Hypotrophy in children under one year of age treatment. Why does fetal malnutrition develop? Causes of malnutrition in a child after birth
Hardly considered rare today. This condition is accompanied by chronic eating disorders, in which the baby’s weight lags behind the norm by more than 10%. Hypotrophy can be either intrauterine or develop after the birth of the child. So what are the causes and symptoms of this pathology?
Causes of intrauterine hypotrophy in a child
In some cases, violation normal nutrition appears during the fetus. Such a child is born with noticeable symptoms - he weighs much less than normal. Sick children are frail with poorly developed fat layers and flaky skin.
To begin with, it is worth noting that the mother’s nutrition plays a significant role in the development of the fetus, and it is worth taking into account not only the quantity, but also the quality of food consumed. The diet of a pregnant woman should be varied and contain the main groups nutrients.
On the other hand, malnutrition may also be associated with metabolic disorders in the placenta. These include insufficient blood circulation, early and late severe toxicosis. Sometimes the reasons lie in unfavorable environmental conditions. The risk of developing malnutrition increases with constant stress.
Causes of malnutrition in a child after birth
Often children are born completely healthy, but in the next few weeks you can notice sudden loss weight. Quite often, malnutrition in infants is associated with insufficient nutrition. For example, shortage subcutaneous tissue sometimes the result of too little breast milk (or formula). Do not forget that a nursing mother must also eat properly, since the quality and satiety of milk depends on this.
On the other hand, the cause of malnutrition may be a disorder in work digestive system. Intestinal infections, dysbiosis and some other diseases are often accompanied by vomiting and diarrhea, which, accordingly, creates a lack of nutrients. Risk factors include damage nervous system or heart muscle, as well as injuries or congenital anatomical anomalies in the structure oral cavity, as this prevents the child from eating normally.
Symptoms and forms of malnutrition in a child
Of course, the signs of this pathology directly depend on its severity.
- First degree hypotrophy in children is accompanied by a lag in weight gain of approximately 10-15%. The amount of subcutaneous fat decreases mainly in the thighs and abdomen.
- The second degree of malnutrition is characterized by a decrease in the layer of subcutaneous fat not only on the torso, but also on the limbs. The delay in mass in this case is 15-30%.
- If the baby’s body weight is more than 30% below normal, then doctors talk about the third, severe degree of malnutrition. The fat layer disappears on the torso, limbs and face.
Treatment of malnutrition in children
Of course, similar condition requires medical care. First of all, the doctor must determine what is causing such an eating disorder. Drug treatment necessary in cases where malnutrition is the result of certain developmental defects, infectious or chronic diseases. If the reasons lie in insufficient nutrition, then you need to adjust the diet of the baby or nursing mother. But the diet should be compiled individually by the attending physician - additional food should be introduced gradually. Additional intake of mineral and vitamin complexes, walks in the fresh air, as well as regular therapeutic exercises will have a positive effect on the child’s condition.
In order to develop, he needs a full-fledged. If a growing body receives few nutrients, 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 same condition that develops with insufficient. Now we will find out what malnutrition is, how it develops and whether it can be avoided negative consequences malnutrition in infants.
What is malnutrition and how often does it occur in children?
Hypotrophy is a rare phenomenon in developed countries. According to World Organization health care, for every hundred infants there are seven to eight babies with malnutrition.
In developing countries, this figure is much higher - as many as twenty children out of every hundred suffer from malnutrition. Hypotrophy can only be diagnosed in children under two years of age; upon reaching this age, the body begins to develop differently. 
Speaking in simple language, malnutrition is the consequences of starvation. It doesn't matter who - the mother or the baby. Mother's milk- the only complete food for a child infancy, and if the mother eats poorly, the child will suffer more than she does.
Hypotrophy is a condition that develops when there is a lack of nutrients in the body. There are quantitative and qualitative shortages. Quantitative is when there is little food.
High-quality develops in the case of incorrectly selected artificial. Mother's milk in sufficient quantities cannot lead to a quality deficiency.
Classification and reasons
Hypotrophy can be intrauterine or acquired. Intrauterine hypotrophy 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. In this case, growth occurs normally, the baby does not reach 10% of normal 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 baby’s development, and if the lack of weight is not compensated for within a month and a half, regressive processes will begin.
Third (severe) degree malnutrition is characterized by a serious lack of mass - from 30% and above, as well as an almost complete cessation of growth. The causes of malnutrition are varied - from developmental defects to the quality of child care.
Most often, malnutrition affects babies who are born to too young girls or women. mature age, due to the fact that both organisms are not able to provide the fetus with sufficient intrauterine nutrition. If the mother is not eating well 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 work disorders endocrine system.
Multiple pregnancy, which is possible with IVF or superovulation, leads to prematurity or malnutrition of all fetuses at once. Dystrophy is also caused by developmental anomalies, genetic mutations and genetically transmitted metabolic disorders.Did you know? No matter how small a newborn baby's hand may seem, it is so strong that it can support the entire weight of his body. Grasp reflex- one of the unconditioned and very important reflexes both for a human child and for many young marsupial animals.
A qualitative lack of food is associated with poor maternal health and unbalanced complementary foods or breast milk substitutes that are unbalanced in proteins, fats and carbohydrates. The physiological causes of quantitative deficiency are a sluggish sucking reflex, in which the child cannot drink sufficient quantity milk, irregular shape nipples and increased density mammary glands.
In addition to the obvious lack of food in, the causes of acquired malnutrition are infectious diseases accompanied by intestinal disorders, unfavorable in environmental terms environment and lack of maternal care.
Maternal care means constant attention, physical contact, communication, frequent walks and sincere affection. How more stress, the higher will be the need for additional power, which should compensate for energy losses. 
Clinical manifestations
Congenital malnutrition is diagnosed immediately external signs- lack of subcutaneous adipose tissue, weak turgor, large folds skin on the neck, sides and buttocks that do not straighten for a long time.
The more the baby’s ribs and joints protrude, and the shoulder blades are visible under the skin, the more developed dystrophy is. Laboratory tests of children with dystrophy usually show a lack of calcium and potassium in the plasma fluid, a decreased number of platelets, as well as low level blood sugar.
Acquired malnutrition can be diagnosed only some time after the child has been 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 the pediatrician, the lower the possibility of malnutrition reaching 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 layer of fat 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 abdomen 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 your baby quickly gain normal weight.
The second stage of malnutrition is characterized by impaired activity of the baby. He becomes lethargic and drowsiness increases. Shortness of breath and tachycardia are possible, as well.
Another sign of second-degree malnutrition is a growth lag of two to three centimeters from the norm. The skin of children begins to turn pale and peel, and the muscle tone and the eating disorder becomes chronic. 
The layer of adipose tissue begins to melt away, this is especially noticeable on the abdomen and limbs. Third degree hypotrophy is characterized by thinning of the subcutaneous fat layer both on the face and throughout the body.
The skin color turns from pale to gray, the folds in the skin do not straighten out. The eyes become sunken, the facial features, on the contrary, become sharper, and the baby stops responding to stimuli.
On last stage malnutrition, inflammatory diseases occur in the child- , . It is possible that urination, on the contrary, becomes less frequent.
There are several diagnostic methods: instrumental, laboratory and general. At general diagnostics 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 his 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 foul odor and often contain undigested food and even particles of muscle fibers. 
Finally, the pediatrician checks the functioning of the central nervous system by observing the child's reaction to external stimuli.
Did you know? There are as many as sixty more bones in the body of a newborn baby than in the body of an adult!
Laboratory tests are prescribed starting from the second stage of malnutrition, when the risk increases pathological changes in organism.
Test results differ by different stages malnutrition, and best shows possible violations blood test - it gives an idea of protein balance, immunity stability and possible inflammatory processes.
Instrumental diagnostics are used when malfunctions are suspected internal organs and organ systems. First of all, the functioning of the heart is checked - the doctor conducts an electrocardiographic study.
Increased feeding will also not be a treatment, since the entire body has already suffered. This requires a competent approach to nutrition, vitamin therapy and medical supervision.
Treatment of first-degree malnutrition can be carried out at home, after first 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, which relate to the normalization of nutrition, daily routine, drug therapy and therapeutic massages.
Important! Frequent fractional feeding of the child speeds up his recovery, in contrast to large 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 to ten and for the third- ten to twelve feedings per day.
At this time, all attention must be paid to the child and round-the-clock care must be organized for him in order to bring him out of the state of dystrophy without consequences.
This main method treatment of malnutrition: without it drug therapy and massages don't make sense. The higher the degree of exhaustion, the more gentle the doctor will select and prescribe food products.
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.
Resistance to products is tested experimentally. If the child has reached the age at which complementary foods can be given, he is gradually introduced into the diet and monitored for bloating and disorders. To treat breastfed children, maternal nutrition is adjusted.
Infants should not be given a lot of food at once. The higher the degree of exhaustion, the smaller portions its restoration begins. At the second stage of diet therapy Special attention pay attention to micro- and macroelements entering the body. 
During the transitional stage, nutrition in children early age should replenish the body's need for calories and food volume for accelerated recovery from malnutrition. The child begins to be fed less often, but more plentifully.
The last stage is characterized by enhanced feeding. The child is given a lot of food when functionality digestive tract completely restored.
It is necessary to limit the protein component of food, as it is the most difficult to digest, but ensure nutritional value - weight gains at this stage are very intense.
Frequent stool analysis - required condition recovery control. Number of undigested dietary fiber and fat elements show how you need to adjust your diet.
Did you know? During the first two years of life, a child sleeps unstably, and therefore his parents do not receive approximately four and a half thousand hours of proper sleep during this time.- this equates to almost half a year of life.
Medications
Medication therapy includes vitamin therapy, enzyme therapy and stimulant therapy. metabolic processes body. Vitamin therapy enriches the body with substances that are lacking more than others - C, B1 and B6.
First practice subcutaneous and intramuscular injection solutions. After digestive function will come back to normal and vitamin complexes stop transiting, enteral administration (by mouth) is prescribed.
Enzyme therapy is prescribed to children who, in the second and third stages of exhaustion, have lost the ability to digest food. Enzymes replace their own gastric juice, which is almost not separated during malnutrition, as well as amylase and lipase secreted by the pancreas.Stimulating therapy is carried out with drugs that strengthen the immune system (up to immunoglobulin in the most severe stages), increase blood circulation and stimulate oxygen transport throughout all tissues. 
Massage and exercise therapy
Exercise therapy is physical therapy. It, together with massage, is used to improve tissue metabolism, stimulate blood circulation, and disperse 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 thereby restore the excitability of the central nervous system, which begins to transmit normal food reflexes.
Important! Physiotherapy can be active or passive. Active movements include movements that the baby performs himself, reacting to stimuli. Passive exercise is performed by the hands of a qualified pediatrician or trained parents.
A woman should stop drinking alcohol, avoid drinking alcohol, including passive alcohol, stay in the fresh air and undergo regular examinations with a gynecologist.
Did you know? Babies have no joints at birth kneecaps. There's simply no need for them- at this age children cannot support themselves vertical position. Finally knee joints are formed only six months after birth.
After birth, the baby must be kept in better conditions- provide him with breastfeeding or purchase balanced ones if there is no milk. A nursing mother must monitor her diet, because everything she eats will turn into food for the baby.
The pediatrician will tell you when to introduce complementary foods. breast milk, and this should be done gradually, checking the child’s reaction to individual products. In addition to nutrition, it is necessary to ensure that the baby stays frequently sunlight and fresh air. 
These natural factors cause strong young children. Hypotrophy is not a death sentence, and with careful care you can return the baby to normal 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 based on 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 alarming symptoms, and seek help from a pediatrician.
Only literate medical assistance will save the baby from progressive malnutrition and give him the opportunity to develop correctly.
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 essential nutrients and vitamins, quantitative - due to incorrect calculation of calorie content or lack of food resources.
Hypotrophy can be a consequence of 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 reasons 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:
- birth defects development
- 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 found. 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, wrinkles easily, 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 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 | Add to 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.
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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 care looking after the child, 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.
Hypotrophy is a chronic malnutrition in children, which is accompanied by a constant lack of body weight relative to the age and height of the baby. Often, malnutrition in children affects not only insufficient development of muscle mass, but also psychomotor aspects, growth retardation, general lag behind peers, and also causes a violation of skin turgor due to insufficient growth of the subcutaneous fat layer.
Body weight deficiency (hypotrophy) in infants usually has 2 causes. Nutrients may enter the child’s body in insufficient quantities for proper development or simply not be absorbed.
In medical practice, malnutrition is distinguished as an independent type of physiological development disorder, a subtype of dystrophy. As a rule, small children under the age of one year are susceptible to this disorder, but sometimes the condition persists up to 3 years, which is due to the peculiarities of the social status of the parents.
First degree
The disease is characterized by a slight decrease in appetite, accompanied by sleep disturbances and frequent anxiety. The baby's skin usually remains virtually unchanged, but has reduced elasticity and a pale appearance. Thinness is visible only in the abdominal area, while muscle tone may be normal (sometimes slightly reduced).
In some cases, grade 1 malnutrition in young children may be accompanied by anemia or. There is also a general decrease in the functioning of the immune system, which causes children to get sick more often and look less well-fed in comparison with their peers. Some children may experience digestive upset leading to diarrhea or constipation.
Often, degree 1 of the disorder remains practically invisible to parents, and only an experienced doctor can identify it through a thorough examination and diagnosis, during which he must find out whether the baby’s thinness is a feature of his physique and a hereditary factor.
Some children inherit tall height and thinness from their parents, so a slender young mother should not worry that her baby does not look as well-fed as the rest if he is active, cheerful and eats well.
Second degree
It is characterized by insufficient weight in children in the amount of 20-30%, as well as a baby’s growth retardation, on average by 3-4 cm. In this case, the baby may experience frequent lethargy, refusal to eat, low mobility, a constant state of sadness, as well as lack of warmth of arms and legs.
With grade 2 malnutrition, newborns experience developmental delays not only in motor but also mental development, poor sleep, pale and dry skin, and frequent peeling of the epidermis. A baby's skin is inelastic and wrinkles easily.
Thinness is very pronounced and affects not only the abdominal area, but also the limbs, while the contours of the baby’s ribs are clearly visible. Children with this form of disorder often get sick and have unstable stools. 
Third degree
Children with this form of disorder are severely stunted, on average up to 10 cm, and have a weight deficit of more than 30%. The condition is characterized by severe weakness, an indifferent attitude on the part of the child to almost everything, tearfulness, drowsiness, as well as rapid loss of many acquired skills.
The thinning of subcutaneous fatty tissue is clearly expressed throughout the child’s body, severe muscle atrophy, dry skin, and cold extremities are observed. The color of the skin is pale with a grayish tint. The baby's lips and eyes are dry, and there are cracks around the mouth. Children often suffer from various infectious diseases of the kidneys, lungs and other organs, for example, pyelonephritis.
Types of malnutrition
Disorders in young children are divided into 2 types.
Congenital malnutrition
Otherwise, the condition is called prenatal developmental delay, which begins in the prenatal period. There are 5 main causes of congenital disorders:
- Maternal. This group includes insufficient and inadequate nutrition of the expectant mother during pregnancy, her very young or, conversely, old age. Previously born stillborn children or miscarriages, the presence of serious chronic diseases, alcoholism, smoking or drug use, as well as severe forms in the second half of pregnancy can lead to the appearance of a baby with malnutrition.
- Paternal. Caused by hereditary causes on the paternal side.
- Placental. The appearance of malnutrition of any degree in a newborn can also be influenced by poor patency of the placental vessels, their narrowing, abnormalities in the location of the placenta, its presentation or partial detachment. The appearance of the disorder can also be affected by vascular thrombosis, heart attacks, and fibrosis of the placenta.
- Socio-biological factors. Insufficient material support for the expectant mother, her adolescence, as well as work in hazardous and chemically hazardous industries, the presence of penetrating radiation.
- Other factors. Mutations at the genetic and chromosomal level, the presence of congenital malformations, multiple pregnancies, premature birth.
Acquired malnutrition
The causes of such developmental disorders are divided into two types: endogenous and exogenous. 
Endogenous factors include:
- Availability ;
- constitutional anomalies in babies under one year of age;
- immunodeficiency, both primary and secondary;
- congenital malformations, such as perinatal encephalopathy, pyloric stenosis, bronchopulmonary dysplasia, Hirschsprung's disease, short bowel syndrome, disorders of the cardiovascular system;
- endocrine disorders, in particular hypothyroidism, adrenogenital syndrome, pituitary dwarfism;
- the presence of malabsorption syndrome, disaccharidase deficiency, cystic fibrosis;
- metabolic abnormalities of hereditary etiology, for example, galactosemia, fructosemia, Niemann-Pick or Tay-Sachs diseases.
- diseases caused by infections, for example, sepsis, pyelonephritis, intestinal disorders caused by bacteria (salmonellosis, dysentery, colienteritis), permanent;
- improper upbringing, non-compliance with the daily routine. This may include improper care of a baby under one year of age, poor sanitary conditions, malnutrition;
- nutritional factors, such as underfeeding of the baby (qualitative or quantitative) during natural feeding can be observed when the mother’s nipple is flat. Underfeeding due to “tight” breasts, in this case the baby cannot suck the required amount of milk. Vomiting or constant regurgitation;
- toxic causes, for example, poisoning, various degrees and forms of hypervitaminosis, feeding with low-quality formula or animal milk from the moment of birth (it is not absorbed by the newborn’s body).
Diagnostics
To accurately diagnose malnutrition in children, a complex of studies is carried out, which includes:
- Anamnesis collection. The features of the baby’s life, his diet, regimen, the presence of possible congenital diseases, medication intake, living conditions, care, as well as diseases of the parents that can be transmitted to the child at the genetic level are clarified.
- Thorough inspection , during which the condition of the baby’s hair and skin, his oral cavity, and nails is determined. The child’s behavior, mobility, existing muscle tone, and general appearance are assessed.
- Calculation of body mass index and comparing it with developmental norms based on the baby’s weight at birth and his age at the time of diagnosis. The thickness of the subcutaneous fat layer is also determined.
- Conducting laboratory tests baby's blood and urine tests.
- Complete immunological examination .
- Breath tests.
- Ultrasound of internal organs.
- ECG.
- Blood collection for a complete biochemical analysis.
- Stool study child for the presence of dysbacteriosis and the amount of undigested fat.
Intrauterine malnutrition can be detected during pregnancy during the next ultrasound, during which the doctor determines the size of the fetus and the expected weight.
If developmental disorders are detected, the expectant mother is sent to the hospital to conduct a full examination and take the necessary measures.
In newborns, the existing malnutrition can be determined by a neonatologist during an examination immediately after the birth of the baby. An acquired developmental disorder is usually discovered by a pediatrician during a routine examination and necessary measurements of height and weight. In this case, the doctor, in addition to conducting research, usually prescribes consultations with other specialists, which helps to accurately establish the diagnosis and degree of malnutrition.
Treatment
Therapy for malnutrition is carried out depending on the degree of the disease. Postnatal malnutrition of the 1st degree is treated in a normal outpatient setting at home with mandatory strict adherence to all doctor’s instructions.
The second and third degrees require treatment in a hospital setting, where specialists can constantly assess the baby’s condition and the results of the treatment, which is aimed at eliminating the existing causes of malnutrition, organizing good care for the baby, and correcting metabolic abnormalities.
The basis for the treatment of malnutrition is special diet therapy, which is carried out in 2 stages. First, possible food intolerances in the baby are analyzed, after which the doctor prescribes a certain balanced diet with a gradual increase in food portions and its calorie content.
The basis of diet therapy for malnutrition is split meals in small portions over a short period of time. The portion size is increased weekly based on the required nutritional load during regular monitoring and examinations. During therapy, adjustments are made to the treatment.
Weakened babies who cannot swallow or suck on their own are fed through a special tube.
Drug treatment is also carried out, in which the baby is prescribed vitamins, enzymes, anabolic hormones, and adaptogens. In cases of particularly severe condition of children with malnutrition, they are given intravenous infusions of special protein hydrolysates, saline solutions, glucose and essential vitamins.
To strengthen muscle tone, children are given exercise therapy and ultraviolet therapy, as well as a course of special massage. 
Lifestyle of children with malnutrition
During the treatment of the child, parents must strictly follow all the doctor’s instructions. The main factors for successful treatment of a baby are establishing the correct regimen not only for feeding, but also for playing, sleeping and walking.
With proper care and proper nutrition, provided there are no metabolic disorders and other congenital (acquired or chronic) diseases, babies quickly gain weight and are quite capable of catching up with the parameters of their healthy peers.
It is important to prevent the appearance of malnutrition in infants and it lies in the correct behavior of the expectant mother while carrying the baby. Registration at a clinic (special center or private clinic) should take place in the early stages of pregnancy, already within the first month.
It is important to complete all prescribed examinations and studies on time, and not to miss scheduled appointments and consultations with specialists. A special point in preventing malnutrition in a child is the nutrition of the expectant mother; it must be balanced, providing the body with all the necessary substances not only for its existence, but also for the development of the fetus.
A timely examination allows you to identify the existing violation in time and take the necessary measures to eliminate it even before the baby is born.
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Hypotrophy is a disease that is diagnosed in children from 0 to 2 years of age. Also, malnutrition can be congenital and manifest in a child during intrauterine life. The disease is characterized by eating disorder, which leads to the baby being underweight. In this case, a diagnosis is made only if the child’s weight is 10% or more below normal for his age.
You should not make a diagnosis on your own and try to supplement your child’s feeding - this is the task of specialistsCauses 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 improper nutrition of a pregnant woman. Newfangled diets that expectant mothers are on pose a danger to the fetus. In addition, the baby may suffer if the pregnant woman is diagnosed with placental insufficiency, somatic diseases, or toxicosis.
At risk are women who decide to bear a child in old age or at a young age, and also if the father and mother are related. Often congenital malnutrition accompanies the development of children with chromosomal mutations, for example, Down syndrome.
Acquired malnutrition can be caused by several factors. Let's look at 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, he is fed a low-calorie formula.
- 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. Biliary atresia, heart defects, kidney defects, central nervous system defects, 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:).
Children with Down syndrome are at risk for malnutrition How is the disease diagnosed?
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Malnutrition 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 carefully, you can detect a decrease in skin elasticity and a low subcutaneous fat layer on the abdomen. According to the parents, the child’s appetite is reduced and his weight is growing slowly. Objectively, the doctor notes that body weight is 10-20% below normal. A decrease in the level of digestive enzymes may be detected, while the body temperature is normal and the development of motor functions is within normal limits (we recommend reading:).
Degree 2
The child is depressed, has decreased activity, and has an impaired appetite. 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 throughout the day within one degree, which indicates a disorder of thermoregulation. The baby's weight is almost not growing (it is 20-30% less than normal); tachycardia and muffled heart sounds may be observed. 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 has no subcutaneous fat layer - on the stomach, arms and legs, and on the face. The child resembles a skeleton covered in skin. His weight does not increase and may even decrease.
The baby's mood changes - from lethargy and apathy he goes into the stage of irritability and tearfulness. Body temperature decreases, hands and feet are cold (see also:). Breathing is shallow, heart sounds are muffled, arrhythmia appears. The child constantly spits up, has frequent loose stools, and urinates in small portions. Weight below normal by more than 30%.
The third degree of malnutrition is complete exhaustion of the body Stool with malnutrition
Classification of stool for 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, “hungry” stool becomes green, there are visible areas of mucus in it, and the smell is putrid and unpleasant. Such stools often occur against the background of the development of dysbacteriosis.
- Mealy. This type of stool is usually liquid, greenish, and mixed with mucus. During a scatological examination, a lot of fiber, starch, neutral fat, mucus and leukocytes are found.
- Protein. The stool is hard, dry, and tiny. The study reveals 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:
- pneumonia;
- developmental delay, including mental retardation;
- inflammation of the large and small intestines;
- rickets;
Hypotrophy can lead to the development of rickets - anemia;
- inflammation of the middle ear;
- development of dysbacteriosis;
- disturbance 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 they are not used in combination:
- The first thing to do is to identify the cause of the disease and eliminate it.
- The next stage is to establish proper child care. It is important to walk with him for at least three hours a day (however, at a temperature not lower than 5˚C), massage regularly, and baths with warm water (about 38˚C).
- Optimize the nutrition of a small patient. It is important that the baby receives the required amount of proteins, fats, and carbohydrates.
- If necessary, use drug therapy.
It is important to optimize feeding of a child with malnutrition and feed it hourly Also, treatment can be divided into stages. Each of them requires a thoughtful approach and careful adherence to the doctor’s advice:
- adaptation stage;
- intermediate period;
- stage of enhanced nutrition.
Caring for a child during the recovery period
Children with degrees 1 and 2 malnutrition need regular massage. All exercises must be performed with the child lying on his back, then turning him over onto his stomach. One of the conditions for carrying out a massage is the preparation of the room: a recognized expert in pediatrics, Dr. Komarovsky, notes that the room should be ventilated and the air temperature should be about 22˚C.
The simplest massage techniques:
- stroking arms and legs;
- spreading your arms to the sides and crossing them on your chest;
- massage the abdomen with circular movements;
- flexion and extension of arms and legs;
- turning over on stomach;
- the child should reflexively try to crawl; to do this, you need to place your palm under his heels and apply light pressure;
- foot massage
There are other massage techniques that can be used depending on the condition of the child, as well as his age. Massage should be performed with caution for those children who have been diagnosed with stage 3 disease. The main elements of such a massage should be stroking.
Nutrition
Diet therapy is the main method of treating malnutrition in both newborns and older children. You need to organize your diet in accordance with your doctor’s recommendations. If you feed your baby immediately the amount of food that is indicated for him at this age, you can aggravate the condition, causing vomiting, indigestion, and weakness. We will outline the basic principles for calculating the number of feedings and the daily volume of food - they are unchanged for each stage of the disease.
This period is intended for a smooth transition from a critical condition to the process of normalizing weight and establishing appetite. Its duration and principles may vary and depend on factors such as the degree of the disease.
An adaptation period is necessary to normalize weight and appetite 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 food intake. The number of feedings should not exceed 6-7 times a day. Regardless of the baby’s age, he should be fed only mother’s milk or formula.
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 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 2 months younger than the patient. Throughout the entire adaptation period, it is necessary to gradually increase the number of feedings per day - by one or two. Since it is advisable to treat a baby with 2nd degree malnutrition in a hospital setting, the child should receive a 5% glucose solution or glucose-salt preparations through a gastric tube. At the moment the calculated daily volume of nutrition is reached, the patient moves on to the next stage - intermediate or reparative.
During 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 amount 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 completed when the amount of food eaten per day equals 1/5 of the child’s body weight.
The total amount of food eaten should reach a fifth of the child’s weight Stage 2 and 3 of therapeutic nutrition
At the second (reparative) stage, the volume of daily nutrition is finally brought to the required norm, according to the weight and age of the child. In addition, special medicinal mixtures are introduced into the diet.
The third stage involves increased high-calorie nutrition. At a norm of 100-120 kilocalories per day, the baby should receive 200. In order to achieve this goal, you can use high-protein mixtures, and also add buckwheat, rice and corn porridge to the diet.
Drug therapy
Drug treatment includes vitamin therapy - vitamins C, B12, B6, B1, A, and folic acid are prescribed. To improve digestion, enzymes are prescribed: pancreatin, festal, Creon, mexase (see also:). The doctor may also recommend hormonal and non-hormonal agents with an anabolic effect. Of particular note are medications containing L-carnitine, for example, Elkar (more details in the article:). This drug is indicated for children with underweight and malnutrition - it stimulates appetite and increases overall tone.
If the baby has a severe form of malnutrition, he will be given a drip with albumin, glucose, and special nutrition. Also, such patients are infused with blood, plasma, and prescribed hormonal drugs.
Often this disease is accompanied by intestinal dysbiosis, then the doctor will recommend special preparations with beneficial bacteria that will help improve intestinal function. In addition, it is necessary to correct functional disorders of the nervous system, so children are prescribed soothing herbal infusions, valerian, and motherwort. Herbs in the form of tinctures are given orally, and also added to bath water.
A bath with soothing herbs is very beneficial for the nervous system Forecast
The first and second stages of the disease respond well to treatment if the cause that led to the lack of body weight is identified. Proper nutrition and adequate child care will allow you to get the first results within 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 remaining patients with the third stage of malnutrition may well have a history of quite serious illnesses.
