Hypotrophy in children. Hypotrophy in young children: the main symptoms
There is nothing worse for parents than the illness of their child. And when a baby is sick, still inexperienced parents often cannot cope with it in time, because they do not know the main symptoms of diseases and what they can lead to. This article will talk about such pathological condition, as malnutrition, which is often found in infants.
What is hypotrophy? Types of malnutrition and the main danger.
Hypotrophy is a chronic eating disorder in a child, which is characterized by an energy and / or quality deficiency. nutrients, which leads to a lack of body weight of the baby, a violation of his physical and intellectual development, pathological changes in all organs and systems. The disease affects mainly children under 3 years of age. AT various countries the frequency of malnutrition varies from 2 to 30%, depending on the economic and social development countries.
There are two types of malnutrition:
- congenital;
- acquired.
Congenital or intrauterine malnutrition is a malnutrition that occurs even in the period prenatal development child.
Main reasons congenital malnutrition fetus:
- insufficiency of uteroplacental circulation;
- chronic fetal hypoxia;
- chromosomal and genomic mutations;
- pathology of pregnancy;
- constitutional features of the mother's body ( short stature, body weight, age);
- mother's bad habits;
- malnutrition in pregnant women.
Acquired malnutrition is a chronic eating disorder of a child, which is characterized by a slowdown or cessation of the growth of the baby's body weight, a violation of normal body proportions, thinning and disappearance of subcutaneous fatty tissue, a violation of the digestive processes, a decrease in the body's resistance to infections, a predisposition to various diseases and delay neuropsychic development. It is this type of malnutrition that occurs most often and brings a lot of grief to young parents, therefore, further we will talk about this violation.
Physiological weight loss in newborns
Before you panic due to the fact that the child stopped gaining weight after birth or lost several hundred grams, you need to be aware of such a phenomenon as physiological weight loss in newborns.
It occurs in all babies, regardless of what weight was at birth. The mechanism of this phenomenon is as follows. Before birth, all metabolic processes in the body of the fetus are greatly activated, which provides it with the necessary energy during childbirth and in the first hours of independent life. Also, in the first days of a baby’s life, his body loses more fluid than it consumes (with breathing, feces, evaporation through the skin).
The newborn loses weight until about the 4th day of life, from the 5th day the baby should begin to gain weight again and by the 7-10-14th day his weight should again be the same as at birth, if this does not happen, then you need to look for the cause (such a phenomenon already considered pathological and requires intervention). The rate of weight loss is up to 7% of the original, if more, then this is already a pathology.
Proper care of the child, early breastfeeding, sufficient fluid intake in the child's body, prevents big loss weight. If physiological weight loss has not occurred, then it is necessary to think about possible reasons. Most often this is due congenital disorders excretory system, because of which fluid accumulates in the body of the child.
Etiology of acquired malnutrition
There are many reasons for acquired malnutrition and it is not always possible to establish why the child is not gaining weight.
The main causes of acquired malnutrition:
- nutritional factors (quantitative or qualitative malnutrition of the infant, violation of the feeding regime, the use of low-energy formulas for feeding);
- diseases digestive tract child;
- chronic and acute infectious diseases (pneumonia, SARS, sepsis, intestinal infections etc.);
- poor child care;
- hereditary diseases;
- birth defects development;
- anomalies of the constitution (diathesis);
- neuroendocrine diseases.
Clinical signs and degrees of malnutrition
AT clinical picture disorders are dominated by 4 main syndromes.
1. Syndrome of trophic disorders.
Includes features such as underweight and/or length for the child's age, various violations proportions of the body, gradual thinning and disappearance of subcutaneous fatty tissue, the skin becomes dry, inelastic, and the muscles of the child become thinner over time.
2. Syndrome of violation of the state of the central nervous system.
Includes violations emotional state(baby cries all the time) and reflex activity(all reflexes weaken). The baby sucks poorly or refuses to breastfeed at all, the muscle tone is reduced, the child moves little, does not roll over, does not hold his head well, etc. The baby’s sleep is disturbed, he does not keep a stable body temperature well.
3. Syndrome of reduced food tolerance.
Over time, the child's appetite decreases until the development of anorexia, he refuses to breastfeed. Disorders of the digestive tract develop (regurgitation, unstable chair, vomit).
4. Syndrome of reducing the body's resistance (immunological reactivity).
The child becomes prone to frequent inflammatory and infectious diseases.
Depending on the severity of the signs of the disease and weight loss, there are 3 degrees of malnutrition.
Hypotrophy 1 degree:
- weight deficit is 10-20%;
- the child's condition is satisfactory;
- PZhK is moderately thinned only on a stomach;
- tissue turgor is moderately reduced;
- the skin is pale, their elasticity is slightly reduced;
- no growth lag;
- psychomotor development is not disturbed;
- food tolerance is not impaired;
- immunological reactivity is normal.
Hypotrophy 2 degrees:
- body weight deficit 20-30%;
- the condition of the child is moderate;
- The pancreas becomes thinner on the abdomen, limbs and torso;
- tissue turgor is reduced;
- the skin is pale, dry, its elasticity is reduced;
- growth lag is 1-3 cm;
- psychomotor development slows down;
- immunological and food tolerance are declining.
Hypotrophy 3 degrees:
- weight deficit is more than 30%;
- complete disappearance of PZhK;
- the child's condition is severe;
- tissue turgor is sharply reduced;
- there is no elasticity of the skin, ulcers, cracks appear on the skin;
- growth lags behind by 3-5 cm;
- significant lag in psychomotor development;
- immunological and food tolerance is sharply reduced.
Principles of treatment of malnutrition
Hypotrophy of the 1st degree is treated in outpatient settings, and 2 and 3 degrees - only in the hospital.
The main directions of therapy:
- elimination of the cause of malnutrition;
- diet therapy;
- correction of metabolic disorders;
- organization of proper care;
- therapy concomitant diseases.
The basis of the treatment of malnutrition is diet therapy, which has 3 stages: the elimination of the syndrome of reduced food tolerance, the increase in food loads, the complete elimination of malnutrition in a child. A gradual increase in caloric content and volume of food leads to an improvement in the child's condition, he gradually begins to
gain mass. If children have weakened sucking or swallowing reflex, then they are fed with a probe. The missing volume of fluid is administered intravenously.
In the complex of treatment, doctors prescribe enzymes, vitamins, microelements, preparations for normalization intestinal microflora, anabolic hormones.
The prognosis for malnutrition of 1 and 2 degrees with timely access to a doctor and diet therapy started on time is favorable. With malnutrition of the 3rd degree, despite intensive treatment, mortality reaches 20-50%.
To prevent this condition in your baby, it is enough to follow a few recommendations. Regularly visit the district pediatrician to examine the child and take all anthropometric measurements. Stick to all the principles proper nutrition your child, introduce complementary foods and complementary foods on time. It is necessary to control the dynamics of the growth of the child's body weight, to organize proper care, eliminate risk factors for the development of malnutrition.
Hypotrophy (Greek hypo - low, and trophe - nutrition) is akin to dystrophy, it is also expressed in the lack of physical development of children, but in addition it leads to serious violations metabolic processes in the body. In an infant in the first months of life, bone and muscle tissue, and the total body weight gained to a sufficient extent indicates its harmonious development.
If the body weight is insufficient, then failures in the child's life support system will not keep you waiting. The lack of vitamins and microelements will not allow to fully develop children's body, but for him, a deficiency of protein - the building material of cells, as well as a lack of calories - energy for the implementation of metabolic processes in the body, is especially dangerous. Pathological process can start from malnutrition, and as a result of some kind of illness or harmful factor leading to incomplete absorption of food.
Factors provoking malnutrition
Internal causes of disturbed trophism of body tissues:
1. Functional failures in digestive system: they do not allow you to fully absorb the nutrients necessary for the baby. This can happen both in the gastrointestinal tract (gastrointestinal tract), and at the cellular level in the very substance of the tissue. Violation of metabolic processes in the cell leads to the depletion of its energy reserves, and upon reaching a critical value, the cell may die.
2. Encephalopathy of the fetus on different stages prenatal development, which in turn leads to the fact that developing with deviations of the central nervous system can cause dysfunction of any internal organ.
3. Immature lung tissue. Blood that is not saturated with oxygen cannot carry it to the sufficient tissues, which slows down the metabolism and inhibits the full development of the whole organism.
4. congenital pathology Gastrointestinal tract, leading to systematic constipation or vomiting (for example, Hirschsprung's disease).
5. Syndrome of "shortened gut" - the consequences of abdominal surgery.
6. Crashes immune system hereditary nature, weakening the body's defenses.
7. Disrupted work endocrine system. For example, diseases thyroid gland lead to a slowdown in both growth and metabolic processes in the body, and deviations in the work of the pituitary gland cause pituitary dwarfism - insufficient production of growth hormone.
8. hereditary diseases associated with metabolic disorders. An example is galactosemia - intolerance to milk and any dairy products or fructosemia, which causes a similar attitude of the child's body to fructose contained in both vegetables and fruits.
External factors cause malnutrition much less frequently. If their impact is long-term, then in the long term they can affect not only growth and physical development child, but general state his body and the performance of organs. These include:
1. Chronic malnutrition due to the characteristics of the mother’s breasts or the small amount of milk she has, besides, the child himself may not be fully developed lower jaw or the frenulum of the edge of the tongue is shortened. An illiterate use of ready-made formulas for feeding babies or untimely introduction of complementary foods can play a large role in underfeeding.
2. Reduced immunity of the baby, provoked by any infection (bacterial, viral) on different stages pregnancy or the life of the child. The presence of pyelonephritis, infections urinary system and damage to the intestinal mucosa to a large extent slow down the development of the body, because it spends a lot of money on the fight against the pathogens of these diseases vital energy(comes up to half of the total costs).
3. Impact toxic substances, including medicines, and an overdose of vitamins (especially A and D).
Stages of the disease
For better control over the general condition of the child with malnutrition and the appointment of adequate treatment, the disease is usually divided into degrees. Such a division is purely conditional, because the course of the disease is continuous and it is difficult to draw a clear line between the stages. In newborns, hypotrophy of the 1st degree is diagnosed if he was born on the dates following the 38th week with a weight not exceeding 2800 g, while having a body length of less than 50 cm.
If the disease is acquired at some stage of the child's life, then to determine its degree, it is necessary to calculate the fatness index (BFI), introduced by Professor Chulitskaya and adopted domestic medicine. The method is based on measuring (in centimeters) the circumferences of the shoulder at two points, the thigh and lower leg, and summing up these results, and then subtracting the height of the baby from the resulting amount. Up to a full year developing baby must have an IUCH index of at least 20 cm.
To give a detailed description of each degree of the disease, it is necessary to consider malnutrition syndromes (the entire set of symptoms of the affected organ). There are several of them:
1. Violation of the trophism of organ tissues due to the slow flow of metabolic processes in the body. This leads to a decrease total weight body, including the subcutaneous fat layer, as well as lethargy and sagging skin.
2. Dysfunction of the digestive organs, while the entire gastrointestinal tract: The stomach does not produce enough pepsin and acid, and the intestines do not have enough enzymes to process food. Therefore, with malnutrition, the presence of stool disorder and flatulence is quite understandable.
3. Functional failures in the work of the central nervous system of the child, which is expressed in his hyperexcitability, sleep disturbance, apathy and a decrease in muscle tone.
4. Impaired hematopoietic process, expressed in anemia, and a significant decrease protective functions immune system. Such children are susceptible to many infectious diseases, the leading symptoms of which are atypical and blurred.
Removal of a child from a pathological state
How do doctors determine the degree of malnutrition? First of all, according to the body weight deficit for the corresponding age of the child (all pediatricians have a correspondence table) and the Chulitskaya index.
Hypotrophy of the 1st degree is characterized by:
- the presence of a weight deficit of 10% - 20% of the original;
- IUCH varies between 10 and 15 cm;
- thinning of the fat layer on the abdomen and loss of elasticity of the skin;
- rapid fatigue and restless sleep;
- the presence of irritability;
- satisfactory general condition of the baby.
Treatment is carried out at home and involves fractional meals (8 times a day). Nutrition should be easily digestible, preference is given to cereals, fresh fruit and vegetables.
Grade 2 is characterized by aggravation of all existing violations:
- the presence of a weight deficit of 20% - 30% of the original;
- IA varies between 1 and 10 cm;
- complete absence of fat on the abdomen and chest, dryness and pallor of the skin;
- degradation muscle mass on the limbs and weakness of the entire muscular corset;
- markedly impaired thermoregulation;
- the appearance of dysbacteriosis;
- delayed closure of the small and large fontanel;
- nervousness and capriciousness;
- susceptibility to frequent infectious diseases, protracted nature.
Treatment can be carried out at home, but it is still better to give preference to the hospital if possible. The principle is used fractional nutrition, but the portions are reduced in volume. Nutrition should be easily digestible, in addition, a course of biostimulants is prescribed, a vitamin-mineral complex and enzymes are taken to improve digestion.
With malnutrition of the third degree, there is already a complete clinic of the disease. The child's condition is very serious, and in the absence of necessary measures possible and fatal outcome. The complexity of the situation lies also in the fact that the effectiveness of the measures taken to remove the child from this situation is small. Even according to appearance it is clear how exhausted his body is:
- the presence of a weight deficit of more than 30% of the original;
- VA is zero or will be negative;
- the absence of a fatty layer on the whole body, even on the face, and the skin is so thin that it resembles the dried skin of a mummy;
- released by fingers skin fold does not straighten out for a long time, sunken cheeks and protruding cheekbones are visible on the face;
- the thermoregulation center in the brain does not function, and the body temperature changes abruptly;
- a clear lack of iron leads to "jamming" in the corners of the lips, and a lack of vitamins (primarily A and C) - to bleeding and atrophy of the gum tissue;
- the appearance of symptoms of osteoporosis, expressed in the softness of the cranial bones;
- due to sharp decline defensive forces the baby is sick very often and for a long time infectious diseases(inflammatory processes of the middle ear or kidneys, often pneumonia);
- overexcitation of the central nervous system, followed by apathy for everything.
Treatment of malnutrition of the 3rd degree is carried out only in stationary conditions, since all types of metabolic processes, functions of organs and systems are completely disrupted in the body. These babies need an intravenous infusion of glucose and a transfusion of blood or its plasma. Appointed course treatment hormones, maintenance enzyme therapy, as well as taking essential vitamins and micronutrients.
Hypotrophy in children is starvation, quantitative or qualitative, as a result of which significant changes occur in the body. The disease is complex, which is based on starvation of the child's body - malnutrition in children.
It is necessary to treat malnutrition in children, based on the degree of the disease. On the initial stage treatment of the disease, it is necessary to eliminate the cause for which it arose.
Treatment of malnutrition should be aimed at eliminating primary disease, as well as secondary infections - otherwise it cannot be effective.
Treatment of sick children with malnutrition should be comprehensive. It includes: identifying the cause and eliminating it; diet therapy, organization of rational care, regimen; massage and gymnastics; identification and treatment of foci of infection and other concomitant diseases; enzyme therapy, vitamin therapy, stimulating therapy; symptomatic therapy.
Treatment of malnutrition in children involves changing the regimen, diet and caloric intake of the child and the nursing mother; if necessary, parenteral correction of metabolic disorders.
basis proper treatment malnutrition is diet therapy. It should be taken into account that as an insufficient amount food ingredients, and their excess adversely affect the condition of a child with malnutrition. Based on many years of experience in treating children with this disease, representatives of different schools have developed the following tactics for diet therapy.
The implementation of diet therapy for malnutrition in children is based on a fractional frequent feeding child, weekly calculation of food load, regular monitoring and correction of treatment.
With malnutrition of the first degree, food tolerance is quite high. Children tolerate nutritional stress well, so they can receive food that is appropriate for their age. Proteins, fats and carbohydrates are calculated per 1 kg of proper weight.
In the treatment of children with malnutrition of the II degree, two periods are distinguished: pre-reparation and reparation period. The pre-reparation period for malnutrition of the II degree is usually 7-10 days. During this period, the patient's tolerance to food is determined. From food, the patient receives either women's milk or products that replace it ( cow's milk, sour milk formulas, adapted milk formulas).
The daily volume of food is reduced to 2/3 of the required volume. Missing water is replenished with liquid ( boiled water, tea, 5% glucose solution, etc.). The child during this period (in its first days) receives food in 8 doses, that is, every 2.5 hours. Subsequently, with good food tolerance (no vomiting, regurgitation, diarrhea), the volume of food can be increased by 100-150 ml for each subsequent day. daily ration. With an excess in volume of 2/3 of the daily food ration, the child begins to be fed after 3 hours, i.e. 7 times. After the child begins to cope with the proper amount of food, we can assume that the pre-reparation period is over.
In the period of reparation, nutrition is corrected, complementary foods are introduced according to general rules. At first, carbohydrates and proteins are prescribed for 1 kg of the required weight, and fats for approximately the required weight.
In the treatment of children with III degree hypotrophy, two periods are also distinguished: pre-reparation and reparation period. Since food tolerance in hypotrophy of the III degree is much lower compared to hypotrophy of the II degree, the food load is carried out even more carefully. The pre-reparation period lasts 14-20 days or more. On the first day, nutrition can be calculated based on the energy spent by the child on the main metabolism (65-70 kcal per 1 kg of actual body weight). This is approximately U 2 part of the required daily amount of food.
For a child with malnutrition of the III degree, food in the form of expressed breast milk(or its substitutes) is given in 10 doses, i.e. every 2 hours with a 6-hour night break. Subsequently, with normal tolerance of this volume of food every 2 days, it can be increased by 100-150 ml. The end of the pre-reparation period can be judged on the basis of the good tolerance of women's milk or its substitutes in a volume normal for a given age. In the period of reparation with malnutrition of the III degree, the tactics are similar to those for malnutrition of the II degree.
In the period of determining food tolerance, enzyme therapy is widely used. For this purpose, use 1% solution of diluted of hydrochloric acid, pepsin, abomin, natural gastric juice, festal. At high content in the coprogram of patients with neutral fat and fatty acids pancreatin is given.
Vitamin therapy in the treatment of patients with malnutrition is used for both replacement and stimulating purposes. In the first days of the treatment of the disease, vitamins are administered parenterally, then they are given orally: vitamin C 50-100 mg, vitamins B 1 25-50 mg, B 6 50-100 mg per day, then alternating courses of treatment with vitamins A, PP, B 15, B 5, E, folic acid, vitamin B 1 2 in age doses.
Stimulant therapy is a mandatory part of the treatment of malnutrition in children. It consists in prescribing alternating courses of treatment with apilac, dibazol, pantocrine, ginseng and other means. In severe malnutrition, especially when combined with diseases of an infectious nature, γ-globulin is administered, a 10% solution of albumin, protein, plasma is administered intravenously, blood is transfused.
In the treatment of malnutrition II and III degree in children, the appointment of anabolic steroid hormones: nerabol (daily inside at 0.1-0.3 mg / kg), retabolil (1 mg / kg once every 2-3 weeks).
Symptomatic therapy depends on the clinical picture of malnutrition. In the treatment of anemia, it is advisable to use iron preparations, blood transfusions from the mother (if the blood is compatible by group and Rh factor and there is no history of hepatitis). In the case of a combination of malnutrition with rickets, after the end of the period of clarification of food tolerance, therapeutic doses of vitamin D are prescribed (with mandatory control according to the Sulkovich reaction!). Therapy of symptomatic malnutrition, in addition to diet therapy, should be aimed at treating the underlying disease.
Sick children with malnutrition of the 1st degree in the absence of severe concomitant diseases can be treated at home, children with malnutrition of the 2nd and 3rd degrees - in a hospital. The patient should be in a bright, spacious, well-ventilated room; the ambient air temperature should be at least 24-25 ° C and not higher than 26-27 ° C, since a child with severe malnutrition is easily overcooled and overheated.
It is important to create a positive emotional tone in the child, to pick it up more often. Positive influence provide warm baths (water temperature 38 ° C), which can be done daily. Mandatory constituent parts treatments are massage and gymnastics.
Update: December 2018
Hypotrophy in children is starvation, quantitative or qualitative, as a result of which significant changes occur in the body. Quality fasting is possible with the wrong artificial feeding, lack of basic nutrients and vitamins, quantitative - in case of incorrect calculation of calorie content or lack of food resources.
Hypotrophy may be due to acute diseases or the result of chronic inflammatory process. Wrong actions of parents - lack of regimen, poor care, unsanitary conditions, lack of fresh air- also lead to this state.
What does a normally developing baby look like?
Signs of normotrophic:
- healthy look
- The skin is pink, velvety, elastic
- A lively look, activity, studies the world around with interest
- Regular increase in weight and height
- Timely mental development
- Proper functioning of organs and systems
- High resistance unfavorable factors external environment, including infectious
- Rarely cries
In medicine, this concept is used only in children under 2 years of age. According to WHO, malnutrition is not ubiquitous:
- in developed countries, its percentage is less than 10,
- and in developing countries - more than 20.
According to scientific research, such scarce state occurs approximately equally in both boys and girls. Severe cases of malnutrition are observed in 10-12 percent of cases, with rickets in a fifth of children, and anemia in a tenth. Half of the children with this pathology are born in the cold season.
Causes and development
The causes of malnutrition in children are diverse. The main factor, causing intrauterine malnutrition, is toxicosis of the first and second half of pregnancy. Other causes of congenital malnutrition are as follows:
- pregnancy before the age of 20 or after 40 years
- bad habits of the expectant mother, poor nutrition
- chronic diseases of the mother endocrine pathologies, heart defects, etc.)
- chronic stress
- work of the mother during pregnancy in hazardous production (noise, vibration, chemistry)
- pathology of the placenta (improper attachment, early aging, one umbilical artery instead of two and other placental circulation disorders)
- multiple pregnancy
- metabolic disorders in the fetus of a hereditary nature
- genetic mutations and intrauterine anomalies
Causes of acquired malnutrition
Internal- caused by pathologies of the body that disrupt food intake and digestion, absorption of nutrients and metabolism:
- congenital malformations
- CNS lesions
- immunodeficiency
- endocrine diseases
- metabolic disorders
In the group of endogenous factors, it is worth highlighting separately food allergy and three hereditary diseases that occur with malabsorption syndrome - one of common causes malnutrition in children:
- cystic fibrosis - disruption of the external secretion glands, affected by the gastrointestinal tract, respiratory system
- , changes in the work of the intestines in a child begin from the moment gluten-containing foods are introduced into the diet - barley grits, semolina, wheat porridge, rye groats, oatmeal
- - the digestibility of milk is disturbed (lack of lactase).
According to scientific studies, malabsorption syndrome provokes malnutrition twice as often as nutritional deficiencies. This syndrome is characterized primarily by a violation of the chair: it becomes plentiful, watery, frequent, frothy.
External- conditioned wrong actions parents and unfavorable environment:
All exogenous factors in the development of malnutrition cause stress in the child. Proved that light stress increases the need for energy by 20%, and for protein - by 50-80%, moderate - by 20-40% and 100-150%, strong - by 40-70 and 150-200%, respectively.
Symptoms
Signs and symptoms of intrauterine malnutrition in a child:
- body weight below the norm by 15% or more (see below the table of the dependence of weight on the height of the child)
- growth is less by 2-4 cm
- the child is lethargic, muscle tone is low
- congenital reflexes are weak
- thermoregulation is impaired - the child freezes or overheats faster and stronger than normal
- in the future, the initial weight is slowly restored
- umbilical wound does not heal well
Acquired malnutrition is characterized common features as clinical syndromes.
- Insufficient nutrition: the child is thin, but the proportions of the body are not violated.
- Trophic disorders(malnutrition of body tissues): the subcutaneous fat layer is thinned (first on the abdomen, then on the limbs, with severe course and on the face), the mass is insufficient, the proportions of the body are disturbed, the skin is dry, elasticity is reduced.
- Changes in the functioning of the nervous system: depressed mood, decreased muscle tone, weakening of reflexes, psychomotor development is delayed, and in severe cases, acquired skills even disappear.
- Decreased food intake: appetite worsens up to its complete absence, frequent regurgitation, vomiting, stool disorders, excretion digestive enzymes oppressed.
- Decreased immunity: the child begins to get sick often, chronic infectious and inflammatory diseases develop, possibly toxic and bacterial infection blood, the body suffers from general dysbacteriosis.
Degrees of malnutrition in children
Hypotrophy of the 1st degree is sometimes practically not noticeable. Only an attentive doctor on examination can identify it, and even then he will first differential diagnosis and find out if a body weight deficit of 11-20% is not a feature of the child's physique. Thin and tall children are usually thin because of hereditary features. Therefore, a new mother should not be afraid if her active, cheerful, well-nourished child is not as plump as other children.
Hypotrophy 1 degree children are characterized slight decrease appetite, anxiety, sleep disturbance. The surface of the skin is practically not changed, but its elasticity is reduced, the appearance may be pale. The child looks thin only in the abdomen. Muscle tone is normal or slightly reduced. Sometimes they show signs of rickets, anemia. Children get sick more often than their well-fed peers. Stool changes are insignificant: a tendency to constipation or vice versa.
Hypotrophy 2 degrees in children it is manifested by a weight deficit of 20-30% and growth retardation (about 2-4 cm). Mom can find cold hands and feet in a child, he can often spit up, refuse to eat, be lethargic, inactive, sad. Such children lag behind in mental and motor development, sleep poorly. Their skin is dry, pale, flaky, easily folded, inelastic. The child looks thin in the abdomen and limbs, and the contours of the ribs are visible. The stool fluctuates greatly from constipation to diarrhea. These kids get sick every quarter.
Sometimes doctors see malnutrition even in healthy child who looks too skinny. But if the growth corresponds to age, he is active, mobile and happy, then the lack of subcutaneous fat is explained by the individual characteristics and high mobility of the baby.
With hypotrophy of the 3rd degree growth retardation 7-10 cm, weight deficit ≥ 30%. The child is drowsy, indifferent, tearful, acquired skills are lost. The subcutaneous fat is thinned everywhere, pale gray, dry skin fits the baby's bones. There is muscle atrophy, cold extremities. Eyes and lips dry, cracks around the mouth. The child often has chronic infection in the form of pneumonia, pyelonephritis.
Diagnostics
Differential Diagnosis
As mentioned above, the doctor first needs to figure out whether malnutrition is an individual feature of the body. In this case, no changes in the work of the body will be observed.
In other cases, it is necessary to conduct a differential diagnosis of the pathology that led to malnutrition: congenital malformations, diseases of the gastrointestinal tract or the endocrine system, lesions of the central nervous system, infections.
Treatment
The main directions of treatment of malnutrition in children are as follows:
- Identification of the cause of malnutrition, its elimination
- Proper care: daily routine, walks (3 hours daily, if outside ≥5˚), gymnastics and professional massage, bathing in warm baths (38 degrees) in the evening
- Organization of proper nutrition, balanced in proteins, fats and carbohydrates, as well as vitamins and microelements (diet therapy)
- Medical treatment
Treatment of congenital malnutrition is to maintain the child constant temperature body and forging breastfeeding.
Nutrition for children with malnutrition
Diet therapy for malnutrition is divided into three stages.
| Stage 1 - the so-called "rejuvenation" of the diet | that is, they use food intended for children more than younger age. The child is fed frequently (up to 10 times a day), the calculation of the diet is carried out on the actual body weight, and a diary is kept for monitoring the assimilation of food. The stage lasts 2-14 days (depending on the degree of malnutrition). |
| Stage 2 - transitional | Add to diet medicinal mixtures, optimize nutrition to an approximate norm (according to the weight that the child should have). |
| Stage 3 - a period of enhanced nutrition | The calorie content of the diet increases to 200 kilocalories per day (at a rate of 110-115). Use special high-protein mixtures. With celiac disease, gluten-containing foods are excluded, fats are limited, buckwheat, rice, and corn are recommended for nutrition. With lactase deficiency, milk and dishes prepared with milk are removed from products. Instead, they use dairy products, soy mixtures. With cystic fibrosis - a diet with a high calorie content, food should be salted. |
The main directions of drug therapy
- Replacement therapy with pancreatic enzymes; drugs that increase the secretion of gastric enzymes
- The use of immunomodulators
- Treatment of intestinal dysbacteriosis
- vitamin therapy
- Symptomatic therapy: correction of individual disorders (iron deficiency, irritability, stimulant drugs)
- At severe forms hypotrophy - anabolic drugs- drugs that promote the formation of building protein in the body for muscles, internal organs.
Treatment of malnutrition requires individual approach. It is more correct to say that children are nursed, not treated. Vaccinations for hypotrophy of the 1st degree are carried out according to the general schedule, for hypotrophy of the 2nd and 3rd degrees - on an individual basis.
Study of the causes and symptoms of malnutrition in children
In one of the somatic hospitals, 40 case histories of children diagnosed with hypertrophy (19 boys and 21 girls aged 1-3 years) were analyzed. The conclusions were obtained as a result of the analysis of specially designed questionnaires: most often, children with malnutrition were born from a pregnancy that proceeded with pathologies, with heredity for pathologies of the gastrointestinal tract and allergic diseases with intrauterine growth retardation.
| Common causes of malnutrition in children: |
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Prevention of malnutrition in children
Prevention of both intrauterine and acquired malnutrition begins with the struggle for the health of the woman and for the preservation of long-term breastfeeding.
The following areas of prevention are tracking the main anthropometric indicators (height, weight), monitoring the nutrition of children.
An important point is timely detection and treatment of diseases childhood, congenital and hereditary pathologies, proper child care, prevention of influence external factors development of hypotrophy.
It should be remembered:
- Mother's milk is the best and irreplaceable food for a baby up to a year old.
- At 6 months, the menu should be expanded by plant food(cm. ). Also, do not transfer the child early to adult food. Weaning from breastfeeding up to 6 months of the child is a crime against the baby, if any, you must first apply it to the breast and only then supplement it.
- Diversity in food is not different types porridge and pasta throughout the day. A complete diet consists in a balanced combination of proteins (animal, vegetable), carbohydrates (complex and simple), fats (animal and vegetable), that is, vegetables, fruits, meat, dairy products must be included in the diet.
- As for meat - after a year it must be present in the child's diet - this is an indispensable product, there can be no question of any vegetarianism, only meat contains the compounds necessary for growth, they are not produced in the body in the amount that is needed for full development and health.
- Important!!! There are no safe medicines"simply" to reduce or increase a child's appetite.
Table of dependence of weight on height in children under 4 years old
Very strong deviations in the mass of the child are not due to reduced appetite or some individual features organism - behind this is usually an unrecognized disease or lack of good nutrition The child has. A monotonous diet, nutrition that does not meet age-related needs - leads to a painful lack of body weight. The weight of the child should be controlled not so much by age as by the growth of the baby. Below is a table of the dependence of the height and weight of the baby (girls and boys) from birth to 4 years:
- Norm is the interval between GREEN and BLUE weight value (25-75 centiles).
- Weight loss- between YELLOW and GREEN figure (10-25 centiles), however, it may be a variant of the norm or a slight tendency to reduce body weight in relation to height.
- Weight gain- between BLUE and YELLOW number (75-90 centiles) is both normal and indicates a trend towards weight gain.
- Increased or reduced body weight- between RED and YELLOW number indicates both low body weight (3-10th centile) and increased (90-97th centile). This may indicate both the presence of the disease and the characteristics of the child. Such indicators require a thorough diagnosis of the child.
- Painful weight loss or gain- per RED border (>97 or<3 центиля). Ребенок с таким весом нуждается в установлении причины гипотрофии или ожирения и корректировки питания и назначения лечения, массажа и пр. , поскольку это является проявлением какого-либо заболевания и опасно негармоничным развитием органов, систем организма, снижению сопротивляемости к инфекциям и негативным факторам окружающей среды.
Parents are not always to blame for the occurrence of malnutrition in children. It happens that the mother has enough milk, and the child sucks the breast reluctantly. Or, a woman’s nipple is strongly drawn in, and the baby does not have the opportunity to get enough of it. It is possible to develop malnutrition in young children and due to congenital defects in the child's oral cavity or the absence of a sucking reflex.
Causes and symptoms of malnutrition in children
Hypotrophy refers to reduced nutrition; is one of the chronic eating disorders in children.
The most common cause of malnutrition in children is a violation of the feeding of the child; Proper feeding is especially important in the first few months of life. If the mother has hypogalactia, the child constantly does not have enough milk. Also, the child may be malnourished for a long time if the mother has a flat nipple, an inverted nipple. Other children do not actively suckle their breasts (they are also called lethargic, or lazy, suckers), in others, physical defects (cleft lip, for example) interfere with normal sucking, and in premature and immature children, as a rule, they are underdeveloped (may be absent altogether). ) sucking reflex. There is congenital malnutrition, which has developed as a result of certain diseases of the mother or as a result of some violations. Often, malnutrition occurs due to frequent and severe diseases of the child (viral infections, diseases of the stomach and intestines, scarlet fever, as well as chronic infections, etc.). Contribute to the development of malnutrition can be constant violations of the daily routine, improper care of the child, hypovitaminosis (insufficient intake of vitamins in the body). Hypotrophy is also observed in a child who, for some reason, is transferred too early to mixed or artificial feeding, and the ratio of nutrients in the food offered to him is not balanced.
The main symptom of malnutrition in children is a decrease in nutrition; significant thinning or complete disappearance of the subcutaneous fat layer.
The photo of malnutrition in children shows how malnourished babies are who do not receive enough nutrition:
Hypotrophy in children I, II and III degree
When classifying malnutrition in children, there are three degrees of the disease.
The manifestations of malnutrition of the 1st degree are as follows: the subcutaneous fat layer is preserved everywhere, however, it becomes somewhat thinner on the abdomen and on the extremities (normally, the skin fold at the level of the navel is 1.5 cm thick); the elasticity of the skin and muscles is somewhat reduced; when weighing, a lag in weight from the norm by 10-20% is detected; growth corresponds to age; the general condition does not suffer, the state of health is not disturbed, however, the child may be capricious; integuments - normal color or slightly pale.
For malnutrition of the II degree in children, the following manifestations are characteristic: the subcutaneous fat layer on the abdomen and on the limbs disappears; on the chest, neck and face, it becomes noticeably thinner; there is a decrease in weight by 20-30%, in addition, growth suffers; the child is pale, the skin is flabby and folds easily; the fold straightens out slowly; the child is lagging behind in, his general condition and well-being are disturbed; the child is sometimes restless and excited, sometimes sluggish and whiny, he has a bad dream.
With hypotrophy of the III degree, which is characterized by a lag in weight from the norm by more than 30%, a different picture is observed: the subcutaneous fat layer is absent everywhere, growth stops; facial features are sharpened, and the child's face takes on an senile look, the eyes seem to fall into the sockets; a large fontanel sinks; the skin is pale, the skin is dry, flaky; the mucous membrane of the lips against this background is bright red; the muscles become thinner, the ribs show through, the stomach retracts; dyspepsia is often observed; feeling unwell; the child is lethargic and weak, inactive; his cry is weak; breathing is slow and uneven, the pulse is poorly palpable; no appetite, but expressed thirst; the child has a reduced reactivity of the body, so it is susceptible to infection, complications such as otitis media, pyelitis, pneumonia, etc. may occur.
Treatment and prevention of malnutrition in young children
Treatment of malnutrition in young children is prescribed complex, and it begins with the elimination of the causes of malnutrition. The child needs good care and proper hygiene. The most important place is occupied by diet therapy. Even with malnutrition of the first degree, the child's nutrition is controlled by a doctor. All appointments are also made by a doctor. In the treatment of malnutrition in children, the child is given a general massage daily, and therapeutic exercises are carried out. Closer to recovery - active games, long walks.
As preventive measures, the following can be considered: a good level of child care; daily monitoring of weight gain (it is recommended for mom to draw a weight curve); strict adherence to the diet (the child's nutrition is periodically monitored by the district pediatrician); control over the sufficient intake of vitamins in the body; observance of the sanitary and hygienic regime aimed at preventing infectious diseases; in case of illness - timely seeking medical help and timely treatment; hardening of the child. Especially careful attention in the prevention of malnutrition in children is required by babies who, for some reason, were transferred to mixed or artificial feeding.
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