Treatment of hypotrophy of the 3rd degree. Treatment of malnutrition in young children. The cause of malnutrition in a child: congenital factors

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.

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, nephropathy, heart disease, hypertension) and her nervous breakdowns, constant depression;
• pregnancy pathologies (, toxicosis, premature birth, placental insufficiency);
• intrauterine infection of the fetus, its hypoxia.

Extrauterine malnutrition:

• congenital malformations up to chromosomal abnormalities;
• fermentopathy (, 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, tuberculosis;
• unfavorable sanitary and hygienic conditions: poor child care, rare exposure to the air, rare bathing, insufficient sleep.

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

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

Classification

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

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

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

Symptoms of childhood malnutrition

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

I degree

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

II degree

• impaired activity of the child (excitation, lethargy, lag in motor development);
• poor appetite;
• pallor, peeling, flabbiness of the skin;
• decreased muscle tone;
• loss of tissue turgor and elasticity;
• disappearance of the subcutaneous fat layer on the abdomen and limbs;
• dyspnea;
• tachycardia;
• 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, candidal stomatitis (thrush);
• alopecia (baldness);
• hypothermia, hypoglycemia or 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;
• 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.

Dystrophy in children (hypotrophy) is a chronic eating disorder, one of the main manifestations of which is a gradually developing child. There are mild and severe forms of dystrophy. A clear boundary between these forms is often difficult to determine. A far advanced form of dystrophy is called atrophy.

Etiology and pathogenesis. The reasons for the development of dystrophy in children are very diverse. It can be caused by external and internal factors. The most common cause (external factor) is malnutrition, both quantitatively and qualitatively. A quantitative lack of food is often associated with malnutrition and can be from the first days of a child's life (lack of milk in the mother, the presence of tight or flat and inverted nipples, lethargy). Insufficiently active sucking is more often observed in, as well as those born in and with intracranial. Getting enough food can interfere with all sorts of congenital (non-closure of the upper and solid, etc.). Hypotrophy also develops as a result of a lack or absence of one of the important components of food (for example, protein, vitamins, salts), if their correct ratio is violated. Qualitative errors in nutrition are more common with mixed and artificial feeding. Of great importance are unfavorable environmental conditions (non-compliance with the sanitary and hygienic regime, lack of air, light, etc.), improper care. There are children in whom dystrophy has developed mainly as a result of a lack of appetite under the influence of improper introduction of complementary foods, drugs, and force-feeding. Infections and chronic diseases contribute to the development of dystrophy due to metabolic disorders and the activity of regulatory mechanisms. Under all these circumstances, the food that enters the body does not cover its needs; as a result, the child's own reserves are used up, which leads to depletion. During starvation, the activity of all body systems is perverted, a violation of all types of metabolism develops. Such children have reduced body resistance and they are prone to all kinds of diseases that are difficult for them and often cause death.

Clinic. The main manifestation of dystrophy (hypotrophy) is a decrease in the subcutaneous fat layer, first of all on the abdomen, then on the chest, back, limbs and later on the face. Happens. slowing down and even stopping weight gain, it becomes less than normal.

There are three degrees of malnutrition. Hypotrophy 1 degree characterized by a lag in weight by 10 - 15%, but the child has a normal. There is a decrease in the subcutaneous fat layer on the abdomen and partially on the limbs. The skin color remains normal or somewhat pale, the general condition is not disturbed.

At hypotrophy of the 2nd degree the weight of the child lags behind the norm by 20-30%, there is also a slight lag in growth (by 1-3 cm). The subcutaneous fat layer is reduced everywhere. The child is pale, the tissues are reduced, the skin is going into folds, the muscles are flabby. The general condition is disturbed, it decreases, the mood becomes unstable, the development of static and motor functions worsens or is delayed.

Hypotrophy 3 degrees characterized by a weight loss of more than 30%, severe wasting and stunting. The subcutaneous fat layer is absent, the eyes sink, wrinkles appear on the forehead, the chin is pointed, the face is senile. The muscles are flabby, retracted, the large fontanelle sinks, the conjunctiva and cornea of ​​the eyes are prone to drying out and ulceration, breathing is shallow, slow, weak, muffled. Appetite is reduced, but there is a tendency to diarrhea. Urination is reduced. Hypochromic anemia develops, with a sharp thickening of the blood, the amount also increases. Children are depressed, their voice is aphonic, the development of static and motor skills, speech is delayed.

The diagnosis of dystrophy in children (hypotrophy) is established on the basis of the anamnesis, appearance of the child, clinical examination data, weight, height.

Hypotrophy treatment- complex, taking into account the individual characteristics of the child, the conditions under which the disease developed. In severe forms - symptomatic, pathogenetic and stimulating therapy. It is especially important to properly prescribe nutrition. So, with hypotrophy of the 1st degree, it is necessary first of all to assign a child nutrition based on the weight that he should have according to his age. With a lack of breast milk, the mother is prescribed supplementary feeding with donor milk or mixtures. With artificial feeding, women's milk and mixtures are temporarily prescribed.

With malnutrition of the 2nd degree, women's milk or sour mixtures are prescribed at the rate of 2/3 or% of the amount required for the given age of the child (see). If the child's weight is reduced by 20%, then the total amount of food is calculated on the actual weight. If more than 20%, then the calculation is carried out on the average weight, that is, on the actual plus 20% of it. The lack of food volume is replenished with fruit and vegetable broths, 5% glucose solution,. The number of feedings increases to 7-8 times a day.

After 5-7 days, when the child's condition improves, the amount of food increases, but the calorie content should not exceed 130-150 calories per 1 kg of body weight. If necessary, carry out a correction with proteins, and (carefully) with fats.

Nutrition is especially carefully prescribed for malnutrition of the 3rd degree. The daily calculation of nutrition is carried out on an average weight between the due and actual. In the first days of treatment, regardless of age, only half of the required amount is prescribed and only women's milk. If it is impossible to provide the child with a sufficient amount of human milk, acid mixtures are given. The lack of food volume is replenished by liquid. An increase in the daily amount of food is carried out very carefully, even with a clear trend towards improvement. Caloric intake per actual weight should not exceed 180 calories per 1 kg of body weight. All children with malnutrition need vitamins and. To improve appetite, appoint 1 / 2-1 teaspoon 5 times a day or 1% solution diluted with before feeding, 0.2 g 2 times a day an hour after meals for 7-10 days. The appointment of anabolic hormones is shown (see). Measures to combat dehydration are carried out as in toxic dyspepsia (see Dyspepsia in children). In severe cases, plasma and blood transfusions are recommended.

Prevention. Proper organization of the general regimen and feeding.

Depends on the degree of the disease, reactivity and timeliness of treatment.

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

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

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

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

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

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

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

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

Types of malnutrition

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

Congenital malnutrition

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

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

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

Acquired malnutrition

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

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

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

Diagnostics

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

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

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

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

Treatment of malnutrition in children

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

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

The diet for this diagnosis is as follows:

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

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

Lifestyle of children with malnutrition

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

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

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

How to recognize malnutrition

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

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

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

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

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

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

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

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

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

Causes of the disease

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

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

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

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

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

How is the disease diagnosed?

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

Degree 1

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

Degree 2

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

Degree 3

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

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

Chair with hypotrophy

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

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

Complications

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

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

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

Treatment

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

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

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

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

Child care during recovery

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

The simplest massage techniques:

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

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

Food

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

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

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

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

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

Stage 2 and 3 of therapeutic nutrition

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

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

Medical therapy

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

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

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

Forecast

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

Prevention

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

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

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

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

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

What is malnutrition and how often does it occur in children

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

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

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

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

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

Classification and reasons

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

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

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

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

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

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

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

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

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

Clinical manifestations

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Medications

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

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

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

Massage and exercise therapy

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

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

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

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

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

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

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

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

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