Unfortunately, children in early and infancy often get sick. There are many reasons for this. Consider the main childhood diseases that lie in wait for the baby.

Diseases of young children

The main diseases of young children are:

1. Anemia. Anemia among childhood diseases is quite common. The cause of this disease is considered to be a violation of the functioning of the hematopoietic organs. Due to the deficiency of various substances, a decrease in hemoglobin levels occurs.
2. Bronchial asthma. The main symptom of this disease is asthma attacks, which are characterized by spasms of the upper respiratory tract. There can be several reasons for this pathology: heredity, allergic reactions, hormonal failure and the consequences of its treatment.
3. Bronchitis. With bronchitis, inflammation of the bronchi occurs, the disease develops against the background of acute respiratory diseases.
4. Stomach ache. If the baby has a stomach ache, then this, as a rule, indicates diseases of the organs of the gastrointestinal tract. Most often, these are intestinal infections, but it is possible that this is a symptom of a disease such as pneumonia.
5. Dyspepsia. Dyspepsia is, in simple terms, indigestion. Dyspepsia is caused by feeding errors.
6. Constipation. The causes of constipation are also violations of the rules of feeding. However, with prolonged constipation, there is a danger of intestinal obstruction, for the diagnosis of this disease, you should immediately contact the hospital.

Despite the fact that these diseases of young children are the most common, today they are successfully treated. The main thing is to seek medical help as soon as possible. Parents should understand that it is better to prevent the severe consequences of the disease than to resist the complications of the disease later. It is important to take preventive measures: strictly monitor the quality of the baby’s nutrition and regimen, follow the rules of hygiene, visit the pediatrician and carry out routine vaccinations.

Diseases of infancy and early childhood.

Among the diseases of infancy and early age, dystrophy, anemia, diathesis, hereditary diseases (cystic fibrosis, galactosemia, celiac disease), rickets, spasmophilia, etc. are of particular importance.

Dystrophy.

Dystrophy is a chronic disorder of nutrition and tissue trophism. The following forms of dystrophy are distinguished: malnutrition, diseases of protein-energy deficiency, hypovitaminosis, paratrophy, obesity, hypervitaminosis. The main symptoms of dystrophy: a decrease in tissue turgor, a change in the thickness of the subcutaneous base and its distribution, a change in body weight and mass-height index, a lag in neuropsychic and motor development, a decrease in emotional tone, a change in food tolerance (decrease, increase in appetite, signs, digestion disorders), a decrease in the overall resistance of the organism.

Hypotrophy can be congenital and acquired.

With a body weight deficit of 10-20% of the norm, a diagnosis of malnutrition of the I degree of severity is made. Clinically, thinning of the subcutaneous tissue on the abdomen is determined with a satisfactory general condition, preserved appetite and function of the digestive system. Hypotrophy of the II degree is characterized by a lag of mass by 20-30%, the disappearance of the subcutaneous base on the abdomen, chest and its thinning on the hips and limbs, unstable stool, reduced activity of abdominal digestion enzymes.

With hypotrophy of the III degree, signs of dystrophy are pronounced (mass loss of more than 30% of the norm), the absence of a subcutaneous base on the whole body, including the face, and a “hungry” stool. Pronounced hypoproteinemia and deficiency anemia. A feature of children with malnutrition II and III degree is a sharp decrease in the formation of enzymes and food tolerance, metabolic disorders, an increase in acidosis, the development of morphological changes in the mucous membrane of the digestive tract, dysbacteriosis, hemodynamic disturbances, impaired immunity and other body systems. In children with malnutrition II and III degree, infectious and inflammatory diseases easily develop and atypically proceed.

Treatment of dystrophy.

Treatment of malnutrition is based on the use of a rational diet: with malnutrition I st. quick transition to good nutrition based on calculation by age, with II and III Art. fractional therapeutic nutrition, according to indications, parenteral and enteral nutrition is carried out, gastric and intestinal enzymes and drugs, stimulants, vitamins are required. Treatment of children with malnutrition II and especially III stage. long, continuous process. It begins in the hospital and, with positive dynamics with an increase in body weight, continues at home. The criteria for the effectiveness of treatment are a satisfactory increase in body weight after reaching age values, a good emotional tone of the child, a satisfactory condition of the skin and tissues, and the absence of changes in internal organs.

Anemia in infants occurs as a result of insufficient intake or impaired absorption of substances necessary to build the hemoglobin molecule. About 90% of anemia in childhood are deficiency anemia, including iron deficiency, which are diagnosed in the first two years in 40% of children. The occurrence of the disease is facilitated by insufficient intake of iron, protein and vitamins with food during poor nutrition or starvation. The cause of the disease may be intestinal diseases that prevent the absorption of food (celiac disease, malabsorption, etc.). Predisposing factors include prematurity, malnutrition, rickets, early artificial feeding.

Anemia develops gradually. Characteristic symptoms: pallor of the skin, lethargy of the child, decrease or perversion of appetite, reduced emotional tone. Trophic changes in the skin are noted dryness, roughness, hyperpigmentation or depigmentation, increased fragility of hair or loss, thinning of nails and their pronounced fragility. There is also atrophy of the papillae of the tongue, angular stomatitis.

From the side of the heart - tachycardia, systolic murmur over the apex and at the projection point of the pulmonary artery, muffled tones. Blood picture decrease in hemoglobin (normal up to 5 years 10.9 mmol / l; after 5 years -11.9 mmol / l) and to a lesser extent erythrocytes, color index below 0.8, hemosideropenia, increased total iron-binding capacity of serum blood. In other deficient anemias, a decrease in the level of serum protein is detected, megalocytes are found in the peripheral blood. Deficiency anemia should be differentiated from other types of anemia (posthemorrhagic, hemolytic, regenerating, etc.).

Anemia treatment.

Treatment consists in a full-fledged, age-appropriate nutrition and the appointment of an appropriate regimen, the appointment of iron preparations with good tolerance per os. In case of intolerance to enteral use and in severe cases, iron preparations are administered parenterally. At the same time, vitamins and microelements are prescribed. The course dose of iron preparations can be calculated by the formula: Fe = P (78 0.35 x Hb), where P body weight, kg; Hb actual hemoglobin level, g/l; Fe is the total amount of iron in mg that must be administered during the course of treatment. In order to avoid side effects, it is sometimes necessary to start treatment with half or a third of the optimal dose for each age.

Prevention begins from the antenatal period, by prescribing vitamins and trace elements to pregnant women. Postnatal prophylaxis is built taking into account the constitutional characteristics of the child. Premature babies and those born from multiple pregnancies suffering from allergic diathesis from 2 months to 1 year are prescribed ferroprophylaxis (2 mg/kg per day).

Rickets (vitamin D-deficient state) is a disease of a rapidly growing organism, observed mainly in children of the 1st, less often the 2nd year of life, due to a lack of vitamin D and its metabolites, impaired phosphorus-calcium metabolism and mineralization of the newly formed bone. Rickets is essentially a general disease of the body, characterized by a variety of morphological and functional changes in various organs and systems, which causes an increased frequency and aggravated course of diseases of the respiratory system, digestion, anemia, diathesis, etc. against the background of this pathology.

pathological conditions. The prevalence, forms and severity of rickets depend on the climatic characteristics and living conditions of the child. The incidence of rickets is high with a lack of feeding and care in premature babies, with intrauterine growth retardation, deep immaturity of endocrine organs and enzyme systems, in children who have suffered birth trauma of the brain and other types of perinatal pathology.

The main signs of rickets: syndrome of violation of phosphorus-calcium metabolism and hypokinetic syndrome. Early manifestations at 2-3 months are associated with dysfunction of the nervous system against the background of a reduced phosphorus content (anxiety, sweating, mild excitability in response to weak stimuli), softening of the sutures and edges of the fontanel, and muscular dystonia. After 2-3-6 weeks, the height of rickets sets in, which is characterized by more pronounced neuromuscular vegetative disorders, the child becomes lethargic, inactive, hypotension of the muscles and ligamentous apparatus is observed, distinct skeletal changes develop (craniotabes, flattening of the occiput, changes in the configuration of the chest, appear frontal and parietal tubercles, thickenings in the wrist area bracelets). Diagnosis consists in conducting an x-ray of tubular bones (determination of osteoporosis, blurring and fuzziness of calcification zones). Hypocalcemia is expressed in the blood (2.0-2.5 mmol/l or less). According to the severity of the course, rickets of I (mild), II and III degrees are distinguished.

Rickets treatment.

Treatment is carried out with vitamin D preparations (specific) against the background of good nutrition and regimen, antilipoxants (potassium pangamate, tocopherol acetate), adaptogens (ascorbic acid and B vitamins, dibazol, glutamic acid), physical culture means (exercise therapy, massage, swimming, etc. .).

Prevention of rickets.

Prevention also begins from the antenatal period by the use of vitamins, ergocalciferol 500 mg per day, in the postnatal period, non-specific prophylaxis is used (nutrition, massage, gymnastics, hardening, sufficient exposure to fresh air in winter, UV irradiation for 10-15 sessions).

Diathesis an anomaly of the constitution, characterized by a predisposition to certain diseases or inadequate reactions to common stimuli. Diathesis is regarded as a condition in which the body has such individual (inherited, congenital or acquired) properties that predispose it to pathological reactions to external stimuli, certain diseases and their more severe course. A feature of the body of children with diathesis is the state of unstable balance of immune, neurovegetative, metabolic processes, which underlies inadequate responses to various external influences and causes a violation of adaptation to existing environmental conditions.

Children with diathesis make up the bulk of the contingent of those who often suffer from various infectious diseases, as a result of which they are referred to the II health group. Under the influence of infectious diseases, stressful situations, environmental influences (irrational nutrition and regimen), diathesis as borderline conditions often transform into recurrent diseases of the respiratory, digestive, hepatobiliary systems, diffuse diseases of the connective tissue, kidneys, and skin.

There are the following types of diathesis:

exudative-catarrhal, lymphatic-hypoplastic;
neuro-arthritic (uric acid, urinemic);
allergic and hemorrhagic.

Exudative-catarrhal diathesis is based on metabolic abnormalities and hereditary changes in some enzyme systems, which creates an increased retention of sodium, chlorine, potassium and water in the body. Children with exudative catarrhal diathesis are prone to acidosis due to the accumulation of uric acid and underoxidized metabolic products, which causes exudative catarrhal inflammation of the skin (dermatitis) and mucous membranes, the development of allergic reactions and a protracted course of inflammatory processes.

As with allergic diathesis, there is a predisposition to any allergic reactions to food, medicines, vaccines, insect bites, etc. Diagnosis of this type of diathesis is based on characteristic changes in the skin and mucous membranes, distinct metabolic and immunological disorders, immunogram data, allergy testing.

Lymphatic-hypoplastic, or lymphatic, diathesis.

Lymphatic-hypoplastic, or lymphatic, diathesis is characterized by diffuse hyperplasia of the lymphoid tissue, in most cases with a simultaneous increase in the thymus, hypoplasia of some internal organs, endocrine dysfunction, as a result of which reactivity changes sharply, resistance to infections decreases, and a predisposition to a protracted, complicated course is created.

Lymphatic diathesis is more common in children whose parents and relatives suffer from allergic diseases. Children with lymphatic diathesis easily develop diseases of the upper respiratory tract (rhinitis, pharyngitis, bronchitis). During inflammatory diseases of the respiratory system, an obstructive syndrome, neurotoxicosis develops. In acute viral infections (flu), in stressful situations, sudden death is possible, in the pathogenesis of which adrenal insufficiency, inherent in this particular type of diathesis, plays a leading role.

Nervous-arthritic diathesis.

Nervous-arthritic diathesis refers to anomalies of the constitution with disorders of uric acid metabolism, accumulation of purines in the body and increased excitability. The basis of neuro-arthritic diathesis is the inheritance of some pathological metabolic mechanisms, primarily purine metabolism disorders with an increase in their content in the blood and urine. Violated fat metabolism and absorption of carbohydrates, there is a tendency to ketoacidosis. Parents and relatives of children with this type of diathesis, as a rule, have such metabolic diseases as obesity, cholelithiasis, diabetes mellitus, uric acid diathesis and urolithiasis.

The clinic is dominated by neurasthenic, metabolic, spastic and skin manifestations. Symptoms are polymorphic: neurodermatitis, urticaria, unstable appetite, emotional lability. Choreic hyperkinesis, logoneuroses, anuria may appear. A characteristic symptom is recurrent acetonemic vomiting, up to an acetonemic crisis, accompanied by acetonuria, the smell of acetone from the mouth, exsicosis, potassium deficiency, hypochloremia, and acidosis. Transient arthralgias are possible. In the diagnosis of great importance is a family history (migraine, gout, cholecystitis, neuralgia, etc.), laboratory tests of urine, blood with the determination of the content of uric acid and salts.

Prevention and treatment of diathesis.

Primary and secondary prevention of diathesis is one of the most promising solutions to the problem of morbidity and infant mortality. Primary prevention is carried out depending on the family history, the characteristics of the onset of the disease and lifestyle (primarily the expectant mother). In all cases, a training regimen, timely diagnosis and treatment of toxicosis and other complications of pregnancy are necessary. A pregnant woman with a risk of allergic reactions needs a diet with the exclusion of obligate allergens (citrus fruits, chocolate, honey, strawberries, coffee, cocoa, mushrooms, etc.).

It is advisable to limit the consumption of whole milk, eggs, sweets, potatoes, strong broths, tomatoes, walnuts, culinary sweets. In the domestic plan, it is necessary to recommend the observance of hygiene of the home, to avoid contact with household chemicals, animals, etc. At the birth of a child, it is necessary to create conditions that exclude the allergization of the body, through hygiene, daily routine, hardening, wearing cotton clothes, etc. Children with diathesis need natural breastfeeding like no other. The nutrition of a nursing mother should also be with the exception of products that are allergic to breast milk, complementary foods are introduced to such children no earlier than 5 months, with a careful expansion of the diet. It is best to keep a food diary. It is necessary to include fermented milk mixtures or dietary supplements enriched with bifido- or lactobacilli in the child's diet.

Children with neuro-arthritic diathesis should not be overfed, they should limit the use of mixtures, primarily rich broths, sausages, smoked meats, products containing meat and milk fats (butter, sour cream), expand and replenish the daily diet with vegetable and fruit dishes, cereals, excluding sorrel, spinach, green beans, tomatoes. Children with this form of diathesis are shown abomin, natural gastric juice, hepatoprojectors, choleretic, real alkaline mineral waters. With acetonemic vomiting, alkalization of the body should be ensured due to alkaline mineral water (Borjomi), oralit, rehydron, alkaline enemas should be prescribed. The condition of the child should be monitored using a test control for the content of acetone in the urine.

Prevention also includes sanitation of all foci of infection in the child and relatives. It is necessary to adhere to the tactics of a sparing and individual plan for conducting preventive vaccinations with preliminary preparation. Secondary prevention includes the use of desensitizing agents, as well as the elimination of dysbacteriosis, helminthic invasions, dyskinesia of the digestive tract, a course of vitamin therapy, sedatives, adaptogens and immunomodulators. Treatment of diathesis is aimed at eliminating clinical manifestations, preventing and eliminating complications of acute respiratory viral infections and other infections pathogenetically associated with the presence and form of diathesis.

Spasmophilia (childhood tetany)

In this disease, there is a tendency to tonic or tonic-clonic convulsions due to a decrease in the level of ionized calcium in the blood serum and interstitial fluid with simultaneous hyperphosphatemia. Spasmophilia can occur with an overdose of vitamin D, with a number of diseases accompanied by fever, intoxication, it is also possible with repeated vomiting, with an overdose of alkalis administered in connection with metabolic alkalosis.

There are hidden and explicit spasmophilia. Diagnosis of the latent form is difficult and is carried out neuropathologically on the basis of characteristic symptoms. Explicit spasmophilia is manifested by laryngospasm, cardoneal spasm and eclamptic seizures. Hospitalization of children with obvious spasmophilia is mandatory. At the prehospital level, in order to relieve seizures, it is possible to administer seduxen, regulate the gamma-oil diet with mandatory intravenous administration of calcium chloride. With latent spasmophilia, calcium preparations are indicated (a course of 2-3 weeks), sedative therapy, treatment of rickets, a protective regimen, and restriction of the use of cow's milk.

hereditary diseases.

In children of this age, hereditary diseases may also already be detected. There are about 3000 hereditary diseases and syndromes. Hereditary diseases are divided into three main groups:

monogenic;
polygenic;
chromosomal.

Monogenic diseases are caused by a defect in one gene. The frequency of these diseases among children of 1 year of age is 2:1000 10:1000. The most common are cystic fibrosis, malabsorption syndrome, celiac disease, hemophilia, phenylketonuria, galactosemia, and others. Polygenic (multifactorial) diseases are associated with a violation of the interaction of several genes and environmental factors. These include diabetes mellitus, obesity, many diseases of the kidneys, liver, allergic diseases, etc.

Chromosomal diseases occur due to changes in the number or structure of chromosomes. The frequency of chromosomal defects is 6:1000. Of these diseases, Down's disease, Klinefelter's syndrome, etc. are more common. Diagnosis of hereditary diseases Diagnosis of hereditary diseases is based on anamnestic data, characteristic clinical manifestations, specialized tests and laboratory data. A consultation with a geneticist for hereditary diseases is required. Diseases of early childhood and preschool period are marked by an increased frequency of respiratory diseases.

A group of various pathological conditions, which are based on a decrease in the content of hemoglobin and (or) erythrocytes in the blood. Anemia can be acquired and congenital. Depending on the causes that caused the disease, they are divided into:
- posthemorrhagic, caused by blood loss;
- hemolytic due to increased destruction of red blood cells;
- anemia due to a violation of the formation of red blood cells.

There are other classifications - according to the size of erythrocytes (with a decrease in size - microcytic, while maintaining a normal size - normocytic, with an increase in size - macrocytic), according to the degree of saturation of erythrocytes with hemoglobin (low saturation - hypochromic, normal - normochromic, increased - hyperchromic).

In the course of anemia, it can be acute (developing quickly, proceeding with severe clinical signs) and chronic (developing gradually, signs may be minimally expressed at first).

These frequent blood diseases are due to the anatomical and physiological characteristics of the child's body (immaturity of the hematopoietic organs, their high sensitivity to the effects of adverse environmental factors).

Anemia caused by a deficiency of various substances (iron deficiency, folate deficiency, protein deficiency) occurs due to insufficient intake of substances necessary for the formation of hemoglobin. They are not uncommon in the first year of life, are noted in diseases accompanied by malabsorption in the intestine, with frequent infections and in preterm infants. The most common in this group are alimentary anemia (i.e., caused by inadequate or monotonous nutrition).

Iron deficiency anemia - occurs when there is a lack of iron in the body. Manifestations depend on the severity of the disease. With mild - appetite decreases, the child is lethargic, the skin is pale, sometimes there is a slight increase in the liver and spleen, in the blood - a decrease in hemoglobin content to 80 grams per 1 liter, the number of red blood cells up to 3.5 million (normal hemoglobin content is from 170 g / l in newborns up to 146 g / l in 14-15 year olds, erythrocytes - respectively from 5.3 million to 5.0 million). With a moderately severe disease, the appetite and activity of the child noticeably decreases, he is lethargic, whiny, the skin is pale and dry, there is a murmur in the heart, the rhythm of its contractions becomes more frequent, the liver and spleen increase, the hair becomes thin and brittle. The content of hemoglobin in the blood decreases to 66 g / l, red blood cells - up to 2.8 million. In severe disease, the child lags behind in physical development, there is no appetite, motor mobility is significantly reduced, frequent constipation, severe dryness and pallor of the skin, thinned nails and hair break easily. There are swellings on the face and legs, the liver and spleen are greatly enlarged, the pulse is sharply accelerated, there are heart murmurs, the papillae of the tongue are smoothed out ("varnished" tongue). The amount of hemoglobin decreases to 35 g/l, erythrocytes - up to 1.4 million. Iron deficiency anemia often develops in premature babies for 5-6 months. life when the iron stores received from the mother are depleted.

Vitamin-deficiency anemia - due to lack of vitamin B12 and folic acid, both congenital and acquired after diseases of the gastrointestinal tract.

Clinical picture: shortness of breath, general weakness, palpitations, burning pain in the tongue, diarrhea, gait disturbance, touch (paresthesia), in which the sensitivity is reduced or increased. There are heart murmurs, smoothness and redness of the papillae of the tongue, some reflexes are distorted. There may be an increase in temperature, sometimes there are mental disorders. The liver and spleen may be enlarged. The disease is chronic and occurs with exacerbations.

Acquired hypoplastic anemia - occurs when the hematopoietic function of the bone marrow is suppressed.

Their reasons are the influence on the hematopoiesis of a number of medicinal substances, ionizing radiation, disorders of the immune system, the function of the endocrine glands, and a long-term infectious process. Characteristic signs are pallor of the skin, bleeding, nasal, uterine and other bleeding. Infectious complications are often observed - pneumonia, inflammation of the middle ear (otitis), renal pelvis (pyelitis), inflammatory changes in the mucous membrane of the mouth, rectum.

The spleen and lymph nodes are not enlarged.
Sometimes there is a slight increase in the liver.

Treatment. Red blood cell transfusion, hormonal therapy (hydrocortisone or prednisolone, retabolil, administration of antilymphocyte globulin). Removal of the spleen or embolization (blocking of the blood vessels of part or the whole spleen, leaving this organ in place), sometimes bone marrow transplantation. When bleeding - hemostatic agents 1 (platelet mass, aminocaproic acid, etc.).

Prevention - monitoring the state of the blood during long-term treatment with substances that cause oppression of hematopoiesis.

Congenital forms of anemia. Among them, the most important are Fanconi anemia, familial hypoplastic Estrana-Dameshek, partial hypoplastic Josephs-Diamond-Blackfan. Fanconi anemia usually appears during the first years of life. Boys get sick 2 times more often than girls. Children lag behind in physical and mental development. There are malformations of the eyes, kidneys, palate, hands, microcephaly (a decrease in the size of the head and, due to this, an underdevelopment of the brain), an increase in the content of pigment in the skin and, as a result, its darkening. At the age of 5 years and older, there is usually an insufficient formation of red blood cells and platelets (pancytopenia), in which bleeding occurs, an enlarged liver without an enlarged spleen and lymph nodes, and inflammatory changes in many organs and tissues. With Estrena-Dameshek anemia, similar changes in the blood are observed, but there are no malformations. Josephs-Diamond-Blackfan anemia manifests itself in the first year of life, often proceeds benignly. The disease develops gradually - pallor of the skin and mucous membranes appears, lethargy, appetite worsens; the content of hemoglobin and erythrocytes is reduced in the blood.

Treatment: RBC transfusion, removal of the spleen or embolization (see above), hemostatic agents for bleeding.

Hemolytic anemia develops due to increased breakdown of red blood cells, due to hemolytic disease of the newborn (see above), in the final stage of renal failure with an increase in the content of urea in the blood (uremia), with vitamin E deficiency. They can also be hereditary (defect in the structure of red blood cells and hemoglobin ). Treatment: the same.

Severe complication - anemic coma. Symptoms and course. Before losing consciousness, the child is shivering, sometimes the body temperature rises, breathing becomes shallow and rapid, as the lungs do not expand well and an insufficient amount of oxygen enters the blood. At this moment, the pulse rate increases, blood pressure decreases, the hemoglobin content in the blood drops sharply. The skin turns pale, acquiring an icteric hue. Perhaps the development of seizures, the so-called. meningeal symptoms: headache, vomiting, increased sensitivity, inability to bend the head forward (stiff neck). Various pathological reflexes arise - with passive forward bending of the head of the patient lying on his back, the legs are bent at the hip and knee joints; when one leg is flexed at the hip joint and extended at the knee joint, the other leg involuntarily flexes.

In the blood, the number of normal erythrocytes decreases (erythrocytes are not sufficiently saturated with oxygen, they are large).

Treatment. The introduction of vitamin B12 intramuscularly, folic acid inside - only after establishing the diagnosis and the causes of the disease. It is necessary to normalize nutrition, eliminate the cause of the disease.

It occurs with excessive emotional arousal, mental illness, disorders of the endocrine system, intoxication (poisoning caused by the action of toxic substances on the body that have entered it from the outside or formed in the body itself), metabolic disorders, diseases of the digestive system (acute gastritis, gastroduodenitis, etc.). ), irregular monotonous diet, poor taste of food, unfavorable environment for its reception, the use of drugs with an unpleasant taste that suppress the function of the gastrointestinal tract or act on the central nervous system, and also as a result of a neurotic reaction to various negative influences. With prolonged anorexia, the body's resistance decreases and its susceptibility to various diseases increases. In young children, anorexia develops more often with force-feeding, violation of the rules of complementary feeding.

Treatment. Identification and elimination of the main cause of anorexia, organization of a diet, introduction of various dishes into the diet, in infants - normalization of complementary feeding. Prescribe drugs that stimulate appetite (the so-called appetizing tea, vitamin B12, cerucal). In severe depletion, multivitamins, hormones (retabolil) are indicated; with neurosis - psychotherapy, the appointment of psychopharmacological agents. In special cases, artificial nutrition is used with the introduction of nutrient solutions into a vein.

Neuropsychic anorexia occupies a special place. This is a pathological condition that manifests itself in the conscious restriction of food in order to lose weight. It occurs in adolescents 15 years of age and older, more often in girls. There is an obsessive idea of ​​​​excessive fullness and the need to lose weight. They resort to food restrictions, inducing vomiting after eating, the use of laxatives. At first, the appetite is not disturbed, at times there is a feeling of hunger, and in connection with this, periodic overeating. Weight falls quickly, mental disorders appear; mood swings from "bad to good", an obsessive desire to look at oneself in a mirror, etc. Treatment: psychotherapy (see Chapter XIII, Mental illnesses).

There are many causes of bronchial asthma. There is a clear hereditary predisposition; the disease can also occur if a person suffers from any allergic disease, especially if the airway is obstructed; the development of the disease is facilitated by hormonal imbalances that can occur during long-term treatment with hormones.

Neuropsychiatric trauma can also cause asthma. With prolonged use of aspirin, analgin, amidopyrine and other drugs in this group, the so-called. aspirin asthma.

Symptoms and course. The first seizures in children usually appear at the age of 2-5 years. Their immediate causes are most often contact with an allergen, acute respiratory diseases, tonsillitis, physical and mental trauma, in some cases - preventive vaccinations and the introduction of gamma globulin. In children, especially at an early age, swelling of the bronchial mucosa and increased secretion of the bronchial glands are of primary importance, which determines the characteristics of the course of the disease.

An asthma attack is usually preceded by warning symptoms: children become lethargic, or, conversely, excited, irritable, capricious, refuse to eat, the skin turns pale, the eyes become shiny, the pupils dilate, itchy in the throat, sneezing, watery nasal discharge, coughing , wheezing (dry), but breathing remains free, not difficult. This state lasts from 10-30 minutes to several hours or even 1-2 days. It happens that it passes (symptoms are smoothed out), but more often it develops into a paroxysm of suffocation. Children become restless, breathing quickens, difficult, mainly exhalation.

Expressed retraction when inhaling compliant places of the chest (between the ribs). Body temperature may rise. Multiple rales are heard.

In older children, the picture is somewhat different. Swelling of the bronchial mucosa and increased secretion of the bronchial glands are less pronounced due to the characteristics of the respiratory tract, and therefore the exit from a severe painful condition occurs faster than in young children.

During an attack, the child refuses to eat and drink, loses weight, sweats, circles appear under the eyes. Gradually, breathing becomes freer, when coughing, a thick, viscous, whitish sputum is released. The condition also improves, but the patient remains lethargic for several days, complains of general weakness, headache, cough with sputum difficult to separate.

Asthmatic status. It is called a condition in which suffocation does not disappear after the treatment. It can proceed in two ways, depending on the reasons that caused it. One occurs after taking antibiotics, sulfonamides, enzymes, aspirin and other medications, develops quickly, sometimes with lightning speed, the severity of suffocation increases rapidly. Another form is caused by improper treatment or the appointment of a higher than necessary dose of drugs. With her, the severity of the condition increases gradually. During status asthmaticus, breathing disorders, cardiac activity are observed, subsequently the central nervous system is deranged, manifested by agitation, delirium, convulsions, loss of consciousness; these signs are more pronounced the younger the child.

Bronchial asthma can be complicated by atelectasis (collapse) of the lung, the development of an infectious process in it and the bronchi.

Treatment. It is necessary to take into account the age and individual characteristics of children. When the harbingers of an attack appear, the child is put to bed, giving him a semi-sitting position, calmed down, it is necessary to divert his attention. The room is pre-ventilated, wet cleaning is carried out. 2-3 drops of a 2% solution of ephedrine are instilled into the nose every 3-4 hours, a powder containing aminophylline and ephedrine is given inside. Mustard plasters, hot wraps, mustard baths are contraindicated, because. the smell of mustard often aggravates the condition.

If it was not possible to prevent an asthma attack with the help of the measures taken, a 0.1% solution of epinephrine hydrochloride is injected subcutaneously in age dosages in combination with a 5% solution of ephedrine hydrochloride. Older children are also given aerosol preparations - salbutamol, alupent, no more than 2-3 inhalations per day, at a younger age, the use of aerosols is not recommended. With a severe attack, the development of status asthmaticus, a hospital is indicated. Young children need to be hospitalized, because. at this age, the clinical picture is similar to acute pneumonia, whooping cough, pulmonary cystic fibrosis - a hereditary disease in which the function of the bronchial and other glands is impaired.

After an attack, medication is continued for 5-7 days, chest massage, breathing exercises, physiotherapy, treatment of foci of chronic infection (adenoids, dental caries, sinusitis, otitis media, etc.) are performed. Treatment of allergic conditions is also necessary.

Acute bronchitis - occurs primarily in children with adenoids and chronic tonsillitis - inflammation of the tonsils; occurs more often in spring and autumn. There is a runny nose, then a cough. Body temperature is slightly elevated or normal. After 1-2 days, sputum begins to stand out. Young children usually do not cough up sputum, but swallow it. Coughing especially worries the child at night.

Treatment. Put the child to bed, drink tea with raspberries and lime flowers, at a body temperature above 37.9 ° C, antipyretics are prescribed, if infectious complications are suspected, according to indications, antibiotics, sulfonamides. To liquefy sputum, warm alkaline drinks are used (hot milk with butter and a small amount of baking soda), incl. alkaline mineral waters (Borjomi, Jermuk), inhalations with soda solution, potato decoction. They put jars, mustard plasters, make hot wraps for the night: a small amount of vegetable oil is heated to a temperature of approximately 40-45 ° C, gauze is impregnated with it, which is wrapped around the body, trying to leave a free area to the left of the sternum in the area of ​​​​the nipple - this is where the heart is located , compress paper or cellophane is applied over the gauze, then cotton wool; from above fix with a bandage, put on a woolen shirt. Usually, with the correct setting of the compress, heat is retained all night. Banks, mustard plasters and wraps are used only if the body temperature is normal. With an increase in it, these procedures are excluded, because. they contribute to a further rise in temperature with a corresponding deterioration in the condition.

The prognosis is favorable, however, in children suffering from rickets (see below), exudative-catarrhal diathesis (see below), the disease may take longer due to impaired bronchial patency, followed by the development of pneumonia (see below) and atelectasis (falling) of the lungs.

Chronic bronchitis - less common in children, occurs against the background of diseases of the nasopharynx, cardiovascular system (congestion in the lungs), cystic fibrosis (a hereditary disease in which the secretion of glands, in particular, bronchial glands) increases. Exudative-catarrhal diathesis (see below), congenital immunodeficiency states, impaired bronchial function, and some malformations of the lungs also contribute to the onset of the disease.

Chronic bronchitis can occur without disturbing the patency of the bronchi. In this case, there is a cough, dry and wet rales.

Treatment is aimed at increasing the body's resistance. For this purpose, foci of chronic infection (dental caries, adenoids, tonsillitis, otitis media, etc.) are identified and sanitized. More vegetables and fruits should be included in the child's diet, in immunodeficient conditions they increase immunity with the help of pentoxyl, dibazol, decaris, vitamin therapy. In case of exacerbation, antibiotics, sulfonamides, suprastin, diphenhydramine are used as prescribed by the doctor. Assign UHF therapy, other physiotherapy procedures.

In chronic bronchitis with impaired bronchial patency, severe shortness of breath appears, audible at a distance.

The exacerbation lasts for weeks, sometimes pneumonia develops, in some cases - bronchial asthma. Treatment is aimed at restoring airway patency and strengthening the body's resistance. For this purpose, expectorants are used to facilitate sputum discharge (alkaline drink, inhalations), which increase immunity, vitamins, especially vitamin Wb (in the morning!).

Prevention of chronic bronchitis - hardening, good nutrition, treatment of adenoids, chronic tonsillitis.

Pain occurs for a variety of reasons at any age. Children under 3 years of age generally cannot accurately indicate the places where they feel it. They are especially inclined to represent any pain in the body as "abdominal pain", indicating its localization in the navel. Children somewhat older, as a rule, also inaccurately determine the painful area, so their instructions are of relatively little diagnostic value. It should also be remembered that abdominal pain can accompany various diseases, such as pneumonia in young children.

Causes of abdominal pain: stretching of the intestinal wall, expansion of its lumen (for example, accumulation of gases or feces), increased intestinal activity (spasm, intestinal colic); inflammatory or chemical damage to the peritoneum; hypoxia, i.e. lack of oxygen, for example, with a strangulated hernia (the exit of the abdominal organs and their compression, which causes insufficient blood supply) or with intussusception (a condition in which one part of the intestine is introduced, screwed into the lumen of another); distention of an organ capsule (eg, liver, spleen, pancreas); some infectious diseases (dysentery, acute hepatitis, measles, whooping cough); severe constipation, intestinal form of cystic fibrosis; pancreatitis, cholecystitis (respectively, inflammation of the pancreas and gallbladder); tumors, kidney stones, stomach ulcers; foreign bodies (especially common in young children); gastritis, appendicitis, in girls - inflammation of the appendages (adnexitis); tonsillitis, diabetes mellitus, inflammation of the periosteum (osteomyelitis) or one of the bones that make up the pelvis - the ilium; pneumonia in the lower parts of the lungs, bordering the diaphragm (the muscle that separates the chest and abdominal cavities); inflammation of the lymph nodes in the abdominal cavity; epilepsy and many other diseases.

Treatment. All children with abdominal pain should be seen by a doctor. If the situation allows, the child should be taken to the hospital, where he will be examined, including blood tests, urine tests, X-ray examination, which is mandatory for sudden, severe, cutting pain in the abdomen, combined with vomiting, stool and gas retention, or severe diarrhea, unsatisfactory general condition, vague anxiety.

With these symptoms, in no case should the child be given water, give him any medicines, do an enema, apply a heating pad to the stomach, because. this may worsen the condition and obscure the picture of the disease, in the latter case, the diagnosis may be made too late. Young children in any case must be referred to a hospital, because. many serious illnesses occur in them with pain in the abdomen.

After examination by a doctor, if the child's condition allows treatment at home, the appointments are carefully performed. If repeated pains in the abdomen appear, you should again go to the hospital, indicating that the pain recurred after the treatment, it is advisable to have the test results with you if they were recently performed.

In cities and towns where there are advisory centers, it is also desirable to conduct an ultrasound examination of the abdominal organs, kidneys, and lymph nodes.

There are several types of hemorrhagic diathesis. With some of them, hemorrhage into the joints is noted, with others - bruising on the skin, bleeding from the nose, gums.

Treatment. It is aimed at eliminating the cause that caused them, reducing vascular permeability, increasing blood clotting. To do this, cancel the drugs that caused bleeding, if necessary, transfuse the platelet mass, prescribe calcium preparations, ascorbic acid; in the case of elimination of the cause of bleeding and cure in the future, regularly conduct a blood test for coagulability and the content of platelets in it. If the disease is incurable (some types of hemophilia), treatment and preventive examinations are carried out throughout life.

Prevention: with hereditary forms - medical genetic counseling, with acquired - prevention of diseases that contribute to their occurrence.

Symptoms and course. The condition is manifested by signs of increased intracranial pressure: headache (first of all), nausea, vomiting, impaired various functions: hearing, vision (the last 3 signs may be absent). In young children, the fontanel bulges. Depending on the cause of the disease, there are other symptoms.

There are acute and chronic phases of the disease. In the acute stage, symptoms of the underlying disease that caused hydrocephalus appear, in the chronic stage. - signs of hydrocephalus itself, which, if untreated, progresses. The disease can also develop in utero, in this case they speak of congenital hydrocephalus. Children are born with a large head (up to 50-70 cm in circumference, with a normal average of about 34-35 cm), in the future, in the case of progression of dropsy of the brain, the circumference of the skull may become even larger.

At the same time, the head takes the form of a ball with a protruding forehead, the fontanelles increase in size, swell, the bones of the skull become thinner, the cranial sutures diverge. ; visual acuity is reduced, epileptic seizures are not uncommon, children are mentally retarded. In the future, after the closure of the fontanelles, headaches, vomiting, as well as various symptoms appear, the nature of which depends on the location of the obstacle that disrupts the outflow of cerebrospinal fluid.

Recognition. The diagnosis of hydrocephalus can only be made in a hospital after various x-ray, radiological, computer studies, as well as studies of the cerebrospinal fluid.

Treatment is carried out initially in a hospital.

In the acute phase, agents are prescribed that reduce intracranial pressure (lasix, mannitol, glycerin), removal of small amounts of cerebrospinal fluid by puncture (puncture) in the fontanel area in order to reduce intracranial pressure. In the future, constant monitoring and treatment by a neurologist is necessary. In some cases, they resort to surgical intervention - to eliminate the cause of the violation of the outflow of cerebrospinal fluid or to surgery, as a result of which cerebrospinal fluid is constantly discharged into the heart or abdominal cavity, and other surgical methods. Without treatment, most children remain severely disabled or die at an early age.

It occurs mainly in children under 2 years of age, more often in the first year of life. According to the time of occurrence, they are divided into congenital and acquired.

Congenital malnutrition may be due to the pathological course of pregnancy, accompanied by circulatory disorders in the placenta, intrauterine infection of the fetus; diseases of the pregnant woman herself, her malnutrition, smoking and alcohol consumption, age (under 18 or over 30), exposure to industrial hazards.

Acquired malnutrition can be caused by underfeeding, difficulty sucking associated with irregularly shaped nipples or tight mammary glands; insufficient amount of milk formula during artificial feeding, qualitatively malnutrition; frequent diseases of the child, prematurity, birth trauma, malformations, intestinal absorption in many metabolic diseases, pathology of the endocrine system (diabetes mellitus, etc.).

Symptoms and course. Depend on the severity of malnutrition. In this regard, hypotrophy of I, II and III degrees is distinguished.

I degree: the thickness of the subcutaneous tissue is reduced in all parts of the body, except for the face. First of all, it becomes thinner on the stomach. The mass deficit is 11-20%. Weight gain slows down, growth and neuropsychic development correspond to age. The state of health is usually satisfactory, sometimes there is a disorder of appetite, sleep. The skin is pale, muscle tone and tissue elasticity are slightly below normal, stools and urination are normal.

II degree: subcutaneous tissue on the chest and abdomen almost disappears, on the face it becomes much thinner. The child lags behind in growth and neuropsychic development. Weakness, irritability increase, appetite worsens significantly, mobility decreases. The skin is pale with a grayish tint, muscle tone and tissue elasticity are sharply reduced. Often there are signs of vitamin deficiency, rickets (see below), children are easily overheated or hypothermic. The liver increases, the stool is unstable (constipation is replaced by diarrhea), its character (color, smell, texture) changes depending on the cause of malnutrition.

III degree: observed mainly in children of the first 6 months of life and is characterized by severe exhaustion. Subcutaneous tissue disappears in all parts of the body, sometimes a very thin layer remains on the cheeks. The mass deficit exceeds 30%. Body weight does not increase, sometimes progressively decreases. Growth and neuropsychic development are suppressed, lethargy increases, reactions to various stimuli (light, sound, pain) are slowed down. The face is wrinkled, "senile". Eyeballs and a large fontanel sink down. The skin is pale gray, dry, the skin fold does not straighten out. Mucous membranes are dry, bright red; tissue elasticity is almost lost. Breathing is weakened, sometimes there are violations. The heart rate is slowed down, blood pressure is reduced; the abdomen is retracted or swollen, constipation is noted, a change in the nature of the stool. Urination is rare, urine is small. The body temperature is below normal, hypothermia easily sets in. Often associated with an infection that occurs without severe symptoms. If left untreated, the child may die.

Treatment. It is carried out taking into account the cause that caused malnutrition, as well as its degree. With 1 degree - outpatient, with II and III degrees - in a hospital. The main principles are the elimination of the cause of malnutrition, proper nutrition and child care, the treatment of metabolic disorders and infectious complications arising from this.

With an insufficient amount of milk from the mother, the child is supplemented with donor or mixtures. With a lower than normal content of constituents in breast milk, they are prescribed additionally (with a deficiency of proteins - kefir, cottage cheese, protein milk, with a deficiency of carbohydrates - sugar syrup is added to drinking water, with a deficiency of fats give 10-20% cream). In severe cases, nutrients are administered intravenously by drip. In the case of malnutrition due to metabolic disorders, special therapeutic nutrition is carried out.

Regardless of the cause of the disease, all children are prescribed vitamins, enzymes (abomin, pepsin, festal, panzinorm, pancreatin, etc.), stimulants (apilac, dibazol, in severe cases, hormone therapy), massage, physiotherapy, ultraviolet irradiation. Proper care of the child is of great importance (regular walks in the fresh air, prevention of congestion in the lungs - more often take the child in your arms, turn it over; when cooling, put a heating pad at your feet; careful oral care).

The prognosis for hypotrophy of the 1st degree is favorable, with the III degree the mortality rate is 30-50%.

Some larvae penetrate the skin when walking barefoot or lying on the ground (helminths common in countries with a hot climate, including Central Asia).

In the middle lane in children, ascariasis and enterobiasis (pinworm infection) are most common. These diseases are figuratively called "diseases of unwashed hands." As the name itself suggests, the causes are contaminated vegetables, fruits, berries (very often strawberries, which children eat straight from the garden), as well as the lack of the habit of washing hands before eating. If a child with ascariasis or enterobiasis attends a kindergarten, the disease may be epidemic. With helminthiasis, signs characteristic of each type of lesion develop.

Ascariasis. Symptoms and course. When infected with ascaris, rashes on the skin first appear, the liver enlarges, the composition of the blood changes (an increased content of eosinophils in it, which indicates an allergization of the body), bronchitis, pneumonia may develop. In later periods, there is malaise, headaches, nausea, sometimes vomiting, abdominal pain, irritability, restless sleep, appetite decreases. With feces, a large number of ascaris eggs are excreted. In the future, complications such as violation of the integrity of the intestines with the development of peritonitis, appendicitis (when roundworm enters the appendix), and intestinal obstruction are possible. With the penetration of ascaris into the liver - its abscesses, purulent cholecystitis (inflammation of the gallbladder), jaundice due to blockage of the biliary tract. When ascaris crawls through the esophagus into the pharynx and respiratory tract, asphyxia may occur (impaired pulmonary ventilation resulting from obstruction of the upper respiratory tract and trachea). Treatment with Mintezol, Vermox, Pipsrazine.

Enterobiasis is an infection with pinworms.

Symptoms and course. Itching in the anus, abdominal pain, stools are sometimes quickened, stools are mushy. As a result of scratching, an infection joins and inflammation of the skin develops - dermatitis. In girls, pinworms can crawl into the genital slit, and in this case, inflammation of the vaginal mucosa develops - vulvovaginitis.

Treatment consists in observing the rules of hygiene, because. The life expectancy of pinworms is very short. With a protracted course of the disease (usually in debilitated children), combaptrin, mebendazole, piperazine are used. With very severe itching, an ointment with anesthesin is prescribed. The prognosis is favorable.

Prevention. Examination for the presence of pinworm eggs is carried out once a year. Those who have been ill are examined for the presence of pinworms three times - the first time 2 weeks after the end of treatment, then a week later. A patient with enterobiasis should wash himself with soap and water 2 times a day, then clean his nails and wash his hands thoroughly, sleep in shorts, which should be changed and boiled every day. Iron trousers, skirts - daily, bed linen - every 2-3 days.

When the brain is affected by Echinococcus, headache, dizziness, vomiting are observed, with an increase in the cyst, these phenomena become more intense. Possible paralysis (lack of movement in the affected limb or lack of activity of the body - intestinal paralysis), paresis (decrease in movement or activity of the organ), mental disorders, convulsive seizures. The course of the disease is slow.

Treatment for all forms of echinococcosis is only surgical - removal of the cyst with suturing of the cavity left after it.

The prognosis depends on the location of the cyst, as well as on the presence or absence of them in other organs and the general condition of the patient.

Symptoms and course. Clinically, damage to the muscles of the limbs, back and neck develops. Their weakness gradually increases, movements are limited, up to complete immobility, moderate pain, muscle atrophy quickly sets in. At the very beginning of the disease, swelling of the muscles is possible, more often of the pharynx, larynx, intercostal and diaphragm, which leads to various disorders, including breathing, voice, swallowing, the development of pneumonia due to food and liquid entering the respiratory tract when the larynx and pharynx are affected. The skin is also affected: redness and swelling appear mainly on the open parts of the body, in the areas of the eyelids, elbow joints and joints of the hand. Possible damage to the heart, lungs, gastrointestinal tract.

Recognition. Based on a typical clinical picture, laboratory data, physiological muscle studies (electromyography). Be aware of the possibility of a malignant tumor.

Treatment. It is carried out only with the help of hormonal drugs, for a long time (for years). The dose of the drug must be prescribed individually. At the same time, regular monitoring and exact implementation of the doctor's instructions regarding the reduction in doses of the drug are necessary, because. excessively rapid or sudden cessation leads to severe hormonal disorders up to adrenal insufficiency and, as a consequence, to death. The prognosis for timely treatment and the appointment of a sufficient dose of hormones is favorable.

Symptoms and course. First, flaky yellowish spots appear in the area of ​​​​the knee joints and above the eyebrows. From 1.5-2 months. there is reddening of the skin of the cheeks with pityriasis peeling, then yellowish crusts on the scalp and above the eyebrows. In severe cases, these crusts are layered on top of each other and form thick layers. Acute respiratory diseases easily occur due to reduced body resistance - runny nose, sore throat, bronchitis, inflammation of the mucous membrane of the eyes (conjunctivitis), middle ear (otitis media), unstable stools are often noted (alternating constipation with diarrhea), after the illness, a slight increase in temperature persists for a long time to 37.0-37.2°C. There is a tendency to water retention in the body - children are "loose", but quickly lose fluid due to sharp fluctuations in weight: its rises are replaced by rapid falls. Various skin lesions, false croup (see below), bronchial asthma, and other complications may occur.

Treatment. Conducted by a doctor. First of all - a diet with the exception of products that provoke this condition. With diaper rash, careful care is necessary, baths with soda and potassium permanganate (alternate), the use of baby cream. In case of inflammation and weeping of the skin, baths with anti-inflammatory drugs are prescribed as directed by the attending pediatrician.

Prevention. Pregnant women. and lactating mothers should avoid or reduce the amount of foods that contribute to the occurrence of exudative-catarrhal diathesis. Not recommended for children under 3 years of age. Toxicosis and other diseases of the period of pregnancy must be treated in a timely manner.

Simple dyspepsia occurs during breastfeeding as a result of an improper diet (more frequent than necessary, feeding, especially with a large amount of milk from the mother); a sharp transition from breastfeeding to artificial without preliminary gradual preparation for new types of food (discrepancy between the composition of food for the age of the child, especially during the period of juice administration, if its amount is increased very quickly). Overheating contributes to the disease.

Symptoms and course. The child has regurgitation and vomiting, in which some of the excess or inappropriate food is removed. Diarrhea often joins, stool becomes more frequent up to 5-10 times a day. The feces are liquid, with greenery, lumps of undigested food appear in it. The stomach is swollen, gases with an unpleasant smell leave. Anxiety is noted, appetite is reduced.

Treatment. When the first symptoms appear, you should consult a doctor. Before his arrival, you should stop feeding the child for 8-12 hours (water-tea break), this time he needs to be given a sufficient amount of liquid (100-150 ml per 1 kg of body weight per day). The doctor prescribes the child the necessary diet and the timing of the gradual transition to nutrition appropriate for the age of the child. Premature return to normal nutrition leads to an exacerbation of the disease.

Toxic intoxication occurs as a result of the same reasons as simple, but differs from it by the presence of a toxic syndrome (see below). The disease can also develop as a result of simple dyspepsia in case of non-compliance with the timing of the water-tea pause, insufficient filling of the body with fluid and failure to comply with the doctor's prescriptions and recommendations. More often occurs in premature babies suffering from dystrophy, rickets, exudative-catarrhal diathesis, weakened or who have undergone various diseases.

Symptoms and course. The disease sometimes develops suddenly. The child's condition deteriorates rapidly, becoming lethargic or unusually moody. The stool is frequent, splashing. Weight drops sharply. At times, the child may lose consciousness. With vomiting and diarrhea, dehydration develops. Toxic (poisonous) substances formed as a result of insufficient digestion of food are absorbed into the bloodstream and cause damage to the liver and nervous system (toxic syndrome). This condition is extremely dangerous at an early age. In severe cases, the gaze is directed into the distance, the face is mask-like; all reflexes gradually fade away, the child stops responding to pain, the skin is pale or with purple spots, the pulse quickens, blood pressure drops.

Treatment. Urgent medical care. At home, the necessary treatment is impossible, patients must be hospitalized. Prior to this, feeding must be stopped for at least 18-24 hours. It is necessary to give liquid in small portions (tea, boiled water), 1-2 teaspoons every 10-15 minutes. or instill into the mouth from a pipette constantly after 3-5 minutes.

Parenteral epilepsy usually accompanies some disease. Most often occurs in acute respiratory diseases, pneumonia, otitis media. Signs of parenteral dyspepsia appear in parallel with the increase in symptoms of the underlying disease. Treatment is aimed at combating the underlying disease.

Prevention of dyspepsia - strict adherence to the feeding regimen, the amount of food should not exceed the norm for the age and weight of the child, complementary foods should be introduced gradually, in small portions.

Child overheating should be prevented. When the first signs of the disease appear, it is necessary to urgently consult a doctor, strictly follow his recommendations.

It must be remembered that with the phenomena characteristic of simple and toxic dyspepsia (diarrhea, vomiting), various infectious diseases begin - dysentery, food poisoning, colienteritis. Therefore, it is necessary to thoroughly boil the diapers of a sick child, to protect other children in the family. From the hospital, the child cannot be taken home until he is fully recovered.

False constipation. It is diagnosed if the child receives or retains a small amount of food in the stomach and its remains after digestion are not excreted in the form of stool for a long time. The reasons for such constipation can be: a sharp decrease in appetite, for example, with infectious diseases; decrease in the amount of milk in the mother; underfeeding a weak infant; pyloric stenosis or frequent vomiting for other reasons; low calorie food. Stool retention can also occur in healthy infants, since breast milk contains very little waste and is almost completely used when it enters the gastrointestinal tract.

Acute stool retention may indicate intestinal obstruction. In this case, you should contact the hospital, where they will conduct x-ray and other studies, and if the diagnosis is confirmed, surgery.

Chronic stool retention. The reasons for it can be divided into four main groups.

1) Suppression of the urge to defecate (it happens with pain caused by anal fissures, hemorrhoids, inflammation of the rectum - proctitis; with psychogenic difficulties - unwillingness to go to the toilet during the lesson; with general lethargy, inertia, in which the child does not pay attention to regular defecation, for example, prolonged bed rest or dementia; with some behavioral disorders, when the child is overprotected, and he, understanding the mother's interest in the regularity of his stool, uses this as a kind of encouragement).

2) Insufficient urge to defecate (damage to the spinal cord, consumption of food poor in slags, restriction of movements during illness, prolonged use of laxatives).

3) Dysmotility of the colon (many endocrine diseases, intestinal malformations, intestinal spasms).

4) Congenital narrowing of the large or small intestine, atypical (wrong) location of the anus.

In any case, with persistent constipation, defecation only after the use of enemas and laxatives, you should contact your pediatrician and undergo an examination. Before visiting a doctor, you should prepare the child, free the rectum from feces, wash the child; within 2-3 days, do not eat food that promotes increased gas formation: black bread, vegetables, fruits, milk; during the same 2-3 days with increased gas formation, activated charcoal can be given.

Treatment for constipation depends on the cause. Sometimes this requires only dieting, it happens that surgical intervention is necessary. The prognosis depends on the underlying disease and the timing of the visit to the doctor.

Blood from the nose does not always come out, sometimes it enters the throat and is swallowed, this happens in young children, debilitated patients. On the other hand, not every discharge indicates a nosebleed. It can be from the esophagus or stomach, when blood is thrown into the nose and released out through its openings.

Treatment, first aid. The child should be seated or put to bed with the upper half of the torso raised, and an attempt should be made to stop the bleeding by inserting gauze or cotton wool moistened with hydrogen peroxide into the anterior part of the nose. Put a handkerchief moistened with cold water on the bridge of the nose, with continued bleeding - an ice pack to the back of the head.

After stopping the bleeding, you should lie down and avoid sudden movements in the coming days, do not blow your nose, do not take hot food. If the bleeding cannot be stopped, a doctor should be called. Since recurring nosebleeds are usually a symptom of a local or general disease, such conditions should be examined by a doctor.

There are true and false croup. True occurs only with diphtheria, false - with influenza, acute respiratory diseases and many other conditions. Regardless of the cause that caused the disease, it is based on the contraction of the muscles of the larynx, the mucous membrane of which is inflamed and swollen. When inhaling, the air irritates it, which causes constriction of the larynx and breathing becomes difficult. With croup, there is also damage to the vocal cords, which is the cause of a rough, hoarse voice and a "barking" cough.

True croup: a patient with diphtheria has a hoarse voice, a rough "barking" cough, shortness of breath. All manifestations of the disease are growing rapidly. Hoarseness intensifies up to complete loss of voice, and at the end of the first or beginning of the second week of the disease, respiratory distress develops. Breathing becomes audible at a distance, the child turns blue, rushes about in bed, quickly weakens, cardiac activity falls and, if help is not provided in a timely manner, death may occur.

False croup: against the background of influenza, acute respiratory diseases, measles, scarlet fever, chickenpox, stomatitis and other conditions, shortness of breath, "barking" cough, hoarseness of voice appear. Often these phenomena are the first signs of the disease. Unlike diphtheria croup, difficulty breathing comes on suddenly. Most often, a child who goes to bed healthy or with a slight runny nose wakes up suddenly at night; he has a rough "barking" cough, may develop suffocation. With a false croup, there is almost never a complete loss of voice. The phenomena of suffocation can pass quickly or last for several hours. Attacks can be repeated the next day.

Treatment. At the first manifestations, urgently call an ambulance. Before the arrival of the doctor, it is necessary to ensure constant access of air to the room, give the child a warm drink, calm him down, make a hot foot bath. Older children are inhaled (inhaled) soda solution vapors (1 teaspoon of baking soda per 1 liter of water).

If it is impossible to eliminate suffocation by conservative methods, the doctor is forced to insert a special tube into the windpipe through the mouth or directly into the trachea.

With croup caused by any cause, urgent hospitalization is necessary, because. the seizure may recur.

It is observed mainly in children who are formula-fed, with a change in the reactivity of the body, metabolic disorders, lack of calcium and vitamin D salts in the body, against the background of bronchopneumonia, rickets, chorea, spasmophilia, hydrocephalus, mental trauma, postpartum trauma, etc. May occur reflexively with pathological changes in the larynx, pharynx, trachea, lungs, pleura, gallbladder, with the introduction of a number of drugs into the nose, for example, adrenaline. Inhalation of air containing irritating substances, lubrication of the mucous membrane of the larynx with certain drugs, excitement, coughing, crying, laughter, fear, and choking can lead to laryngospasm.

Symptoms and course. Laryngospasm in children is manifested by a sudden noisy, wheezing, labored breathing, pallor or cyanosis of the face, the inclusion of auxiliary muscles in the act of breathing, and neck muscle tension. During an attack, the child's head is usually thrown back, the mouth is wide open, cold sweat, thready pulse, and temporary cessation of breathing are noted. In mild cases, the attack lasts a few seconds, ending with an elongated breath, after which the child begins to breathe deeply and rhythmically, sometimes falling asleep for a short time. Attacks can be repeated several times a day, usually during the day. In severe cases, when the attack is longer, convulsions, foam at the mouth, loss of consciousness, involuntary urination and defecation, cardiac arrest are possible. With a prolonged attack, death may occur.

Treatment, first aid. During an attack, you should calm the child, provide fresh air, let him drink water, splash his face with cold water, apply an irritating effect (pinch the skin, pat on the back, pull the tongue, etc.). Laryngospasm can be relieved by inducing a gag reflex by touching the root of the tongue with a spoon. It is also recommended to inhale vapors of ammonia through the nose, in protracted cases - warm baths, orally - 0.5% solution of potassium bromide in an age dosage. In any case, the child should be under the supervision of a doctor after an attack. Treatment of laryngospasm should be aimed at eliminating the cause that caused it. General strengthening therapy and hardening are shown. Assign calcium, vitamin D, ultraviolet irradiation, a rational regimen with a long stay in the fresh air, mainly dairy and vegetable food.

The prognosis is often favorable. Laryngospasm in children usually disappears with age.

The cause of this condition may be dementia, in which the child is not able to master the skills of voluntary urination; paralysis of the sphincter of the bladder in diseases of the spinal cord (the so-called neurogenic bladder, which is quite common in childhood); diabetes and diabetes insipidus; hereditary factors, when this symptom is observed in several children in a given family or in several generations; various stressful situations, strong one-time or permanent, weaker impact (excessive demands on an only child or harassment by older children in the family, tense relations between parents).

In any case, bedwetting should not be considered as some kind of disobedience, bad behavior of the child. When developing the appropriate skills, he should be able to voluntarily hold urine and ask for a pot, otherwise he should consult a doctor who will prescribe an examination and further treatment from the relevant specialists (nephrologist, urologist, neuropathologist, psychiatrist, endocrinologist or other doctors).

The prognosis depends on the nature of the disease, the time of treatment and the correct implementation of the appointments.

Pyelonephritis can occur on its own or against the background of various infectious diseases, urinary outflow disorders due to the formation of stones in the kidneys or bladder, pneumonia (see below). Pyelonephritis develops when pathogenic microbes are introduced into the renal tissue by "ascent" from the urethra and bladder or when microbes are transferred through the blood vessels from the foci of inflammation present in the body, for example, from the nasopharynx (with angina, tonsillitis), the oral cavity (with caries teeth).

Symptoms and course. There are acute and chronic pyelonephritis. The most characteristic manifestations of acute are severe chills, fever up to 40 C, pouring sweat, pain in the lumbar region (on one side or on both sides of the spine), nausea, vomiting, dry mouth, muscle weakness, muscle pain. In the study of urine, a large number of leukocytes and microbes are found.

Chronic pyelonephritis for several years can be hidden (without symptoms) and is detected only in the study of urine. It is manifested by a slight pain in the lower back, frequent headache, sometimes the temperature rises slightly. There may be periods of exacerbation, with typical symptoms of acute pyelonephritis. If early measures are not taken, then the inflammatory process, gradually destroying the renal tissue, will cause a violation of the excretory function of the kidneys and (with bilateral damage) severe poisoning of the body with nitrogenous slags (uremia) may occur.

Treatment of acute pyelonephritis is usually in the hospital, sometimes for a long time. Neglect of doctor's prescriptions can contribute to the transition of the disease into a chronic form.

Patients with chronic pyelonephritis should be under the constant supervision of a doctor and strictly follow the regimen and treatment recommended by him. In particular, food intake is of great importance. Usually exclude spices, smoked meats, canned food, limit the use of salt.

Prevention. Timely suppression of infectious diseases, the fight against focal infection, hardening of the body. Children whose parents have pyelonephritis should be examined for changes in their kidneys (ultrasound of the kidneys).

Pleurisy is conditionally divided into dry and exudative (exudative). When "dry" pleura swells, thickens, becomes uneven. With "exudative" fluid accumulates in the pleural cavity, which can be light, bloody or purulent. Pleurisy is more often unilateral, but may be bilateral.

Symptoms and course. Usually, acute pleurisy begins with chest pain, aggravated by inhalation and coughing, general weakness, fever appear. The occurrence of pain is due to the friction of the inflamed rough pleural sheets during breathing, if fluid accumulates, the pleural sheets are separated and the pain stops. However, pain can also be caused by the main process, complicated by pleurisy.

With pleurisy, the patient often lies on the sore side, because. in this position, the friction of the pleural sheets decreases and, consequently, pain. With the accumulation of a large amount of fluid, respiratory failure may occur, as evidenced by the pallor of the skin, cyanosis of the lips, rapid and shallow breathing.

Due to the greater reactivity of the child's body and the anatomical features of the lungs, the younger the child, the more difficult it is for him to tolerate pleurisy, his intoxication is more pronounced. The course and duration are determined by the nature of the underlying disease. Dry pleurisy, as a rule, disappears after a few days, exudative - after 2-3 weeks. In some cases, the effusion becomes encysted and pleurisy may continue for a long time. A particularly severe course is noted in the purulent process. It is characterized by a high rise in temperature, large fluctuations between morning and evening, pouring sweat, severe weakness, increasing shortness of breath, cough.

Recognition. Produced only in a medical institution: X-ray examination of the chest, complete blood count. If there is fluid in the pleural cavity (which can be seen on an x-ray) and to determine its nature, as well as for therapeutic purposes, a puncture of the pleural cavity is performed (puncture with a hollow needle).

Treatment. It is carried out only in the hospital. In the acute period, bed rest is necessary. With shortness of breath, the child is given a semi-sitting position. Food should be high in calories and rich in vitamins. In case of development of purulent inflammation, surgical intervention is necessary. During the recovery period, general strengthening therapy is carried out, periodically they are examined at the place of residence.

There are transverse and longitudinal flat feet, a combination of both forms is possible.

With transverse flat feet, the transverse arch of the foot is flattened, its anterior section rests on the heads of all five metatarsal bones, and not on the first and fifth, as is normal.

With longitudinal flat feet, the longitudinal arch is flattened and the foot is in contact with the floor with almost the entire area of ​​the sole.

Flat feet can be congenital (very rare) and acquired. The most common causes of the latter are overweight, weakness of the musculoskeletal apparatus of the foot (for example, as a result of rickets or excessive exertion), wearing ill-fitting shoes, clubfoot, injuries to the foot, ankle, ankle, and paralysis of the lower limb (often polio - t .n paralytic flat feet).

Symptoms and course. The earliest signs of flat feet are fatigue of the legs (when walking, and later when standing) in the foot, calf muscles, thighs, and lower back. By evening, swelling of the foot may appear, disappearing overnight. With a pronounced deformity, the foot lengthens and expands in the middle part. Those suffering from flat feet walk with their toes turned and legs wide apart, slightly bending them at the knee and hip joints and waving their arms vigorously; they usually wear out the inside of the soles.

Prevention. An important role is played by the correct selection of shoes: they should not be too tight or spacious. It is also necessary to monitor the posture, paying attention to the fact that the children always keep the body and head straight, do not spread their toes wide when walking. Strengthening the musculoskeletal apparatus of the legs is facilitated by daily gymnastics and sports, in the warm season it is useful to walk barefoot on uneven soil, sand, in a pine forest. This causes a protective reflex, "sparing" the arch of the foot and preventing the appearance or progression of flat feet.

Treatment. With signs of flat feet, you should consult an orthopedist. The basis of treatment is special gymnastics, which is carried out at home daily. At the same time, it is useful to combine individually selected exercises with the usual ones that strengthen the musculoskeletal apparatus of the groan. It is also recommended daily warm baths (water temperature 35-36 C) up to the knees, massage of the muscles of the foot and head. In some cases, special insoles are used - instep supports, which raise the ultimate arch of the foot.

The prognosis largely depends on the stage of development; advanced cases may require long-term treatment, wearing special orthopedic shoes, and even surgery.

Pneumonia is not transmitted from person to person, its causative agents are various bacteria and viruses. Unfavorable conditions contribute to development - severe hypothermia, significant physical and neuropsychic overload, intoxication and other factors that lower the body's resistance, which can lead to the activation of the microbial flora present in the upper respiratory tract. By the nature of the course, acute and chronic pneumonia are distinguished, and by the prevalence of the process - lobar, or croupous (damage to an entire lobe of the lung) and focal, or bronchopneumonia.

Acute pneumonia. It occurs suddenly, lasts from several days to several weeks and ends in most cases with complete recovery. The onset is characteristic: the body temperature rises to 38-40 ° C, severe chills, fever, cough appear, initially dry, then with sputum, which has a rusty appearance due to the admixture of blood. There may be pain in the side, aggravated by inhalation, coughing (more often with croupous pneumonia). Breathing often (especially with extensive and severe lesions) becomes superficial, rapid and accompanied by a feeling of lack of air. Usually after a few days the condition improves.

chronic pneumonia. It can be an acute outcome or occur as a complication of chronic bronchitis, as well as with foci of infection in the paranasal sinuses (sinusitis), in the upper respiratory tract. A significant role is played by factors that contribute to the weakening of the body and its allergic restructuring (chronic infections and intoxications, adverse environmental effects - sudden temperature fluctuations, gas pollution and dustiness of the air, etc.). The disease flows in waves and is characterized by periods of remission of the process and its exacerbation. In the latter case, symptoms similar to an acute process appear (cough with sputum, shortness of breath, chest pain, fever), but, unlike acute pneumonia, these phenomena subside more slowly and complete recovery may not occur. The frequency of exacerbations depends on the characteristics of the patient's body, environmental conditions. Prolonged and frequent leads to sclerosis of the lung tissue (pneumosclerosis) and bronchial dilation - bronchiectasis. These complications, in turn, aggravate the course of pneumonia - periods of exacerbation are prolonged, ventilation of the lungs, gas exchange are disturbed, pulmonary insufficiency develops, and changes in the cardiovascular system are possible.

Treatment. It is carried out only under the supervision of a doctor. The protracted course of acute pneumonia and its transition to a chronic form are often due to the inept use of antibiotics in self-medication. The complete elimination of the disease, the restoration of the normal structure of the affected lung is facilitated by various procedures used simultaneously with antibacterial treatment: banks, mustard plasters, hot wraps, physiotherapy, breathing exercises. Recovery is facilitated by the activation of the body's defenses, rational hygiene measures and good nutrition.

Treatment of chronic pneumonia is long and depends on the stage of the disease. With exacerbation, it is carried out in a hospital. To achieve a therapeutic effect, it is necessary to correctly select an antibiotic, administer it in a sufficient dose and with the required frequency. It is important to remember that taking antibiotics and antipyretics on your own (without a doctor) leads to a "formal" decrease in temperature, which does not reflect the true course of the inflammatory process. Incorrect selection and insufficient dosage of antibiotics contribute to the development of microbial resistance to therapeutic effects and thus complicate further recovery.

It is necessary to ventilate the room where the patient is located as best as possible. It is necessary to change bed and underwear more often (especially with excessive sweating), take care of the skin of the body (rubbing with a wet towel). When shortness of breath occurs, the patient should be laid down, lifting the upper body. During the calming down of the process, a rational hygienic regimen is recommended, staying in a park, forest, walking in the fresh air, and therapeutic exercises. Exercises are selected aimed at teaching full breathing, prolonged exhalation, development of diaphragmatic breathing, increasing the mobility of the chest and spine.

Prevention includes measures aimed at general strengthening of the body (hardening, physical education, massage), the elimination of focal infections, and the treatment of bronchitis.

Pneumonia in children of the first year of life. It proceeds hard, especially in a weakened child, premature, sick with rickets, anemia, malnutrition, and can often end tragically if help is not provided in time. It often develops after influenza, acute respiratory diseases.

Symptoms and course. The first clinical sign is the deterioration of the general condition. The child becomes restless, sometimes lethargic. He sleeps little and restlessly, sometimes refuses to eat. Some may have regurgitation, vomiting, stool becomes liquid. Paleness of the skin is noted, blue appears around the mouth and nose, which intensifies during feeding and crying, shortness of breath. There is almost always a runny nose and cough. Cough painful, frequent, in the form of seizures. It must be remembered that in children of the first year of life, the temperature does not always reach high numbers with pneumonia. The child's condition can be very severe at a temperature of 37.1-37.3 ° C, and sometimes even at normal.

Treatment. When the first signs of illness appear, it is urgent to call a doctor who will decide whether the child can be treated at home or whether he needs to be hospitalized. If the doctor insists on hospitalization, do not refuse, do not hesitate.

In the event that the doctor leaves the child at home, it is necessary to create peace for him, good care, and exclude communication with strangers. It is necessary to do daily wet cleaning of the room where it is located, to ventilate it more often; if the air is dry, you can hang a wet sheet on the battery.

The temperature in the room should be 20-22°C. When the child is awake, you should put on clothes that do not restrict breathing and movement - a vest (cotton and flannelette), sliders, woolen socks. It is advisable to change the position of the child more often, to take him in your arms. Swaddle before going to bed and give a warm drink. During the day, the child should sleep with the window open, in the summer - with the window open. Walking on the street is possible only with the permission of a doctor. Before feeding, the nose and mouth should be cleared of mucus. The nose is cleaned with a cotton wick, the mouth is cleaned with gauze, wrapped around the handle of a teaspoon. It is necessary to give the child as much to drink as possible. The duration of the disease is from 2 to 8 weeks, so you need to be patient and clearly follow all the doctor's prescriptions.

Children with pneumonia may develop complications. The most common of these are otitis media and pleurisy. The outcome of pneumonia largely depends on how accurately all medical recommendations are followed.

The disease develops with insufficient care for the child, limited exposure to fresh air, improper feeding, which causes a deficiency in the intake of vitamin D in the body or a violation of its formation in the skin due to a lack of ultraviolet rays. In addition, the occurrence of rickets is promoted by frequent illnesses of the child, malnutrition of the mother during pregnancy. Rickets is the cause of anomalies in the work of various organs and systems. The most pronounced changes are noted in the exchange of mineral salts - phosphorus and calcium.

The absorption of calcium in the intestines and its deposition in the bones are disturbed, which leads to thinning and softening of bone tissues, distortion of the function of the nervous system and internal organs.

Symptoms and course. The first manifestation of rickets is the difference in the behavior of the child: he becomes shy, irritable, moody or lethargic. Sweating is noted, especially on the face during feeding or on the back of the head during sleep, which makes the pillow damp. Since the child is worried about itching, he constantly rubs his head, which causes the hair on the back of his head to fall out. With the development of the disease, muscle weakness, a decrease in their tone, motor skills appear later than usual. The abdomen grows in volume, constipation or diarrhea often occurs. Later, changes in the skeletal system are observed. The back of the head takes on a flat shape.

The size of the head increases, frontal and parietal tubercles appear, the forehead becomes convex, there may be areas of softening of the bones in the parietal and occipital regions.

A large fontanel does not close in time, often thickening of the ribs (the so-called rosary) is formed closer to the sternum. When the child begins to walk, an X-shaped or O-shaped curvature of the legs is detected. The shape of the chest also changes: it looks as if squeezed from the sides. Children are prone to various infectious diseases (pneumonia is especially frequent), they may experience convulsions.

Parents sometimes do not pay attention to the appearance of rickets in a child or are not serious about the advice of a doctor. This can lead to a significant curvature of the spine, legs, flat feet; can cause a violation of the correct formation of the pelvic bones, which in the future in women who have had severe rickets in childhood, complicates the course of childbirth. Therefore, parents should consult a doctor at the slightest suspicion of rickets.

Prevention. It starts during pregnancy. The expectant mother should be in the fresh air as much as possible, maintain a regimen, and eat rationally.

After the birth of a child, it is necessary to follow all the rules for caring for him and try but possible to breastfeed him. Regular visits to the clinic are required. In the autumn-winter time, according to the doctor's prescription, you can conduct a course of irradiation with a quartz lamp, give fish oil.

When an excessive amount of vitamin D enters the child's body, calcium salts accumulate in the blood and body poisoning occurs, in which the cardiovascular system, liver, kidneys and gastrointestinal tract are especially affected.

In the treatment of rickets, vitamin D is prescribed individually in combination with other drugs against the background of proper feeding. If necessary, the pediatrician introduces therapeutic exercises and massage.

Symptoms and course. The clinical picture is determined mainly by the underlying disease and the form of the toxic syndrome. Neurotoxicosis (a toxic syndrome triggered by damage to the central nervous system) begins acutely and is manifested by excitation, alternating with depression of consciousness, convulsions. There is also an increase in temperature to 39-40 ° C (with a coma, the temperature can, on the contrary, be reduced), shortness of breath. The pulse is initially normal or accelerated to 180 beats per minute, with deterioration, it increases to 220 beats per minute.

The amount of urine excreted decreases up to its complete absence. The skin is initially normal in color. Sometimes its reddening is observed, and with an increase in toxic phenomena it becomes pale, "marble", with a coma - gray-bluish. Acute liver failure, acute renal failure, acute coronary (heart) failure, and other conditions of extreme severity may develop. Toxicosis with dehydration usually develops gradually. Initially, the symptoms of lesions of the gastrointestinal tract (vomiting, diarrhea) predominate, then the phenomena of dehydration and lesions of the central nervous system join. In this case, the severity of the condition is determined by the type of dehydration (water-deficient, when fluid loss predominates; salt-deficient, in which a very large amount of mineral salts is lost and, as a result, metabolism is disturbed; isotonic, in which salts and fluid are equally lost).

Treatment. A patient with a toxic syndrome must be urgently hospitalized, in case of impaired consciousness - to the intensive care unit. In the hospital, dehydration is corrected (by intravenous drip of glucose solutions, saline solutions), as well as relief of convulsions, cardiovascular disorders and respiration. The underlying disease is treated, against which the toxic syndrome has developed.

The prognosis depends largely on the severity of the manifestations of the toxic syndrome, the disease that caused it, and the timeliness of going to the hospital. Delay may result in death.

Symptoms and course. The patient is concerned about the feeling of sand and a foreign body in the eyes, itching of the eyelids, accumulation of white discharge in the corners of the eyes. Later, photophobia, ulceration of the cornea of ​​​​the eye joins. The second constant symptom is the defeat of the salivary glands, leading to the development of dryness of the oral mucosa, rapid destruction of teeth and the addition of a fungal infection of the oral mucosa - stomatitis.

Recognition. It is based on the detection of simultaneous damage to the eyes and oral mucosa, salivary glands.

Treatment begins in the hospital. Apply substances that reduce the body's immunological reactions, anti-inflammatory, drop drops containing vitamins, antibiotics are instilled into the eyes. The disease often leads to early disability of patients and is often complicated by a malignant lesion of the lymphatic system (lymphoma, Waldenström's disease).

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UDC 616-053.2: 616\18-005

The manual was prepared by: Bykov V.O., Vodovozova E.V., Dushko S.A., Gubareva G.N., Kuznetsova I.G., Kulakova E.V., Ledeneva L.N., Mironova E.V. , Popova T.A. Stremenkova I.V., Shchetinin E.V.,

The textbook is written in accordance with the requirements of the “Program for students in Pediatrics” of pediatric faculties. The manual contains up-to-date data on the etiology, pathogenesis, clinic, principles of diagnosis and treatment of major diseases in young and older children, as well as in newborns.

The manual is designed for students of pediatric faculties, interns, clinical residents.

Reviewer:

Stavropol State Medical Academy, 2010

FOREWORD

Currently, textbooks by N.P. Shabalov "Children's diseases" and "Neonatology". Paying tribute to the quality of the presentation of the material, the coverage of all sections of pediatrics, the availability of modern information on the etiology, pathogenesis and treatment of diseases, at the same time, it is necessary to point out some shortcomings of these textbooks, primarily related to the not always justified abundance of information offered for mastering.

Many years of experience in teaching children's diseases to students of the pediatric faculty indicates that not all sections of the existing textbooks on "Pediatrics" and "Neonatology" are equally accessible to students.

These problems urgently require the creation of teaching aids for students, which, without replacing existing textbooks, would facilitate the development of complex sections of pediatrics by students.

The methodological manual on pediatrics developed by the staff of the Stavropol Medical Academy includes material that meets the requirements of the “Program for students in Pediatrics” of pediatric faculties.

The first part of the manual presents the diseases of young and older children, covered from the modern point of view and the requirements of consensuses, national programs, guidelines and guidelines issued in recent years. The second part of the manual is devoted to the issues of neonatology.

PART 1. DISEASES IN YOUNGER AND SENIOR CHILDRENWRASTA

1. 1 Anomalies of the constitution

DIATESES(anomalies of the constitution) are the most controversial problem in pediatrics. Currently, the prevailing point of view is that diathesis is a kind of "tribute to tradition". Moreover, this concept has been preserved only in domestic pediatrics. Abroad, in the ICD-10, the ciphers of this pathology are not provided.

Currently in the concept constitution the following meaning is put - this is a set of geno- and phenotypic properties and characteristics (morphological, biochemical and functional) of an organism that determine the possibility of its protective and adaptive reactions aimed at maintaining homeostasis, i.e. health. At the same time, health is always relative and individual and is determined by metabolic characteristics. Features of metabolism can be relatively the same in different people, which makes it possible to classify them, to distinguish between their types. This is diathesis - or anomalies, i.e. genetically determined features of metabolism (metabolic individuality), which determine the originality of the adaptive reactions of the body and predispose to a certain group of diseases.

It is known that the risk factors for the development of many diseases are not only in the action of the environment, but sometimes to a greater extent in the constitutional features of the body. It is believed that most chronic diseases are based on the constitution of the sick. In this sense, diathesis is considered as a predisease.

Isolation of one or another type of diathesis helps in developing recommendations for the primary prevention of possible diseases in the future. Those. Diathesis is a predisposition, pre-illness, pre-insufficiency of certain metabolic mechanisms. Determining the predisposition and degree of risk of a disease is much more difficult than diagnosing an already developed disease, even in cases of its minimal manifestations.

Predisposition (diathesis) to diseases is determined by the peculiarities of the structure and function of one or more body systems: immune, central nervous system, neurohumoral, etc. The amplitude of fluctuations in the “normal” functioning of the body is very individual. Extreme norms and compensated metabolic defects are the essence of predisposition (diathesis). In cases where the body cannot provide adaptation to changing environmental conditions, the predisposition is realized by the disease.

Currently, about 20 diatheses are distinguished, grouped into groups:

I. Immunopathological: atopic, autoimmune, lymphatic, infectious-allergic.

II. Dysmetabolic: uric acid, oxalate, diabetic, hemorrhagic, adipose diathesis.

III. Organotopic: nephrotic, intestinal, hypertensive, cardioischemic, atherosclerotic.

IV. Neurotopic: psycho-asthenic, vegetative-dystonic.

Pediatricians most often encounter four diathesis: allergic (atopic), exudative-catarrhal, lymphatic-hypoplastic, neuro-arthritic.

Exudative-catarrhal and allergic diathesis have a largely similar clinical picture (both can be realized as atopic dermatitis) and etiological moments, but differ in pathogenesis.

Prevention of diseases to which some children are predisposed can be based on the allocation of risk groups or the assignment of such children to one or another diathesis. Currently, the allocation of risk groups (health groups IIA and IIB) for the development of chronic pathology is becoming more common. THEN. at present, diathesis is the basis for classifying this category of children as one or another risk group.

Prevention of diseases to which children with diathesis are predisposed should begin before the birth of the child. Even before pregnancy, it is necessary to take care of the treatment of chronic genital and extragenital pathology in the expectant mother. A pregnant woman should follow a rational diet. Of great importance is the elimination of occupational hazards from the first month of pregnancy, excessive exposure to the sun, the cessation of active and passive smoking, the adverse effects of various radiation, medicines. It should be borne in mind that prolonged natural feeding is an important direction in the prevention of many diseases. The nutritional issues of children with diathesis are key to preventing the development of diseases such as atopic dermatitis, bronchial asthma, and food allergies. Nutrition also plays an important role in preventing the development of metabolic diseases.

An essential point in preventing the development of diseases is the control of the state of the environment. It is well known that the formation of a frequently ill child, allergic diseases are directly related to the unfavorable state of the environment.

Increasing the body's adaptation to adverse environmental factors, infections is especially important for children with diathesis such as lymphatic-hypoplastic and exudative-catarrhal. Strengthening the immunological reactivity of the organism of such children through hardening, a rational lifestyle, the use of adaptagens, immunomodulators will help reduce the antigenic load, reduce the frequency of infectious diseases.

EEXCESSIVELY- catarrhal(pseudo-allergic) DIBUTTES(ECD) - a peculiar state of the body, accompanied by a tendency of the skin and mucous membranes to the occurrence of infiltrative-desquamous processes, lymphoid hyperplasia, lability of water-salt metabolism, peculiarities of histamine, protein and carbohydrate metabolism.

Epidemiology. ECD occurs in 40-60% of children in the first year of life.

Etiologyand natogenesis. ECD is based on a hereditary predisposition to the peculiarities of metabolism, water and electrolyte balance. The formation of these features is facilitated by: pathology of pregnancy, diseases of the mother, pathology of the central nervous system in a child. As a result, the originality of the functions of the autonomic nervous system (vagotonia with an increase in the level of acetylcholine), the mastocyte system (increased liberation of inflammatory mediators), the regulation of intracellular calcium functions, the originality of the structure of the connective tissue and the vascular wall are formed. Morphofunctional immaturity of the gastrointestinal tract leads to incomplete digestion of food, malabsorption, hyperproduction of IgE.

With ECD, there are numerous metabolic features that manifest themselves: tendencies to hypoproteinemia, hyperglycemia, hyperlipidemia, adrenal dysfunction (discorticism), the formation of cell membrane instability, a decrease in the intestinal barrier function, a decrease in the activity of intestinal enzymes, anaerobic type of metabolism, inferiority of connective tissue, impaired transferrin exchange, lability of water and electrolyte metabolism.

The pathogenesis of ECD in some aspects is similar to the mechanisms of development of atopic dermatitis, however, in the pathogenesis of ECD there is no immunological stage, but only pathochemical and pathophysiological. Histaminase and liberator disorders are characteristic (excessive synthesis of histamine, insufficient activity of histaminase), as well as disorders in the metabolism of cyclic nucleotides (impaired synthesis of c-AMP and c-GMP).

Research are not required for ECD.

Anamnesis, clinic. The first appearances of ECD are possible already in the first months of life. Children with ECD are overweight. The skin is pale pink in color. When applied to the skin of the hand, palm prints remain on it, indicating a pronounced lability of vascular reactions. Pastosity (not edema!) and a decrease in soft tissue turgor are characteristic. Often there are diaper rash, which are stubborn even with good care for the child. An uneven increase in body weight is noted. Periodically there is pollakiuria and / or a tendency to oligria.

The most common skin manifestations are:

1) hyperemia and pastosity of the skin of the cheeks, which is accompanied by slight peeling;

2) gneiss, milk scab;

3) transient erythema of the skin of the cheeks, buttocks.

The main feature of skin manifestations is their reversibility in the application of elimination measures, a hypoallergenic diet. By the age of 3-4, the manifestations of ECD disappear. Untimely and inadequate implementation of therapeutic and preventive measures in a child with ECD leads to the transformation of ECD into allergic dermatitis.

Diagnosis ECD is established only on the basis of the presence of characteristic clinical manifestations. Laboratory studies are necessary for the differential diagnosis.

Differential Diagnosis ECD is performed primarily with atopic dermatitis (Table 1).

Tab. 1. Differential diagnosis exudative- catarrhal diathesis and atopic dermisatita

* lichinification - thickening and strengthening of the skin pattern

Treatment, treatment goals: prevention of the development of atopic dermatitis and other allergic diseases.

Treatment regimen: Mandatory treatment: care, diet, education.

Auxiliary treatment: antihistamines, enzymes, vitamins, calcium preparations, ketotifen, topical treatment.

indications for hospitalization. Children with ECD are observed on an outpatient basis.

Diet: hypoallergenic with the exclusion of obligate allergens.

The nutrition of children with ECD should be carried out taking into account the following provisions:

a) it is necessary to ensure long-term breastfeeding for children with ECD (at least up to 4-6 months).

b) children with low sensitivity to cow's milk proteins can be fed with fermented milk mixtures (NaN fermented milk, Bifilin, acidophilic mixture Malyutka, etc.);

c) if, with the exclusion of cow's milk proteins from the diet, manifestations of ECD persist, it is necessary to exclude reactions to gluten (cereal protein). In this case, gluten-free products should be prescribed (porridges NaN, Humana, Heinz).

d) the first complementary foods are introduced from 5-6 months in the form of hypoallergenic cereals of industrial production. The least allergenic are: corn and buckwheat porridge.

e) the second complementary food - vegetable puree (zucchini, squash, cabbage, potatoes). The volume of potatoes should not exceed 20% in vegetable puree. First, they give complementary foods of one type of vegetable, then its composition is gradually expanded every 3-4 days.

f) meat puree is introduced at 6-7 months: lean beef and pork, horse meat, white turkey meat.

g) the third complementary foods - at 7-8 months - the second vegetable or vegetable-cereal dishes (zucchini, pumpkin, buckwheat).

h) requirements for food processing: potatoes are soaked for 12-14 hours, cereals - 1-2 hours, meat is boiled twice.

i) exclude: eggs, smoked meats, liver, fish, caviar, seafood, spicy and processed cheeses, mushrooms, nuts, coffee, chocolate, carbonated drinks, honey.

Medical treatment. In the treatment of ECD, antihistamines are used: I generation (suprastin, diazolin, fencarol, tavegil, 2 mg / kg of body weight per day in 3 divided doses for 10-14 days); II generation (zyrtec from 6 months 5-10 drops 1 time per day on an empty stomach for 14 days to 6 months) xizal; erius, kestin, telfast from 4 years of age, 1 tablet 1 time per day in the morning.

Anti-liberators, membrane stabilizers are indicated for persistent ECD (ketotifen 0.05 mg/kg of body weight per day in 2 divided doses with meals); cinnarizine - 12.5 mg 3 times a day, for a long time for several months.

Local treatment includes baths with chamomile, bran, string. Indifferent ointments without hormones (for example, naphtholane) are shown.

Children with ECD need to limit the unreasonable use of medications. An individual approach to preventive vaccinations is shown.

Forecast. Subject to the requirements for nutrition, care, the environment, and adequate therapeutic measures, the prognosis is favorable.

LIMFOTICO- HYPOPLASTIC DIATHESIS(LGD)

PHD is a congenital generalized immunopathy with a violation of both cellular and humoral immunity and dysfunction of the endocrine system. With PHD, it is noted: hyperplasia of the reticular stroma of the thymus and lymph nodes, and hypoplasia of the chromaffin tissue, reticuloepithelial apparatus, aorta, heart, smooth muscles, gonads, and most importantly, hypofunction of the adrenal glands. Of all the diatheses, LGD is the least demanded by practical health care. From a practical standpoint, enlarged thymus syndrome (SUVZH) is of greater practical importance.

predisposing factors. According to L.V. Volodina, women with the following diseases are at risk of having a baby with PHD:

endocrine - obesity, diabetes mellitus;

allergic - bronchial asthma, hay fever, allergic dermatosis, recurrent urticaria, angioedema, insect and drug allergies, photodermatosis;

purulent-septic - abscesses, purulent appendicitis, purulent otitis media, furunculosis, recurrent blepharitis, prolonged wound healing.

Epidemiology. The frequency of LGD has not been studied enough. Enlargement of the thymus II-III degree is more common in children of the first year, and I degree - in children older than a year.

Etiology. The causes of the development of PHD are multifactorial. Most often they are caused by adverse effects on the fetus in the period of embryogenesis and fetogenesis (adverse effects of environmental factors, maternal diseases, unfavorable course of pregnancy and childbirth), which leads to disturbances in the formation of organs of the immune and endocrine systems. Mothers of children with SUVH have chronic foci of infection, allergic diseases, endocrine pathology, aggravated obstetric anamnesis, unfavorable course of pregnancy (preeclampsia of the 2nd half), pathology during childbirth.

In some cases, VSV can be genetically determined, and can also develop with intranatal fetal damage and in the period of postnatal ontogenesis.

Pathogenesis. Adverse factors affecting the fetus during pregnancy lead to the formation of disorders in the functioning of the hormonal system. As a result, dysfunction of the pituitary gland, thyroid gland, hypothalamus develops (according to the principles of direct and feedback).

In children with PHD, a decrease in the level of cortisol in the blood is detected. A low level of cortisol corresponds to a low level of ACTH, which indicates a violation of the regulation of the adrenal cortex by the hypothalamic-pituitary system.

The immune system in young children with PHD functions with great stress, which creates the prerequisites for its rapid depletion.

Immune deficiency in PHD is characterized by excessive proliferation and delayed maturation of T-lymphocytes in the thymus. In children with PHD, both in the acute period of intercurrent diseases and in the period of convalescence, high lymphocytosis and lower IgG levels are noted, and in the recovery period, IgA. Also reduced the content of lysozyme, complement in the blood serum, phagocytic activity of neutrophils.

Disturbances in the immune system are one of the factors in the formation of a frequently ill child.

Research. General analysis of blood and urine, chest x-ray, ultrasound of the thymus, immunogram.

Anamnesis, clinic. Most children with LGD have rounded body shapes, slight pastiness of tissues, relatively large facial features, hypertelorism, sunken bridge of the nose, short neck, broad chest, broad shoulders, broad hands and feet, relatively short and wide fingers, light hair and eyes. , underdeveloped muscles and reduced physical activity. Features of the growth and development of children with PHD are asynchronism of development and maturation, most pronounced in the 1st year of life.

Pallor of the skin with a marble pattern, increased hydrophilicity of tissues are characteristic. Many children with PHD have generalized hyperplasia of the lymph nodes and accumulations of lymphoid tissues, hypertrophy of the tonsils and adenoids, which occurs with infectious diseases, vaccination, and persists for a long time after recovery.

A child with LGD is characterized by calmness, a slow reaction to painful stimuli, and a decrease in the excitability of the central nervous system. With age - there are no claims to leadership. There is a tendency to recurrent (protracted) or chronic inflammatory diseases (frequent SARS, adenoiditis, sinusitis, chronic tonsillitis, prolonged low-grade fever).

In young children with PHD, there is a high incidence of atopic dermatitis. From the side of the central nervous system, such syndromes as hypertensive-hydrocephalic, convulsive, muscular hypotension, autonomic-visceral dysfunctions are more common. Often there is a violation of thermoregulation after an infectious and inflammatory disease in the form of a long-term (from 2 weeks to 2-3 months) subfebrile condition.

These children are at risk of developing autoimmune conditions, lymphomas, leukemia, bronchial asthma, and diabetes. There is a high risk of sudden death syndrome, there is a predisposition to tuberculosis. Possible anaphylactoid reactions to vaccines, some drugs.

DiagnosisLGD is established on the basis of the characteristics of the clinic: 1) appearance: excessive fullness, pastosity of tissues (not swelling!), pallor of the skin, decreased tissue turgor, some hypodynamia and emotional lethargy, body imbalances (short neck and torso, relatively long limbs);

2) lymphoproliferative syndrome: lymphopolyadenopathy, hyperplasia of the palatine and pharyngeal tonsils, proliferation of adenoids, thymomegaly;

3) a tendency to adrenal insufficiency.

4) cardiovascular syndrome: muffled tones, functional systolic murmur on the vessels of the neck, a tendency to tachycardia, a tendency to decrease in blood pressure;

5) allergic (non-atopic) symptoms: arthralgia;

6) syndrome of compression of vital organs in children with thymomegaly: hoarseness of voice, low timbre, "cock's cry" when crying, throwing back the head during sleep, noisy breathing, hard breathing (thymic asthma);

7) hypoplastic syndrome (rare): hypoplasia of the genital organs, heart, aorta, thyroid and parathyroid glands, adrenal chromaffin tissue.

The diagnosis of SUVZh is based on the detection of an enlarged thymus gland on x-ray (ultrasound) examination.

Laboratory research. In blood tests, there is an increase in the total number of lymphocytes, a decrease in the level of T-lymphocytes and a higher content of B-lymphocytes. A lower level of suppressor T-lymphocytes is detected, which leads to an increase in the immunoregulatory index (CD4 / CD8). The functional activity of B-lymphocytes is lower than in healthy children. The level of IgG often decreases, the content of IgE - increases.

Differential Diagnosis

Tab. 2 . The main directions of differential diagnosis inLGD

Treatment, treatment tasks: prevention of adverse reactions of the body to stress, infections, surgical interventions; reduction in the incidence of infectious diseases.

The scheme of treatment. Mandatory treatment: diet, regimen, adaptogens, vitamins.

Adjuvant treatment: immunomodulators, bacterial lysates, glucocorticoids.

Indications for hospitalization: the need for an in-depth examination.

Diet. Fight for breastfeeding. In case of its absence, the use of adapted fermented milk or hypoallergenic mixtures (“NAN GA” and “Nutrilon GA”). Gradually and carefully introduced vegetables and fruits, lean meats, fish.

Mode. You need an optimal motor regime, stay in the fresh air, massage. Exclusion of strong irritants (oral route of drug administration, the use of sparing procedures, etc.)

Medical treatment. Immunomodulators (Taktivin - from 6 months to 14 years, the drug is prescribed subcutaneously at the rate of 2-3 mcg per 1 kg of body weight for 7-10 days; thymogen - intranasally for children under 1 year, 10 mcg, 1-3 years - 10- 20 mcg, 4-6 years 20-30 mcg, 7-14 years 50 mcg for 3-10 days;). Repeated courses of Taktivin up to 4 times a year. Therapy with Taktivin is carried out under the control of immunograms.

Vitamins: BUT- an oil solution in capsules of 3300 IU for children over 7 years old - 1 capsule per day, a course of 30 days; IN 1- daily doses for children up to a year 0.003-0.005 g., from 1 to 3 years old - 0.005-0.01 g., 3-7 years old - 0.01-0.02 g., 7-14 years old - 0.025-0 03, 1-3 times a day after meals, course 15-30 days; IN 2- daily doses for children up to a year 0.002-0.006 g., from 1 year to 3 years - 0.006-0.01 g., 3-7 years old - 0.01-0.015 g., 7 years and older - 0.015-0.03 g., 1-2 times a day after meals, a course of 1-1.5 months, AT 5- daily doses for children under 6 months 0.015 g, from 6 months to 1 year - 0.02-0.025 g, 1-2 years - 0.03 g, 3-4 years - 0.045 g, 5-6 years - 0.075 g, 7-9 years 0.09 g, 10-14 years 0.15 g 2-3 times a day after meals, course 10-15 days; B15- daily doses for children under 3 years of age 0.05 g, from 3 years to 7 years - 0.1 g, 7-14 years - 0.15 g 3-4 times a day after meals, in a course of 2-3 months; FROM- single doses for children under 1 year old - 50 mg, 1-7 years old - 75-100 mg, 7-14 years old - 100-200 mg. 2-3 times a day after meals, course 15-30 days; B15- daily doses for children under 3 years of age 0.05 g, from 3 years to 7 years - 0.1 g, 7-14 years - 0.15 g 3-4 times a day after meals, in a course of 2-3 months.

Prevention of ARI also includes: limiting contact with sick children, courses of viferon (ointment) 2 times a day in the nose for 10 days of each month for 3 months; imunoriks - for children over 3 years old: 400 mg (1 bottle) once a day without food for 15 days or more., ascorbic acid and B vitamins; echinacea - for children 1-6 years old, 5-10 drops, 6-12 years old, 10-15 drops, over 21 years old, 20 drops 3 times a day, lasting at least 8 weeks.

The use of bacterial lysates of local (IRS-19) and systemic action (bronchomunal, ribomunil, etc.) is shown.

When carrying out planned surgical interventions in children with RVH, it is recommended to use small doses (25 mg) of hydrocortisone immediately before surgery.

Phytotherapy. Herbs and plants with a desensitizing effect are used: chamomile, yarrow, blueberries, wild garlic, birch buds and inflorescences.

In order to stimulate the function of the adrenal cortex, an infusion of black currant leaves, licorice root is used. Adaptogens are recommended: pantocrine - inside 10-15 drops or 1/4-1/2 tablets 2-3 times a day with water, 20-30 minutes before meals or 3 hours after meals. The course of treatment is 3-4 weeks, lure, leuzea, ginseng tincture 1 drop per year of life 3 times a day for 10 days, etc.

With thymomegaly: herbal medicine (chamomile, yarrow, birch buds and inflorescences, wild garlic, blueberries, sea buckthorn oil). With severe thymomegaly, short courses of glucocorticoids.

Vaccination prophylaxis in children with CVD has its own characteristics. For children with an enlarged thymus of I-II degree, the same indications and contraindications remain as for healthy children. However, given the high frequency of perinatal encephalopathy, incl. hypertensive-hydrocephalic syndrome, in this contingent of children, the appointment of diacarb according to the scheme is indicated. Vaccination should be carried out against the background of a hypoallergenic diet and hyposensitizing therapy 3 days before and 3 days after vaccination.

Children with an enlarged thymus gland of the III degree require observation and a temporary medical withdrawal from preventive vaccinations for a period of 3-6 months. These children are recommended to be re-examined to clarify the size of the thymus gland. With a decrease in the size of the thymus during the period of clinical well-being, vaccination is indicated against the background of a hypoallergenic diet and hyposensitizing therapy. Vaccination in children with an increase in the thymus gland of varying degrees requires rational tactics of preparation and implementation, taking into account the individual characteristics of the child. In children with grade III thymus enlargement, a course of immunocorrective therapy with Taktivin is recommended. After a course of Taktivin, the Mantoux reaction can be done no earlier than 2 months later, since a false positive result is possible.

After immunocorrective therapy, vaccination is indicated no earlier than 1-2 months after the end of therapy.

Children with PHD and SUVZh require dispensary observation of an immunologist and an endocrinologist.

Forecast with PHD, it is determined by the characteristics of the clinical manifestations of diathesis, the degree of immunological disorders, and the effectiveness of therapeutic and preventive measures. The prognosis for LDH is usually good.

HERVNO- ARTHRITIC DIATHESIS(ABOVE)(uremic or uric acid diathesis) - a hereditary, enzyme deficiency syndrome with a violation of purine metabolism and an increase in the synthesis of uric acid. Characterized by instability of carbohydrate and lipid metabolism, ketoacidosis, impaired acetylation.

Epidemiology. NAD occurs in 2-5% of children.

Etiology NAD is associated with a hereditary purine defect, maternal malnutrition during pregnancy (excess meat), and in young children. In a hereditary history, an increase in the excitability of the central nervous system and a violation of the activity of enzymes that ensure the metabolism of purine and pyrimidine bases and the acetylating ability of the liver are revealed: arthritis, urinary and cholelithiasis, gout, SVD, migraine, etc.

Pathogenesis. Hyperuricemia increases the excitability of the central nervous system, increases the sensitivity of the vascular wall to the action of catecholamines, has a diabetogenic effect, promotes stone formation.

Research. General analysis of blood and urine, determination of the level of uric acid in the blood, the study of KOS indicators.

Clinical history. NAD manifests itself in children aged 6-7 years. History: poor weight gain, unstable stool, loss of appetite. White fast dermographism, tachycardia, low-grade fever, sympathicotonia are often noted.

Children with NAD are predisposed to the development of malnutrition, vomiting, psychoneurosis, infectious metabolic arthritis, dysmetabolic nephropathy, interstitial nephritis, and diabetes mellitus.

Neuropsychic syndrome: increased excitability, choreic hyperkinesis, tics, night terrors, emotional lability, accelerated development of the psyche and speech (children are child prodigies);

Dysmetabolic syndrome: appetite perversion, anorexia, slow weight gain, "unreasonable" temperature rises, transient arrhythmias, muffled heart sounds, symptoms of acetonemic crises (sudden, frequent, cyclic vomiting with the development of dehydration, fever, the appearance of the smell of acetone), pain symptoms (pain in the abdomen, dysuric manifestations, pain in the extensor muscles, migraine, neuralgia, arthralgia, rarely arthritis).

Spastic syndrome: a tendency to increase blood pressure, bronchospasm, headaches, constipation, cardialgia.

Diagnosis. NAD is diagnosed by the presence of metabolic disorders in history, the identification of clinical manifestations of diathesis.

Laboratory data. NAD markers are: uraturia and high levels of uric acid in the blood. Eosinophilia is found in the general blood test. In the study of CBS, acidosis is detected.

Differential Diagnosis

Tab. 3. Differential diagnosis of neuro-arthritic diathesis(main directions)

Treatment, treatment tasks: normalization of uric acid metabolism, prevention of the negative effects of uric acid on internal organs.

Treatment regimen: Mandatory treatment: diet, regimen.

Auxiliary treatment: vitamin therapy, sedative therapy, normalization of uric acid metabolism.

Indications for hospitalization: acetonemic vomiting, the need for an in-depth examination.

Diet: a) restriction in the diet: veal, poultry, offal (liver, heart, brains, kidneys, lungs), sausages, mushrooms (porcini, champignons), fish broths, jelly, sorrel, spinach, rhubarb, parsley, asparagus, cauliflower, polished rice, oatmeal, sauces, beans, fish, coffee, cocoa, strong tea, spices, spices;

Plentiful alkaline drinking, especially in the second half of the day (from 1 month 1 teaspoon of warm degassed Borjomi per kg of weight per day);

Cranberries, lemons;

Vitamin B6 in the morning;

citrate blend;

Protective mode: sufficient rest, limitation of excessive psycho-emotional stress, gymnastics, water procedures.

Sedative therapy (herbs: valerian, horsetail, mint, motherwort, if necessary - drug therapy).

Tranquilizers (in the absence of the effect of herbal medicine) - sibazon, diazepam, seduxen - the maximum daily dose for children is 10 mg 2-3 times a day for a course of 10-14 days.

With severe hyperuricemia in children over 10 years of age, the following are shown: etamide - for school-age children, 1/-1 tablet 4 times a day, the course of treatment is 10-12 days, after 5-7 days the course is repeated, the treatment is carried out under the control of laboratory urine tests; butadion - children under 6 months are not prescribed, 6-12 months a single dose of 0.01 g, 1-3 years 0.02 g, 3-4 years 0.03 g., 5-6 years 0.04 g, 7-9 years 0.05-0.06, 10-14 years 0.08-0.1 g 3 times a day with meals, the course of treatment is 15-30 days; allapurinol -10-20 mg / kg per day, taken orally 3 times a day after meals with plenty of water for 2-4 weeks; orotic acid - orally 1 hour before or 4 hours after meals, 0.25-0.3 g 2-3 times a day, colchicine - for prevention 1 mg in the evening, a course of 3 months, is used in children over 12 years old.

Forecast with NAD, it is determined by the severity of the manifestations of diathesis, the degree of uric acid metabolism disorders, the child's response to therapeutic and preventive measures.

1 . 2 Allergic diseases

BUTTOPIC DERMATITIS(atopic eczema, atopic eczema/dermatitis syndrome) (HELL)- a chronic inflammatory disease of the skin, accompanied by itching, which begins in early childhood, may continue or recur in adulthood and leads to physical and emotional maladaptation of the child and his family members.

AD develops in individuals with a hereditary predisposition and is often combined with other allergic diseases.

Epidemiology. The frequency of AD has increased over the past 3 decades and in developed countries is 10-15% in children under 5 years of age and 15-20% in schoolchildren.

Etiology AD is multifactorial and polyetiological in nature. AD develops in 81% of children if both parents are sick, and in 56% if one of the parents is sick.

Allergens, the importance of which in the development of AD has been scientifically proven:

Food: milk, eggs, nuts, soy, wheat, shellfish, fish.

Pollen: Pollen, fungi (spores), dust mites, animal dander, cockroaches.

Bacterial: bacteria, staphylococcus aureus, streptococci.

Fungal: pitorosporum ovale, trichophyton.

Non-allergenic triggersHELL: climate; high temperatures and humidity; chemical irritants (laundry detergents, soaps, cleaning chemicals, perfumed lotions); food that has an irritating effect (spicy, sour); emotional stress; chronic diseases; infection; sleep disturbance; psychosocial stressors.

Pathogenesis.

When the body comes into contact with the allergen, IgE antibodies are formed, which are fixed on mast cells in various organs (sensitization period). When the allergen enters the body again, T-lymphocytes are activated, which produce interleukins (IL4, IL5, IL13), cytokines. IL4 is the leading factor in switching the synthesis of B cells not from conventional immunoglobulins, but from IgE. As a result of the antigen + antibody reaction, biologically active substances (allergy mediators) are released.

The main mediator of allergy is histamine. Histamine exerts its action through the stimulation of histamine receptors (H1, H2, H3, H4). As a result, clinical manifestations of allergy develop: itching, rashes, hyperemia, blistering. The described changes are attributed to an early allergic reaction.

4-6 hours after exposure to the allergen, a late allergic reaction develops. Basophils, eosinophils, T-lymphocytes, as well as substances secreted by these cells, take part in the development of this component of allergy. As a result, chronic allergic inflammation is formed.

Working classification of blood pressure

Age periods of the disease:

I age period - infantile (up to 2 years);

II age period - children's (from 2 years to 13 years);

III age period - adolescence and adult (from 13 years and older).

Disease stages:

Stage of exacerbation (phase of pronounced clinical manifestations, phase of moderate clinical manifestations);

Remission stage (incomplete and complete remission).

Epidemiology of the process: limited localized; common; diffuse.

Severity of the process: mild; moderate; severe course

Research. O general blood and urine analysis, coprogram, ultrasound of parenchymal organs, skin tests, feces for worm eggs, determination ofbcurrentIgE. According to the indications: urinalysis according to Nechiporenko, coagulogram, determination of ALT, AST, blood glucose, with frequent exacerbations, an immunological study and the determination of specific IgE are indicated; Echoeg, EEG, ultrasound, radiography of the paranasal sinuses and chest, skin tests (not earlier than 3 years with a satisfactory skin condition).

Specialists: allergist (diagnosis, allergy testing, selection and correction of therapy, patient education), dermatologist (diagnosis, differential diagnosis, selection and correction of local therapy, training), nutritionist (individual nutrition), gastroenterologist (diagnosis and treatment of gastropathology), ENT (detection and sanitation of foci of infection), a psychoneurologist (correction of behavioral disorders), a medical psychologist (training in relaxation techniques, stress relief, behavior modification).

Outpatient research, order of the Ministry of Health of the Russian Federation No. 268: general analysis of craboutyou, consultation of the allergist. According to indications: examination of feces for worms and protozoa, determination of general and specific IgE, blood platelets, blood glucose, culture of feces for flora, coprogram, skin tests.

Anamnesis, clinic. The clinical picture of AD depends on the age of the child. In children of the first year of life, two types of the course of the disease are distinguished.

The seborrheic type is characterized by the presence of scales on the scalp, which appear already in the first weeks of life, or proceed as dermatitis in the skin folds. In the future, transformation into erythroderma is possible.

The numular type occurs at the age of 2-6 months and is characterized by the appearance of spotted elements with crusts; characteristic localization - cheeks, buttocks and / or limbs. It also often transforms into erythroderma.

Preschool age: in 50% of children suffering from childhood eczema, skin manifestations are leveled by 2 years of age. In the remaining half, the characteristic localization of the process is skin folds.

School age: characteristic localization - skin folds. A separate form of AD at this age is juvenile palmoplantar dermatosis, in which the skin pathological process is localized on the palms and feet. This form of AD is characterized by seasonality: exacerbation of symptoms in the cold season and remission in the summer months. In the presence of dermatitis of the feet, it must be remembered that dermatophytosis in children is observed very rarely. AD with localization in the buttocks and inner thighs usually appears at the age of 4-6 years and persists into adolescence.

Phases of atopic dermatitis:

Acute phase (itching, erythematous papules and vesicles, against the background of skin erythema, often accompanied by significant excoriations and erosions, serous exudate).

Subacute phase (skin erythema, excoriation, peeling), including - against the background of compaction (lichenification) of the skin.

Chronic phase (thickened plaques, lichenification, fibrous papules).

Diagnoh. Diagnostic criteria for AD are divided into basic and additional.

Main criteria: itching, eczema (acute, subacute, chronic): with typical morphological elements and localization characteristic of a certain age (face, neck and extensor surfaces in children 1 year of age and older; flexor surfaces, groin and axillary areas - for all age groups) with a chronic or relapsing course.

Additional criteria: the presence of dermatitis (or a history of dermatitis) in the area of ​​the flexor surfaces of the limbs (elbow and popliteal folds, anterior surface of the ankles); the presence of close relatives of bronchial asthma or hay fever; widespread dry skin; onset of dermatitis before 2 years of age.

Laboratory and instrumental research methods:

Determination of the content of total IgE in blood serum (the test is not diagnostic);

Skin tests (PRIK test, skin prick tests, intradermal tests) reveal IgE-mediated allergic reactions, they are performed in the absence of acute manifestations of AD in the patient;

An elimination diet and a food allergen challenge test are usually performed to confirm the diagnosis of food allergy, especially to cereals and cow's milk;

Determination of allergen-specific IgE antibodies in blood serum (RAST, ELISA, etc.) is preferable for patients with ichthyosis taking antihistamines or antidepressants, with questionable results of skin tests or in the absence of a correlation between the clinic and the results of skin tests, with a high risk of developing anaphylactic reactions to a certain allergen during skin testing.

SCORAD (Scoring Atopic Dermatitis), EASY (Eczema Area and Severity Index), SASSAD (Six Area Six Sign Atopic Dermatitis Severity Score) scales are currently most widely used to assess the severity of clinical symptoms of AD. In our country, the SCORAD scale has become widespread (Fig. 2), which takes into account the prevalence of the skin process ( BUT), the intensity of clinical manifestations ( AT) and subjective symptoms ( FROM).

A. The prevalence of the skin process is the area of ​​\u200b\u200baffected skin, which is calculated according to the rule of nine (see Fig. 2, the surface area for children under 2 years is indicated in brackets). For evaluation, you can also use the "palm" rule (the area of ​​the palmar surface of the hand is taken equal to 1% of the entire skin surface).

b. To determine the intensity of clinical manifestations, the severity of 6 signs (erythema, edema / papules, crusts / weeping, excoriations, lichenification, dry skin) are counted. Each sign is evaluated from 0 to 3 points (0 - absent, 1 - weakly expressed, 2 - moderately expressed, 3 - sharply expressed; fractional values ​​are not allowed). The assessment of symptoms is carried out on the area of ​​the skin where they are most pronounced. The total score can be from O (no skin lesions) to J8 (maximum intensity of all 6 symptoms). The same area of ​​affected skin can be used to assess the severity of any number of symptoms.

C. Subjective symptoms - itching of the skin and sleep disturbances - are assessed in children older than 7 years. The patient or his parents are asked to indicate a point within a 10-cm ruler, corresponding, in their opinion, to the severity of itching and sleep disturbances, averaged over the last 3 days. The sum of subjective symptom scores can range from 0 to 20.

The overall score is calculated by the formula: A/5 + 7B/2 + C. The total score on the SCORAD scale can range from 0 (no clinical manifestations of skin lesions) to 103 (the most pronounced manifestations of AD).

Rice. 2. Determining the severity of AD

In practical work, for the diagnosis of AD, as a rule, it is sufficient to determine the clinical parameters. The first and obligatory clinical parameter is itching. Of the remaining four parameters, at least three must be set. These include:

Characteristic localization of skin lesions;

The presence of atopic disease in the next of kin;

Widespread dry skin;

The appearance of dermatitis before the age of 2 years.

In deciphering the diagnosis of AD, two characteristics are of practical importance: the phase of the disease, the severity of the skin lesion.

The severity of AD can also be determined by the duration of periods of exacerbation and remission, the severity of itching, the prevalence of the skin process, and an increase in peripheral lymph nodes (Table 4).

Tab. four. Assessing the severity of AD

Differentialnydiagnosticallyh AD is carried out with: immunodeficiencies, lichen planus, infections and invasions, metabolic diseases, Gilbert's pink lichen, ichthyosis vulgaris, neoplastic diseases, dermatitis, exudative erythema multiforme, exudative-catarrhal diathesis (see "Exudative-catarrhal diathesis").

Treatment, treatment goals: reduction in the severity of symptoms of the disease; ensuring long-term control of the disease by preventing or reducing the severity of exacerbations; change in the natural course of the disease. Complete cure of the patient is impossible.

Treatment regimen: The main directions of AD therapy: elimination of causative factors that cause exacerbation (diet, hypoallergenic lifestyle), medical and cosmetic skin care; external anti-inflammatory therapy, antihistamines.

Auxiliary treatment: enterosorption, therapeutic plasmapheresis, phototherapy, cytostatics, antibiotics, vitamins, immunomodulators, probiotics.

Indications for hospitalization: - exacerbation of blood pressure, accompanied by a violation of the general condition; widespread skin process, accompanied by secondary infection; recurrent skin infections; ineffectiveness of standard anti-inflammatory therapy; the need for an allergy test.

The AD diet should exclude foods that have been proven to play a role in the development of AD. For babies in their first year of life, breast milk is the best food. In its absence, adapted mixtures with a low degree of hydrolysis are used (hypoallergenic mixtures - NaH hypoallergenic, Hipp GA, Humana GA, etc.) for mild manifestations of AD. With pronounced manifestations of AD, the appointment of mixtures based on a high degree of protein hydrolysis (Alfare, Nutrilon Pepti TSC, Nutramigen, etc.) is indicated. Complementary foods are recommended for children with AD 1 month later than healthy ones.

External Therapy AD includes skin care (moisturizing and softening) and the use of drugs applied to the skin. External therapy for AD is a mandatory part of the treatment. The main objectives of external therapy for AD are: a) relief of itching and inflammation; b) increasing the barrier function of the skin, restoring its water-lipid layer; c) proper skin care.

Skin care should be carried out depending on the phase of AD:

1. Acute and subacute phases with weeping of the skin:

The use of wet-drying dressings, lotions, irrigation with thermal water is shown;

Affected areas of the skin should be promptly cleaned of pus, crusts, scales;

Bathing children in this phase of dermatitis is not contraindicated if all bathing rules are followed;

If bathing is not possible, skin cleansing with special micellar solutions (Dalianzh) is used;

The use of creams and ointments in this phase of AD is not indicated, as their use can provoke weeping.

2. Acute and subacute phases without wetting of the skin:

Daily bathing followed by the use of creams with an unsaturated texture;

Of the skin care products, preference is given to irrigation with thermal water, the use of emulsions is preferred to special soap, gel, mousse.

3. Chronic phase:

The main thing is the use of a sufficient amount of moisturizers and mainly emollients;

It is mandatory to apply moisturizers/emollients after bathing (Table 10);

For some patients with severe dry skin, repeated bathing (showering) throughout the day to increase skin hydration, followed by the application of moisturizers / emollients, may be recommended.

For external therapy of AD, topical glucocorticoids (THC), Elidel, traditional therapeutic agents (aniline dyes, naftalan, tar, ichthyol, ASD fraction III) are used. Depending on the severity of the inflammatory process, lotions, talkers, creams, gels, lipogels, ointments are used for treatment. The rules for choosing drugs for AD are presented in Table. 5.

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