more than 42% of normal body weight for age.

Why does fetal hypotrophy develop?

Fetal hypotrophy- this is a condition in which the actual weight of the child in utero is determined below the physiological level corresponding to the gestational age. The main provoking factors:

• toxicosis of pregnancy;
• nephropathy of a pregnant woman;
• a large amount of amniotic fluid;
• infectious diseases of the expectant mother;
• exacerbation of chronic diseases of internal organs;
• nutritional deficiencies in women.

Fetal hypotrophy is diagnosed by ultrasound. After diagnosis, the obstetrician should take measures to eliminate the causes of fetal hypotrophy.

How is malnutrition diagnosed in newborns?

After birth, malnutrition in newborns can be diagnosed at the first examination. The child is weighed and the data of his height and weight are compared. The doctor assesses the condition of the turgor of the skin and the thickness of the subcutaneous fat layer. With deviations from the norm, a diagnosis of underweight is established. In the newborn period, malnutrition in children can develop under the influence of:

• congenital disorders of the development of the digestive system;
• insufficiency of milk in the mother;
• improperly chosen scheme of artificial and mixed feeding;
• enzymatic deficiency;
• lactose intolerance;
• frequent colds and infectious diseases.

When diagnosing, the indicator of body weight gain is of decisive importance.

Symptoms of malnutrition in children

During the diagnosis, the main symptoms of malnutrition in children are distinguished:

• insufficient body weight;
• decrease in physical and mental activity;
• decrease in skin turgor;
• dry mucous membranes and skin;
• reduction in the amount of subcutaneous adipose tissue.

To prescribe the correct method of treatment, the cause of malnutrition should be identified. In newborns, this phenomenon is often associated with nutritional deficiencies or disorders of the gastrointestinal tract.

Treatment of malnutrition in children

Treatment of malnutrition in children begins with the diagnosis and elimination of the causes that form the complex of clinical symptoms. The diet and calorie content of the diet are adjusted. When breastfeeding, attention is paid to the diet of the mother. A high protein intake is recommended. If necessary, the diet of a nursing woman is supplemented with vitamin and mineral complexes. If these measures do not help within 1-2 weeks, then the child is transferred to a mixed type of feeding. The doctor recommends mixtures that are most suitable for the baby in terms of age and type of physiological characteristics. If the malnutrition of newborns is associated with lactose intolerance, then breastfeeding is completely replaced with artificial one using mixtures without milk protein.

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Hypotrophy in children is starvation, quantitative or qualitative, as a result of which significant changes occur in the body. Qualitative starvation is possible with improper artificial feeding, lack of essential nutrients and vitamins, quantitative - with incorrect calculation of caloric content or lack of food resources. Hypotrophy can be the result of acute diseases or the result of a chronic inflammatory process. Wrong actions of parents - lack of regimen, poor care, unsanitary conditions, lack of fresh air - also lead to this condition.

What does a normally developing baby look like?

Signs of normotrophic:

• healthy look
• The skin is pink, velvety, elastic
• A lively look, activity, studies the world around with interest
• Regular increase in weight and height
• Timely mental development
• Proper functioning of organs and systems
• High resistance to adverse environmental factors, including infectious ones
• Rarely cries

In medicine, this concept is used only in children under 2 years of age. According to WHO, malnutrition is not ubiquitous:

• in developed countries, its percentage is less than 10,
• and in developing countries - more than 20.

According to scientific studies, this deficiency condition occurs approximately equally in boys and girls. Severe cases of malnutrition are observed in 10-12 percent of cases, with rickets in a fifth of children, and anemia in a tenth. Half of the children with this pathology are born in the cold season.

Causes and development

The causes of malnutrition in children are diverse. The main factor causing intrauterine malnutrition is toxicosis of the first and second half of pregnancy. Other causes of congenital malnutrition are as follows:

• pregnancy before the age of 20 or after 40 years
• bad habits of the expectant mother, poor nutrition
• chronic diseases of the mother (endocrine pathologies, heart defects, and so on)
• chronic stress
• work of the mother during pregnancy in hazardous production (noise, vibration, chemistry)
• placental pathology (improper attachment, early aging, one umbilical artery instead of two, and other placental circulation disorders)
• multiple pregnancy
• metabolic disorders in the fetus of a hereditary nature
• genetic mutations and intrauterine anomalies

Causes of acquired malnutrition

Internal- caused by pathologies of the body that disrupt food intake and digestion, absorption of nutrients and metabolism:

• congenital malformations
• CNS lesions
• immunodeficiency
• endocrine diseases
• metabolic disorders

In the group of endogenous factors, food allergies and three hereditary diseases that occur with malabsorption syndrome, one of the common causes of malnutrition in children, should be singled out separately:

• cystic fibrosis - disruption of the external secretion glands, affected by the gastrointestinal tract, respiratory system
• celiac disease - gluten intolerance, changes in the work of the intestines in a child begin from the moment gluten-containing foods are introduced into the diet - barley groats, semolina, wheat porridge, rye groats, oatmeal
• lactase deficiency - the digestibility of milk is impaired (lack of lactase).

According to scientific studies, malabsorption syndrome provokes malnutrition twice as often as nutritional deficiencies. This syndrome is characterized primarily by a violation of the chair: it becomes plentiful, watery, frequent, frothy.

External- due to the wrong actions of parents and an unfavorable environment:

All exogenous factors in the development of malnutrition cause stress in the child. It has been proven that light stress increases the need for energy by 20%, and for protein - by 50-80%, moderate - by 20-40% and 100-150%, strong - by 40-70 and 150-200%, respectively.

Symptoms

Signs and symptoms of intrauterine malnutrition in a child:

• body weight below the norm by 15% or more (see below the table of the dependence of weight on the height of the child)
• growth is less by 2-4 cm
• the child is lethargic, muscle tone is low
• congenital reflexes are weak
• thermoregulation is impaired - the child freezes or overheats faster and stronger than normal
• in the future, the initial weight is slowly restored
• umbilical wound does not heal well

Acquired malnutrition is characterized by common features in the form of clinical syndromes.

• Insufficient fatness: the child is thin, but the proportions of the body are not violated.
• Trophic disorders (malnutrition of body tissues): the subcutaneous fat layer is thinned (first on the abdomen, then on the limbs, in severe cases and on the face), the weight is insufficient, body proportions are disturbed, the skin is dry, elasticity is reduced.
• Changes in the functioning of the nervous system: depressed mood, decreased muscle tone, weakened reflexes, psychomotor development is delayed, and in severe cases, acquired skills even disappear.
• Decreased perception of food: appetite worsens up to its complete absence, frequent regurgitation, vomiting, stool disorders appear, the secretion of digestive enzymes is inhibited.
• Reduced immunity: the child begins to get sick often, chronic infectious and inflammatory diseases develop, possibly toxic and bacterial damage to the blood, the body suffers from general dysbacteriosis.

Degrees of malnutrition in children

Hypotrophy of the 1st degree is sometimes practically not noticeable. Only an attentive doctor on examination can identify it, and even then he will first conduct a differential diagnosis and find out if a body weight deficit of 11-20% is a feature of the child's physique. Thin and tall children are usually so due to hereditary characteristics. Therefore, a new mother should not be afraid if her active, cheerful, well-nourished child is not as plump as other children. Hypotrophy of the 1st degree in children is characterized by a slight decrease in appetite, anxiety, sleep disturbance. The surface of the skin is practically not changed, but its elasticity is reduced, the appearance may be pale. The child looks thin only in the abdomen. Muscle tone is normal or slightly reduced. Sometimes they show signs of rickets, anemia. Children get sick more often than their well-fed peers. Stool changes are insignificant: a tendency to constipation or vice versa. Hypotrophy of the 2nd degree in children is manifested by a mass deficit of 20-30% and growth retardation (about 2-4 cm). Mom can find cold hands and feet in a child, he can often spit up, refuse to eat, be lethargic, inactive, sad. Such children lag behind in mental and motor development, sleep poorly. Their skin is dry, pale, flaky, easily folded, inelastic. The child looks thin in the abdomen and limbs, and the contours of the ribs are visible. The stool fluctuates greatly from constipation to diarrhea. These kids get sick every quarter.

Sometimes doctors see malnutrition even in a healthy child who looks too thin. But if the growth corresponds to age, he is active, mobile and happy, then the lack of subcutaneous fat is explained by the individual characteristics and high mobility of the baby.

With hypotrophy of the 3rd degree, growth retardation is 7-10 cm, weight deficit is ≥ 30%. The child is drowsy, indifferent, tearful, acquired skills are lost. The subcutaneous fat is thinned everywhere, pale gray, dry skin fits the baby's bones. There is muscle atrophy, cold extremities. Eyes and lips dry, cracks around the mouth. A child often has a chronic infection in the form of pneumonia, pyelonephritis.

Diagnostics

Differential Diagnosis

As mentioned above, the doctor first needs to figure out whether malnutrition is an individual feature of the body. In this case, no changes in the work of the body will be observed.
In other cases, it is necessary to conduct a differential diagnosis of the pathology that led to malnutrition: congenital malformations, diseases of the gastrointestinal tract or the endocrine system, lesions of the central nervous system, infections.

Treatment

The main directions of treatment of malnutrition in children are as follows:

• Identification of the cause of malnutrition, its elimination
• Proper care: daily routine, walks (3 hours daily, if outside ≥5˚), gymnastics and professional massage, bathing in warm baths (38 degrees) in the evening
• Organization of proper nutrition, balanced in proteins, fats and carbohydrates, as well as vitamins and microelements (diet therapy)
• Medical treatment

Treatment of congenital malnutrition consists in maintaining a constant body temperature in the child and establishing breastfeeding. Nutrition of children with malnutrition Diet therapy for malnutrition is divided into three stages.

The main directions of drug therapy

• Replacement therapy with pancreatic enzymes; drugs that increase the secretion of gastric enzymes
• The use of immunomodulators
• Treatment of intestinal dysbacteriosis
• vitamin therapy
• Symptomatic therapy: correction of individual disorders (iron deficiency, irritability, stimulant drugs)
• In severe forms of malnutrition - anabolic drugs - drugs that promote the formation of building protein in the body for muscles and internal organs.

Treatment of malnutrition requires an individual approach. It is more correct to say that children are nursed, not treated. Vaccinations for hypotrophy of the 1st degree are carried out according to the general schedule, for hypotrophy of the 2nd and 3rd degrees - on an individual basis.

Study of the causes and symptoms of malnutrition in children

In one of the somatic hospitals, 40 case histories of children diagnosed with hypertrophy (19 boys and 21 girls aged 1-3 years) were analyzed. The conclusions were obtained as a result of the analysis of specially designed questionnaires: most often, children with malnutrition were born from a pregnancy that proceeded with pathologies, with heredity for gastrointestinal pathologies and allergic diseases, with intrauterine growth retardation.

Prevention of malnutrition in children

Prevention of both intrauterine and acquired malnutrition begins with the struggle for the health of the woman and for the preservation of long-term breastfeeding. The following areas of prevention are tracking the main anthropometric indicators (height, weight), monitoring the nutrition of children. An important point is the timely detection and treatment of childhood diseases, congenital and hereditary pathologies, proper child care, and prevention of the influence of external factors in the development of malnutrition. It should be remembered:

• Mother's milk is the best and irreplaceable food for a baby up to a year old.
• At 6 months, the menu should be expanded with plant foods (see how to properly introduce complementary foods to a child). Also, do not transfer the child to adult food too early. Weaning from breastfeeding up to 6 months of the child is a crime against the baby, if there are problems with lactation, the child does not have enough milk, you must first apply it to the breast and only then supplement it.
• Variety in nutrition is not different types of cereals and pasta throughout the day. A complete diet consists in a balanced combination of proteins (animal, vegetable), carbohydrates (complex and simple), fats (animal and vegetable), that is, vegetables, fruits, meat, dairy products must be included in the diet.
• As for meat - after a year it must be present in the child's diet - this is an indispensable product, there can be no talk of any vegetarianism, only meat contains the compounds necessary for growth, they are not produced in the body in the amount that is needed for full development and health.
• Important!!! There are no safe drugs "just" to reduce or increase a child's appetite.

Table of dependence of weight on height in children under 4 years old

Very strong deviations in the weight of the child are not due to reduced appetite or some individual characteristics of the body - this is usually due to an unrecognized disease or lack of good nutrition in the child. A monotonous diet, nutrition that does not meet age-related needs - leads to a painful lack of body weight. The weight of the child should be controlled not so much by age as by the growth of the baby. Below is a table of the dependence of the height and weight of the baby (girls and boys) from birth to 4 years:

• Norm is the interval between GREEN and BLUE weight value (25-75 centiles).
• Weight loss- between YELLOW and GREEN figure (10-25 centiles), however, it may be a variant of the norm or a slight tendency to reduce body weight in relation to height.
• Weight gain- between BLUE and YELLOW number (75-90 centiles) is both normal and indicates a trend towards weight gain.
• Increased or reduced body weight- between RED and YELLOW number indicates both low body weight (3-10th centile) and increased (90-97th centile). This may indicate both the presence of the disease and the characteristics of the child. Such indicators require a thorough diagnosis of the child.
• Painful weight loss or gain- per RED border (>97 or
  

There is nothing worse for parents than the illness of their child. And when a baby is sick, still inexperienced parents often cannot cope with it in time, because they do not know the main symptoms of diseases and what they can lead to. This article will focus on such a pathological condition as malnutrition, which is often found in infants.

What is hypotrophy? Types of malnutrition and the main danger.

Hypotrophy is a chronic nutritional disorder in a child, which is characterized by an energy and / or qualitative lack of nutrients, which leads to a lack of body weight of the baby, impaired physical and intellectual development, pathological changes in all organs and systems. The disease affects mainly children under 3 years of age. In different countries, the frequency of malnutrition varies from 2 to 30%, depending on the economic and social development of the country.

There are two types of malnutrition:

• congenital;
• acquired.

Congenital or intrauterine malnutrition is a malnutrition that occurs even in the period of intrauterine development of the child.

The main causes of congenital fetal malnutrition:

• insufficiency of uteroplacental circulation;
• chronic fetal hypoxia;
• chromosomal and genomic mutations;
• pathology of pregnancy;
• constitutional features of the mother's body (small stature, body weight, age);
• mother's bad habits;
• malnutrition in pregnant women.

Acquired malnutrition is a chronic eating disorder of a child, which is characterized by a slowdown or cessation of the growth of the baby's body weight, a violation of normal body proportions, thinning and disappearance of subcutaneous fatty tissue, a violation of the digestive processes, a decrease in the body's resistance to infections, a predisposition to various diseases and a delay in neuropsychic development . It is this type of malnutrition that occurs most often and brings a lot of grief to young parents, therefore, further we will talk about this violation.

Physiological weight loss in newborns

Before you panic due to the fact that the child stopped gaining weight after birth or lost several hundred grams, you need to be aware of such a phenomenon as physiological weight loss in newborns.

It occurs in all babies, regardless of what weight was at birth. The mechanism of this phenomenon is as follows. Before birth, all metabolic processes in the body of the fetus are strongly activated, which provides it with the necessary energy during childbirth and in the first hours of independent life. Also, in the first days of a baby’s life, his body loses more fluid than it consumes (with breathing, feces, evaporation through the skin).

The newborn loses weight until about the 4th day of life, from the 5th day the baby should begin to gain weight again and by the 7-10-14th day his weight should again be the same as at birth, if this does not happen, then you need to look for the cause (such a phenomenon already considered pathological and requires intervention). The rate of weight loss is up to 7% of the original, if more, then this is already a pathology.

Proper care of the child, early breastfeeding, sufficient fluid intake in the child's body, prevents greater weight loss. If physiological weight loss has not occurred, then it is necessary to think about possible reasons. Most often this is due to congenital disorders of the excretory system, due to which fluid accumulates in the child's body.

Etiology of acquired malnutrition

There are many reasons for acquired malnutrition and it is not always possible to establish why the child is not gaining weight.

The main causes of acquired malnutrition:

• nutritional factors (quantitative or qualitative malnutrition of the infant, violation of the feeding regime, the use of low-energy formulas for feeding);
• diseases of the child's digestive tract;
• chronic and acute infectious diseases (pneumonia, SARS, sepsis, intestinal infections, etc.);
• poor child care;
• hereditary diseases;
• congenital malformations;
• anomalies of the constitution (diathesis);
• neuroendocrine diseases.

Clinical signs and degrees of malnutrition

The clinical picture of the disorder is dominated by 4 main syndromes.

1. Syndrome of trophic disorders.

It includes such signs as a lack of mass and / or body length for the child's age, various violations of body proportions, gradual thinning and disappearance of subcutaneous fatty tissue, the skin becomes dry, inelastic, and the child's muscles become thinner over time.

2. Syndrome of violation of the state of the central nervous system.

It includes violations of the emotional state (the child cries all the time) and reflex activity (all reflexes weaken). The baby sucks poorly or refuses to breastfeed at all, the muscle tone is reduced, the child moves little, does not roll over, does not hold his head well, etc. The baby’s sleep is disturbed, he does not keep a stable body temperature well.

3. Syndrome of reduced food tolerance.

Over time, the child's appetite decreases until the development of anorexia, he refuses to breastfeed. Disorders of the digestive tract develop (regurgitation, unstable stool, vomiting).

4. Syndrome of reducing the body's resistance (immunological reactivity).

The child becomes prone to frequent inflammatory and infectious diseases.

Depending on the severity of the signs of the disease and weight loss, there are 3 degrees of malnutrition.

Hypotrophy 1 degree:

• weight deficit is 10-20%;
• the child's condition is satisfactory;
• PZhK is moderately thinned only on a stomach;
• tissue turgor is moderately reduced;
• the skin is pale, their elasticity is slightly reduced;
• no growth lag;
• psychomotor development is not disturbed;
• food tolerance is not impaired;
• immunological reactivity is normal.

Hypotrophy 2 degrees:

• body weight deficit 20-30%;
• the condition of the child is moderate;
• The pancreas becomes thinner on the abdomen, limbs and torso;
• tissue turgor is reduced;
• the skin is pale, dry, its elasticity is reduced;
• growth lag is 1-3 cm;
• psychomotor development slows down;
• immunological and food tolerance are reduced.

Hypotrophy 3 degrees:

• weight deficit is more than 30%;
• complete disappearance of PZhK;
• the child's condition is severe;
• tissue turgor is sharply reduced;
• there is no elasticity of the skin, ulcers, cracks appear on the skin;
• growth lags behind by 3-5 cm;
• significant lag in psychomotor development;
• immunological and food tolerance is sharply reduced.

Principles of treatment of malnutrition

Hypotrophy of the 1st degree is treated on an outpatient basis, and 2nd and 3rd degrees - only in a hospital.

The main directions of therapy:

• elimination of the cause of malnutrition;
• diet therapy;
• correction of metabolic disorders;
• organization of proper care;
• therapy for comorbidities.

The basis of the treatment of malnutrition is diet therapy, which has 3 stages: the elimination of the syndrome of reduced food tolerance, the increase in food loads, the complete elimination of malnutrition in a child. A gradual increase in caloric content and volume of food leads to an improvement in the child's condition, he gradually begins to
gain mass. If children have a weakened sucking or swallowing reflex, then they are fed with a probe. The missing volume of fluid is administered intravenously.

In the complex of treatment, doctors prescribe enzymes, vitamins, microelements, preparations for the normalization of intestinal microflora, anabolic hormones.

The prognosis for malnutrition of 1 and 2 degrees with timely access to a doctor and diet therapy started on time is favorable. With malnutrition of the 3rd degree, despite intensive treatment, mortality reaches 20-50%.

To prevent this condition in your baby, it is enough to follow a few recommendations. Regularly visit the district pediatrician to examine the child and take all anthropometric measurements. Adhere to all the principles of proper nutrition for your child, introduce complementary foods and complementary foods on time. It is necessary to control the dynamics of the growth of the child's body weight, organize proper care, and eliminate risk factors for the development of malnutrition.

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

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

Causes of the disease

Correctly identified causes of malnutrition will help doctors prescribe the best treatment in each case. Factors of the prenatal or postnatal period can lead to a pathological malnutrition of a child.

Intrauterine malnutrition:

• unfavorable conditions for the normal development of the fetus during its gestation (bad habits of a woman, malnutrition, non-compliance with the daily regimen, environmental and industrial hazards);
• somatic diseases of the expectant mother (diabetes mellitus, pyelonephritis, nephropathy, heart disease, hypertension) and her nervous breakdowns, constant depression;
• pregnancy pathologies (preeclampsia, toxicosis, premature birth, fetoplacental insufficiency);
• intrauterine infection of the fetus, its hypoxia.

Extrauterine malnutrition:

• congenital malformations up to chromosomal abnormalities;
• fermentopathy (celiac disease, lactase deficiency);
• immunodeficiency;
• constitutional anomaly;
• protein-energy deficiency due to poor or unbalanced nutrition (underfeeding, sucking difficulties with flat or inverted nipples in the mother, hypogalactia, insufficient amount of milk formula, profuse regurgitation, micronutrient deficiency);
• poor nutrition of a nursing mother;
• some diseases of the newborn do not allow him to actively suckle, which means - to eat fully: cleft palate, congenital heart disease, cleft lip, birth trauma, perinatal encephalopathy, cerebral palsy, pyloric stenosis, alcohol syndrome;
• frequent SARS, intestinal infections, pneumonia, tuberculosis;
• unfavorable sanitary and hygienic conditions: poor child care, rare exposure to the air, rare bathing, insufficient sleep.

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

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

Classification

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

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

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

Symptoms of childhood malnutrition

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

I degree

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

II degree

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

III degree

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

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

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

Treatment of the disease

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

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

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

Prevention methods

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

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

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

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

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

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

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

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

Degrees of malnutrition in children and symptoms of the disorder

First degree

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

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

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

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

Second degree

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

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

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

Third degree

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

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

Types of malnutrition

Violation in young children is divided into 2 types.

Congenital malnutrition

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

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

Acquired malnutrition

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

Endogenous factors include:

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

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

Diagnostics

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

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

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

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

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

Treatment

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

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

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

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

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

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

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

Lifestyle of children with malnutrition

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

With proper care and good nutrition, provided there are no metabolic disorders and other congenital (acquired or chronic) diseases, babies quickly gain weight and are quite capable of catching up with the parameters of their healthy peers.

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

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

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

How to recognize malnutrition in a child?

Hypotrophy of the newborn is discrepancy between his weight and height to normal indicators for this period.

This deviation is considered quite common, most often the disease is diagnosed among patients who abuse bad habits and do not follow their diet.

What do you need to know?

Causes of the disease

In newborns, a lot depends on the weight, weight compliance with the standards is a sign of normal development.

Hypotrophy can be congenital, acquired and mixed, the causes of the disease are different.

Congenital malnutrition often occurs as a result of disorders provoked by various complications of the course of pregnancy:

• intrauterine infection;
• pathology of the umbilical cord and implants;
• acute diseases, exacerbations of chronic;
• propensity to miscarriage;
• polyhydramnios;
• toxicosis.

The lifestyle of a pregnant woman also plays an important role:

• malnutrition;
• stress;
• physical exercise;
• work in hazardous industries;
• smoking, drug, alcohol abuse.

Under the influence of the above factors, the supply of nutrients and oxygen to the fetus from the mother is disrupted, as a result of which malnutrition develops.

Improper feeding, diseases of the gastrointestinal tract - all these factors lead to poor absorption of carbohydrates, fats, proteins, energy-rich substances.

With mixed form diseases, social, infectious or alimentary consequences are added to negative intrauterine factors.

In children with acquired malnutrition lack of weight is not associated with malformations and heredity, their general condition is quite encouraging, mental and physical development corresponds to the gestational age.

Infants with congenital disorders are considered more vulnerable in terms of survival and further mental development.

Symptoms and signs

In appearance, children with intrauterine dystrophy can be divided into two groups, the first one is underweight children with no or slight stunting, to the second- developmental delay affects not only weight and height, but also head circumference.

Children from the second group practically no different from premature babies, the presence of malnutrition is determined after familiarization with their gestational age.

This type of pathology has received the designation hypostatura or hypoplastic type.

The aggravating factors of pregnancy, which provoked developmental delay in this case, appear in the second trimester of pregnancy.

In newborns with underweight and growth retardation, but with a normal head circumference, the disease manifests itself in the form of physical imbalances, the signs may resemble those of hydrocephalus.

With intrauterine hypotrophy various lesions of the skin can occur from barely noticeable dryness to severe wrinkling up to the effect of parchment.

Pathology can be local and widespread, most often the inner surface of the feet and palms is affected.

Dry skin all over body is considered a severe case of malnutrition, regardless of the correspondence of its weight and growth to the gestational age, in this case we are not talking about patients with ichthyosis.

Degrees of the disease

Three degrees of malnutrition:

1. I (light) degree- lag in weight 10-20% of the norm, growth is normal.
2. II (medium) degree- deviation from the norm of weight - 20-30%, height - 2-3 cm.
3. III (severe) degree- weight lag is 30%, deviations in growth are significant.

What causes the disease

Speaking of complications, it is also necessary to mention the degree of the disease, hypotrophy of the 1st degree practically does not affect the development of the child.

Due to insufficient weight, there may be an increased tendency to hypothermia, but with breastfeeding and proper care, weight gain is easy.

With hypotrophy of the second and third degree the situation is more complicated, it must be taken into account that due to a lack of nutrients, the formation of internal organs is disrupted, incl. nervous system, which can lead to negative consequences.

The cause of mental deviations (oligophrenia, imbecility) of children of alcoholics and drug addicts is chronic intoxication of the mother's body, as well as a deficiency of substances necessary for development.

Complications

Complications of malnutrition are not always encountered, in some newborns, the adaptation process proceeds without any difficulty.

In others, growth retardation is accompanied by violations of life-important functions provoked by complications during pregnancy.

The most common complication poor nutrition in late pregnancy is hypoxia.

Prolonged hypoxia is accompanied by clouding of the amniotic fluid and skin, as a result of which the membranes and the umbilical cord acquire a yellow-green tint.

This pathology has a definition - Clifford syndrome (placental dysfunction). Most often, pathology occurs in post-term fetuses, however, the syndrome is diagnosed only in 20% of infants born after the term.

In most cases, these babies develop severe forms of respiratory distress, sometimes there are signs of liver enlargement, heart enlargement.

Breathing problems can occur even after successful resuscitation.

Another common complication is pneumothorax., which develops due to rupture of the alveoli.

Pathology usually develops in the first hours after birth and manifests itself in the form of a sudden deterioration in the functioning of the respiratory system, in some cases even the disappearance of heart sounds is diagnosed.

Treatment

Treatment of malnutrition involves an integrated approach

Within the framework of which diet therapy, medication and vitamins are provided.

For older children, massage, physiotherapy exercises, physiotherapy are provided.

Which doctor should I contact?

The most important role in the treatment of the disease is played by diet therapy, which depends on the severity of the disease and appointed individually by a pediatrician.

Parents should follow his recommendations as closely as possible.

How is malnutrition treated?

With hypotrophy of the first degree, treatment at home is allowed, daily the baby should receive the same amount of food as newborns with normal weight, the number of meals increased from 6 to 7 times.

Sugar can be added to milk and cereals when they are included in the diet.

The child additionally receives enzymes and vitamins prescribed by the doctor.

The main difficulty in feeding a newborn with malnutrition is that the baby needs an increased amount of nutrients.

At the same time, the resistance of the child's gastrointestinal tract to stress is reduced, enhanced nutrition can provoke indigestion, which can further aggravate the situation.

Newborns with the second and third degree of malnutrition temporarily placed in a hospital, in which the body adapts to normal food intake, in severe cases, nutrient solutions are administered intravenously.

As part of therapy, the number of meals is increased and its volume is reduced.

Treatment also includes drug therapy., within which vitamins, enzymes, metabolic stimulants are prescribed, the next stage, babies begin to be given skim milk, subsequently the diet is supplemented with cereals and sugar, cream and butter.

With effective treatment, children's appetite normalizes, positive emotions appear, the condition of the skin and soft tissues improves, weight increases daily by 20-25 g, digestion improves, mental and physical skills are restored.

Do you need special care and nutrition?

When treating malnutrition, it is necessary to establish whether the baby is sick with something else.

In the presence of other diseases, therapy begins with their elimination.

An important role in this case is played by cleanliness of the room which must be constantly maintained.

special care must be taken when preparing food.

Prevention

To prevent the development of intrauterine malnutrition it is necessary to exclude all harmful effects on the body, it is recommended to avoid stress, adhere to a healthy lifestyle, eat right, take vitamins

An infant should be fed an appropriate amount of food for its age, it is recommended to visit the pediatrician regularly for weighing.

A woman should pay great attention to her diet, during and after pregnancy.

With congenital pathology and genetic mutations, metabolism and digestion are different, therefore you must strictly adhere to the diet prescribed by the doctor.

Summing up

Hypotrophy in newborns is quite common, women are at risk, abusing bad habits, not watching their diet.

The severity of the disease is determined by the lag in the weight and height of the child from the norm.

Treatment involves a special diet, which is prescribed individually by a doctor.

To prevent the development of the disease It is recommended to lead a correct lifestyle, monitor nutrition.

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