Hypotrophy in children. Hypotrophy in young children: main symptoms
There is nothing worse for parents than their child's illness. And when a baby is sick, inexperienced parents often cannot cope with it in time, because they do not know the main symptoms of the disease and what they can lead to. This article will talk about this pathological condition, like malnutrition, which is common in infants.
What is malnutrition? Types of malnutrition and the main danger.
Hypotrophy is a chronic nutritional disorder in a child, which is characterized by energy and/or quality deficiency nutrients, which leads to a deficiency of the baby’s body weight, impairment of his physical and intellectual development, pathological changes in all organs and systems. The disease mainly affects children under 3 years of age. IN various countries the frequency of malnutrition varies from 2 to 30%, which depends on the economic and social development countries.
There are two types of malnutrition:
- congenital;
- acquired.
Congenital or intrauterine malnutrition is a nutritional disorder that occurs even in the period intrauterine development child.
Main reasons congenital malnutrition fetus:
- insufficiency of uteroplacental circulation;
- chronic fetal hypoxia;
- chromosomal and genomic mutations;
- pathology of pregnancy;
- constitutional features of the mother’s body ( short stature, body weight, age);
- mother's bad habits;
- Poor nutrition of a pregnant woman.
Acquired malnutrition is a chronic nutritional disorder of a child, which is characterized by a slowdown or cessation of the increase in the baby’s body weight, a violation of normal body proportions, thinning and disappearance of subcutaneous fatty tissue, disruption of digestive processes, a decrease in the body’s resistance to infections, and a predisposition to various diseases and delay neuropsychic development. It is this type of malnutrition that occurs most often and brings a lot of grief to young parents, so we will discuss this disorder further.
Physiological weight loss in newborns
Before you panic because your baby has stopped gaining weight after birth or has lost several hundred grams, you need to be aware of the phenomenon of physiological weight loss in newborns.
It occurs in all babies, regardless of their birth weight. The mechanism of this phenomenon is as follows. Before birth, all metabolic processes in the fetus’ body are greatly 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, bowel movements, evaporation through the skin).
A newborn loses weight until approximately the 4th day of life, from the 5th day the baby should begin to gain weight again and by 7-10-14 days his weight should again be the same as at birth, if this does not happen, then you need to look for the reason (this phenomenon is already considered pathological and requires intervention). The norm for weight loss is up to 7% of the original, if more, then this is already a pathology.
Proper child care, early breastfeeding, sufficient fluid intake into the child’s body, prevents big loss weight. If physiological weight loss has not occurred, then you need to think about possible reasons. Most often this is due to congenital disorders excretory system, which causes fluid to accumulate 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 a child does not gain weight.
The main causes of acquired malnutrition:
- nutritional factors (quantitative or qualitative malnutrition of the infant, violation of the feeding regime, use of low-energy formulas for feeding);
- diseases digestive tract child;
- chronic and acute infectious diseases (pneumonia, ARVI, sepsis, intestinal infections etc.);
- poor child care;
- hereditary diseases;
- birth defects development;
- constitutional anomalies (diathesis);
- neuroendocrine diseases.
Clinical signs and degrees of malnutrition
IN clinical picture disorders are dominated by 4 main syndromes.
1. Trophic disorder syndrome.
Includes such signs as deficiency of weight and/or body length for the child’s age, various disorders body proportions, gradual thinning and disappearance of subcutaneous fat tissue, the skin becomes dry, inelastic, and over time the child’s muscles also become thinner.
2. Central dysfunction syndrome nervous system.
Includes violations emotional state(the child cries all the time) and reflex activity(all reflexes weaken). The baby sucks poorly or refuses at all, muscle tone is reduced, the baby moves little, does not roll over, does not hold his head well, etc. The baby's sleep is disturbed, he does not maintain a stable body temperature.
3. Syndrome of decreased food tolerance.
Over time, the child’s appetite decreases until anorexia develops, and he refuses to breastfeed. Disorders of the digestive tract develop (regurgitation, unstable chair, vomit).
4. Syndrome of decreased body resistance (immunological reactivity).
The child becomes prone to frequent inflammatory and infectious diseases.
Depending on the severity of signs of the disease and loss of body weight, 3 degrees of malnutrition are distinguished.
Hypotrophy 1st degree:
- weight deficit is 10-20%;
- the child's condition is satisfactory;
- The pancreas becomes moderately thinner only on the abdomen;
- tissue turgor is moderately reduced;
- the skin is pale, its elasticity is slightly reduced;
- no growth retardation;
- psychomotor development is not impaired;
- food tolerance is not impaired;
- immunological reactivity is normal.
Hypotrophy 2nd degree:
- body weight deficiency 20-30%;
- the child's condition 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 retardation is 1-3 cm;
- psychomotor development slows down;
- immunological and food tolerance are decreasing.
Hypotrophy 3 degrees:
- weight deficit is more than 30%;
- complete disappearance of PFA;
- the child's condition is serious;
- tissue turgor is sharply reduced;
- There is no elasticity of the skin, ulcers and cracks appear on the skin;
- growth lags behind by 3-5 cm;
- significant delay in psychomotor development;
- immunological and food tolerance is sharply reduced.
Principles of treatment of malnutrition
Hypotrophy of the 1st degree is treated in outpatient setting, and grades 2 and 3 - only in a hospital.
Main directions of therapy:
- eliminating the cause of malnutrition;
- diet therapy;
- correction of metabolic disorders;
- organizing proper care;
- therapy concomitant diseases.
The basis for the treatment of malnutrition is diet therapy, which has 3 stages: elimination of the syndrome of reduced food tolerance, increasing food loads, and complete elimination of malnutrition in the child. A gradual increase in calorie content and volume of food leads to an improvement in the child’s condition; he gradually begins to
gain weight. If children have weakened sucking or swallowing reflex, then they are fed using a tube. The missing volume of fluid is administered intravenously.
As part of the treatment, doctors prescribe enzymes, vitamins, microelements, and drugs to normalize intestinal microflora, anabolic hormones.
The prognosis for grade 1 and 2 malnutrition is favorable if you consult a doctor in a timely manner and diet therapy is started on time. With grade 3 malnutrition, despite intensive treatment, mortality reaches 20-50%.
To prevent this condition from occurring in your baby, it is enough to follow a few recommendations. Visit your local pediatrician regularly to examine your child and take all anthropometric measurements. Adhere to all principles proper nutrition your child, introduce supplementary feeding and complementary feeding on time. It is necessary to monitor the dynamics of the child’s weight gain, organize proper care, eliminate risk factors for the development of malnutrition.
Hypotrophy (Greek hypo - low, and trophe - nutrition) is akin to dystrophy, it is also expressed in the lack of physical development of children, but in addition it leads to serious violations metabolic processes in organism. In the first months of life, a baby's bones and muscle tissue, and sufficiently gained total body weight indicates its harmonious development.
If the body weight is insufficient, then failures in the child’s life support system will not take long to occur. Lack of vitamins and microelements will not allow full development children's body, but a deficiency of protein - the building material of cells, as well as a lack of calories - energy for carrying out metabolic processes in the body is especially dangerous for him. Pathological process can begin from malnutrition, and as a result of some kind of disease or harmful factor leading to incomplete absorption of food.
Factors provoking malnutrition
Internal causes of impaired trophism of body tissues:
1. Functional failures in digestive system: They do not allow the baby to fully absorb the nutrients necessary for the baby. This can happen both in the gastrointestinal tract (gastrointestinal tract) and at the cellular level in the tissue substance itself. Disruption of metabolic processes in a cell leads to depletion of its energy reserves, and when a critical value is reached, the cell may die.
2. Fetal encephalopathy on different stages intrauterine development, which in turn leads to the fact that a developing central nervous system with abnormalities can cause dysfunction of any internal organ.
3. Immature lung tissue. Blood unsaturated with oxygen cannot carry it to sufficiently tissues, which slows down metabolism and inhibits the full development of the entire organism.
4. Congenital pathology Gastrointestinal tract, leading to systematic constipation or vomiting (for example, Hirschsprung's disease).
5. “Short bowel” syndrome – consequences of abdominal surgery.
6. Crashes immune system hereditary nature, weakening the body's defenses.
7. Disrupted work endocrine system. For example, diseases thyroid gland lead to a slowdown in both growth and metabolic processes in the body, and deviations in the functioning of the pituitary gland cause pituitary dwarfism - insufficient production of growth hormone.
8. Hereditary diseases associated with metabolic disorders. An example is galactosemia - intolerance to milk and any dairy products or fructosemia, which causes a similar attitude of the child’s body to fructose contained in both vegetables and fruits.
External factors cause malnutrition much less frequently. If their impact is long-lasting, then in the future they can affect not only growth and physical development child, but also general state his body and the performance of organs. These include:
1. Chronic malnutrition due to the characteristics of the mother’s breasts or the small amount of milk she has, and the child himself may not be fully developed lower jaw or the frenulum of the edge of the tongue is shortened. Illiterate use of ready-made formulas for feeding babies or untimely introduction of complementary foods can play a big role in underfeeding.
2. Decreased immunity of the baby, provoked by any infection (bacterial, viral) different stages pregnancy or child's life. Presence of pyelonephritis, infections urinary system and damage to the intestinal mucosa in to a large extent slow down the development of the body, because it spends a lot of time fighting the pathogens of these diseases vital energy(up to half of total costs).
3. Impact toxic substances, including medicines, and overdose of vitamins (especially A and D).
Stages of the disease
For better control over the general condition of the child with malnutrition and the appointment of adequate treatment, the disease is usually divided into degrees. This division is purely arbitrary, because the course of the disease is continuous and it is difficult to draw a clear line between stages. In newborns, grade 1 malnutrition is diagnosed if the child was born after the 38th week with a weight not exceeding 2800 g and a body length of less than 50 cm.
If the disease is acquired at some stage of the child’s life, then to determine its degree it is necessary to calculate the body condition index (FII), introduced by Professor Chulitskaya and accepted domestic medicine. The method is based on measuring (in centimeters) the circumferences of the shoulder at two points, the hip and the lower leg and summing these results, and then subtracting the baby’s height from the resulting amount. Fully up to a year developing baby must have an IUL indicator of at least 20 cm.
To give a detailed description of each degree of the disease, it is necessary to consider malnutrition syndromes (the entire set of symptoms of the affected organ). There are several of them:
1. Violation of the trophism of organ tissues due to the slow occurrence of metabolic processes in the body. This leads to a decrease total mass body, including the subcutaneous fat layer, as well as lethargy and flabbiness skin.
2. Dysfunction of the digestive organs, and the whole body suffers gastrointestinal tract: The stomach does not produce enough pepsin and acid, and the intestines do not have enough enzymes to process food. Therefore, with malnutrition, the presence of stool disorders and flatulence is quite understandable.
3. Functional disruptions in the child’s central nervous system, which is expressed in his hyperexcitability, sleep disturbance, apathy and decreased muscle tone.
4. Disrupted hematopoietic process, expressed in anemia, and a significant decrease protective functions immune system. Such children are susceptible to many infectious diseases, the leading symptoms of which are atypical and vague.
Removing a child from a pathological condition
How do doctors determine the degree of malnutrition? First of all, according to body weight deficiency for the corresponding age of the child (all pediatricians have a correspondence table) and the Chulitskaya index.
For malnutrition of the 1st degree it is characteristic:
- the presence of a weight deficit of 10% - 20% of the original;
- IUL varies between 10 and 15 cm;
- thinning of the fat layer on the abdomen and loss of elasticity of the skin;
- rapid fatigue and restless sleep;
- presence of irritability;
- satisfactory general condition of the baby.
Treatment is carried out at home and involves split meals (8 times a day). Food should be easily digestible, preference is given to cereals, fresh fruit and vegetables.
Grade 2 is characterized by aggravation of all existing disorders:
- the presence of a weight deficit of 20% - 30% of the original;
- IUL varies between 1 and 10 cm;
- complete absence of fat on the abdomen and chest, dry and pale skin;
- degradation muscle mass on the limbs and weakness of the entire muscle corset;
- noticeably impaired thermoregulation;
- the appearance of dysbacteriosis;
- delayed closure of the small and large fontanel;
- nervousness and moodiness;
- exposure to frequent infectious diseases of a protracted nature.
Treatment can be carried out at home, but if possible, it is better to give preference to a hospital. The principle used fractional meals, but the portions are reduced in volume. The food should be easily digestible; in addition, a course of biostimulants, a vitamin-mineral complex and enzymes should be prescribed to improve digestion.
With third degree malnutrition, the full clinical picture of the disease is already evident. The child's condition is very serious, and in the absence necessary measures possible and death. The complexity of the situation also lies in the fact that the effectiveness of the measures taken to remove the child from this situation is low. Even by appearance It’s clear how exhausted his body is:
- the presence of a weight deficit of more than 30% of the original;
- IUCH is zero or will be negative;
- lack of fat on the entire body, even on the face, and the skin is so thin that it resembles the dried skin of a mummy;
- released with fingers skin fold does not straighten out for a long time, sunken cheeks and protruding cheekbones are visible on the face;
- the thermoregulation center in the brain does not function, and body temperature changes abruptly;
- a clear lack of iron leads to “sticking” in the corners of the lips, and a lack of vitamins (primarily A and C) leads to bleeding and atrophy of gum tissue;
- the appearance of symptoms of osteoporosis, expressed in the softness of the cranial bones;
- because of sharp decline protective forces the baby gets sick very often and for a long time infectious diseases(inflammatory processes of the middle ear or kidneys, often pneumonia);
- overexcitation of the central nervous system followed by apathy towards everything.
Treatment of grade 3 malnutrition is carried out only in inpatient conditions, since all types of metabolic processes, functions of organs and systems in the body are completely disrupted. Such babies require intravenous glucose infusion and blood or plasma transfusions. Appointed course treatment hormones, enzyme maintenance therapy, and taking essential vitamins and microelements.
Hypotrophy in children is starvation, quantitative or qualitative, as a result of which significant changes occur in the body. The disease is complex, which is based on starvation of the child’s body - malnutrition in children.
It is necessary to treat malnutrition in children based on the degree of the disease. On initial stage To treat a disease, it is necessary to eliminate the cause that caused it.
Treatment of malnutrition should be aimed at eliminating primary disease, as well as secondary infections, otherwise it cannot be effective.
Treatment of sick children with malnutrition should be comprehensive. It includes: identifying the cause and eliminating it; diet therapy, organization of rational care, regimen; massage and gymnastics; identification and treatment of foci of infection and other concomitant diseases; enzyme therapy, vitamin therapy, stimulating therapy; symptomatic therapy.
Treatment of malnutrition in children involves changing the regime, diet and caloric intake of the child and the nursing mother; if necessary, parenteral correction of metabolic disorders.
Basis proper treatment malnutrition is diet therapy. It should be taken into account that how an insufficient amount food ingredients and their excess adversely affect the condition of a child suffering from malnutrition. Based on many years of experience in treating children with this disease by representatives of different schools, the following dietary therapy tactics have now been developed.
The implementation of diet therapy for malnutrition in children is based on fractional frequent feeding child, weekly calculation of food load, regular monitoring and correction of treatment.
With grade I malnutrition, food tolerance is quite high. Children tolerate food loads well, so they can receive age-appropriate food. Proteins, fats and carbohydrates are calculated per 1 kg of required weight.
In the treatment of children with stage II malnutrition, two periods are distinguished: pre-repair and reparation. The pre-repair period for stage II malnutrition is usually 7-10 days. During this period, the patient’s tolerance to food is determined. From food products, the patient receives either human milk or products that replace it ( cow's milk, sour milk formulas, adapted milk formulas).
The daily volume of food is reduced to 2/3 of the required volume. The missing water is replenished with liquid ( boiled water, tea, 5% glucose solution, etc.). During this period (in the first days) the child receives food in 8 doses, i.e. every 2.5 hours. Subsequently, with good food tolerance (no vomiting, regurgitation, diarrhea), the volume of food can be increased by 100-150 ml for each subsequent day daily ration. If the volume exceeds 2/3 of the daily food ration, the child begins to be fed after 3 hours, i.e. 7 times. After the child begins to cope with the required amount of food, we can assume that the pre-repair period is over.
During the reparation period, nutritional correction is made, complementary foods are introduced according to general rules. At first, carbohydrates and proteins are prescribed per 1 kg of the required weight, and fats - per approximately the required weight.
In the treatment of children with grade III malnutrition, two periods are also distinguished: pre-repair and reparation period. Since food tolerance in stage III malnutrition is significantly lower compared to stage II malnutrition, the food load is carried out even more carefully. The pre-reparation period lasts 14-20 days or more. On the first day, nutritional calculations can be made based on the energy expended by the child on basal metabolism (65-70 kcal per 1 kg of actual body weight). This is approximately 2 parts of the required daily amount of food.
For a child suffering from grade III malnutrition, food in the form of expressed breast milk(or its substitutes) is given in 10 doses, i.e. every 2 hours, observing a 6-hour night break. Subsequently, with normal tolerance of this volume of food, it can be increased by 100-150 ml every 2 days. The end of the pre-repair period can be judged on the basis of good tolerance of human milk or its substitutes in a volume normal for a given age. During the repair period for grade III hypotrophy, the tactics are similar to those for grade II hypotrophy.
During the period of determining food tolerance, enzyme therapy is widely used. For this purpose, use a 1% solution of diluted of hydrochloric acid, pepsin, abomin, natural gastric juice, festal At high content in the coprogram of patients with neutral fat and fatty acids Pancreatin is prescribed.
Vitamin therapy in the treatment of patients with malnutrition is used for both replacement and stimulating purposes. In the first days of treatment of the disease, vitamins are administered parenterally, then given orally: ascorbic acid 50-100 mg, vitamins B 1 25-50 mg, B 6 50-100 mg per day, then alternating courses of treatment with vitamins A, PP, B 15, B 5, E are carried out, folic acid, vitamin B 1 2 in age-specific doses.
Stimulating therapy is a mandatory part of the treatment of malnutrition in children. It consists of prescribing alternating courses of treatment with apilak, dibazole, pantocrine, ginseng and other agents. In case of severe malnutrition, especially when combined with diseases of an infectious nature, γ-globulin is administered, a 10% albumin solution, protein, plasma are injected intravenously, and blood is transfused.
In the treatment of malnutrition II and III degrees in children, the use of anabolic drugs is indicated steroid hormones: nerabola (daily orally 0.1-0.3 mg/kg), retabolil (1 mg/kg once every 2-3 weeks).
Symptomatic therapy depends on the clinical picture of malnutrition. When treating anemia, it is advisable to use iron supplements and blood transfusions from the mother (if the blood group and Rh factor are compatible and there is no history of hepatitis). In the case of a combination of malnutrition and rickets, after the end of the period of determining food tolerance, therapeutic doses of vitamin D are prescribed (with mandatory monitoring according to the Sulkovich reaction!). Therapy for symptomatic malnutrition, in addition to diet therapy, should be aimed at treating the underlying disease.
Sick children with malnutrition of the first degree in the absence of severe concomitant diseases can be treated at home, children with malnutrition of the second and third degrees - in a hospital setting. The patient should be in a bright, spacious, well-ventilated room; The ambient temperature should be at least 24-25° C and not higher than 26-27° C, since a child with severe degrees of malnutrition easily becomes hypothermic and overheated.
It is important to create a positive emotional tone in the child and pick him up more often. Positive influence provide warm baths (water temperature 38°C), which can be performed daily. Mandatory components Treatments include massage and gymnastics.
Update: December 2018
Hypotrophy in children is starvation, quantitative or qualitative, as a result of which significant changes occur in the body. High-quality fasting is possible with the wrong artificial feeding, lack of basic nutrients and vitamins, quantitative - in case of incorrect calculation of calorie content or lack of food resources.
Hypotrophy may be a consequence of previous acute diseases or the result of chronic inflammatory process. Wrong actions of parents - lack of routine, poor care, unsanitary conditions, lack of fresh air– also lead to this condition.
What does a baby who is developing normally look like?
Signs of normotrophic:
- Healthy looking
- The skin is pink, velvety, elastic
- Lively look, active, exploring the world around him with interest
- Regular increase in weight and height
- Timely mental development
- Proper functioning of organs and systems
- High resistance unfavorable factors external environment, including infectious
- Rarely cries
In medicine, this concept is used only in children under 2 years of age. According to WHO, malnutrition is not widespread:
- in developed countries its percentage is less than 10,
- and in developing countries – more than 20.
According to scientific research, such deficit state It occurs approximately equally in both boys and girls. Severe cases of malnutrition are observed in 10-12 percent of cases, and in a fifth of children it is accompanied by rickets, and in a tenth by anemia. Half of the children with this pathology are born during the cold season.
Causes and development
The causes of malnutrition in children are varied. Main factor, which causes intrauterine hypotrophy, is toxicosis of the first and second half of pregnancy. Other causes of congenital malnutrition are:
- 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, etc.)
- chronic stress
- mother's work during pregnancy in hazardous work (noise, vibration, chemicals)
- pathology of the placenta (improper attachment, early aging, one umbilical artery instead of two and other placental circulatory disorders)
- multiple pregnancy
- hereditary metabolic disorders in the fetus
- genetic mutations and intrauterine anomalies
Causes of acquired malnutrition
Domestic- 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, it is worth highlighting separately food allergies and three hereditary diseases, which occur with malabsorption syndrome - one of common reasons malnutrition in children:
- cystic fibrosis - a disorder of the exocrine glands, affecting the gastrointestinal tract and respiratory system
- , changes in a child’s intestinal function begin from the moment gluten-containing products are introduced into the diet – barley grits, semolina, wheat porridge, rye cereal, oatmeal
- — the digestibility of milk is impaired (lactase deficiency).
According to scientific research, malabsorption syndrome provokes malnutrition twice as often as nutritional deficiency. This syndrome is characterized primarily by impaired stool: it becomes copious, watery, frequent, and foamy.
External- conditional wrong actions parents and unfavorable environment:
All exogenous factors in the development of malnutrition cause stress in the child. It has been proven that mild 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 hypotrophy in a child:
- body weight below normal by 15% or more (see below table of the relationship between weight and height of the child)
- height is 2-4 cm less
- the child is lethargic, muscle tone is reduced
- innate reflexes are weak
- thermoregulation is impaired - the child freezes or overheats faster and stronger than normal
- subsequently the original weight is slowly restored
- umbilical wound does not heal well
Acquired malnutrition is characterized by common features in the form of clinical syndromes.
- Lack of nutrition: the child is thin, but the body proportions are not disturbed.
- Trophic disorders(malnutrition of body tissues): the subcutaneous fat layer is thinned (first on the stomach, then on the limbs, with severe course and on the face), the mass is insufficient, the body proportions are disturbed, the skin is dry, the 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 food perception: appetite worsens to the point of its complete absence, frequent regurgitation, vomiting, stool disorders, discharge digestive enzymes oppressed.
- Decreased immunity: the child begins to get sick often, chronic infectious and inflammatory diseases develop, possibly toxic and bacterial infection blood, the body suffers from general dysbiosis.
Degrees of malnutrition in children
Hypotrophy of the first degree is sometimes almost invisible. Only an attentive doctor can identify it during an examination, and even then he will first differential diagnosis and find out whether a body weight deficiency of 11-20% is a feature of the child’s physique. Children who are thin and tall are usually so due to hereditary characteristics. Therefore, a young mother should not be alarmed if her active, cheerful, well-nourished child is not as well-fed as other children.
Hypotrophy 1st degree in children it is characterized slight decrease appetite, anxiety, sleep disturbance. The surface of the skin is practically unchanged, but its elasticity is reduced, and the appearance may be pale. The child looks thin only in the abdominal area. Muscle tone is normal or slightly decreased. Sometimes signs of rickets and anemia are detected. Children get sick more often than their well-fed peers. Changes in stool are minor: tendency to constipation or vice versa.
Hypotrophy 2nd degree in children it manifests itself as a 20-30% weight deficit and stunted growth (about 2-4 cm). The mother may notice that the child has cold hands and feet, he may burp frequently, refuse to eat, be lethargic, inactive, and sad. Such children are lagging behind in mental and motor development and sleep poorly. Their skin is dry, pale, flaky, easily wrinkled, and inelastic. The child appears thin in the abdomen and limbs, and the outline of the ribs is visible. Stool fluctuates greatly from constipation to diarrhea. Such children get sick every quarter.
Sometimes doctors see malnutrition even in healthy child who looks too thin. But if the height corresponds to his 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.
For malnutrition of the 3rd degree growth retardation 7-10 cm, weight loss ≥ 30%. The child is drowsy, indifferent, whiny, acquired skills are lost. The subcutaneous fat is thinned everywhere, pale gray, dry skin stretches over the baby’s bones. There is muscle atrophy, the limbs are cold. The eyes and lips are dry, there are cracks around the mouth. The child often has 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 functioning of the body will be observed.
In other cases, it is necessary to carry out a differential diagnosis of the pathology that led to malnutrition: congenital defects, diseases of the gastrointestinal tract or endocrine system, damage to the central nervous system, infections.
Treatment
The main directions of treatment of malnutrition in children are as follows:
- Identifying the cause of malnutrition and eliminating it
- Proper care: daily routine, walks (3 hours daily, if it’s ≥5˚ outside), gymnastics and professional massage, swimming 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)
- Drug treatment
Treatment of congenital malnutrition consists of maintaining the child's constant temperature body and establishing breastfeeding.
Nutrition for children with malnutrition
Diet therapy for malnutrition is divided into three stages.
| Stage 1 – the so-called “rejuvenation” of the diet | that is, they use food products intended for children more younger age. The child is fed frequently (up to 10 times a day), the diet is calculated based on actual body weight, and a diary is kept to monitor food absorption. The stage lasts 2-14 days (depending on the degree of malnutrition). |
| Stage 2 – transitional | Added to the diet medicinal mixtures, optimize nutrition to the approximate norm (according to the weight that the child should have). |
| Stage 3 – period of enhanced nutrition | The calorie content of the diet increases to 200 kilocalories per day (with the norm being 110-115). Special high-protein mixtures are used. For celiac disease, gluten-containing foods are excluded, fats are limited, and buckwheat, rice, and corn are recommended for the diet. In case of lactase deficiency, remove milk and dishes prepared with milk from foods. Instead they use dairy products, soy mixtures. For cystic fibrosis - a diet with high calorie content, food should be salted. |
Main directions of drug therapy
- Pancreatic enzyme replacement therapy; drugs that increase the secretion of gastric enzymes
- Use of immunomodulators
- Treatment of intestinal dysbiosis
- Vitamin therapy
- Symptomatic therapy: correction of individual disorders (iron deficiency, increased excitability, stimulant drugs)
- At severe forms malnutrition – anabolic drugs– medications that promote the formation of building protein in the body for muscles and internal organs.
Treatment of malnutrition requires individual approach. It would be more correct to say that children are nursed rather than treated. Vaccinations for malnutrition of the 1st degree are carried out according to a general schedule, for malnutrition of the 2nd and 3rd degrees - on an individual basis.
Research into 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 1-3 years old) were analyzed. The conclusions were obtained as a result of the analysis of specially designed questionnaires: most often, children with malnutrition were born from pregnancies that occurred with pathologies, with heredity for gastrointestinal tract pathologies and allergic diseases, with intrauterine growth retardation.
| Common causes of malnutrition in children: |
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Prevention of malnutrition in children
Prevention of both intrauterine and acquired malnutrition begins with the fight for the woman’s health and for maintaining long-term breastfeeding.
The following areas of prevention are tracking basic anthropometric indicators (height, weight), monitoring children’s nutrition.
An important point is timely detection and treatment of diseases childhood, congenital and hereditary pathologies, proper child care, preventing influence external factors development of malnutrition.
Things to remember:
- Mother's milk is the best and irreplaceable food for a baby up to one year old.
- At 6 months the menu should be expanded with plant food(cm. ). Also, do not transfer your child to early adult food. Weaning a child from breastfeeding before 6 months is a crime against the baby; if problems arise, you must first put him to the breast and only then supplement him.
- Variety in nutrition is not different types porridge and pasta throughout the day. A nutritious diet consists of a balanced combination of proteins (animal, vegetable), carbohydrates (complex and simple), fats (animal and vegetable), that is, the diet must include vegetables, fruits, meat, and dairy products.
- As for meat - after a year it must be present in the child’s diet - this is an irreplaceable product, there can be no talk of any vegetarianism, only meat contains compounds necessary for growth, they are not produced in the body in the quantities needed for full development and health.
- Important!!! There are no safe medicines“simply” to reduce or increase the child’s appetite.
Table of weight versus height in children under 4 years of age
Very strong deviations in a child’s weight do not occur due to decreased appetite or any other individual characteristics body - this is usually due to an unrecognized disease or lack of good nutrition The child has. A monotonous diet, nutrition that does not meet age-related needs, leads to painful underweight. The child’s weight should be controlled not so much by age as by the baby’s height. Below is a table of the relationship between the height and weight of a baby (girls and boys) from birth to 4 years:
- Norm- this is the interval between GREEN And BLUE weight value number (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 decrease body weight in relation to height.
- Weight gain- between BLUE And YELLOW number (75-90 centiles) is both normal and indicates a tendency towards weight gain.
- Increased or decreased body weight- between RED And YELLOW the number indicates both low body weight (3-10th centile) and increased body weight (90-97th centile). This may indicate both the presence of a disease and the characteristics of the child. Such indicators require a thorough diagnosis of the child.
- Painful weight loss or gain- behind RED border (>97 or<3 центиля). Ребенок с таким весом нуждается в установлении причины гипотрофии или ожирения и корректировки питания и назначения лечения, массажа и пр. , поскольку это является проявлением какого-либо заболевания и опасно негармоничным развитием органов, систем организма, снижению сопротивляемости к инфекциям и негативным факторам окружающей среды.
Parents should not always be blamed for the occurrence of malnutrition in children. It happens that the mother has enough milk, but the baby sucks the breast reluctantly. Or the woman’s nipple is strongly retracted, and the baby is not able to get enough satiety. The development of malnutrition in young children is also possible due to congenital defects of the child’s oral cavity or the absence of a sucking reflex.
Causes and symptoms of malnutrition in children
Malnutrition refers to decreased nutrition; is one of the chronic eating disorders in children.
The most common cause of malnutrition in children is poor feeding; Proper feeding is especially important in the first few months of life. If the mother has hypogalactia, the baby constantly does not have enough milk. Also, a child may be malnourished for a long time if the mother has a flat nipple or an inverted nipple. Some children do not suckle actively enough at the breast (they are also called sluggish or lazy suckers), in others physical defects prevent normal sucking (cleft lip, for example), and in premature and immature children, as a rule, the breast is underdeveloped (may be completely absent). ) sucking reflex. There is congenital malnutrition, which developed as a consequence of certain diseases of the mother or as a result of some kind of disorder. Often, malnutrition occurs due to frequent and severe illnesses of the child (viral infections, diseases of the stomach and intestines, scarlet fever, as well as chronic infections, etc.). Constant violations of the daily routine, improper child care, and hypovitaminosis (insufficient intake of vitamins into the body) can contribute to the development of malnutrition. Hypotrophy is also observed in a child who, for some reason, is switched to mixed or artificial feeding too early, and the ratio of nutrients in the food offered to him is not balanced.
The main symptom of malnutrition in children is a decrease in nutrition; significant thinning or complete disappearance of the subcutaneous fat layer.
The photo of malnutrition in children shows how exhausted children are who do not receive sufficient nutrition:
Hypotrophy in children I, II and III degrees
When classifying malnutrition in children, three degrees of the disease are distinguished.
Manifestations of degree I malnutrition are as follows: the subcutaneous fat layer is preserved everywhere, but it becomes somewhat thinner on the abdomen and limbs (normally, the skin fold at the navel level is 1.5 cm thick); the elasticity of the skin and muscles is slightly reduced; when weighed, a lag in weight from the norm by 10-20% is detected; height corresponds to age; the general condition does not suffer, the state of health is not impaired, but the child may be capricious; the skin is of normal color or slightly pale.
For stage II malnutrition in children, the following manifestations are characteristic: the subcutaneous fat layer on the abdomen and limbs disappears; on the chest, neck and face it becomes noticeably thinner; there is a weight loss of 20-30%, in addition, growth suffers; the child is pale, the skin is flabby and easily wrinkles; the fold straightens out slowly; the child is lagging behind, his general condition and well-being are impaired; The child is sometimes restless and excited, sometimes lethargic and whiny, and has poor sleep.
With grade III malnutrition, which is characterized by a weight gap of more than 30% from the norm, a different picture is observed: the subcutaneous fat layer is absent everywhere, growth stops; facial features become sharper, and the child’s face takes on an senile appearance, the eyes seem to fall into their sockets; a large fontanelle sinks; the skin is pale, the skin is dry, flaky; the mucous membrane of the lips against this background is bright red; the muscles become thinner, the ribs appear, the stomach retracts; symptoms of dyspepsia are often observed; feeling unwell; the child is lethargic and weak, inactive; his cry is weak; breathing is slow and uneven, the pulse is difficult to palpate; no appetite, but thirst is expressed; the child’s body reactivity is reduced, so he is susceptible to infection; complications such as otitis media, pyelitis, pneumonia, etc. may occur.
Treatment and prevention of malnutrition in young children
Treatment of malnutrition in young children is prescribed in a comprehensive manner, and it begins with eliminating the causes of the development of low nutrition. The child requires good care and proper hygiene regimen. Diet therapy plays an important role. Even with grade I malnutrition, the child’s nutrition is controlled by a doctor. All appointments are also made by the doctor. When treating malnutrition in children, the child is given a general massage daily and therapeutic exercises are performed. Closer to recovery - active games, long walks.
The following can be considered as preventive measures: good level of child care; daily monitoring of weight gain (mom is recommended to draw a weight curve); strict adherence to the diet (the child’s nutrition is periodically monitored by the local pediatrician); control over sufficient intake of vitamins into the body; compliance with sanitary and hygienic conditions aimed at preventing infectious diseases; in case of illness - timely seeking medical help and timely treatment; hardening the child. Particularly careful attention in the prevention of malnutrition in children requires babies who, for some reason, were transferred to mixed or artificial feeding.
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