Causes and signs of protein-energy deficiency, malnutrition, in children. Causes, symptoms and treatment of malnutrition in a child

Parents should not always be blamed for the occurrence of malnutrition in children. It happens that the mother has enough milk, but the baby sucks the breast reluctantly. Or the woman’s nipple is strongly retracted, and the baby is not able to get enough satiety. Possible development of malnutrition in children early age and for the reason birth defects oral cavity child or lack of sucking reflex.

Causes and symptoms of malnutrition in children

Malnutrition refers to decreased nutrition; is one of chronic disorders nutrition in children.

The most common cause of malnutrition in children is poor feeding; especially great importance proper feeding has in the first few months of life. If the mother has hypogalactia, the baby constantly does not have enough milk. Also, the child may be malnourished for a long time if the mother has a flat nipple, inverted nipple. Some children do not suckle actively enough at the breast (they are also called sluggish or lazy suckers), in others physical defects prevent normal sucking (cleft lip, for example), and in premature and immature children, as a rule, the breast is underdeveloped (may be completely absent). ) sucking reflex. There is congenital malnutrition, which developed as a consequence of certain diseases of the mother or as a result of some kind of disorder. Often malnutrition occurs due to frequent and serious illnesses child ( viral infections, diseases of the stomach and intestines, scarlet fever, as well as chronic infections etc.). Constant violations of the daily routine can contribute to the development of malnutrition, improper care for a child, hypovitaminosis (insufficient supply of vitamins to the body). Hypotrophy is also observed in a child who, for some reason, is transferred too early to mixed or artificial feeding, and in the food offered to him the ratio nutrients not balanced.

The main symptom of malnutrition in children is a decrease in nutrition; significant thinning or complete disappearance of the subcutaneous fat layer.

The photo of malnutrition in children shows how exhausted children are who do not receive sufficient nutrition:

Hypotrophy in children I, II and III degrees

When classifying malnutrition in children, three degrees of the disease are distinguished.

Manifestations of degree I malnutrition are as follows: the subcutaneous fat layer is preserved everywhere, but it becomes somewhat thinner on the abdomen and limbs (normally, the skin fold at the navel level is 1.5 cm thick); the elasticity of the skin and muscles is slightly reduced; when weighed, a lag in weight from the norm by 10-20% is detected; height corresponds to age; general state does not suffer, health is not affected, but the child may be capricious; skin - normal color or slightly pale.

For grade II malnutrition in children, the following manifestations are characteristic: the subcutaneous fat layer on the abdomen and limbs disappears; on the chest, neck and face it becomes noticeably thinner; there is a weight loss of 20-30%, in addition, growth suffers; the child is pale, the skin is flabby and easily wrinkles; the fold straightens out slowly; the child is lagging behind, his general condition and well-being are impaired; The child is sometimes restless and excited, sometimes lethargic and whiny, and has poor sleep.

With grade III malnutrition, which is characterized by a weight gap of more than 30% from the norm, a different picture is observed: the subcutaneous fat layer is absent everywhere, growth stops; facial features become sharper, and the child’s face takes on an senile appearance, the eyes seem to fall into their sockets; a large fontanelle sinks; the skin is pale, the skin is dry, flaky; the mucous membrane of the lips against this background is bright red; the muscles become thinner, the ribs appear, the stomach retracts; symptoms of dyspepsia are often observed; feeling unwell; the child is lethargic and weak, inactive; his cry is weak; breathing is slow and uneven, the pulse is difficult to palpate; no appetite, but thirst is expressed; the child’s body reactivity is reduced, so he is susceptible to infection; complications such as otitis media, pyelitis, pneumonia, etc. may occur.

Treatment and prevention of malnutrition in young children

Treatment of malnutrition in young children is prescribed in a comprehensive manner, and it begins with eliminating the causes of the development of low nutrition. The child needs good care and proper hygiene regime. Diet therapy plays an important role. Even with grade I malnutrition, the child’s nutrition is controlled by a doctor. All appointments are also made by the doctor. When treating malnutrition in children, the child is given daily general massage, classes are held therapeutic exercises. Closer to recovery - active games, long walks.

As preventive measures, the following can be considered: on good level baby care; daily monitoring of weight gain (mom is recommended to draw a weight curve); strict adherence to the diet (the child’s nutrition is periodically monitored by the local pediatrician); control over sufficient intake of vitamins into the body; compliance with sanitary and hygienic conditions aimed at preventing infectious diseases; in case of illness - timely seeking medical help and timely treatment; hardening the child. Particularly careful attention in the prevention of malnutrition in children requires babies who, for some reason, were transferred to mixed or artificial feeding.

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Hypotrophy in children is starvation, quantitative or qualitative, as a result of which significant changes occur in the body. The disease is complex, which is based on starvation of the child’s body - malnutrition in children.

It is necessary to treat malnutrition in children based on the degree of the disease. On initial stage To treat a disease, it is necessary to eliminate the cause that caused it.

Treatment of malnutrition should be aimed at eliminating primary disease, as well as secondary infections, otherwise it cannot be effective.

Treatment of sick children with malnutrition should be comprehensive. It includes: identifying the cause and eliminating it; diet therapy, organization of rational care, regimen; massage and gymnastics; identification and treatment of foci of infection and other concomitant diseases; enzyme therapy, vitamin therapy, stimulating therapy; symptomatic therapy.

Treatment of malnutrition in children involves changing the regime, diet and caloric intake of the child and the nursing mother; if necessary, parenteral correction of metabolic disorders.

The basis of proper treatment of malnutrition is diet therapy. It should be taken into account that both an insufficient amount of food ingredients and their excess adversely affect the condition of a child suffering from malnutrition. Based on many years of experience in treating children with this disease with representatives different schools To date, the following dietary therapy tactics have been developed.

The implementation of diet therapy for malnutrition in children is based on fractional frequent feeding of the child, weekly calculation of the food load, regular monitoring and correction of treatment.

With grade I malnutrition, food tolerance is quite high. Children tolerate food loads well, so they can receive age-appropriate food. Proteins, fats and carbohydrates are calculated per 1 kg of required weight.

In the treatment of children with stage II malnutrition, two periods are distinguished: pre-repair and reparation. The pre-repair period for stage II malnutrition is usually 7-10 days. During this period, the patient’s tolerance to food is determined. From food products, the patient receives either human milk or products that replace it (cow's milk, sour milk formulas, adapted milk formulas).

The daily volume of food is reduced to 2/3 of the required volume. The missing water is replenished with liquid ( boiled water, tea, 5% glucose solution, etc.). During this period (in the first days) the child receives food in 8 doses, i.e. every 2.5 hours. Subsequently, with good food tolerance (no vomiting, regurgitation, diarrhea), the volume of food can be increased by 100-150 ml for each subsequent day daily ration. If the volume exceeds 2/3 of the daily food ration, the child begins to be fed after 3 hours, i.e. 7 times. After the child begins to cope with the required amount of food, we can assume that the pre-repair period is over.

During the reparation period, nutritional correction is made, complementary foods are introduced according to general rules. At first, carbohydrates and proteins are prescribed per 1 kg of the required weight, and fats - per approximately the required weight.

In the treatment of children with grade III malnutrition, two periods are also distinguished: pre-repair and reparation period. Since food tolerance in stage III malnutrition is significantly lower compared to stage II malnutrition, the food load is carried out even more carefully. The pre-reparation period lasts 14-20 days or more. On the first day, nutritional calculations can be made based on the energy expended by the child on basal metabolism (65-70 kcal per 1 kg of actual body weight). This is approximately 2 parts of the required daily amount of food.

A child suffering from grade III malnutrition is given food in the form of expressed breast milk (or its substitutes) in 10 doses, i.e. every 2 hours, observing a 6-hour night break. Subsequently, with normal tolerance of this volume of food, it can be increased by 100-150 ml every 2 days. The end of the pre-repair period can be judged on the basis of good tolerability human milk or its substitutes in a normal amount for a given age. During the repair period for grade III hypotrophy, the tactics are similar to those for grade II hypotrophy.

During the period of determining food tolerance, enzyme therapy is widely used. For this purpose, use a 1% solution of diluted of hydrochloric acid, pepsin, abomin, natural gastric juice, festal With a high content of neutral fat and fatty acids Pancreatin is prescribed.

Vitamin therapy in the treatment of patients with malnutrition is used for both replacement and stimulating purposes. In the first days of treatment of the disease, vitamins are administered parenterally, then given orally: ascorbic acid 50-100 mg, vitamins B 1 25-50 mg, B 6 50-100 mg per day, then alternating courses of treatment with vitamins A, PP, B 15, B 5, E are carried out, folic acid, vitamin B 1 2 in age-specific doses.

Stimulating therapy is a mandatory part of the treatment of malnutrition in children. It consists of prescribing alternating courses of treatment with apilak, dibazole, pantocrine, ginseng and other means. In case of severe malnutrition, especially when combined with diseases of an infectious nature, γ-globulin is administered, a 10% albumin solution, protein, plasma are injected intravenously, and blood is transfused.

In the treatment of degree II and III malnutrition in children, the use of anabolic drugs is indicated. steroid hormones: nerabola (daily orally 0.1-0.3 mg/kg), retabolil (1 mg/kg once every 2-3 weeks).

Symptomatic therapy depends on the clinical picture of malnutrition. When treating anemia, it is advisable to use iron supplements and blood transfusions from the mother (if the blood group and Rh factor are compatible and there is no history of hepatitis). In the case of a combination of malnutrition with rickets, after the end of the period of determining tolerance to food, prescribe therapeutic doses vitamin D (with mandatory monitoring according to the Sulkovich reaction!). Therapy for symptomatic malnutrition, in addition to diet therapy, should be aimed at treating the underlying disease.

Sick children with malnutrition of the first degree in the absence of severe concomitant diseases can be treated at home, children with malnutrition of the second and third degrees - in a hospital setting. The patient should be in a bright, spacious, well-ventilated room; The ambient temperature should be at least 24-25° C and not higher than 26-27° C, since a child with severe degrees of malnutrition easily becomes hypothermic and overheated.

It is important to create a positive emotional tone in the child and pick him up more often. Positive influence provide warm baths (water temperature 38°C), which can be performed daily. Mandatory components Treatments include massage and gymnastics.

Sometimes it happens that babies look thin. This may be due to malnutrition.

Hypotrophy in children under one year of age is a nutritional disorder of a young child, which is characterized by a stop or slowdown in the increase in body weight (more than 10% of the age standard), progressive thinning of the subcutaneous tissue, disturbances in body proportions, disorders of the digestive and metabolic functions, and a decrease in the body’s defenses. , a tendency to develop other diseases, delayed physical and neuropsychic development. This disease is one of the most common among types of dystrophy. With malnutrition, the basic energy metabolism, there is a delay in physical and neuropsychic development.

Causes of congenital and acquired malnutrition in infants

The disease is classified according to the factors of its occurrence.

Congenital hypotrophy in infant associated with toxicosis at the beginning of pregnancy, fetal hypoxia, disruption of placental circulation in the uterus in the expectant mother, processes that lead to developmental delays in the womb. A negative role can also be played somatic diseases women in labor, poor conditions for the full growth of the fetus, its infection.

Acquired malnutrition in one-year-old children appears due to a deficiency of energy and protein. There are many factors that contribute to the onset of the disease. To a greater extent, they are caused by organic pathologies and developmental defects. In addition, limited nutrition, impaired digestion of food, immunodeficiency, lactation failure, frequent illnesses, lack of proper care for the newborn - all of these are considered to be the causes of acquired malnutrition in young children.

In case of mixed form adverse events, which were in the prenatal period are added negative factors from the outside (infections, social causes).

The causes of malnutrition in children are quite diverse, closely related and influence each other, so the disease develops quickly. Factors are internal and appearance. Among the causes of malnutrition in children of the first year of life and early age are the following:

1. Negative conditions for fetal development.
2. Pathologies during pregnancy.
3. Dietary disorder.
4. Infectious – acute and chronic diseases, including .
5. Defects in care and education - attention deficit, lack of systematic walks, bathing, massage and gymnastics.
6. Anomalies of the constitution and others.

Very common cause is malnutrition precisely in terms of the amount of food. It can be observed from the first day of a newborn’s life. It is associated with the fact that the woman in labor does not produce enough breast milk, her mammary gland is tight, and it is difficult for the newborn to suck food out of it, although sluggish sucking is possible (for example, in premature infants born with asphyxia or with intracranial birth trauma with other developmental defects). It is important that forcing a child to eat by force can also cause the disease in question. The disease in most children is associated with nutritional deficiencies: proteins, fats, carbohydrates, vitamins, microelements, gross violations all types of metabolism. Such cases are possible if the newborn’s nutrition is mixed: breast milk and mixtures.

Internal causes of malnutrition in young children are divided into congenital (deviations in development internal organs) and hereditary (immunodeficiency, metabolic disorders, etc.).

Unfavorable conditions can play a significant role in the development of the disease. environment(external factor). This includes violation of sanitary and hygienic standards, lack of time spent on fresh air and light. Also, external factors include improper care of the baby.

Signs of malnutrition of 1, 2 and 3 degrees in newborns

Clinically, there are 3 degrees of malnutrition in young children. The leading symptom is body weight deficiency with relatively normal indicators growth. The course of the disease is divided into periods:

1. Elementary.
2. Progression.
3. Stabilization.
4. Convalescence.

If signs of the disease are identified at the initial stage, with proper care and proper treatment, the baby quickly gains required weight, especially when breastfeeding.

With malnutrition in young children, it can be noted a large number of manifestations various symptoms. Most important sign– this is a malnutrition, as a result of which the baby’s weight decreases and growth slows down. Also, a consequence of poor appetite and malnutrition is a change in the functions of the central nervous system (muscle tone weakens, restless sleep, emotional condition unstable). Another significant symptom is deterioration in digestion of food (possible vomiting, poor appetite, bowel functions slow down). The body becomes very susceptible to infectious diseases.

Take a look, below are photos depicting the manifestations of malnutrition of varying degrees of severity in children:

Hypotrophy 1 degrees characterized by the fact that a lack of body weight appears by approximately 1/10 - 1/5 of the established norm, but at the same time the baby is not inferior in height to his peers. The skin practically does not change its color or may turn slightly pale, but the state of health is not affected. The appetite in children with 1st degree of hypertrophy worsens slightly, but the stool is normal. Externally, the disease is almost invisible, only experienced doctor will be able to deliver correct diagnosis, and before that he will conduct a series of diagnostics to understand whether the lack of mass is related to the structural features of the body.

Hypotrophy 2nd degree in one-year-old children is caused by a deficiency of body weight, which reaches up to 20-30% of the norm. In this case, a growth lag of 2-4 cm from the norm is possible. The patient's skin is dry and pale, the subcutaneous fat layer becomes thinner, causing it to wrinkle, and the muscles become flabby. Appetite noticeably worsens, and after eating food the child regurgitates it. The baby becomes capricious, his mood is changeable, his sleep is restless, and his general physical condition is disturbed. Breathing quickens, blood pressure drops, and heart rate quickens. There is also a deterioration in thermoregulation, which is characterized by constantly cold hands and feet. Infectious diseases frequent and prolonged, rickets develops, the child becomes irritable and quickly weakens.

For grade 3 malnutrition Young children are characterized by a decrease in body weight by more than 30%, a growth lag of up to 10 cm. The dermis is devoid of subcutaneous fat, wrinkled and pale, sallow in color, the face becomes similar to that of an old man, with a pointed chin. The extremities are always cold, the temperature is low, the stool is loose, and urination is infrequent. The muscle tone is extremely high, while they are thinned, the stomach sinks. The blood pressure is low, breathing is shallow, the baby is lethargic in reacting to stimuli, asthenic emotions dominate, immunity is critically reduced, persistent infections occur, and are pronounced. Anemia can be diagnosed, in which the blood suddenly becomes thicker, hemoglobin and the number of red blood cells increase. There may be a delay in the development of various static and moving skills, speech that is devoid of intonation.

Diagnostics for identifying malnutrition in children under one year of age

Diagnosis of malnutrition in young children is necessary when the first symptoms of the disease are identified. It is a very important step to ensure proper treatment and get well soon child.

If you think that your child is underweight, you need to contact your local pediatrician.

During a medical examination in a children's clinic, the pediatrician conducts a detailed history taking, examination of the child, control weighing, makes sure that breast milk is sufficient or insufficient, and prescribes additional methods examinations – general analysis blood, general urine test, coprogram, stool for dysbiosis and immunogram (according to indications), as well as consultations with medical specialists - neurologist, orthopedist, ophthalmologist, endocrinologist and immunologist (according to indications).

Treatment, nutrition and care for children with different degrees of malnutrition

Treatment of malnutrition in young children should be comprehensive and take into account individual characteristics patient. The doctor prescribes it.

Sick children should eat regularly. It is preferable to use mother's milk, but if it is not available, then it is permissible to feed with prescribed formulas that are necessary for low-weight children.

The nutrition of children in the presence of malnutrition is divided into 2 phases. The first involves the body being accustomed to a gradual increase in nutrients and useful substances. After successful completion this stage start the second when the baby eats the usual baby food in doses that correspond to the age norm.

It is important to know that malnutrition found in newborns has a lower recovery rate, especially if the degree of the disease is severe. A long-term illness can cause deterioration mental development. Therefore, stage 1 of the disease is treated on an outpatient basis, and stages 2 and 3 – in a hospital setting.

A pediatrician diagnoses malnutrition, eliminates feeding defects, and calculates nutrition according to the main food ingredients(by proteins, fats, carbohydrates, calories per kilogram of the child’s weight), prescribes balanced diet(increasing the calorie content of the diet by 10-15%) until the required weight is achieved. Optimal nutrition For children with malnutrition, breast milk is used. If breast milk is insufficient, measures to combat hypogalactia are prescribed, and in its absence, adapted physiological, preferably fermented milk formulas are prescribed for feeding healthy children in the first year of life.

Treatment of malnutrition different stages in young children may be accompanied by prescriptions of vitamins and enzymes:

1. Gastric juice – ½ tsp. 5 times a day or 1% HCl solution with pepsin before feeding.
2. Pancreatin - 0.2 g 2 times a day, an hour after meals.

Therapy is carried out for 1-1.5 weeks. It is possible to use anabolic steroids.

As for caring for a small child with malnutrition, it is important to provide the most favorable conditions for life due to reduced immunity. In the room where the baby lives, you need temperature regime not less than +24°С. He should choose clothes for walking according to the weather conditions, so as not to overcool his weakened body. When the air temperature outside is less than +5° C, walking is not recommended. In addition, you need:

1. Bathing your child before bed.
2. Washing the baby morning and evening.
3. Treatment of skin folds.
4. Exception long stay on wet diapers.
5. Washing after urination or defecation.

Despite all Taken measures, malnutrition can continue to develop if it is caused by a congenital defect.

Prevention of the development of malnutrition and paratrophy in young children

Prevention of malnutrition in children should begin at the stage of gestation.

Very important:

1. Proper nutrition, smoking and alcohol cessation for a pregnant woman.
2. In case of influence of harmful production factors removal from such work, transition to lighter work.
3. Rational consumption of food by a nursing woman.
4. Feeding the newborn only breast milk or special dry formulas.
5. Monthly baby weight monitoring.
6. Compliance with child care rules.

Prevention of the development of malnutrition and paratrophy in children also implies sufficient exposure of the baby to fresh air and sun, providing massage and children's gymnastics. Up to 1.5 years of age, as prescribed by the doctor, your child should be given vitamin D.

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Dystrophy(Greek dys - disorder, trophe - nutrition) develops mainly in young children and is characterized by impaired absorption of nutrients by body tissues. The following types of dystrophy are distinguished: 1) dystrophy with deficiency of body weight (hypotrophy); 2) dystrophy with body weight corresponding to height or some excess of weight over length (paratrophy); 3) dystrophy with overweight (obesity) (Table 1).

Hypotrophy(Greek hypo - under, below trophe - nutrition) - chronic eating disorder with underweight. 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 is diagnosed in 20-30% or more of young children.

Etiology: Based on the time of occurrence, congenital (prenatal) and acquired (postnatal) malnutrition are distinguished (Table 1). The causes, clinical picture and treatment of intrauterine growth retardation are discussed above in the section “Antenatal malnutrition”.

There are 2 groups of acquired malnutrition based on etiology - exogenous and endogenous (Table 1). With careful collection of anamnesis data, a mixed etiology of malnutrition in a child is often established. For exogenous causes, primary malnutrition is diagnosed; for endogenous causes, secondary (symptomatic) malnutrition is diagnosed.

Exogenous causes of malnutrition:

1. Nutritional factors- quantitative underfeeding in case of hypogalactia in the mother or difficulties in feeding on the part of the mother or child, or qualitative underfeeding (use of an age-inappropriate formula, 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- use of low-quality milk formulas with expired storage, hypervitaminosis A and D, drug poisoning.

4. Disadvantages of care, regime, education.

Endogenous causes of malnutrition:

1. Perinatal encephalopathies 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 (lactase deficiency, sucrose, maltase, cystic fibrosis, exudative enteropathy) or secondary (protein intolerance cow's milk, “short bowel” syndrome after extensive intestinal resections, secondary disaccharidase deficiency).

5. Hereditary immunodeficiency conditions.

6. Hereditary metabolic disorders.

7. Endocrine diseases (hypothyroidism, adrenogenital syndrome).

8. Anomalies of the constitution.

Pathogenesis:

With malnutrition, the utilization of nutrients (primarily proteins) both in the intestines and in tissues is impaired. 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, and pancreas is characteristic, and the level of deficiency corresponds to the severity of malnutrition. Therefore, the nutritional load is adequate healthy child, in a patient with II-III degree hypotrophy can cause acute digestive upset. With malnutrition, the functions of the liver, heart, kidneys, lungs, immune, endocrine, and central nervous systems are impaired.

The most typical metabolic disorders are: hypoproteinemia, hypoalbuminemia, aminoaciduria, tendency to hypoglycemia, acidosis, hypokalemia and hypokalium histia, hypocalcemia and hypophosphamenia.

Classification:

According to the severity, there are three degrees of malnutrition: I, II, III: (Table 1). The diagnosis indicates the etiology, time of onset, period of the disease, concomitant pathology, complications. It is necessary to distinguish between primary and secondary (symptomatic) malnutrition. Primary malnutrition can be the main or concomitant diagnosis and is usually a consequence of underfeeding.

Secondary malnutrition- complication of the underlying disease. Diagnosis

malnutrition is valid in children under 2-3 years of age.

Clinical picture:

All clinical symptoms of malnutrition in children fall into the following groups of syndromes:

1. Trophic_disorder syndrome- thinning of the subcutaneous fat layer, body mass deficiency and imbalance of body composition (Chulitskaya, Erisman indices are reduced), flat weight gain curve, trophic changes in the skin, muscle thinning, decreased tissue turgor, signs of polyhypovitaminosis.

2. Low food tolerance syndrome- 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- disturbance of emotional tone and behavior; low activity, predominance of negative emotions, sleep and thermoregulation disturbances, delayed psychomotor development, muscle hypo-, dystonia.

4. Syndrome of decreased immunobiological reactivity- a tendency to frequent infections - inflammatory diseases, their mild and atypical course, the development of toxic-septic conditions, dysbiocenosis, secondary immunodeficiency states, a decrease in nonspecific resistance rates.

Hypotrophy I degree characterized by thinning of the subcutaneous fat layer in all parts of the body and especially in the abdomen. Chulitskaya's body condition index decreases to 10-15. Tissue turgor and muscle tone are reduced, the fat fold is flabby. Characterized by pallor of the bones and mucous membranes, decreased firmness and elasticity of the skin. The child's growth does not lag behind the norm. Body weight deficiency is 10-20%. The curve of body weight gain is flattened. The child's well-being is not affected. Psychomotor development corresponds to age. The child is restless and does not sleep well. Immunological reactivity is not impaired.

Second degree hypotrophy. The subcutaneous fat layer is absent on the abdomen and chest, sharply thinned on the limbs, and preserved on the face. Severe pallor, dryness, decreased elasticity of the skin. The Chulitskaya body condition index 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 hypotonia, symptoms of osteoporosis, osteomalacia and hypoplasia. Body weight deficiency is 20-30% (in relation to height), there is stunting. The curve of body weight increase is flat. Appetite is reduced. Food tolerance is reduced. Regurgitation and vomiting are often observed. Characterized by weakness and irritability, the child is indifferent to his surroundings. Restless sleep. The child loses already acquired motor skills and abilities. Thermoregulation is impaired, and the child quickly cools down or overheats.

Most children develop various diseases (otitis, pneumonia, pyelonephritis), which are asymptomatic and long-lasting.

The stool is unstable (usually liquefied, undigested, less often constipation). The acidity of gastric juice, the secretion and activity of enzymes of the stomach, pancreas and intestines are significantly reduced. Subcompensated intestinal dysbiosis develops.

Hypotrophy III degree(senility, atrophy). Primary malnutrition of the third degree is characterized by an extreme degree of exhaustion: the external appearance of the child resembles a skeleton covered with skin. There is no subcutaneous fat layer. The skin is pale gray and dry. Extremities are cold. Skin fold does not straighten out because there is no elasticity of the skin. Thrush and stomatitis are typical. The forehead is covered with wrinkles, the chin is pointed, the cheeks are sunken. The abdomen is distended, bloated, or intestinal loops are contoured. The chair is unstable.

Body temperature is often lowered. The patient quickly cools down during examination and easily overheats. Against the background of a sharp decrease in immunological reactivity, various

foci of infection that are asymptomatic. Significantly reduced muscle mass. The body weight gain curve is negative. Body weight deficiency exceeds 30% in children of the same height. The Chulitskaya index is negative. The child is sharply stunted in growth. With secondary hypotrophies of the third degree, the clinical picture is less severe than with primary ones; they are easier to treat if the underlying disease is identified and it is possible to actively influence it.

Hypotrophy in a simplified form is chronic disorder nutrition. This pathology most often occurs in children at an early age. A child with malnutrition is severely delayed in growth and weight gain.

From the very first day of life, children rapidly gain weight. Everything grows in them: skeletal bones, muscle tissue, internal organs. If babies do not receive sufficient amounts of nutrition or the diet is prepared incorrectly, this will very quickly affect the development of the body and the functioning of its various systems and organs.

Doctors say that the main reason for the development of malnutrition is a lack of protein in food and insufficient caloric intake in the diet.

The main reasons for the development of malnutrition in children

This pathology can develop under the influence of internal and external factors. Besides, malnutrition can be primary and secondary.

• Primary malnutrition in children develops due to lack of nutrition.
• Secondary malnutrition in children appears against the background internal diseases, in which the absorption of nutrients from food is disrupted or becomes impossible.

Internal factors that cause malnutrition in newborns include diseases of the internal organs associated with digestion. Simply put, due to these diseases, nutrients are not fully absorbed. It is worth noting that these are not necessarily diseases of the digestive system. These may be changes at the level of tissues and cells, manifested in violation metabolic processes. Because of them, the energy reserves in the cells are depleted, which leads to their death.

Internal causes of pathology

The most common internal reasons malnutrition in young children are:

Doctors say that internal factors that cause malnutrition in children are much more common than external ones. But this does not mean that the latter should not be paid attention to. In order for malnutrition to occur under the influence of external factors, they must act on the child’s body for a long time. This means that pathology can manifest itself not only in lack of weight and height, but also in more serious disorders that will certainly manifest themselves in the future.

External causes of malnutrition in children

TO external reasons that cause this pathology include:

The symptoms of this pathology are mainly determined by a lack of nutrients in the baby’s body. In second place are the symptoms of diseases that cause disturbances in the functioning of various organs. Doctors divide all symptoms into separate syndromes, which combine a set of symptoms that arise from a disease of a particular organ or system.

With malnutrition, 4 main syndromes are identified:

As a rule, each small patient with malnutrition exhibits only one syndrome.

Doctors distinguish 3 degrees of malnutrition. This division helps doctors more accurately determine the child’s condition and select correct treatment. Degrees replace each other. At each stage of the pathology, additional symptoms appear in young patients.

Hypotrophy 1st degree

In children, it is manifested by a decrease in subcutaneous fat tissue. This is explained by the fact that the body, with a lack of nutrition, tries to compensate for energy costs through subcutaneous fat, which is the best energy storage. Fat from subcutaneous tissue enters the blood, where it is processed into the necessary for normal life energy.

First, fat is lost in the abdominal area, and then from other parts of the body. Assessment of the condition of fatty tissue is carried out using various techniques. IN last years doctors prefer the Chulitskaya index, based on measuring the circumference of the shoulders, hips and legs.

Symptoms of 1st degree malnutrition:

• Decreased muscle tone and skin elasticity.
• The child's growth does not lag behind age indicators.
• Body weight is 20% below normal.
• I feel within normal limits.
• The child gets tired quickly.
• The child sleeps poorly and becomes irritable.

Hypotrophy 2nd degree

The initial symptoms are the same as those of the 1st degree of pathology. The main difference is the deepening of previous symptoms and the appearance of new ones.

Main features:

Hypotrophy 3rd degree

At this stage of the disease clinical manifestations become especially acute. There are disturbances in the functioning of all organs and systems. It is very difficult for doctors to bring a small patient out of this state. The severity of primary pathologies determines the possibility of further recovery. Newborns suffer the most severe malnutrition of the 3rd degree.

Characteristic signs of pathology:

Options for the course of pathology

Lack of weight and growth retardation can be observed in a baby at all stages of its development. Moreover, at each stage the pathology has its own characteristics.

Depending on the period in which the pathology develops, Doctors identify 4 variants of its course:

1. Intrauterine flow.
2. Hypostature.
3. Kwishiorkor.
4. Nutritional insanity.

Intrauterine course

Pathology develops when the child is still in the womb. Doctors distinguish 3 options for intrauterine hypotrophy:

1. Hypotrophic. All fetal organs do not receive enough nutrients. Because of this, the child grows very slowly.
2. Hypoplastic. With this variant of pathology, along with a delay in general development the fetus has a disturbance in the maturation of organs.
3. Dysplastic. Various organs develop unevenly. Some of them correspond to the timing of pregnancy, while others do not correspond.

Hypostature

We are talking about the uniform lag of a newborn child in height and body weight from his peers.

Hypostature is secondary pathology, developing as a result of diseases of internal organs. It can manifest itself not only in newborns, but also in adolescents.

Most often, hypostatura is provoked by:

• Heart diseases and circulatory disorders.
• Encephalopathy complicated by endocrine disorders.
• Bronchopulmonary dysplasia. This pathology appears during the period of intrauterine development and manifests itself in insufficient development lung tissue, due to which the newborn does not receive enough oxygen during breathing.

Kwashiorkor

With this variant of the course of malnutrition, the body receives protein food in insufficient quantities or not at all able to absorb protein products.

The development of kwashiorkor is promoted by:

• Long-term digestive problems, manifested by unstable stools.
• Problems with liver function.
• Kidney diseases.
• Burns and significant blood loss.
• Some infectious diseases.

Lack of protein leads to disturbances in the functioning of the central nervous system. The child becomes apathetic, falls asleep as soon as possible, and does not want to eat. He may develop edema due to a lack of albumin and globulin in the blood. His muscle mass is rapidly decreasing.

Nutritional insanity

This course of malnutrition is most often detected in children school age. This condition is characterized by a lack of proteins and calories. Nutritional insanity is accompanied by the following symptoms:

Conclusion

Hypotrophy in children is quite dangerous disease. The prognosis for recovery depends on what caused the pathology. The earlier the disease is detected, the less damage it will cause to the child’s health.