Can lead to postnatal malnutrition. Hypotrophy in children: degrees, causes, treatment
Dystrophy(Greek dys - disorder, trophe - nutrition) develops mainly in young children and is characterized by impaired absorption of nutrients by body tissues. There are the following types of dystrophies: 1) dystrophy with a lack of body weight (hypotrophy); 2) dystrophy with body weight corresponding to height or some excess of mass over length (paratrophy); 3) dystrophy with overweight (obesity) (Table 1).
Hypotrophy(Greek hypo - under, below trophe - nutrition) - a chronic eating disorder with a lack of body weight. This is a pathophysiological reaction of a young child, accompanied by a violation of the metabolic and trophic functions of the body and characterized by a decrease in food tolerance and immunobiological reactivity. According to WHO, malnutrition (malnutrition) is diagnosed in 20-30% or more of young children.
Etiology: According to the time of occurrence, congenital (prenatal) and acquired (postnatal) malnutrition are distinguished (Table 1). Causes, clinic and treatment of delay prenatal development of the fetus are discussed above in the section "Antenatal malnutrition".
There are 2 groups of acquired malnutrition according to etiology - exogenous and endogenous (Table 1). With careful collection of anamnesis data, a mixed etiology of malnutrition in a child is often established. With exogenous causes, primary malnutrition is diagnosed, with endogenous causes - secondary (symptomatic).
Exogenous causes of malnutrition:
1. Nutritional factors- Quantitative underfeeding in case of hypogalactia in the mother or feeding difficulties on the part of the mother or child, or qualitative underfeeding (use of an age-inappropriate mixture, late introduction of complementary foods).
2. Infectious factors- intrauterine infections, infectious diseases of the gastrointestinal tract, repeated acute respiratory viral infections, sepsis.
3. Toxic factors- the use of low-quality milk mixtures with an expired shelf life, hypervitaminosis A and D, drug poisoning.
4. Disadvantages of care, regime, education.
Endogenous causes of malnutrition:
1. Perinatal encephalopathy of various origins.
2. Bronchopulmonary dysplasia.
3. Congenital malformations of the gastrointestinal tract, cardiovascular system, kidneys, liver, brain and spinal cord.
4. Primary malabsorption syndrome (deficiency of lactase, sucrose, maltase, cystic fibrosis, exudative enteropathy) or secondary (intolerance to cow's milk proteins, "short gut" syndrome after extensive bowel resections, secondary disaccharidase deficiency).
5. Hereditary immunodeficiency states.
6. Hereditary metabolic disorders.
7. Endocrine diseases (hypothyroidism, adrenogenital syndrome).
8. Anomalies of the constitution.
Pathogenesis:
With malnutrition, the utilization of nutrients (primarily proteins) is impaired both in the intestine and in tissues. In all patients, the excretion of nitrogenous products in the urine increases with a violation of the ratio between urea nitrogen and total urine nitrogen. A decrease in the enzymatic activity of the stomach, intestines, pancreas is characteristic, and the level of deficiency corresponds to the severity of malnutrition. Therefore, a nutritional load that is adequate for a healthy child can cause acute indigestion in a patient with II-III degree malnutrition. With malnutrition, the functions of the liver, heart, kidneys, lungs, immune, endocrine, and central nervous systems are disrupted.
Of the metabolic disorders, the most typical are: hypoproteinemia, hypoalbuminemia, aminoaciduria, a tendency to hypoglycemia, acidosis, hypokalemia and hypokalemia, hypocalcemia and hypophosphamenia.
Classification:
According to the severity, three degrees of malnutrition are distinguished: I, II, W: (Table 1). The diagnosis indicates the etiology, time of onset, period of the disease, comorbidity, complications. It is necessary to distinguish between primary and secondary (symptomatic) malnutrition. Primary malnutrition can be the main or concomitant diagnosis and is usually the result of undernutrition.
Secondary malnutrition- complication of the underlying disease. Diagnosis
malnutrition is competent in children up to 2-3 years of age.
Clinical picture:
All clinical symptoms of malnutrition in children for the following groups of syndromes:
1. Trophic_disorder syndrome- thinning of the subcutaneous fat layer, lack of body weight and disproportionate physique (Chulitskaya and Erisman indices are reduced), a flat weight gain curve, trophic skin changes, muscle thinning, decreased tissue turgor, signs of polyhypovitaminosis.
2. Syndrome of reduced food tolerance- loss of appetite up to anorexia, development of dyspeptic disorders (regurgitation, vomiting, unstable stool), decrease in secretory and enzymatic functions of the gastrointestinal tract.
3. CNS dysfunction syndrome- violation of emotional tone and behavior; low activity, the predominance of negative emotions, sleep disturbance and thermoregulation, delayed psychomotor development, muscle hypo-, dystonia.
4. Syndrome of decreased immunobiological reactivity- a tendency to frequent infections - inflammatory diseases, their erased and atypical course, the development of toxic-septic conditions, dysbiocenoses, secondary immunodeficiency states, a decrease in nonspecific resistance.
Hypotrophy I degree characterized by thinning of the subcutaneous fat layer in all parts of the body and especially on the abdomen. The fatness index of Chulitskaya is reduced to 10-15. Tissue turgor and muscle tone are reduced, the fat fold is flabby. Characterized by pallor of the bones and mucous membranes, a decrease in firmness and elasticity of the skin. The growth of the child does not lag behind the norm. The body weight deficit is 10-20%. The weight gain curve is flattened. The child's health is not disturbed. Psychomotor development corresponds to age. The child is restless, does not sleep well. Immunological reactivity is not broken.
Hypotrophy II degree. The subcutaneous fat layer is absent on the abdomen, chest, sharply thinned on the limbs, preserved on the face. Severe pallor, dryness, decreased elasticity of the skin. The fatness index of Chulitskaya is 0-10. Reduced tissue turgor (by inner surface hips skin fold hanging down) and muscle tone. Active rickets in children is manifested by muscle hypotension, symptoms of osteoporosis, osteomalacia and hypoplasia. The body weight deficit is 20-30% (in relation to height), there is a lag in growth. The body weight gain curve is flat. Appetite is reduced. Food tolerance is reduced. Often regurgitation and vomiting are observed. Characterized by weakness and irritability, the child is indifferent to the environment. Sleep is restless. The child loses already acquired motor skills and abilities. Thermoregulation is impaired, and the child quickly cools or overheats.
Most children develop various diseases (otitis media, pneumonia, pyelonephritis), which are asymptomatic and long-term.
The chair is unstable (often liquefied, undigested, rarely constipation). Significantly reduced acidity gastric juice, secretion and activity of enzymes of the stomach, pancreas and intestines. Subcompensated intestinal dysbacteriosis develops.
Hypotrophy III degree(marasmus, atrophy). Primary malnutrition of the III degree is characterized by an extreme degree of exhaustion: the external child resembles a skeleton covered with skin. The subcutaneous fat layer is absent. Skin pale grey, dry. Extremities are cold. Skin folds do not straighten out, as there is no elasticity of the skin. Characterized by thrush, stomatitis. The forehead is covered with wrinkles, the chin is pointed, the cheeks are sunken. The abdomen is distended, distended, or bowel loops are contoured. The chair is unstable.
Body temperature is often lowered. The patient quickly cools on examination, easily overheats. On the background sharp decline immunological reactivity, various
foci of infection that are asymptomatic. Significantly reduced muscle mass. The weight gain curve is negative. The body weight deficit exceeds 30% in children of appropriate height. The Chulitskaya index is negative. The child is severely retarded. With secondary malnutrition of the III degree, the clinical picture is less severe than with primary ones, they are easier to treat if the underlying disease is identified and there is an opportunity to actively influence it.
In pediatrics, this disease is considered as an independent type of dystrophy. Since malnutrition in young children is accompanied by a very serious violations in the body (failure of metabolic processes, decreased immunity, lag in speech and psychomotor development), it is important to identify the disease in a timely manner and begin treatment.
Causes of the disease
Correctly identified causes of malnutrition will help doctors prescribe the best treatment in each case. Factors of the prenatal or postnatal period can lead to a pathological malnutrition of a child.
Intrauterine malnutrition:
- unfavorable conditions for normal development the fetus during its gestation (bad habits of a woman, malnutrition, non-compliance with the daily routine, environmental and industrial hazards);
- somatic diseases of the expectant mother (diabetes mellitus, pyelonephritis, nephropathy, heart disease, hypertension) and her nervous breakdowns, constant depression;
- pregnancy pathologies (preeclampsia, toxicosis, premature birth, fetoplacental insufficiency);
- intrauterine infection of the fetus, its hypoxia.
Extrauterine malnutrition:
- congenital malformations up to chromosomal abnormalities;
- fermentopathy (celiac disease, lactase deficiency);
- immunodeficiency;
- constitutional anomaly;
- protein-energy deficiency due to meager or not balanced nutrition(underfeeding, difficulty sucking with flat or inverted nipples in the mother, hypogalactia, insufficient amount of milk formula, profuse regurgitation, micronutrient deficiencies);
- poor nutrition of a nursing mother;
- some diseases of the newborn do not allow him to actively suckle, which means - to eat fully: cleft palate, congenital heart disease, cleft lip, birth trauma, perinatal encephalopathy, cerebral palsy, pyloric stenosis, alcohol syndrome;
- frequent SARS, intestinal infections, pneumonia, tuberculosis;
- unfavorable sanitary and hygienic conditions: poor child care, rare exposure to the air, rare bathing, insufficient sleep.
All these causes of childhood malnutrition are closely interrelated, have a direct impact on each other, thus forming a vicious circle that accelerates the progression of the disease.
For example, due to malnutrition, malnutrition begins to develop, while frequent infectious diseases contribute to its strengthening, which, in turn, leads to malnutrition and weight loss by the child.
Classification
There is a special classification of malnutrition in children, depending on the lack of body weight:
- Hypotrophy of the 1st degree is usually detected in newborns (in 20% of all infants), which is diagnosed if the child's lag in weight is 10–20% less than the age norm, but growth rates are absolutely normal. Parents should not worry about such a diagnosis: with timely care and treatment, the baby recovers in weight, especially when breastfeeding.
- Hypotrophy of the 2nd degree (average) is a decrease in weight by 20–30%, as well as a noticeable lag in growth (by about 2–3 cm).
- Hypotrophy of the 3rd degree (severe) is characterized by a lack of mass, exceeding 30% of the age norm, and a significant lag in growth.
The above three degrees of malnutrition suggest different symptoms and methods of treatment.
Symptoms of childhood malnutrition
Usually, the symptoms of malnutrition in newborns are determined already in the hospital. If the disease is acquired, and not congenital, attentive parents, according to some signs, even at home will be able to understand that their child is sick. Symptoms depend on the form of the disease.
I degree
- satisfactory state of health;
- neuropsychic development quite appropriate for age;
- loss of appetite, but within moderate limits;
- pale skin;
- reduced tissue turgor;
- thinning of the subcutaneous fat layer (this process begins with the abdomen).
II degree
- impaired activity of the child (excitation, lethargy, lag in motor development);
- poor appetite;
- pallor, peeling, flabbiness of the skin;
- decreased muscle tone;
- loss of tissue turgor and elasticity;
- disappearance of the subcutaneous fat layer on the abdomen and limbs;
- dyspnea;
- tachycardia;
- muscle hypotension;
- frequent otitis, pneumonia, pyelonephritis.
III degree
- severe exhaustion;
- atrophy of the subcutaneous fat layer on the entire body of the child;
- lethargy;
- lack of response to banal stimuli in the form of sound, light and even pain;
- a sharp lag in growth;
- neuropsychic underdevelopment;
- pale gray skin;
- dryness and pallor of the mucous membranes;
- muscles atrophy;
- loss of tissue turgor;
- retraction of the fontanel, eyeballs;
- sharpening of facial features;
- cracks in the corners of the mouth;
- violation of thermoregulation;
- frequent regurgitation, vomiting, diarrhea, conjunctivitis, candidal stomatitis(thrush);
- alopecia (baldness);
- hypothermia, hypoglycemia, or bradycardia may develop;
- infrequent urination.
If malnutrition is detected in a child, an in-depth examination is carried out to clarify the causes of the disease and appropriate treatment. For this, consultations of children's specialists are appointed - a neurologist, a cardiologist, a gastroenterologist, a geneticist, an infectious disease specialist.
Various diagnostic studies are carried out (ECG, ultrasound, EchoCG, EEG, coprogram, biochemical blood test). Based on the data obtained, therapy is already prescribed.
Treatment of the disease
On an outpatient basis, treatment of malnutrition of the I degree in young children is carried out, inpatient - II and III degrees. The main activities are aimed at:
- normalization of nutrition;
- diet therapy (gradual increase in calorie content and volume of food consumed by the child + fractional, frequent feeding);
- compliance with the regime of the day;
- organization of proper child care;
- correction of metabolic disorders;
- drug therapy (enzymes, vitamins, adaptogens, anabolic hormones);
- in the presence of severe form diseases are prescribed intravenous administration of glucose, protein hydrolysates, vitamins, saline solutions;
- massage with elements of exercise therapy.
With timely treatment of the disease of I and II degrees, the prognosis is favorable, but with hypotrophy of the III degree, a lethal outcome is noted in 50% of cases.
Prevention methods
Prevention of malnutrition in children involves a weekly examination by a pediatrician, constant anthropometry and nutritional correction. About the warning of such terrible disease you need to think even while carrying a baby:
- observe the daily routine;
- eat on time;
- correct pathologies;
- exclude all adverse factors.
After the baby is born important role are playing:
- high-quality and balanced nutrition of a nursing mother;
- timely and correct introduction of complementary foods;
- body weight control;
- rational, competent care of the newborn;
- treatment of any, even spontaneously occurring concomitant diseases.
Having heard such a diagnosis as malnutrition, parents should not give up. If the child is provided with normal conditions for the regimen, care and nutrition, quick and effective treatment of possible infections, severe forms can be avoided. New articles We are in social networks
Hypotrophy is a chronic malnutrition in babies, which is accompanied by a constant underweight in relation to the age and height of the infant. Often, malnutrition in children affects not only the insufficient development of muscle mass, but also psychomotor aspects, growth retardation, general lagging behind peers, and also causes a violation of skin turgor due to insufficient buildup of the subcutaneous fat layer. Underweight (hypotrophy) in infants usually has 2 causes. Nutrients may enter the child's body in insufficient quantities for proper development or simply not be absorbed. AT medical practice malnutrition is isolated as an independent type of disorder physiological development, a subspecies of dystrophy. As a rule, small children under the age of one year are susceptible to such a violation, but sometimes the condition persists up to 3 years, due to the peculiarities of the social status of the parents.
Degrees of malnutrition in children and symptoms of the disorder
First degree
The disease is characterized by a slight decrease in appetite, accompanied by sleep disturbance and frequent anxiety. The baby's skin usually remains practically unchanged, but has reduced elasticity and a pale appearance. Thinness is visible only in the abdomen, while muscle tone can be normal (sometimes slightly reduced). In some cases, 1 degree of malnutrition in young children may be accompanied by anemia or rickets. There is also a general decrease in the functioning of the immune system, from which babies get sick more often, look less well-fed in comparison with their peers. Some children may have indigestion leading to diarrhea or constipation.
Often, the 1st degree of violation remains almost imperceptible to parents, and only an experienced doctor can identify it with a thorough examination and diagnostics, during which he must find out if the thinness of the baby is a feature of his physique and hereditary factor. For some children, height and thinness are inherited from their parents, so a slender young mother should not worry that her baby does not look as well-fed as the rest, if at the same time he is active, cheerful and eats well.
Second degree
It is characterized by underweight in children in the amount of 20-30%, as well as a lag in growth of the baby, on average by 3-4 cm. At the same time, the baby may experience frequent regurgitation, lethargy, refusal to eat, low mobility, permanent state sadness, as well as the lack of warmth of the arms and legs. With malnutrition of the 2nd degree in newborns, there is a developmental delay not only in motor, but also mental, poor sleep, pallor and dry skin, frequent peeling of the epidermis. Baby's skin is not elastic, it easily gathers into folds. Thinness is strongly pronounced and affects not only the abdomen, but also the limbs, while the contours of the ribs are clearly visible in the baby. Children with this form of disorder are very often sick and have unstable stools.
Third degree
Babies with this form of impairment are severely stunted, on average up to 10 cm, and have a weight deficit of more than 30%. The state is characterized by severe weakness, an indifferent attitude on the part of the child to almost everything, tearfulness, drowsiness, as well as the rapid loss of many acquired skills. The thinning of the subcutaneous fatty tissue is clearly expressed throughout the body of the child, there is a strong atrophy of the muscles, dry skin, cold extremities. The color of the skin is pale with a grayish tinge. The lips and eyes of the baby are dry, cracks are observed around the mouth. Often in children there are various infectious diseases of the kidneys, lungs and other organs, for example, pyelonephritis, pneumonia.
Types of malnutrition
Violation in young children is divided into 2 types.
Congenital malnutrition
Otherwise, the condition is called prenatal developmental delay, which begins even in the prenatal period. There are 5 main causes of congenital disorders:
- Maternal. This group includes insufficient and not good nutrition future mother during pregnancy, her very young or, conversely, old age. Previously appeared stillborn children or miscarriages, the presence of serious chronic diseases, alcoholism, smoking or drug use, as well as severe preeclampsia in the second half of pregnancy can lead to the appearance of a baby with malnutrition.
- Paternal. Caused by hereditary causes on the paternal side.
- Placental. The appearance of hypotrophy of any degree in a newborn can also be affected by poor patency of the vessels of the placenta, their narrowing, anomalies in the location of the placenta, its presentation or partial detachment. Vascular thrombosis, heart attacks, fibrosis of the placenta can also affect the appearance of the disorder.
- Socio-biological factors. Insufficient material support for the expectant mother, her adolescence, as well as work in hazardous and chemically hazardous industries, the presence of penetrating radiation.
- Other factors. Mutations at the genetic and chromosomal level, the presence of congenital malformations, multiple pregnancy, premature birth.
Acquired malnutrition
The causes of such developmental disorders are divided into two types: endogenous and exogenous. Endogenous factors include:
- the presence of diathesis in infancy;
- anomalies of the constitution in babies up to a year;
- immunodeficiency, both primary and secondary;
- congenital malformations, such as perinatal encephalopathy, pyloric stenosis, bronchopulmonary dysplasia, Hirschsprung's disease, "short bowel" syndrome, disorders in the cardiovascular system;
- endocrine disorders, in particular hypothyroidism, adrenogenital syndrome, pituitary dwarfism;
- the presence of malabsorption syndrome, disaccharidase deficiency, cystic fibrosis;
- anomalies of the metabolic process of hereditary etiology, for example, galactosemia, fructosemia, Niemann-Pick or Tay-Sachs disease.
- diseases caused by infections, for example, sepsis, pyelonephritis, intestinal disorders caused by bacteria (salmonellosis, dysentery, colienteritis), persistent dysbacteriosis;
- improper upbringing, non-compliance with the daily routine. This may include improper care for a baby under the age of one year, bad sanitary conditions, malnutrition;
- nutritional factors such as underfeeding of the infant (qualitative or quantitative) with natural feeding can be observed with a flat nipple in the mother. Underfeeding due to a "tight" breast, in this case, the baby cannot suck out the required amount of milk. Vomiting or constant spitting up;
- toxic causes, for example, poisoning, various degrees and forms of hypervitaminosis, feeding with low-quality milk formula or animal milk from the moment of birth (it is not absorbed by the body of the newborn).
Diagnostics
To accurately establish the diagnosis of malnutrition in babies, a set of studies is carried out, which includes:
- Collection of anamnesis. The features of the baby's life, his nutrition, regimen, the presence of possible congenital diseases, reception medicines, living conditions, care, as well as diseases of the parents that can be transmitted to the child at the genetic level.
- Careful inspection, during which the condition of the baby's hair and skin, his oral cavity, and nails is determined. The child's behavior, mobility, existing muscle tone, general appearance are assessed.
- Body mass index calculation and comparing it with the norms of development based on the weight of the baby at birth and his age at the time of the diagnosis. The thickness of the subcutaneous fat layer is also determined.
- Holding laboratory research baby blood and urine tests.
- Complete immunological examination.
- Breath tests.
- Ultrasound of internal organs.
- ECG.
- Blood sampling for a complete biochemical analysis.
- The study of feces child for the presence of dysbacteriosis and the amount of undigested fat.
Intrauterine malnutrition can be detected even during pregnancy during the next ultrasound, in which the doctor determines the size of the fetus and the estimated weight. When developmental disorders are detected future mother sent to the hospital for a full examination and taking the necessary measures. In newborns, existing malnutrition can be determined by a neonatologist during an examination immediately after the birth of the baby. Acquired developmental disorder is usually detected by a pediatrician during a routine examination and the necessary measurements of height and weight. In this case, the doctor, in addition to conducting research, usually appoints consultations of other specialists, which helps to accurately establish the diagnosis and degree of malnutrition.
Treatment
Therapy for malnutrition is carried out depending on the degree of the disease. Postnatal malnutrition of the 1st degree is treated under normal outpatient conditions at home with mandatory strict adherence to all doctor's prescriptions. The second and third degree require treatment in stationary conditions, where specialists can constantly assess the condition of the baby and the results of the treatment, which is aimed at eliminating the existing causes of malnutrition, organizing good care for the baby, and correcting metabolic abnormalities. The basis of the treatment of malnutrition is a special diet therapy, which is carried out in 2 stages. First, an analysis of possible food intolerances in an infant is carried out, after which a certain balanced diet with a gradual increase in portions of food and its calorie content. The basis of diet therapy for malnutrition is fractional nutrition small portions over a short period of time. The serving size is increased weekly, taking into account the necessary nutritional load during regular monitoring and examinations. In the course of therapy, adjustments are made to the treatment. Weakened babies who cannot swallow or suck on their own are fed through a special tube. Held and drug treatment, in which the baby is prescribed vitamins, enzymes, taking anabolic hormones, adaptogens. In cases of a particularly serious condition of children with malnutrition, they are given intravenous infusions of special protein hydrolysates, saline solutions, glucose and essential vitamins. To strengthen muscle tone, kids are given exercise therapy and UVR, as well as a course of special massage.
Lifestyle of children with malnutrition
During the treatment of the child, parents must strictly comply with all the doctor's instructions. The main factors for the successful cure of the crumbs are the establishment of the correct regimen not only for feeding, but also for playing, sleeping and walking. With proper care and good nutrition, in the absence of metabolic disorders and other congenital (acquired or chronic) diseases, babies quickly gain weight and are quite capable of catching up with the parameters of their healthy peers. It is important to prevent the appearance of malnutrition in infants and it lies in the correct behavior of the expectant mother during the bearing of the crumbs. Registration at a polyclinic (special center or private clinic) must take place on early dates pregnancy, already during the first month. It is important to pass all the scheduled examinations and studies on time, not to miss scheduled appointments and consultations of specialists. A special moment in the prevention of malnutrition in a child is the nutrition of the expectant mother, it must be balanced, provide the body with all the necessary substances not only for its existence, but also for the development of the fetus. Timely examination allows you to identify the existing violation in time and take the necessary measures to eliminate it even before the birth of the crumbs.
How to recognize malnutrition in a child?
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Hypotrophy in children- this is the deviation of the actual body weight from the physiological age norms. This is an alimentary disease, which is characterized by a decrease in the amount or complete absence of the subcutaneous fat layer. AT rare cases hereditary metabolic disorders, malnutrition in children is associated with insufficient muscle mass. Muscular hypotrophy in children is complicated by dysfunctions of internal organs, heart failure and dystrophy subsequently. The classification of malnutrition in children is carried out in accordance with the indicators of the lag in weight gain:
- 1 degree diagnosed with a loss of body weight by 10-20%;
- 2 degree- this is the abandonment of the actual body weight from the physiological age norm by 21-40%;
- 3 degree- loss of more than 42% of normal body weight for age.
Why does fetal hypotrophy develop?
Fetal hypotrophy- this is a condition in which the actual weight of the child in utero is determined below the physiological level corresponding to the gestational age. The main provoking factors:
- toxicosis of pregnancy;
- nephropathy of a pregnant woman;
- a large amount of amniotic fluid;
- infectious diseases of the expectant mother;
- exacerbation of chronic diseases of internal organs;
- nutritional deficiencies in women.
Fetal hypotrophy is diagnosed by ultrasound. After diagnosis, the obstetrician should take measures to eliminate the causes of fetal hypotrophy.
How is malnutrition diagnosed in newborns?
After birth, malnutrition in newborns can be diagnosed at the first examination. The child is weighed and the data of his height and weight are compared. The doctor assesses the condition of the turgor of the skin and the thickness of the subcutaneous fat layer. With deviations from the norm, a diagnosis of underweight is established. In the newborn period, malnutrition in children can develop under the influence of:
- congenital developmental disorders digestive system;
- insufficiency of milk in the mother;
- improperly chosen scheme of artificial and mixed feeding;
- enzymatic deficiency;
- lactose intolerance;
- frequent colds and infectious diseases.
When diagnosing, the indicator of body weight gain is of decisive importance.
Symptoms of malnutrition in children
During the diagnosis, the main symptoms of malnutrition in children are distinguished:
- insufficient body weight;
- decrease in physical and mental activity;
- decrease in skin turgor;
- dry mucous membranes and skin;
- reduction in the amount of subcutaneous adipose tissue.
To prescribe the correct method of treatment, the cause of malnutrition should be identified. In newborns, this phenomenon is often associated with nutritional deficiencies or disorders of the gastrointestinal tract.
Treatment of malnutrition in children
Treatment of malnutrition in children begins with the diagnosis and elimination of the causes that form the complex of clinical symptoms. The diet and calorie content of the diet are adjusted. When breastfeeding, attention is paid to the diet of the mother. A high protein intake is recommended. If necessary, the diet of a nursing woman is supplemented with vitamin and mineral complexes. If these measures do not help within 1-2 weeks, then the child is transferred to a mixed type of feeding. The doctor recommends mixtures that are most suitable for the baby in terms of age and type of physiological characteristics. If the malnutrition of newborns is associated with lactose intolerance, then breastfeeding is completely replaced with artificial one using mixtures without milk protein.
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Hypotrophy in children is starvation, quantitative or qualitative, as a result of which significant changes occur in the body. Qualitative starvation is possible with improper artificial feeding, lack of essential nutrients and vitamins, quantitative - with incorrect calculation of caloric content or lack of food resources. Hypotrophy can be the result of acute diseases or the result of a chronic inflammatory process. Wrong actions of parents - lack of regimen, poor care, unsanitary conditions, lack of fresh air - also lead to this condition.
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 to adverse environmental factors, including infectious ones
- 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 studies, this deficiency condition occurs approximately equally in 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)
- placental pathology (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 food allergies 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
- celiac disease - gluten intolerance, changes in the work of the intestines in a child begin from the moment gluten-containing foods are introduced into the diet - barley groats, semolina, wheat porridge, rye groats, oatmeal
- lactase deficiency - the digestibility of milk is impaired (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- due to the wrong actions of parents and an unfavorable environment:
All exogenous factors in the development of malnutrition cause stress in the child. It has been proven 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 by common features in the form of clinical syndromes.
- Insufficient fatness: 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, in severe cases and on the face), the weight is insufficient, body proportions are disturbed, the skin is dry, elasticity is reduced.
- Changes in the functioning of the nervous system: depressed mood, decreased muscle tone, weakened reflexes, psychomotor development is delayed, and in severe cases, acquired skills even disappear.
- Decreased perception of food: appetite worsens up to its complete absence, frequent regurgitation, vomiting, stool disorders appear, the secretion of digestive enzymes is inhibited.
- 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 conduct a differential diagnosis and find out if a body weight deficit of 11-20% is a feature of the child's physique. Thin and tall children are usually so due to hereditary characteristics. Therefore, a new mother should not be afraid if her active, cheerful, well-nourished child is not as plump as other children. Hypotrophy of the 1st degree in children is characterized by a slight decrease in 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 of the 2nd degree in children is manifested by a mass 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 a healthy child who looks too thin. 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 is 7-10 cm, weight deficit is ≥ 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. A child often has a 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 consists in maintaining a constant body temperature in the child and establishing breastfeeding. Nutrition of 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 foods intended for younger children. 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 fermented milk 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)
- In severe forms of malnutrition - anabolic drugs - drugs that promote the formation of building protein in the body for muscles and internal organs.
Treatment of malnutrition requires an 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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| The main symptoms of malnutrition: |
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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. Quite a few important point is timely detection and treatment of diseases of childhood, congenital and hereditary pathologies, proper care of the child, prevention of the influence of external factors in the development of malnutrition. 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 with plant foods (see how to properly introduce complementary foods to a child). 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 there are problems with lactation, the child does not have enough milk, 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 talk 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 drugs "just" 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 weight of the child are not due to reduced appetite or some individual characteristics of the body - this is usually due to an unrecognized disease or lack of good nutrition in the child. 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
From birth, the child begins to significantly gain in body weight, all his organs grow, including the bones of the skeleton. If the baby is not properly fed and cared for, the first signs of malnutrition will immediately begin to appear in the form of a disruption in work. various bodies and systems. Most often, malnutrition develops due to a lack of protein and calories in the diet. With the initial lag in body weight, disturbances from the gastrointestinal tract begin, which leads to a violation of the absorption of nutrients. As a rule, children also suffer from a lack of vitamins and trace elements in their diet.
Causes of malnutrition
The causes leading to the occurrence of malnutrition are both internal and external factors. It is customary to distinguish between primary pathology, in which there is a lack of nutrition, and secondary - when against the background of various diseases, or other harmful factors, the nutrients from the food you eat are simply not absorbed by the body.Internal factors include diseases of various internal organs involved in digestion, that is, nutrients, under the influence of any reasons, cannot be absorbed by the body. Here, for example, it is appropriate to say that the violation can be both at the level of the gastrointestinal tract, and at the tissue and cellular level. At the same time, there are various violations exchange within the cell. Cellular energy reserves gradually decrease. In case they complete exhaustion starts natural process cell death.
Internal causes of malnutrition
The immediate internal causes of malnutrition are:- Encephalopathy that occurs in the fetus during pregnancy. Here in question that during the period of intrauterine development in the fetus, the normal activity of the central nervous system is disrupted, with a secondary disruption of the work of all internal organs and systems.
- Underdevelopment of lung tissue. Insufficient oxygen enrichment of the blood leads to metabolic disorders in the body, and slows down the development of organs and systems.
- Congenital pathology of the gastrointestinal tract - when such phenomena as constipation or vomiting are constantly present (with Hirschsprung's disease, dolichosigma, impaired location of the pancreas).
- Frequent abdominal operations that lead to "short bowel" syndrome. The natural physiological process of food digestion is disturbed.
- Hereditary diseases of the immune system, leading to a decrease in the body's defenses, inability to fight infection.
- Some endocrine diseases. Hypothyroidism is a disease of the thyroid gland, in which growth and metabolic processes in the body slow down. Pituitary dwarfism is a disease of the central organ of the endocrine system, as a result of which a sufficient amount of growth hormone is not produced.
- Metabolic diseases that are inherited. For example, galactosemia (intolerance to milk and dairy products), fructosemia is a similar disease in which the child's body does not absorb the fructose contained in vegetables and fruits. Rarer hereditary pathologies related to metabolic disorders include: leucinosis, Niemann-Pick disease, Tay-Sachs and others.
External causes of malnutrition
External factors affecting the development of malnutrition include:
1. nutritional factors. This includes several categories of reasons:
- Firstly, the quantitative underfeeding of the baby occurs due to the underdevelopment of the female breast (flat nipple, inverted nipple) or lack of female milk. On the part of the child, the cause may be: an underdeveloped lower jaw, constant vomiting, a short frenulum at the lower edge of the tongue.
- Secondly, insufficient feeding with mother's high-quality breast milk, or improper use of the nutrient mixture, late introduction of supplementary feeding or complementary foods to the child, insufficient intake of all necessary and healthy ingredients in the diet of the baby - also leads to chronic malnutrition and the development of malnutrition.
On average, the body spends 10% more energy with mild infectious diseases. And in the case of moderate infectious and inflammatory processes, energy costs increase significantly, and can reach about 50% of the total energy costs of the whole organism.
3. Intestinal lesions , namely its mucous membrane, lead to impaired absorption of nutrients and the development of malnutrition.
4. toxic factors. Long-term exposure to toxic toxic substances, hazardous waste products of chemical production, poisoning with vitamins A or D, drugs - all this has an extremely adverse effect on the body of children, especially infants.
Clinical signs and symptoms of malnutrition by degree
The clinical picture of malnutrition is largely associated with insufficient intake of food products. In addition, an important place in the symptoms of the disease is occupied by disorders normal functioning organs and systems. All clinical signs and symptoms are usually divided into syndromes. Syndrome is a set of symptoms in the defeat of any organ or system.With malnutrition, there are several main syndromes:
1.
The first of these is a syndrome in which the trophic function of organs and tissues is disturbed. Here we are talking about the fact that metabolic processes in the organs and tissues of the body slow down, body weight drops, the subcutaneous fat layer becomes much thinner, the skin becomes lethargic and flabby.
2.
Another important syndrome is a syndrome in which there is a violation of digestive functions. The entire digestive tract is affected. The stomach produces less of hydrochloric acid and pepsin, there are not enough enzymes in the intestines to process the food bolus.
The main symptoms of the syndrome of digestive disorders are:
- stool disorder, which can manifest itself both in the form of constipation and diarrhea;
- the chair becomes unformed, shines;
- at more detailed study stool, in it I find undigested food residues.
4. The next important syndrome that requires special attention is a syndrome in which hematopoiesis and the protective functions of the immune system are disturbed. A decrease in the number of red blood cells (erythrocytes with hemoglobin) manifests itself in the form of anemia. Decreased resistance to various infections leads to the fact that such children often suffer from chronic inflammatory and infectious diseases, and all symptoms are mild and atypical.
In each individual case, more than one of the above syndromes may be expressed. The manifestations of malnutrition also depend on the predominance of the lack of any component of food. For example, during protein starvation, symptoms of hematopoiesis and a decrease in the body's defenses prevail.
There are three degrees of malnutrition. This separation is necessary for the convenience of assessing the general condition of the child and for planning the amount of treatment. But in reality, the degrees of malnutrition are stages of the same process, following one after another.
Hypotrophy of the first degree
Initially, the body tries to compensate for the lack of nutrients with the accumulated subcutaneous fat layer. Fats from the depot migrate into the blood, pass through the liver and turn into energy to maintain the normal physiological activity of organs and systems. Initially, fat reserves disappear in the abdomen, then in other places. The degree of depletion of the subcutaneous fat layer is assessed different methods. The most practical, and at the same time informative method, is the Chulitskaya index. This method is based on measuring the circumference of the shoulder in two different places, then the hips and lower legs, and the child's height is subtracted from the resulting amount. The norm for a child up to a year is 20-25 cm. Another method is to measure the skin fold in four different places: on the abdomen to the left of the navel, on the shoulder, in the area of the shoulder blades, and finally, on the thigh from the outside. With normal growth and development of the child, the skin fold is approximately 2-2.5 cm. In the first degree of malnutrition, the Chulitskaya index is 10-15 centimeters, and the skin fold slightly decreases.
Symptoms of hypotrophy of the first degree:
- Fat folds are flabby, muscle tone is reduced, elasticity and firmness of the skin is lost.
- The growth of the child initially corresponds to age norms.
- Body weight is reduced from approximately 11% to 20% of the original.
- General health is normal. There is rapid fatigue.
- There are no disorders of the central nervous system. Sleep disturbing, intermittent.
- The child is a little irritable, may spit up the food he has eaten.
Hypotrophy of the second degree
The changes are the same as in the first degree, but the difference is that they deepen a little, and other characteristic symptoms also appear:Signs of malnutrition of the second degree:
- The subcutaneous fat layer is very thin on the legs, arms, and may be absent on the abdomen or chest.
- The Chulitskaya index decreases, and varies from one to ten centimeters.
- The skin is pale, dry.
- The skin is flabby, easily shifts into folds.
- Hair and nails become brittle.
- Muscle mass on the limbs decreases, body weight decreases by about twenty to thirty percent, and stunting is also noted.
- Thermoregulation is disturbed, such children quickly freeze, or also quickly overheat.
- High risk of exacerbation chronic infections(pyelonephritis, otitis, pneumonia).
- Violation of resistance to the food taken. In connection with trophic disorders of the villi and the intestinal mucosa, digestion is disturbed, in particular the absorption of nutrients. Dysbacteriosis appears, that is, pathogenic bacterial flora predominates. Children appear: increased gas formation, bloating and discomfort in the abdomen. Frequent constipation or diarrhea, often alternating one after another.
- Decreased muscle tone. Due to the significantly reduced muscle tone, the abdomen protrudes outward, and the impression of a frog's abdomen is created.
- The lack of vitamin D and calcium in the body leads to additional development of muscle weakness, the development of symptoms of osteoporosis (washing out of calcium from the bones). At the same time, the bones of the skull become soft, the large and small fontanelles remain open for quite a long time.
- On the part of the central nervous system, a number of pathological disorders similar to those in the first degree of malnutrition are also revealed. Children are restless, cannot fall asleep, often act up. Then the characteristic symptoms of overexcitation of the central nervous system are gradually replaced by lethargy and apathy towards the outside world.
Hypotrophy of the third degree
reflects the full clinical picture diseases. At this degree, violations of the work of all organs and systems are most pronounced. The primary cause of the disease determines the most serious condition of the child, the ineffectiveness of the measures taken to remove the child from given state and his subsequent recovery. The third degree of malnutrition is characterized by a strong depletion of the body, a decrease in all types of metabolism.Characteristic signs and symptoms of hypotrophy of the third degree:
- By appearance you can immediately determine that there is a chronic malnutrition. The subcutaneous fat layer is absent in almost all places, including the face. The skin is dry, pale and so thin that the child looks like a mummy.
- When you try to form a skin fold with your fingers, there is practically no resistance. healthy skin. The elasticity of the skin is so reduced that the fold does not straighten out for a long time after releasing the fingers. Deep wrinkles form all over the body.
- Muscle mass and body weight as a whole are so small that the fatness index according to Chulitskaya is not determined, or is negative. The overall weight loss is 30% or more of normal values.
- On the face, the retraction of the cheeks is visible, the cheekbones protrude forward, the sharpening of the chin is pronounced.
- Manifestations of lack of vital trace elements and vitamins are clearly expressed.
- Lack of iron affects the appearance of cracks in the corners of the mouth (jamming), as well as anemia.
- The lack of vitamins A and C manifests itself in the form of appearance on the mucous membranes: bleeding and atrophy (death, reduction in size) of the gums, stomatitis in the form of small whitish rashes.
- The abdomen is greatly distended due to the weakness of the muscles that support it.
- Body temperature often jumps up and down due to the fact that the thermoregulation center in the brain does not work.
- Immunity is sharply reduced. You can detect signs of sluggish chronic infections. Inflammation of the middle ear - otitis, inflammation of the kidneys - pyelonephritis, pneumonia - pneumonia.
- The child's growth lags behind the average.
Options for the course of malnutrition
A lag in the growth and development of a child can be present at every stage of its development, starting mainly from the second half of pregnancy, and ending with the period of primary school age. At the same time, the manifestations of the disease are characterized by their own characteristics.Depending on the period of development of hypotrophic manifestations, there are four variants of the course of hypotrophy:
- intrauterine malnutrition;
- hypostatura;
- alimentary insanity.
Intrauterine malnutrition
Intrauterine malnutrition originates in the prenatal period. Some authors call this pathology intrauterine growth retardation. There are several options for the development of intrauterine malnutrition:
1. Hypotrophic- when the nutrition of all organs and systems is disturbed, the fetus develops very slowly, and does not correspond to the gestational age.
2. Hypoplastic– this development option means that, along with insufficient common development body of the fetus, there is also some lag in the maturation and development of all organs. Here we are talking about the fact that organs and tissues at birth are not sufficiently formed, and do not fully perform their functions.
3. Dysplastic the variant of the course of malnutrition is characterized by uneven development of individual organs. Some, such as the heart, liver, develop normally, corresponding to the gestational age, while others, on the contrary, lag behind in their development, or develop asymmetrically.
Hypostatura
Hypostatura - the term originates from Greek, and means hypo - below, or under, statura - growth, or size. With this variant of the development of malnutrition, there is a uniform lag both in the growth of the child and in his body weight.The only difference from true malnutrition is that the skin and subcutaneous fat layer do not undergo strong changes.
Hypostatura, as one of the variants of the course of malnutrition, occurs secondarily in chronic diseases of some internal organs. The development of hypostature is usually associated with transitional periods of growth and development of the child. One of these periods falls on the first six months of a child's life. At the same time, they begin to gradually add food products, milk formulas to mother's milk - in other words, to supplement the child. The appearance of this pathology in the second year of life is associated primarily with congenital chronic diseases. Here are the most common ones:
- Congenital malformations of the cardiovascular system. Violation of blood circulation leads to insufficient flow of oxygen and nutrients to organs and tissues.
- Encephalopathies in combination with endocrine disorders also have an extremely adverse effect on the metabolism in the body, delaying development and growth.
- Bronchopulmonary dysplasia is a disturbed development of the lung tissue during the period of intrauterine development of the fetus. In this case, there are serious complications associated with breathing and the delivery of oxygen to the blood.
Kwashiorkor
The term kwashiorkor is commonly used to refer to such a variant of the course of malnutrition, which occurs in countries with a tropical climate, and where plant foods predominate in the diet.In addition, there are specific disorders in which the body receives less, does not synthesize or does not absorb protein foods at all.
Disorders that contribute to the development of kwashiorkor include:
- Long-term indigestion, manifested by persistent unstable stools - in other words, the child has chronic diarrhea.
- In diseases of the liver, its protein-forming function is disrupted.
- kidney disease associated with increased loss protein along with urine.
- Burns, excessive blood loss, infectious diseases.
1. Neuropsychiatric disorders- the child is apathetic, lethargic, he has increased drowsiness, lack of appetite. When examining such children, it is often possible to identify a lag in psychomotor development (late in holding his head, sitting, walking, speech is formed with a great delay).
2. Edema due to a lack of protein molecules in the blood (albumin, globulins, etc.). Albumins maintain oncotic pressure in the blood by binding water molecules to themselves. As soon as protein deficiency occurs, water immediately leaves the vascular bed and penetrates into the interstitial space - local swelling of the tissues is formed. In the initial stages of the disease, mainly internal organs swell, but this fact escapes the attention of parents. In the developed (manifest) stages of the disease, peripheral tissues swell. Edema appears on the face, feet, limbs. An erroneous idea is created that the child is healthy and well-fed.
3. Decreased muscle mass. Muscle mass, and with it strength, is significantly reduced. Protein starvation causes the body to borrow its own proteins from the muscles. There is a so-called atrophy of muscle fibers. Muscles become flabby, lethargic. Together with the muscles, the nutrition of the underlying tissues and subcutaneous fat is disrupted.
4. Being late for physical development children. It is accompanied by a lack of growth rate, while body weight is reduced much less. Children with kwashiorkor are short, squat, physical activity is below normal.
In addition to the constant symptoms, children with kwashiorkor have other signs of the disease that occur with varying frequency.
Common symptoms are:
1.
Color change, softening of thinning and, eventually, hair loss on the head. Hair becomes lighter, and in later manifestations of the disease, or in older children, discolored or even gray strands of hair are found.
2.
Dermatitis is an inflammation of the superficial layers of the skin. Redness, itching, cracks appear on the skin. Subsequently, the skin in the affected areas exfoliates, and traces remain in this place in the form of light spots.
Rare symptoms include:
1.
Dermatosis - red-brown spots of a rounded shape.
2.
Hepatomegaly is an abnormal enlargement of the liver. The liver tissue is replaced by fat and connective tissue. The liver is unable to form enzymes and other active substances, necessary for normal function the whole organism.
3.
Kidney dysfunction. The filtration capacity is reduced. In the blood, harmful metabolic products accumulate.
4.
Stool disorders are permanent. The child has persistent diarrhea. The feces are shiny and smell unpleasant.
Summing up the material presented, we can say with confidence that kwashiorkor is a disease that is extremely rare in countries with a temperate climate. Countries located in this geographical latitude, have developed social status and standard of living, therefore, the possibility of malnutrition and deficiency in the diet of proteins and calories is practically excluded.
Alimentary insanity
Alimentary marasmus (exhaustion) occurs in children of primary and secondary school age. With insanity, there is a lack of both proteins and calories. To establish the cause and put accurate diagnosis, find out:
- From the history of the onset of the disease, they learn what the body weight of the child was even before the first signs of malnutrition appeared.
- The socio-economic situation in which the child's family is located.
- If possible, find out the daily diet.
- Is there vomiting or chronic diarrhea and how often it occurs.
- Is this child taking any medications? For example, anorexigenic, which suppress appetite, or diuretics, which remove many useful nutrients from the body, including protein.
- Are there any disorders of the central nervous system: stressful situations, alcohol or drug addiction.
- AT adolescence, in particular, in girls, starting from the age of 12, they find out the presence and evaluate the regularity, frequency and duration of the menstrual cycle.
Among all the symptoms that appear with alimentary insanity, permanent and rare symptoms are distinguished.
Permanent symptoms include:
- weight loss reaches up to 60% of normal, age-appropriate;
- decrease in the thickness of the subcutaneous fat layer;
- reduction in the mass of muscle fibers;
- the limbs of the patient become very thin;
- many wrinkles appear on the face, the skin fits all the facial bones and it seems as if this is the face of an old man.
- Diarrhea is chronic. The chair is liquid, shines, with an unpleasant smell.
- Thinning and clarification of hair, which eventually begin to fall out.
- Exacerbation of chronic infections is a very frequent companion of an organism weakened by malnutrition.
- Thrush - fungal disease, in which the mucous membranes of the oral cavity, vagina and urethra are affected. They are manifested by whitish discharge, itching and discomfort in these places.
- poly symptoms vitamin deficiency, depending on the lack of certain vitamins and minerals.
- Eye changes are manifested by inflammation of the eyelids, the formation of new small vessels on the cornea. Grayish plaques appear in the inner corners of the eyes (lack of vitamin A).
- AT oral cavity inflammatory changes in the mucous membrane and gums are observed. The tongue increases in size (due to a lack of vitamin B 12).
- The heart is enlarged. Insufficient strength heart tremors leads to stagnation of blood in the veins, swelling of the lower extremities appears.
- Weakness of the muscles of the anterior abdominal wall causes a sagging, protruding abdomen. The liver protrudes beyond the lower edge of the right hypochondrium.
- Obvious neurological disorders are manifested in nervousness, increased irritability, muscle weakness, in the reduction of tendon reflexes.
- Memory worsens, mental and cognitive abilities, including working capacity, decrease.
- Decreased visual acuity. A lack of vitamin A causes a decrease in vision at dusk.
- sharpness taste sensations also reduced.
- A lack of vitamin C leads to increased capillary fragility. Small punctate hemorrhages can be seen on the skin after a slight pinch.
Lack of essential fatty acids
If there is a deficiency of essential fatty acids (linoleic and linolenic acids), specific symptoms immediately appear, characteristic of their insufficient consumption. Linolenic and linoleic acids in in large numbers contained in vegetable oils(olive, sunflower, soy). In most cases, this variant of malnutrition appears in infants who lack the nutrition of mother's milk. Cow's milk and other milk mixtures do not contain essential fatty acids in the amount necessary for the energy and plastic costs of a young organism. Depending on the deficiency of one or another fatty acid, the symptoms of the disease will differ slightly from each other.
With a lack of linoleic acid, the following symptoms appear:
- Dryness of the skin with exfoliation of the superficial stratum corneum.
- Wound healing continues for a long period.
- Thrombocytopenia - a reduced number of platelets (blood cells responsible for its clotting) in the blood. The lack of platelets leads to increased fragility of small vessels, with accidental minor domestic injuries of the skin, bleeding lengthens. Insignificant tweaks cause the appearance of many small-point hemorrhages.
- Prolonged loose stools (diarrhea).
- Periodic exacerbations of infectious diseases (for example, skin or lungs).
- numbness and paresthesia (tingling sensation) of the lower and upper extremities;
- general muscle weakness;
- visual impairment.
Diagnosis of malnutrition
Key points
Approaching the stage of diagnosing malnutrition, course options, possible complications from other organs, several points must be taken into account.Discovery of important clinical signs for all major systems involved in the pathological process. This includes the following violations:
- fatness disorders - manifested in the form of thinning of the subcutaneous fat layer and trophic changes;
- violations digestive function– include changes in food resistance;
- metabolic disorders: protein, fat, carbohydrate, mineral, vitamin;
- functional disorders of the central nervous system.
The second point that should not escape the attention of doctors is the differentiation of pathological changes that occur during malnutrition, with other similar diseases, with a decrease in height, body weight, and overall physical development of children.
Symptoms of children with hypostatura are very similar to a disease such as nanism. This is a pathology of the central endocrine organs (hypothalamus and pituitary gland), in which growth hormone, somatotropin, is not produced. With this disease, unlike hypostatura, there are no pathological changes in the form of thinning of the subcutaneous fat layer and other trophic disorders. All organs develop evenly, although they are reduced in size.
Assessment of the child's condition and determination of the degree of pathological changes is also determined by the nature of the feces. Initially, with malnutrition, the stool is scanty, colorless, with a characteristic fetid odor. In the future, violations of the functional ability to process food through the gastrointestinal tract lead to the fact that the stool becomes plentiful, shiny, it contains the remains of undigested food, muscle fibers. infection pathogenic bacteria the intestinal mucosa entails the phenomena of dysbacteriosis (diarrhea, bloating and discomfort in the abdomen).
Due to insufficient intake of protein, the body uses internal reserves (from muscles, adipose tissue), the metabolic products of which are excreted by the kidneys in the form of ammonia. The urine of such patients has the smell of ammonia.
Laboratory research
Due to the fact that with malnutrition there is a variety of pathological changes, laboratory tests will be variable, depending on the primary lesion of a particular organ. For example, with anemia, there will be a decrease in the number of red blood cells and hemoglobin in the bloodstream.In biochemical analyzes, signs of impaired liver function, lack of vitamins and trace elements can be detected.
Instrumental diagnostic methods
They are used in cases where there are significant complications from the internal organs. Widespread methods are: electrocardiographic examination of the heart, electroencephalogram of the brain, ultrasound examination of other internal organs.Ultrasound is used when the borders of the heart are enlarged, the liver is enlarged, or there are other pathological changes in the abdominal cavity.
If necessary, or in doubtful cases, the attending physician prescribes the appropriate instrumental diagnostic method at his discretion.
Diagnosis of malnutrition and the degree of pathological changes is not an easy task, and requires a lot of patience, care and experience from the doctor.
Hypotrophy treatment
To treat malnutrition, it is not enough to take drugs in the form vitamin preparations or start booster feeding. Therapy of such a disease should include a whole range of measures aimed at eliminating the cause of malnutrition, maintaining an optimal balanced diet for age, as well as performing therapeutic measures to eliminate complications associated with malnutrition.Complex therapy includes:
- Determination of the cause that caused malnutrition, simultaneously with an attempt to regulate and eliminate it.
- Diet therapy, which is selected individually in each specific case, and also depends on the degree of pathological disorders in the body.
- Detection of chronic foci of infection that contribute to the development of malnutrition, as well as their active treatment.
- Symptomatic treatment, which includes the use of multivitamin and enzyme preparations.
- Appropriate regimen with proper care and educational activities.
- Periodic courses of massage and therapeutic exercises.
diet therapy
D
ietotherapy is fundamental method treatment for malnutrition. The appointment of appropriate food products depends on many factors, in particular on the degree of exhaustion of the body. But the most important thing in the approach to diet therapy is the degree of damage to the gastrointestinal tract or central nervous system. Not in all cases it happens that with a large decrease in the subcutaneous fat layer, the patient felt bad. When prescribing diet therapy, several basic principles (stages) are followed:
1. Initially, the resistance of the digestive system to the food consumed is checked. That is, how badly the gastrointestinal tract is affected, and whether food can be fully processed and absorbed by the body.
The period of clarification of food resistance in duration takes from several days with the first degree of malnutrition, up to one and a half to two weeks with the third degree. This process involves the doctor monitoring how the food is absorbed and whether there are any complications in the form of diarrhea, bloating, or other symptoms of a gastrointestinal disorder.
From the first day of treatment, the daily amount of food should not exceed the usual age:
- 2/3 for hypotrophics of the first degree.
- 1/2 for hypotrophics of the second degree.
- 1/3 for hypotrophics of the third degree.
In this period, there is a gradual compensation of missing trace elements, vitamins and other nutrients. There is a decrease in the number of meals, but the calorie content and quantitative volume increase. Every day, add a small amount of the mixture to each meal, up to full recovery full nutrition, according to age.
3.
The third period in diet therapy is the stage of enhanced food intake. Only after complete restoration of the functional activity of the gastrointestinal tract, the patient can increase the load of food.
In the third period, intensive feeding is continued, however, with a restriction of protein intake, since the increased intake of protein products is not fully absorbed by the body.
During each stage of diet therapy, the stool is periodically checked for the content of residual dietary fiber and fat (coprogram).
Others, no less important conditions when prescribing a diet, are:
1.
Reducing the periods between feedings. And the frequency of feeding itself increases several times a day, and is:
- with hypotrophy of the first degree - seven times a day;
- in the second degree - eight times a day;
- in the third degree - ten times a day.
3. Maintaining adequate periodic nutritional control. For this purpose, special diaries are kept, where the amount of food eaten is noted. Systematic control is simultaneously performed for stool, diuresis (number and frequency of urination). If nutrient mixtures are administered intravenously, then their amount is also recorded in the diary.
4. Fecal samples are taken several times a week for the presence of undigested dietary fiber and fatty inclusions.
5. Every week, the child is weighed, and additional calculations are made to calculate the required amount of nutrients (proteins, fats and carbohydrates).
The criteria for the effectiveness of dietary therapy are:
- normalization of the condition and elasticity of the skin;
- improved appetite and emotional state child;
- daily weight gain, an average of 25-30 grams.
Care of patients with malnutrition
An integrated approach in the treatment of malnutrition provides for proper care for such children. At home, children with the first degree of malnutrition can be treated, but provided that there are no other concomitant diseases, and the risk of complications is minimal. Inpatient treatment of malnutrition of 2-3 degrees is carried out in a hospital in without fail along with mothers of babies.- The conditions for staying in the wards should be as comfortable as possible, and are as follows: the lighting complied with all regulatory standards, ventilation was carried out twice a day, the air temperature was optimal, within 24-25 degrees Celsius.
- Daily walks in the fresh air serve both as hardening and as a prevention of upper respiratory tract infections (congestive pneumonia).
- Periodic gymnastic exercises and massage courses will help restore reduced muscle tone, and will have a beneficial effect on the general condition of the body.
Enzyme therapy
Enzyme therapy is used for reduced functional capacity of the gastrointestinal tract. The drugs taken replace the lack of gastric juice; amylases, pancreatic lipases; this group of drugs includes festal, creon, panzinorm, diluted gastric juice.vitamin therapy
It is an essential part of the treatment of malnutrition. Reception begins with parenteral administration (intravenously, intramuscularly) of vitamins C, B 1, B 6. With the improvement of the general condition, they switch to enteral (through the mouth) intake of vitamins. Subsequently, apply multivitamin complexes, courses. Stimulant Therapy
Designed to improve metabolic processes in the body. In severe cases, immunoglobulin is prescribed, which protects the body from the increasing harmful effects of pathogenic microorganisms, increases defensive forces and prevents chronic infections from developing.Preparations dibazol, pentoxiffilin, ginseng - improve peripheral blood circulation, access of oxygen and nutrients to internal organs and tissues. Activate the work of the central nervous system.
Symptomatic treatment
Each hypotrophic person has some kind of complications. Therefore, depending on the pathological condition, drugs are prescribed that support their performance and functional activity:- With anemia, iron preparations (sorbifer, totem) are prescribed. If a child has a very low hemoglobin value (below 70 g/l), he is prescribed a red blood cell transfusion.
- With rickets, vitamin D is prescribed, as well as preventive courses of physiotherapy. For this purpose, irradiation with ultraviolet rays using a special quartz lamp is used.
Prevention of the development of malnutrition
1. Even during pregnancy, it is necessary to apply preventive measures for the correct regimen of a pregnant woman. Proper care, proper nutrition and prevention of the influence of harmful environmental factors will minimize the risk of malnutrition at birth.2. Starting from birth, a very important point in the prevention of malnutrition is the natural feeding of the mother of her baby. Mother's milk contains a huge amount of nutrients and vitamins necessary for a young body, and most importantly - in an easily digestible form.
3. Under conditions of shortage of women's milk, the child is supplemented with nutritious milk mixtures. One of the main rules of supplementary feeding is that it should be done before breastfeeding.
4. Starting from the age of six months, the child must begin to feed. There are several main rules for complementary foods:
- The child must be completely healthy.
- Eat food according to the age of the child.
- Complementary foods are introduced gradually, and before breastfeeding. The child eats with a small spoon.
- The change of one type of feeding is replaced by one type of complementary foods.
- The food you eat should be rich in vitamins and essential minerals.
Summing up the above material, it should be noted that the prognosis for the development of malnutrition depends primarily on the causes that participated in the occurrence of this pathological condition. The conditions of the external and internal environment, the nature of feeding, as well as the age of the patient - all this plays a big role in the development of malnutrition. With alimentary insufficiency, the outcome of the disease is usually favorable.
Before use, you should consult with a specialist.Hypotrophy(lat. Hypertrophy) is a pathological condition with a "chronic eating disorder", characterized by a reduced, compared with the norm, body weight.
Hypotrophy - causes (etiology)
With hypertorophy, a decrease in food tolerance and a decrease in immunity are characteristic.
The concept of "chronic eating disorders", or "dystrophy", includes pathological conditions characterized by either excess or reduced body weight compared to the norm. The first forms are called "paratrophy". The second forms, which are more common, are combined under the name "hypotrophy", they are characterized by weight loss, a decrease in food tolerance and a decrease in immunity.
Hypotrophy is inherent in young children (up to 2 years), in older children they occur only under extremely unfavorable conditions.
Children with malnutrition are especially susceptible to diseases. Quite often, malnutrition is a background against which all infectious and inflammatory processes are more difficult.
With the increase in the material and cultural level of the population, the implementation of systematic medical control over the feeding and development of children in the first years of life, the organization of a wide network of dairy kitchens, the incidence of malnutrition among young children has significantly decreased. Currently, children with severe forms of malnutrition (grade III) are very rare, but mild and moderate malnutrition (grades I and II) continue to be common diseases among young children.
The causes of malnutrition in young children are numerous and varied, they can be conditionally divided into the following groups:
- alimentary;
- infectious;
- related to adverse environmental conditions.
In previous years, defects in child feeding played a leading role in the etiology of malnutrition.
The most important among the alimentary causes of malnutrition is malnutrition in violation of the correct ratio of individual ingredients in the composition of food. Insufficient introduction of proteins, fats, carbohydrates, mineral salts, vitamins can lead to the development of malnutrition. Of the greatest importance is protein deficiency, which adversely affects the growth and development of the body, leads to profound changes in metabolism, causes a violation of the enzymatic functions of the liver and other organs.
Deficiency of vitamins (A, C, group B, etc.) can be the cause of malnutrition, since they are regulators of all life processes; established their close relationship with hormones and enzymes.
Nutritional deficiencies can be of a different nature, but the cause of malnutrition during breastfeeding is most often malnutrition or partial starvation, which can occur when the mother has insufficient milk due to temporary or permanent hypogalactia. Sometimes a child receives an insufficient amount of milk either as a result of the presence of malformations in him (pyloric stenosis, splitting of the hard palate, cleft of the upper lip, congenital heart disease, Hirschsprung's disease, etc.), or due to defects in the mammary gland in the mother (flat, inverted, split nipple , tight chest, etc.).
Less often, during breastfeeding, deviations of a qualitative nature can be observed, when the amount of mother's milk is sufficient, but it is defective in its composition, mainly in terms of fat and protein.
In addition to malnutrition, erratic feeding, early feeding without medical indications, errors in feeding technique, etc.
Much more often, feeding defects (quantitative and qualitative nature) play an etiological role in the development of malnutrition in children who are on mixed and mainly artificial feeding. Hypotrophy in such children most often develops with monotonous and prolonged feeding with cow's milk, flour products. Hypotrophy can also occur in children receiving highly fat-free food for a long time.
All nutritional factors are very significant in the development of malnutrition in the 1st half of life, but their role is also significant in later life child.
At present, due to the widespread implementation of preventive measures, chronic eating disorders of alimentary etiology are much less common. In recent years, the infectious factor has begun to play the main role in the development of this pathology in young children. The most important in the occurrence of malnutrition are often recurring acute respiratory infection and influenza, often giving complications from the lungs, ears and kidneys.
The constant presence of purulent foci in the body of a child leads to a violation of metabolic processes.
Hypotrophy very often develops in children on the basis of infectious gastrointestinal diseases, especially chronic dysentery and coli infection.
immediate cause malnutrition in children can serve as congenital enteropathy of a different nature, in particular cystic fibrosis of the pancreas, celiac disease, and tuberculosis.
The infectious factor plays an important role in the occurrence of malnutrition in children of the 2nd half of life, especially in the 2nd year of life. This is facilitated by the great contact of children with others.
Poor living conditions (cramped, damp, poorly ventilated room), wrapping, leading to overheating of the child, incorrect daily routine, insufficient use of air, lack of favorable conditions for sleep, pedagogical neglect and many other defects in the organization of the environment can lead to the development of malnutrition. Combined with a violation of the diet, these factors usually contribute to the frequent illness of the child. Hypotrophy occurs especially easily in premature babies with the slightest disturbance in the organization of the environment.
It must be emphasized that all of the listed causes of malnutrition are so closely intertwined with each other, so mutually influence each other, that it is sometimes difficult to determine what is primary and what is secondary.
Hypotrophy - the mechanism of occurrence and development (pathogenesis)
Hypotrophy is based on violations of protein, fat, carbohydrate, water-mineral and vitamin metabolism with a violation of the regulatory mechanisms of metabolism in the body.
Protein metabolism suffers especially sharply: hypo- and dysproteinemia develops. Protein deficiency affects the function of enzymes that cause deamination processes, resulting in increased excretion of amino acids in the urine.
Changes in fat metabolism are associated with a violation of the pancreas and are characterized by a significant decrease in the digestion and absorption of fats, which leads to steatorrhea (the release of fatty acids, and sometimes neutral fat with feces). Hypocholesterolemia is detected in the blood.
Violation of carbohydrate metabolism is less pronounced, but hypoglycemia occurs. Features of the metabolism of children with malnutrition lead to the development of acidosis.
Changes in water-salt and mineral metabolism lead to thickening of the blood, loss of the body's ability to regulate the balance of electrolytes, as a result of which hypo K + and hypo Na + can occur (with hypotrophy III stage). A distinct deficiency of iron, cobalt, copper is revealed.
A deficiency of vitamins develops, especially vitamin C and group B. The lack of vitamins aggravates the violation of oxidative processes in tissues, maintaining acidosis.
Thus, various etiological factors cause changes in the digestive system, leading to a distortion of the absorption of food products in the intestine, a decrease in their utilization by tissues, and disruption of the activity of regulatory mechanisms.
With malnutrition, there is a decrease in the acidity of gastric juice and the enzymatic activity of the stomach and intestines, a slowdown in the evacuation function of the stomach.
Secretory and enzymatic functions of the gastrointestinal tract are in interaction with endocrine system and CNS. In chronic eating disorders, not only the functions of the cerebral cortex and vegetative subcortical centers suffer, but also humoral regulatory factors. CNS dysfunction affects enzymatic activity Gastrointestinal tract, leading to a violation of the digestion and assimilation of food, and further deepens dystrophic processes. This, in turn, worsens the trophic activity of the central nervous system.
Profound changes in the activity of the central nervous system during eating disorders ultimately cause a violation of homeostasis, as well as the functions of internal organs: degenerative changes occur in the liver, pancreas and other organs, as well as the central nervous system. All this leads to a decrease in immunobiological protection, the child's tendency to diseases.
Hypotrophy - pathological anatomy
I degree of hypotrophy
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 of malnutrition
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, children easily overheat or overcool. 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 of malnutrition
It is observed mainly in children of the first 6 months of life and is characterized by a sharp 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 fontanelle sink. 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.
Hypotrophy - symptoms (clinical picture)
With the development of malnutrition, functional disorders appear in the activity of systems and organs (primarily the gastrointestinal tract, the nervous system), changes in metabolism, and a decrease in general and local resistance. Distinguish malnutrition I, II and III degree.
With hypotrophy of the I degree, the general condition of the child remains satisfactory, and he does not give the impression of a patient, especially when the child is dressed or wrapped. However, an objective study reveals signs of malnutrition. The subcutaneous fat layer becomes thinner on the abdomen and trunk, so the fold at the level of the navel is only 0.8 cm or less.
The color of the skin and visible mucous membranes may be normal or slightly pale. At the same time, the elasticity of muscles and skin, characteristic of a healthy child, is somewhat reduced. Body weight vs. normal indicators may be less by 10-20%; with regard to such parameters of physical development as height, circumference chest, they usually remain within the normal range. Sleep, appetite and stool are either preserved or slightly disturbed,
With malnutrition of the II degree, the body weight deficit can reach 20-30%. At the same time, these children also show a slight (2-4 cm) growth retardation. The subcutaneous fat layer disappears on the trunk, limbs and decreases on the face. The skin loses its elasticity, it easily gathers into folds on the inner surface of the thighs, shoulders and buttocks. The skin becomes pale or gray in color, becomes dry, lethargic, in some areas it is possible to detect pityriasis peeling, pigmentation. Hair becomes stiff and sparse. Skin turgor is significantly reduced, in most cases there is muscle hypotension. Body temperature loses its monothermicity, temperature fluctuations can reach 1°C or more.
As a rule, appetite is significantly reduced, some children have an aversion to food, and with force-feeding, vomiting. Often there are dyspeptic disorders.
The nervous system of such a child is characterized by instability: excitement, anxiety, causeless crying are replaced by lethargy, apathy, weakness. Sleep in most patients is restless. There is a lag in the development of motor functions: children later begin to sit, stand, walk, sometimes acquired motor skills are lost.
Quite often, in children with hypotrophy of the II degree, infectious and inflammatory processes occur in the ears, lungs, urinary tract, and it should be noted that all diseases proceed sluggishly, torpidly.
Hypotrophy of the III degree is characterized by a sharp decrease in the subcutaneous fat layer on the face and its complete disappearance on the trunk and limbs. The child's face becomes small and takes on a triangular shape, an senile appearance. Curved body weight with hypotrophy III degree continues to fall progressively. The child's body weight deficit exceeds 30%. The growth retardation is also significant (by 4-6 cm or more). Such children have a characteristic appearance. The skin is pale gray, flabby, dry, in places with scaly peeling, hemorrhages, hanging in folds on the inner surface of the thighs, shoulders, buttocks; gathered in folds, it does not straighten out. Visible mucous membranes are dry, bright red, easily vulnerable, often develop thrush, stomatitis, ulceration, difficult to treat. Muscles become atrophic, their tone is increased. Initially, these children are restless, irritable, whiny, later lethargy, indifferent, apathetic attitude to the environment increases, they sleep a lot, do not show a feeling of hunger at all. Often, all previously acquired motor skills are completely lost. In some cases, the formation of motor skills and the development of speech slow down dramatically. Almost always characteristic low temperature body. Breathing is disturbed - it is superficial, arrhythmic, slow, atelectasis often develops, pneumonia occurs, occurring atypically (without fever, cough, pronounced catarrhal phenomena).
Heart sounds in most cases are muffled, the pulse weakens and slows down to 60-80 per minute. The limbs are usually cold to the touch.
The abdomen is drawn in or swollen. Appetite sharply decreases, sometimes a complete aversion to food develops, and often regurgitation or even vomiting appears as a protective reflex. The stool is usually liquid, quickened, reminiscent of dyspeptic; constipation is less common. Diuresis in these children in most cases is reduced.
This degree of malnutrition is gradually accompanied by manifestations of vitamin deficiency (A, C, group B), however, sharp pronounced rickets are not observed due to a delay in growth processes.
Children with malnutrition are very susceptible to all kinds of diseases that occur in them for a long time, peculiarly, severely, often accompanied by complications. The most common diseases such as influenza, acute respiratory infection, pneumonia, otitis media, otoantrpt, occur in children with severe degrees of malnutrition atypically, often latently, for a long time, with short remissions and frequent outbreaks, without fever, without obvious clinical symptoms, without changes in peripheral blood. It is quite clear that the diagnosis of infectious diseases in such children presents certain difficulties.
In the presence of any local focus with malnutrition, general septic and toxic conditions easily occur. At the same time, sepsis also proceeds atypically, in some cases without an increase in body temperature, without characteristic changes in the blood, without bacteriological confirmation.
A disease of any nature contributes to a further increase in malnutrition in a child.
The reduced reactivity of children with malnutrition is also manifested in their reduced food tolerance. Often, a child with malnutrition II and III responds to the usual food load with a paradoxical reaction: instead of weight gain, it falls, vomiting appears, frequent loose stools, and sometimes even toxicosis develops. This indicates a reduced resistance of the gastrointestinal tract. Based on this, when prescribing a diet, care must be taken and consistency.
Over the past 10-15 years, the etiological structure of malnutrition in young children has undergone significant changes. Everywhere there is a significant reduction in the number of children with malnutrition due to irrational feeding and care defects. The number of children with malnutrition, which has developed as a result of infectious diseases, is also decreasing, but to a lesser extent. However, at the same time, the significance of harmful factors acting at various stages of embryonic and fetal development and causing the occurrence of intrauterine malnutrition began to be more clearly revealed.
Prenatal malnutrition is understood as acute and chronic intrauterine metabolic disorders that appear already at birth or in the neonatal period. These metabolic disorders can develop with toxicosis of pregnancy, hypertension, anemia, diseases of the heart, endocrine glands, tuberculosis and other diseases of the mother. Harmful can be acting environmental factors (irrational nutrition of a pregnant woman, radioactive substances, X-rays, chemicals, certain drugs, etc.).
At a normal gestational age, children with this pathology have reduced indicators of physical development. And this primarily concerns body weight, the deficit of which, compared with normal values, can range from 200 to 900 g. Because of this, the subcutaneous fat layer may be insufficiently expressed or completely absent, depending on the degree of malnutrition.
Significantly less often, growth deficiency is also detected, which is not so pronounced (from 1.5 to 3 cm) and occurs only with severe degrees of the disease.
Usually the skin has a pale pink color with a slight cyanotic tint, it is dry, thin, with translucent veins on the abdomen and chest, with abundant pityriasis peeling. These children, as a rule, have a large physiological loss of body weight (more than 10-15%), delayed recovery of the initial weight, more pronounced and longer physiological jaundice, later falling off of the remainder of the umbilical cord and healing of the umbilical wound.
The prognosis for malnutrition depends on the severity of the disease, the age of the child and the presence of complications.
With hypotrophy of the I degree with timely diagnosis and proper treatment recovery occurs in a relatively short period of time. Hypotrophy of the II degree in modern conditions in the vast majority of cases proceeds favorably, however, the treatment of these children usually requires at least 4-6 weeks. With hypotrophy of the III degree, the prognosis is always serious.
Hypotrophy - treatment
The whole complex of therapeutic measures for malnutrition should be based on the severity of the disease and the individual reactivity of the child. A large place in the treatment of malnutrition is given to the organization of the environment, the elimination of the causes that led to the development of the disease.
To get a child out of the state of malnutrition of the I degree, it is enough to eliminate its cause and establish a proper, vitamin-enriched diet for the child, taking into account his age, this is not enough to treat hypotrophy of the II and even more so of the III degree. In addition to eliminating the cause of the pathology, a complex of therapeutic measures is needed, among which the leading place is occupied by proper nutrition. The two-phase power supply method is widely used. The first phase is careful feeding to establish the child's food tolerance, the second phase is enhanced nutrition, which should not only cover the vital need for food, but also restore depleted reserves.
Diet therapy for malnutrition in children is carried out differentially depending on its degree. With malnutrition of the I degree, the calorie content and volume of food can be either normal or somewhat reduced for some time, depending on appetite. The correct ratio of individual food ingredients is necessary (up to 1 year, proteins, fats and carbohydrates should be in a ratio of 1:3:6, after 1 year - 1:1:3-4) and enrichment with vitamins.
If the control calculation reveals a deficiency of one or another ingredient, it is necessary to correct the nutrition, providing the child with the appropriate physiological norms amount of proteins, fats, carbohydrates.
The missing amount of protein can be replenished with ordinary cottage cheese, “Health” cottage cheese or protein preparations (“Enpit”, “Kasecit”). Fat deficiency is best corrected with fish oil, as well as cream and, at an older age, butter. Used to make up for the missing amount of carbohydrates sugar syrup, cereals, vegetable, fruit dishes.
With malnutrition of the II degree, 2/3 of the required daily caloric content is prescribed for 5-7 days. They give women's milk or sour mixtures (acidophilic mixture, "Baby", "Kid", kefir, etc.), and the number of feedings is increased to 7-8. During this period of limited nutrition, the missing amount of food is replenished either with 10% rice water with 5% glucose solution, or X-ray solution (100-200 ml) with 5% glucose solution, or vegetable broth from cabbage, carrots, turnips, beets (rich in mineral salts). When breastfeeding, the addition of cottage cheese is indicated, starting from 5 g per day with a gradual increase to 10 g 2-3 times a day, as well as B-kefir or kefir, 1-3 teaspoons 3-5 times a day.
After 5-7 days, when the condition improves, the caloric content and volume of food are gradually brought to normal, while the amount of food ingredients and calorie content is calculated for the proper body weight of the child.
With malnutrition of the III degree, the first 5-7 days give 1/2 or 1/3 of the daily calorie content, calculated on the average body weight (actual body weight + 20% of this mass). The amount of food missing in terms of volume is replenished with liquids (vegetable decoctions, 5% glucose solution, vitamin juices, tea). Assign only women's milk in fractional doses (up to 10 times a day).
With the improvement of the general condition, appetite, some increase in the body weight of the child, the amount of food should be gradually increased in order to provide the child with the necessary daily calorie content.
If the child is bottle-fed, at least a small amount of women's milk must be introduced into the diet; in its absence, dilutions of kefir or whole kefir should be used, depending on age.
Vitamins must be included in the complex treatment of malnutrition. Ascorbic acid up to 200-300 mg per day should be prescribed. B vitamins can be given as synthetic drugs(thiamine 10-15 mg per day, riboflavin 6-10 mg per day) or in the form of baker's yeast paste 1 teaspoon per day or dry brewer's yeast hydrolyzate 2 teaspoons. The appointment of vitamin B 12 at 30-50 mcg, vitamin B 6 - 2.5-5% at 0.5 ml intramuscularly every other day or daily, 10-15 injections per course of treatment is shown.
Vitamins A and D are found in fish oil, begin to give it with 1-2 drops and gradually reach 1-2 teaspoons per day.
All vitamins should be given for at least 3-4 weeks. For young children, it is most advisable to additionally introduce vitamins in the form of fruit, berry, vegetable juices (50-75 ml per day in 2-3 doses).
Pepsin is prescribed with a 1-2% solution of hydrochloric acid before meals (1 teaspoon 2-3 times a day), pancreatin 0.1-0.15 g with calcium carbonate (0.2-0.25 g) after meals 2-3 times a day, natural gastric juice 1/2-1 teaspoon 3 times before meals (the indicated amount of gastric juice should be diluted in 3-4 teaspoons boiled water), abomin (1 tablet 3 times a day). Usually enzymes are prescribed for 3-4 weeks.
Hormones are shown to raise the general tone of the child and increase metabolic processes.
Insulin is prescribed in small doses (2-4-6 IU subcutaneously) with simultaneous ingestion of glucose at the rate of 3-5 g per 1 IU of insulin. Insulin is administered after meals (to avoid the development of hypoglycemic shock) daily or every other day, the course of treatment is 6-12 injections.
Of the anabolic hormones, methandrostenolone is prescribed (at the rate of 0.1 mg / kg per day in 1-2 doses), methylandrosten-diol (1-1.5 mg / kg per day). Hormones are given orally once a day 1 hour after feeding for 3-4 weeks. Retabolil is also used (intramuscularly 5-7.5 mg once every 3-4 weeks).
As a stimulant, you can prescribe apilak - bee royal jelly; it should be used for 10-14 days at a dose of 0.005 to 0.01 g in the form of suppositories 3 times a day. With malnutrition caused by enzymopathies, stimulating and replacement therapy is used simultaneously with a special diet (depending on the type of enzymopathy).
With malnutrition of the II degree, transfusion of donor blood is indicated at the rate of 5-7 ml / kg, blood transfusions are carried out after 5-7 days. With malnutrition of the III degree, as well as with malnutrition with acute toxicosis, with pneumonia, gastrointestinal disorders, it is better to start with a transfusion of dry plasma or blood serum in the same doses as donor blood; when the child's condition improves, they switch to blood transfusion. Intramuscular and intravenous transfusions of blood and plasma are carried out according to strict indications, taking into account the possibility of unnecessary sensitization of the child's body. For the course of treatment, depending on the degree of malnutrition, 3-6 blood transfusions are prescribed.
In all forms of malnutrition, if there are indications, gamma globulin is used (3-5 injections of 3 ml every 2-3 days).
One of the types of stimulating therapy is ultraviolet irradiation, which is carried out according to the scheme adopted for the treatment of rickets.
Simultaneously with other methods of stimulating therapy, massage and gymnastics should be used,
Depending on the degree of malnutrition, one or another type of massage is mainly used. However, when massaging children, as a rule, three of the five basic techniques are always used: stroking, rubbing, and kneading.
Therapeutic exercises should be carried out regularly, once or several times a day, for a long time in the form of courses, with a gradual and even increase in physical activity. This, however, requires a rigorous individual approach.
General contraindications to massage and therapeutic exercises are purulent, processes, pyoderma, common skin manifestations of exudative diathesis, the presence of toxicosis, acute febrile illnesses, acute gastrointestinal disorders, blooming rickets.
The main background against which all dietary and medical measures in a child with malnutrition, is the strict observance of all the rules for caring for him. Correct daily routine, regular use of fresh air in winter and summer, careful care of the skin and mucous membranes, well-established pedagogical process- these are the obligatory and extremely important regime conditions, without which, even with the right treatment, it is impossible to cure malnutrition.
Given the instability of thermoregulation, especially in severe manifestations of malnutrition, it is necessary to maintain the ambient temperature within + 24-26 ° C. In this case, the rooms must be particularly well ventilated. For a child suffering from malnutrition, outdoor walks should be organized, taking into account air temperature, wind speed, and humidity. The clothes of the child should be warm, free, not constraining his movements. In order to avoid stagnation in the lungs, it is necessary to take the child in your arms more often, shift it in bed, put it in the arena.
Given that children with malnutrition have a reduced resistance to infection, it is necessary to constantly follow the rules hygiene care after the child (washing, bathing, rubbing the body). It is necessary to carefully monitor the condition of the oral cavity, nose, ears, eyes, skin, and at the first manifestations of their infection, immediately take measures to eliminate inflammatory foci. Of course, it is necessary to protect the child from contact with other sick children.
A very important point is to raise the emotional tone of a child with malnutrition. Attention, affectionate speech, a variety of toys, communication with healthier children in the overall complex of ongoing activities, of course, play a very positive role.
Paratrophy belongs to chronic disorders of nutrition and digestion. The reason for it, as a rule, is an excess of carbohydrates in food compared to the amount of protein. This can be due to improper preparation of mixtures from "Baby", "Baby" (excessive dose) or two, and sometimes three complementary foods with cereals.
The height and body weight of a child with paratrophy is normal, although body weight is often slightly more than normal (up to 10%). The thickness of the subcutaneous fat fold is usually increased. With any disease in a child, the body weight decreases very quickly. There are blanching of the mucous membranes, dry skin and flabbiness of the skin fold, muscle hypotension, instability of emotional tone, restless sleep, unstable stools, with the periodic appearance of mucus and greenery, reduced resistance to infection (frequent acute respiratory infections, otitis media, etc.).
Treatment is reduced to the normalization of the diet, the introduction of vegetable complementary foods, its enrichment with proteins, vitamins. Useful are massage, gymnastics, walking, hardening, vitamin therapy (C, B 1 B 2, B 6, B 12, B 15, folic acid), stimulating therapy (alternating cycles of treatment with pentoxyl, dibazol, pantocrine, etc.).
The prognosis is usually favorable, with rational treatment, complete recovery occurs.
Hypotrophy - prevention
The basis for the prevention of malnutrition should be rational feeding, organization of proper care, regimen, protection from infectious diseases, careful treatment of all diseases and sanitary and educational work among the population.
It is necessary to constantly conduct the most active promotion of natural feeding. Translation into mixed feeding should be carried out under certain indications. Before deciding on the appointment of supplementary feeding, it is necessary to make sure that there is a lack of milk by weighing the child before and after feeding (at least 3 times - in the morning, afternoon and evening).
Dairy kitchens and women's milk drain points at maternity hospitals, clinics, and antenatal clinics are of great importance in the organization of rational nutrition.
Of particular importance for the prevention of malnutrition is the timely introduction of vitamins C, A, complex B, D, as well as the first physiological complementary foods into the diet.
Premature babies, twin babies, as well as children transferred to artificial feeding who have had acute illnesses or gastrointestinal disorders suffering from rickets.
When organizing child care, you should first of all pay attention to the daily routine, that is, the correct alternation of sleep and rest, and taking walks in the air. At the same time, we must strive to harden the body, for this purpose they spend sleeping in the air, sleeping with windows open in the room, rubbing the body, dousing the child, air baths in combination with massage and light gymnastics.
Sunbathing for children under the age of 1 year is not prescribed.
In autumn and winter, ultraviolet radiation should be used.
In maintaining a good emotional state of the child, a sufficient number of bright, colored toys and constant affectionate communication with him are of great importance.
Hypotrophy (protein-energy deficiency) is a clinical syndrome that occurs in children against the background of serious illnesses or due to alimentary insufficiency (imbalance in nutrient intake, underfeeding). Characterized by reduced body weight in relation to age norm, as well as a violation of tissue trophism, and, as a result, a violation of the development and functioning of internal organs.
In the treatment of malnutrition, properly organized therapeutic nutrition is of primary importance.
Hypotrophy is a common childhood pathology. According to medical statistics, in 5% of cases of visiting a pediatrician are associated with insufficient weight gain.
Source: serebryanskaya.com
Causes and risk factors
Hypotrophy can develop under the influence of a number of exogenous (external) and endogenous (internal) causes. Exogenous include:
- alimentary (nutrition that does not correspond to age, underfeeding);
- infectious (acute infectious diseases, sepsis);
- social (low social level of the family, defective upbringing).
The following diseases and pathological conditions become internal causes of malnutrition:
- anomalies of the constitution (diathesis);
- malformations of internal organs;
- neuroendocrine and endocrine disorders (pituitary dwarfism, adrenogenital syndrome, hypothyroidism, anomalies of the thymus gland);
- violation of the absorption process in the intestine (malabsorption syndrome, lactose deficiency, celiac disease);
- insufficient breakdown of nutrients (cystic fibrosis);
- primary metabolic disorders (fat, protein, carbohydrate);
- some chromosomal disorders.
Factors that increase the risk of malnutrition in children are:
- frequent respiratory viral infections;
- poor child care (insufficient sleep, infrequent bathing, lack of walks).
Kinds
Depending on the time of occurrence, the following types of malnutrition are distinguished:
- congenital (prenatal) Also called fetal hypotrophy. Its occurrence leads to a violation of the uteroplacental circulation, leading to intrauterine growth retardation. Prenatal malnutrition is always combined with fetal hypoxia;
- acquired (postnatal)- its development is based on protein-energy deficiency, resulting from insufficient intake of nutrients and energy into the child's body (i.e., the intake of nutrients in an amount that does not cover the costs of the body);
- mixed- caused by a combination of pre- and postnatal factors.
In the case of prenatal hypotrophy (fetal hypotrophy), the prognosis depends on the degree of hypoxic damage to the central nervous system.
Prenatal malnutrition depending on clinical manifestations is divided into the following types:
- neuropathic- weight loss is insignificant, sleep and appetite disturbances are noted;
- neurodystrophic- characterized by a decrease in body weight, a lag in psychomotor development, persistent anorexia;
- neuroendocrine- characterized by a violation of the endocrine regulation of psychomotor development, as well as the functional state of internal organs;
- encephalopathic- is manifested by a pronounced neurological deficit, a severe lag in the child's mental and physical development, hypoplasia of the skeletal system.
Depending on the lack of body weight, the following degrees of malnutrition in children are distinguished:
- Light. The deficit is 10-20%, body length corresponds to the age norm.
- Average. Body weight is reduced by 20-30%, there is a growth delay of 2-3 cm.
- Heavy. The deficit exceeds 30%, the child is significantly stunted.
With timely and complex treatment of malnutrition of I and II degrees, the prognosis is favorable.
Source: present5.com
signs
Clinical signs of malnutrition in children are determined by a lack of body weight.
With I degree of malnutrition, the general condition of the child remains satisfactory. There is a slight decrease in the thickness of the subcutaneous adipose tissue layer.
Signs of malnutrition II degree are:
- lability of the central nervous system (decreased emotional tone, lethargy, apathy, agitation);
- dryness, pallor, peeling of the skin;
- decrease in soft tissue turgor and skin elasticity;
- loss of subcutaneous tissue (remains only on the face);
- microcirculation disorders (cold extremities, marbling of the skin);
- dyspeptic disorders (constipation, vomiting, nausea);
- rapid breathing (tachypnea);
- tendency to tachycardia;
- muffled heart sounds.
At the III degree of malnutrition, a pronounced developmental delay is observed. The general condition of the child is severe. There is a loss of previously acquired skills, signs of anorexia, weakness, lethargy are expressed. The skin is pale and dry, with a grayish tinge, gathering into folds (the so-called senile skin). Subcutaneous tissue is completely absent, the face becomes sunken, as Bish's lumps disappear, giving roundness to children's cheeks. Muscle hypotrophy develops up to their complete atrophy. The child looks like a skin-covered skeleton. Often there are symptoms of dehydration:
- dry mucous membranes;
- retraction of a large fontanel;
- shallow breathing;
- muffled heart tones;
- a significant decrease in blood pressure;
- violation of thermoregulation.
Diagnostics
Diagnosis of malnutrition begins with an examination and careful collection of obstetric and postnatal history (features of the course of pregnancy, maternal illness, toxicosis, the course of childbirth, the use of obstetric benefits, the duration of the anhydrous period, the monthly weight gain of the child, past illnesses). They also find out the social (socio-economic situation of the family, living conditions) and hereditary (endocrine, metabolic diseases, enzymopathies in family members) anamnesis.
Against the background of malnutrition I and II degree, children often develop intercurrent diseases (pyelonephritis, pneumonia, otitis media).
Laboratory diagnosis of malnutrition in children includes the following types of tests:
- complete blood count (hypochromic anemia, increased hematocrit and ESR, thrombocytopenia, leukopenia);
- general and biochemical analysis of urine;
- determination of the acid-base composition of the blood;
- determination of serum concentrations of electrolytes (sodium, calcium, potassium);
- immunogram (performed during infectious processes);
- endocrine profile (hormones of the adrenal glands, thyroid gland) - if indicated;
- study of sweat for the content of chlorides (if cystic fibrosis is suspected);
- virological and bacteriological studies - if infectious processes are suspected.
If necessary, the child is referred for a consultation with an endocrinologist, ophthalmologist, gastroenterologist, etc.
To avoid specific pulmonary process(tuberculosis, cystic fibrosis) x-ray examination chest organs.
Treatment
With I and II degrees of malnutrition with satisfactory tolerance to food loads, treatment is carried out on an outpatient basis. Indications for hospitalization are:
- age less than one year;
- the presence of infectious or somatic concomitant diseases;
- low tolerance to food loads;
- III degree of malnutrition.
In the treatment of malnutrition, properly organized therapeutic nutrition is of primary importance. It has three phases:
- Preparatory.
- Enhanced nutrition.
- Recovery.
The purpose of the preparatory phase is to determine the child's tolerance to the food load and its increase, correction of violations of the water-salt balance. With malnutrition of the I degree, food loads are reduced compared to the norm to 2/3 of the required volume of food, and with II and III degrees of malnutrition, to 1/3-1/2. When breastfeeding, a child with malnutrition I and II degree is prescribed 100 ml breast milk per kilogram of body weight per day.
With poor nutritional tolerance, it becomes necessary to parenteral nutrition. For this purpose, solutions of colloids and crystalloids are administered intravenously in a ratio of 1:1.
The goals of the enhanced nutrition phase are to restore all types of metabolism and energy, as well as the transition to complete intestinal nutrition. The calorie content of the diet is 150-180 kcal per kilogram of the child's actual body weight. The diet is gradually expanded, introducing all macro- and micronutrients into it in age proportions.
General principles of diet therapy for malnutrition:
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The duration of the period of clarification of tolerance to food |
10–14 days |
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Human milk or adapted lactic acid formulas |
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Daily volume |
2/3 or 1/2 of due |
1/2 or 1/3 of due |
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Number of feedings |
6-7 in 3 hours |
8 in 2.5 hours |
10 in 2 hours |
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Permissible daily food intake |
Full volume without additives |
100-150 ml daily |
100-150 ml every 2 days |
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Criteria for changing the number of feedings |
Do not change |
When 2/3 of the volume is reached, they switch to 7 feedings after 3 hours |
When 1/2 of the volume is reached, they switch to 8 feedings every 2.5 hours, and 2/3 of the volume - 7 feedings every 3 hours |
According to medical statistics, in 5% of cases of visiting a pediatrician are associated with insufficient weight gain.
The recovery phase of therapeutic nutrition is aimed at organizing the normal intake of nutrients in terms of the body weight due to the age of the child.
