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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Lack of appetite in the presence of a physiological need for nutrition, due to disturbances in the activity of the food center.

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

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

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

A chronic disease, the main manifestation of which is asthma attacks, caused by a violation of the patency of the bronchi due to their spasm, swelling of the mucous membrane and increased mucus formation.

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

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

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

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

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

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

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

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

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

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

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

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

Inflammation of the bronchi with a primary lesion of their mucosa. There are acute and chronic bronchitis. In children, as a rule, acute bronchitis develops, most often it is one of the manifestations of respiratory infections (ARI, influenza, adenovirus infection, etc.), sometimes before the onset of measles and whooping cough.

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

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

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

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

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

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

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

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

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

They are a signal of a disease of the abdominal organs, as well as adjacent and more distant organs.

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

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

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

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

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

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

A group of diseases characterized by increased bleeding, occurring independently, or provoked by trauma or surgery. There are hereditary and acquired hemorrhagic diathesis. The former appear in children, the latter occur at any age and are more often a complication of other diseases, such as liver and blood diseases. Increased bleeding can occur with an overdose of heparin (a drug that reduces blood clotting, used in some conditions, such as kidney failure), aspirin.

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

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

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

Excessive accumulation of fluid contained in the cavities of the brain and spinal canal. Hydrocephalus can be congenital or acquired. Occurs when there is a violation of absorption, excessive formation of fluid in the cavities of the brain and difficulty in its outflow, for example, with tumors, adhesions after an inflammatory process.

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

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

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

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

Treatment is carried out initially in a hospital.

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

A chronic eating disorder caused by insufficient intake of nutrients or a violation of their absorption and characterized by a decrease in body weight.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Enterobiasis is an infection with pinworms.

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

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

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

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

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

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

A progressive disease with a predominant lesion of the muscles and skin. Girls predominate among the patients. In most cases, the cause of the disease is not clear. Sometimes dermatomyositis develops as a reaction to an overt or latent malignant tumor.

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

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

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

The state of the body, expressed by inflammation of the skin. It is caused by a metabolic disorder with intolerance to certain foods, more often eggs, strawberries, citrus fruits, milk, honey, chocolate. Changes in the skin cover occur already in the first weeks of life, but are especially strong from the second half of the year, when the child's nutrition becomes more varied. The weakening of the disease or the complete disappearance of its manifestations occurs after 3-5 years, however, most children who have undergone exudative-catarrhal diathesis tend to allergic reactions of a different nature and severity.

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

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

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

Indigestion caused by improper feeding of the child, and characterized by diarrhea, vomiting and a violation of the general condition. It occurs mainly in children of the first year of life. There are three forms of dyspepsia: simple, toxic and parenteral.

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

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

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

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

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

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

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

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

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

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

Its signs are: stool retention for several days, in young children - 1-2 bowel movements in 3 days. Pain in the abdomen and when passing dense feces, its characteristic appearance (large or small balls - "sheep" feces), loss of appetite. Constipation is true and false.

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

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

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

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

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

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

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

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

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

It can occur when the nose is bruised or its mucous membrane is damaged (scratches, abrasions), due to general diseases of the body, mainly infectious, with increased blood pressure, heart, kidney, liver diseases, as well as some blood diseases. Sometimes fluctuations in atmospheric pressure, temperature and humidity, hot weather (drying of the nasal mucosa and a rush of blood to the head during prolonged exposure to the sun) lead to nosebleeds.

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

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

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

Spasmodic narrowing of the lumen (stenosis) of the larynx, characterized by the appearance of a hoarse or hoarse voice, a rough "barking" cough and difficulty breathing (suffocation). Most often observed at the age of 1-5 years.

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

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

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

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

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

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

A sudden, paroxysmal convulsive spasm of the muscles of the larynx, causing a narrowing or complete closure of the glottis.

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

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

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

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

The condition is manifested by involuntary urination during sleep. The reasons are varied. This is primarily a serious condition against the background of a general disease, accompanied by high fever, malformations of the urinary tract and bladder stones, pyelonephritis. Bedwetting may be one of the manifestations of an epileptic seizure, in which case fatigue and irritability in the morning, usually not characteristic of this child, may indicate the neurological basis of the disease.

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

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

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

Inflammatory disease of the kidneys and renal pelvis. Usually both of these diseases occur simultaneously (nephritis - inflammation of the kidney tissue, pyelitis - inflammation of the pelvis).

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

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

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

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

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

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

It usually develops as a complication of pneumonia, less often it turns out to be a manifestation of rheumatism, tuberculosis and other infectious and allergic diseases, as well as chest injuries.

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

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

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

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

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

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

Deformation of the foot with flattening of its arches.

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

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

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

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

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

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

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

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

An infectious process in the lungs that occurs either as an independent disease or as a complication of other diseases.

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

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

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

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

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

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

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

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

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

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

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

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

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

A disease caused by a lack of vitamin D and the resulting violation of phosphorus-calcium metabolism. It often occurs at the age of 2-3 months to 2-3 years, especially in debilitated, premature, formula-fed children.

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

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

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

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

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

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

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

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

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

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

A pathological condition that develops in children in response to exposure to toxic substances that come from outside or are formed in the body itself. It is characterized by pronounced metabolic disorders and the functions of various organs and systems, primarily the central nervous and cardiovascular. It occurs more often in young children.

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

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

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

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

A chronic disease, the main symptom of which is damage to the mucous membranes, primarily the mouth and eyes. It occurs more often in girls, in younger children it is extremely rare.

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

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

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

Diseases of children of early and older age

Anemia. More often it develops in children of the first two years of life due to a deficiency of substances necessary for hematopoiesis. With insufficient replenishment of iron through complementary foods, iron deficiency anemia is easily formed, since the main type of food for a child is milk, even mother's milk, contains very little iron and trace elements. The development of the disease is facilitated by a greater consumption of iron, protein, microelements than in adults due to the rapid increase in body weight and length, blood volume. Children who are anemic are more likely to get sick, have more severe illnesses, and easily develop life-threatening conditions with pneumonia and gastrointestinal disorders. Anemia can be hemolytic, associated with blood loss (trauma, hemorrhagic diathesis), and also caused by autoimmune mechanisms.

The symptoms of anemia depend primarily on the underlying cause that caused it. With iron deficiency anemia, appetite decreases sharply, pallor gradually increases, muscle tone decreases, and systolic murmur appears when listening to the heart. Depending on the degree of anemia, the liver and spleen increase. Treatment: strict regimen, prolonged exposure to fresh air. Food should be rich in vitamins, mineral salts, animal protein (vegetables, green peas, carrots, fruits, liver, meat, cottage cheese, egg yolk, etc.). Assign preparations of iron, copper, ascorbic acid. In severe forms of anemia (hemoglobin content below 75 g / l), inpatient treatment is mandatory - red blood cell transfusion, vitamin B 12 , (in exceptional cases, parenteral administration of iron).

Asthma bronchial. There are two forms of asthma: truly allergic and infectious-allergic. In the first case, sensitization by food allergens is important, acute respiratory disease, influenza, pneumonia can be resolving factors. The infectious-allergic form of asthma develops against the background of repeated or chronic bronchopulmonary diseases.

In young children, sneezing, coughing, anxiety, loss of appetite can often be a harbinger of the disease. Gradually, swelling of the mucous membrane of the bronchi develops with increased secretion, which is difficult to separate, clogs the gaps of the bronchi, which can lead to atelectasis. Expressed shortness of breath with particular difficulty exhalation. All auxiliary muscles take part in the act of breathing. In the lungs, a large number of different-sized wet and dry rales (wet asthma) are heard. There is a general anxiety of the child.

In older children, asthma attacks usually proceed in the same way as in adults. If the disease began at an early age, then the child is stunted, he has pronounced dystrophy, deformity of the chest. Attacks often take a protracted character with the development of asthmatic status. To stop an acute attack of suffocation, a 0.1% solution of adrenaline is injected under the skin at a dose of 0.2-0.75 ml, depending on age, the effect occurs after 2-3 minutes and persists for hours. Subcutaneous injection of a 5% solution of ephedrine (0.1 ml per year of life) gives a lasting effect, the spasm is removed after 40-60 minutes, the effect lasts 4-6 hours. Ephedrine can also be given orally in tablets. For severe attacks, hospitalization is necessary. In extremely severe cases, corticosteroid drugs are prescribed and bronchoscopy is performed according to vital indications. Treatment in the interictal period includes a strict regimen, restorative therapy, a complex of vitamins, sanitation of foci of chronic infection (nasopharynx, oral cavity), prolonged exposure to fresh air. Physiotherapy exercises, breathing exercises, sanatorium treatment in the conditions of the climatic zone in which the child lives are important. Pets, birds, fish, flowers with a pungent odor should be removed from the house, foods that provoke allergic reactions and asthma attacks should be excluded from the diet.

Bronchitis asthmatic. The disease often precedes bronchial asthma, but it can also be a special form of bronchitis.

Symptoms: catarrhal phenomena, shortness of breath, "puffing" breathing, frequent, painful cough, sometimes with seizures. In the lungs moist, various dry rales are heard.

Treatment includes therapy for the underlying disease (rickets, exudative diathesis), a strict regimen, fresh air, systematic ventilation of the room. Rational nutrition is important with the exclusion of products that enhance exudative manifestations, the appointment of vitamins, hyposensitization with antihistamines.

acute bronchitis. Inflammation of the bronchial mucosa. It is caused by various microbes and a viral infection, more often in spring and autumn.

Symptoms: the child's well-being, appetite, sleep worsen. The temperature for the first 2 days can be high. Cough at first dry, then loose, with expectoration, which young children usually swallow. Dry and moist rales are heard in the lungs. The duration of the illness is 1-2 weeks.

Recommended bed rest, ventilation of the room, plenty of warm drink (infusion of raspberries, lime blossom, warm milk with warmed borzhom or sodium bicarbonate), acetylsalicylic acid, amidopyrine. With a dry cough in children older than a year, codterpin or codtermopsis is prescribed, with a wet cough - expectorant mixtures, ammonia-anise drops, mustard plasters, jars.

Bronchitis chronic. This is usually the outcome of acute bronchitis in debilitated children. Symptoms: signs of general chronic intoxication - the child is pale, irritable, refuses to eat, sleeps poorly, sweating. There is a constant, periodically increasing cough. In the lungs, emphysema is determined, dry and periodically moist rales are heard. The course is recurrent, protracted.

Treatment is aimed at eliminating foci of chronic infection in the nasopharynx, paranasal sinuses, increasing the overall resistance of the child's body. A regimen, good nutrition, physiotherapy exercises, a complex of vitamins, calcium preparations, periodic courses of antihistamines (diphenhydramine, diprazine, suprastin) are recommended. In the period of exacerbation - sulfa drugs or antibiotics for 4-6 days. UHF on the chest area or ultraviolet irradiation.

Stomach ache. In infants, abdominal pain is most often caused by a significant accumulation of gases in the intestines. At the same time, the stomach is swollen, the child is restless, screaming. Often the pain has the character of seizures. After emptying the bowels or passing gases, the child calms down. In young children, however, much less frequently than in older children, there are appendicitis and strangulated hernia. In older children, abdominal pain can occur with acute and chronic intestinal diseases (colitis, enterocolitis, dysentery), with cholecystitis, acute or chronic inflammation of the mesenteric glands, and helminthic invasion.

In nervous, excitable children with autonomic disorders, frequent abdominal pain can be explained by transient spasm of various parts of the gastrointestinal tract. Similar disturbances of motor function can be confirmed by X-ray examination of the stomach and intestines with barium. A strict diet and proper daily routine, exercise therapy, drugs that calm the nervous system, and in some cases anti-spastic drugs usually improve the condition of children.

Abdominal pain in children can also occur with a pain reaction emanating from the abdominal muscles due to constant tension, for example, with prolonged painful coughing with whooping cough, bronchitis, and excessive sports. Pain can be caused by hyperesthesia of the skin in diseases of the nervous system (meningitis), with typhoid. In these cases, the pain is not limited to just the abdomen.

To establish the correct diagnosis, it is necessary to carefully examine the child. When feeling the abdomen, the attention of the child should be maximally diverted from the ongoing manipulation, since if the pains are reflex in nature, then even deep palpation does not cause pain. Against the background of treatment of the underlying disease, abdominal pain usually disappears. Before establishing an accurate diagnosis and finding out the cause of the pain, you can not apply a heating pad to the stomach, do an enema and give painkillers.

Hypotrophy- chronic malnutrition and tissue trophism. There are prenatal and postnatal malnutrition. Prenatal is fixed already at the birth of a child (in the first 2-3 weeks) of his life. The reason for it is a violation of the trophic function of the central nervous system, caused by a number of risk factors (toxicosis and diseases of pregnant women, pathology of the placenta, alcoholism, smoking, etc.). Postnatal malnutrition develops in a child under the influence of a complex of factors - alimentary, infectious, caused by constitutional features or malformations.

Hypotrophy of the 1st degree is characterized by a lag in body weight of no more than 20% in relation to the norm. Growth is not far behind. The subcutaneous fat layer on the trunk is reduced. With malnutrition of the II degree, the weight is reduced by 20-40% in relation to the norm, there is a lag in growth. The subcutaneous fat layer is absent on the trunk and underdeveloped on the limbs. The skin is dry, gathers in folds, muscle tone is reduced. The child is pale, lethargic, irritable, appetite is reduced, regurgitation appears, unstable stool. Hypotrophy of the III degree, or atrophy, is characterized by a decrease in weight by more than 40% relative to the norm, growth retardation, and the complete disappearance of subcutaneous fatty tissue on the trunk, limbs and face. The child's face is wrinkled, senile, the eyes are sunken, the skin is gray-dirty, dry, the muscles are flabby, atrophic. Extremities are cold, body temperature is lowered. Heart sounds are muffled. Appetite is absent, regurgitation, vomiting, dyspeptic stools are observed. Apathy, occasional excitement. There is a sharp decrease in immunity (resistance), therefore, with malnutrition, various complications often occur.

Treatment should be complex and strictly individual. It is necessary to find out the cause of malnutrition and eliminate it. The main one is nutrition. With malnutrition of the I degree and initial signs of the II degree, the child must be given food according to his age. In case of malnutrition of the II-III degree during the first week, nutrition is prescribed in an amount equal to S-2/3 of the amount of nutrition required for a child of this age. The missing volume of food is replenished with tea, glucose, isotonic sodium chloride solution. When the patient adapts to such a diet, vomiting and weight loss stop, and stool normalizes. After 6-10 days, you can gradually increase the volume and calorie content of food due to protein (fresh cottage cheese from 1 to 3 teaspoons per day), and then carbohydrates - up to the age norm. At first, the number of feedings should be more frequent at intervals of up to 2 hours, then the intervals between feedings are increased. Infants at the beginning of treatment should be provided with mother's or donor milk (at least 200-300 ml / day). Immediately appoint fruit juices. An indicator of proper nutrition is an improvement in general condition and appetite, a gradual increase in body weight.

Stimulating therapy is also recommended: plasma transfusion at 5-7 ml / kg of body weight after 3-4 days, blood transfusion at 5-7 ml / kg of body weight after 5-7 days, only 3-5 times.

In the presence of purulent foci of infection, antibiotics are prescribed. Showing a complex of vitamins, enzymes. Recommended massage, therapeutic exercises (primarily breathing), careful care of the skin and mucous membranes.

Diathesis exudative-catarrhal. These are unusual reactions from the skin and mucous membranes of the respiratory tract, digestive and urinary tract to various stimuli of the external and internal environment.

Early manifestations of exudative diathesis include seborrhea and milky scab, which usually occurs in the first 2-3 months of life. As a result of excessive secretion of the sebaceous glands, yellow crusts form on the head above the eyebrows, which reappear after removal. Later, a milk scab is found on the cheeks as a limited reddening of the skin with some thickening of the epidermis and the formation of scales, then dry or weeping eczema with severe itching may appear on this site. Diaper rash develops in the inguinal folds, behind the ears, in the armpits and neck folds. At the age of 4-5 months, strophulus appears - pruritus, itchy red nodules located on the extensor sides of the limbs. There is a tendency of these children to conjunctivitis, catarrhs ​​of the upper respiratory tract, dyspepsia.

Children suffering from exudative diathesis are characterized by increased excitability, irritability, sleep anxiously. They have a labile, especially water-salt, more often these are “loose” children, with increased weight, but with the slightest illness they quickly lose it. Any diseases against the background of exudative diathesis tend to be protracted.

In children older than 3 years, exudative diathesis is usually expressed by eczema, often with an outcome in neurodermatitis, and periodic urticaria.

In some cases, against the background of exudative diathesis, bronchial asthma develops. The course of the disease is usually undulating, in most children by the age of 2-3 years, skin changes disappear, only special sensitivity and vulnerability of the respiratory tract can be preserved.

First of all, it is necessary to find out which substances or foods increase exudative manifestations in a child, exclude them from the diet, while the food should contain all the necessary ingredients for the normal physical development of the child with a predominance of plant foods and milk restriction. Exclude eggs, chocolate, honey, cocoa, citrus fruits, concentrated broths. In especially severe cases, in children of the first months of life, fed only with mother's milk, it is necessary to switch to mixed feeding, and sometimes completely wean the child from the breast. Older children with overweight limit the daily intake of liquids, carbohydrates, replacing these products with vegetables and protein. In the diet, it is necessary to provide a large amount of vitamins, especially group B and ascorbic acid.

Child care and regimen should be individual, hardening, therapeutic exercises, and massage are required. So that the child does not comb the skin when itching, the sleeves of the vest are sewn up, in some cases it is even necessary to fix the hands. With extensive damage to the skin, you can not swaddle the child tightly, as overheating can occur with a sharp increase in body temperature.

Treatment of skin manifestations local and general. General baths with a weak solution of potassium permanganate or string are recommended. Treatment for eczema depends on its nature. If weeping, anti-inflammatory lotions are prescribed, then drying ointments.

In severe cases, chlorpromazine is prescribed at an age dose, short courses of prednisolone (0.5-1 mg / kg of body weight per day) with a gradual decrease in the daily dose for 7-10 days until the drug is completely discontinued.

Preventive vaccinations for children with a moderate form of exudative diathesis are carried out at the age of 2-3 years with great care against the background of antihistamines and taking rutin, ascorbic acid, and calcium preparations.

Dyspepsia simple. Causes of the disease: improper feeding of the child (overfeeding, underfeeding, food that does not correspond to age, overload with fat, carbohydrates or protein, etc.), violation of the regimen, care, intestinal infection, as well as other diseases (pneumonia, otitis media, acute respiratory disease), against the background of which the so-called parenteral dyspepsia develops. More often, dyspepsia is observed in debilitated children suffering from exudative diathesis, rickets, and malnutrition.

The onset of the disease is acute: regurgitation, sometimes vomiting, appetite decreases. Stool 8-10 times a day, liquid, with a sour smell, yellow-green in color with a small amount of mucus, white lumps of saponified fats in the feces. Flatulence, so the child is periodically restless, crying, and after the passage of gases quickly calms down. The temperature is normal.

Treatment. First you need to find out the cause that caused dyspepsia, and eliminate it. In the first 6-9 hours, 1-2 feedings are skipped, at this time the child is given plenty of isotonic sodium chloride solution and tea at the rate of 150 ml of liquid per 1 kg of body weight per day. With parenteral dyspepsia with minor dyspeptic symptoms, you can not arrange a break in feeding.

After a pause in feeding, the child is applied to the breast only for 5 minutes, or they are given expressed milk, and with artificial feeding, acidic mixtures in half the amount. In the next 2-3 days, the amount of food is adjusted to the age norm. The missing amount of nutrition is compensated by liquid. Vitamins, pepsin with hydrochloric acid or natural gastric juice, pancreatin are prescribed.

With flatulence, pain in the abdomen, heat on the stomach, a warming compress, dill water, chamomile decoction, 1 teaspoon several times a day, a gas outlet tube are indicated.

constipation. Constipation is often observed both in older and in early childhood. In newborns, stool retention may indicate a congenital pathology of various parts of the gastrointestinal tract. Urgent consultation of the surgeon is necessary.

In infants, constipation occurs during starvation or with an excess content of protein, fat in food (very fatty breast milk or cream overload), with monotonous nutrition with artificial mixtures, with a decrease in the tone of the abdominal muscles in children suffering from rickets, malnutrition. In older children, in violation of the diet and monotonous food containing little fiber, habitual constipation may occur. In addition, during the game, children systematically suppress the urge to defecate, as a result of which the lower segment of the large intestine is gradually stretched, the tone of its muscles is disturbed, which also leads to constipation. Constipation occurs after acute intestinal diseases (dysentery, colitis), as a result of persistent intestinal spasticity, and also with anal fissures. With constant constipation in children, appetite decreases, sleep worsens, fatigue, headache, and irritability appear.

Treatment should be aimed at eliminating the cause of constipation. Juices are added to infants, with mixed feeding they systematically give vegetable, fruit purees, prunes. Older children are prescribed products that enhance peristalsis: black bread, yogurt, kefir, etc. It is necessary to accustom the child to regular bowel movements at the same time, that is, to promote the development of a conditioned reflex. Showing therapeutic exercises, massage of the abdomen, and at an older age, sports. With cracks in the anus - suppositories with anestezin. Enemas and laxatives are useful only at the beginning, while the causes of constipation are being eliminated, and then they should be avoided.

Bleeding nose. Nosebleeds in children are observed quite often, especially at an older age with infectious diseases (scarlet fever, influenza), diseases of the blood system, and other diseases accompanied by an increase in blood pressure. The cause of nosebleeds can be local factors: trauma to the nose, foreign body in the nose, which toddlers often put in the nose. Nosebleeds are promoted by large adenoid growths, high body or ambient temperature, and prolonged games.

Treatment: the child takes a semi-sitting or sitting position with his head thrown back. A cotton swab moistened with hydrogen peroxide or vaseline oil is inserted into the nose, and the wing of the nose is pressed against the nasal septum with a finger. In case of severe bleeding, either a piece of cloth moistened with cold water is placed on the bridge of the nose and to the back of the head. A heating pad is placed at the feet. Give to drink a solution of sodium chloride (1 teaspoon per 1 glass of water) 1 tablespoon every 20-30 minutes or 10% calcium chloride solution 1 tablespoon 4-6 times a day. If the bleeding does not stop, an anterior or posterior nasal tamponade is recommended. When external bleeding from the nose stops, the pharynx should always be carefully examined to check if blood is draining down the back of the throat. It is necessary to establish the cause of nosebleeds in a child, since further therapy and prevention of rebleeding are closely related to the elimination of a specific disease.

Croup false is a rapidly developing swelling of the mucous membrane of the larynx. In severe cases, it can lead to asphyxia with a fatal outcome. False croup develops with viral diseases of the respiratory tract, influenza, measles, inflammatory diseases of the larynx, chemical or thermal burns. The disease begins suddenly: at night there are shortness of breath, a rough cough, the voice is preserved (unlike diphtheria, true croup, in which hoarseness of the voice appears very quickly, and then complete aphonia - loss of voice). Expressed catarrhal phenomena, fever. With the progression of the croup (second phase), against the background of difficulty in breathing, retraction of the compliant places of the chest, cyanosis appear, the child becomes restless. In severe cases, during the first hours, the third, asphyxic phase of croup may occur, in which cyanosis sharply increases, the child rushes about, covered with cold sweat, loses consciousness, the pulse becomes arrhythmic, of weak filling. If the child is not treated immediately, death may occur.

It is necessary to calm the child, provide fresh air, distracting foot or general hot baths with water temperature up to 39-40 ° C for 5-7 minutes, warm drink. You can prescribe antispastic powder atropine - 0.0001 g, papaverine - 0.002 g, amidopyrine - 0.1 g; antihistamines (diprazine, diphenhydramine, suprastin). In severe cases, hormonal preparations are indicated (prednisolone 1 mg / kg body weight per day for several days), intravenous administration of a 20% glucose solution, cordiamine, caffeine. Treat the underlying disease with antibiotics. With the transition of the second phase of the process to the third and in the absence of the effect of conservative therapy, surgical intervention is necessary - tracheotomy.

Bed-wetting. It is observed in children of early and preschool age with increased nervous excitability. Reason: fright, mental trauma or anomalies in the development of the urinary tract, bladder disease. Plus, the wrong regimen of the day, poor nutrition, endocrine disorders, etc.

Involuntary urination occurs 3-4 hours after falling asleep, sometimes repeated at the time of deep sleep. During the day, most of these children are lethargic, apathetic, the disease makes them withdrawn. There are symptoms of autonomic dystonia, decreased muscle tone.

Treatment: systematic psychotherapy should be aimed at suggesting to the child that the disease will pass. A strict day regimen and a hygienic regimen, a semi-rigid bed, every night, 2-3 hours after falling asleep, the child must be woken up in order to develop a conditioned reflex to the need to get up and empty the bladder. In the afternoon, liquid intake is limited, at 6-7 pm it is recommended to give the child a dry dinner, consisting of a small amount of meat, bread and butter. Before going to bed, they give a small amount of salty food - a sandwich with herring, caviar or ham, or 1-2 g of salt. Assign systematic gymnastics, sponging, coniferous baths.

Pyelitis. Often, pyelitis (inflammation of the renal pelvis) is accompanied by inflammation of the bladder, as well as damage to the renal parenchyma. Pyelonephritis, pyelitis, pyelocystitis are the most common forms of kidney damage.

Often occurs in infants, much more often in girls than boys. The frequency of pyelitis at an early age is explained by the reduced resistance of the body to infection and some anatomical and physiological features of the renal pelvis and ureters, which impede the free outflow of urine. The cause of pyelitis can be congenital anomalies (polycystic kidney disease, doubling of the kidney, urethral stenosis, etc.).

Symptoms are scarce and atypical. An objective examination reveals only phenomena of general intoxication, pallor of the skin, decreased nutrition, loss of appetite, subfebrile temperature or single temperature rises up to 38-40 °C. This condition dictates the need for a urine test to exclude the diagnosis of pyelitis.

With the acute development of the disease in older children, there may be persistent fever up to 39-40 ° C with large swings during the day, sometimes with chills and subsequent profuse sweat and adynamia. Intoxication is manifested by headache, dizziness, loss of appetite, nausea, pain in the lumbar region. There may be a short-term retention of urine. In children of the first year of life, acute pyelitis often begins with toxicosis: vomiting, frequent dyspeptic stools, dehydration, blackout, sometimes meningeal syndrome, convulsions.

Turbid urine, with traces of protein, in the sediment a large number of leukocytes, single erythrocytes, sometimes cylinders. Laboratory diagnosis of pyelitis includes a quantitative count of leukocytes in the urine according to the method of Kakovsky-Addis, Nechiporenko and others.

Treatment includes a strict hygienic regimen, especially in girls, therapy for foci of chronic infection and the underlying disease. Plentiful drink, in severe cases in young children, isotonic sodium chloride solution, 5% glucose solution is injected under the skin, in enemas. Antibiotics are prescribed under the control of the sensitivity of the microbial flora, nitrofuran preparations. With malformations of the urinary system, surgical treatment is recommended.

Pyelonephritis. The cause of the disease and the predisposing moments are the same as with pyelitis. In addition to the general phenomena of intoxication, there are more pronounced deviations in urine tests (the protein content exceeds 1 g / l, in the sediment, in addition to leukocytes, leached erythrocytes and cylinders are found). The concentration ability of the kidneys is impaired, the relative density of urine decreases.

The course of pyelonephritis is undulating, prolonged, followed by periods of exacerbation followed by light intervals. Any infectious diseases, cooling, tonsillitis, influenza, acute respiratory diseases, violation of the regimen contribute to the exacerbation. The outcome of the disease can be uremia and secondarily wrinkled kidney.

Treatment: the same as for pyelitis. In addition to antibacterial agents to fight infection, they include stimulating therapy: gamma globulin, a complex of vitamins. Treatment should be persistent, long-term, under the control of urinalysis and renal function tests.

flat feet. Foot deformity in childhood is very common. The reason is a decrease in muscle tone in children who have had rickets, malnutrition, who suffer from chronic intoxication, who have overweight on the background of endocrine disorders.

Symptoms: pain in the legs in the afternoon, sometimes at night, from which the child wakes up. More often the pain appears after a lot of physical activity, a long walk or playing football. Pain is in the calf muscles, in the feet. When examining a child, there is a decrease in overall muscle tone, autonomic disorders, flattening of the arch of the feet during exercise.

Treatment: special therapeutic exercises, water procedures, wearing arch supports or orthopedic shoes, temporary restriction of physical activity.

Acute focal pneumonia. One of the most common diseases in children. Anatomical and physiological features of the respiratory organs predispose to pneumonia: the younger the child, the less his reserve breathing capacity and the higher the need for gas exchange. Therefore, during inflammatory processes in the lungs, serious functional disorders easily occur, aggravating the course and outcome of the disease. More often the disease develops in children who are bottle-fed, against the background of rickets, malnutrition, exudative diathesis, in violation of the hygienic regime. The immediate cause of the disease is an infection, often viral. More than 90% of all pneumonia in children of the first years of life begins with acute viral respiratory diseases, then they are joined by a bacterial infection (staphylococcus, pneumococcus, etc.), i.e. pneumonia is a viral-bacterial infection, in which it is necessary to observe the epidemiological regimen.

At the onset of the disease, catarrhal phenomena are usually expressed, then anxiety, irritability or, conversely, lethargy appear, appetite decreases, children suckle poorly. One of the first microsymptoms of pneumonia may be cyanosis of the nasolabial triangle, aggravated by anxiety, the release of foamy mucus from the mouth, tension and swelling of the wings of the nose. Then there is obvious shortness of breath. Breathing becomes intermittent, groaning, groaning, sometimes "grunting". The temperature reaction (38-39 ° C) is pronounced from the onset of the disease, but in children with malnutrition, pneumonia can occur with subfebrile or normal temperature. Pulmonary symptoms first recede into the background, and then areas of shortened percussion sound and weakened breathing appear, bronchophony is enhanced, moist small and large bubbling rales are heard. On radiographs in the first 3-4 days of illness against the background of emphysema and enhanced pulmonary pattern, focal shadows are detected. In blood tests - leukocytosis or leukopenia, increased ESR.

Children have toxic and toxic-septic forms of pneumonia. The toxic form is characterized by an extremely severe general condition of the child with a pronounced reaction of all organs and systems and the development of threatening clinical syndromes. The syndrome of acute respiratory failure is most often noted: pallor, cyanosis, shortness of breath, the number of breaths exceeds the norm by more than twice, apnea attacks and respiratory arrest with the development of asphyxia are observed. Sometimes a syndrome of acute cardiovascular insufficiency develops, tachycardia may be replaced by bradycardia, the pupils are dilated, the gaze is fixed, and general pastosity.

Hyperthermic and convulsive syndromes are often observed: temperature of 40 ° C and above, cold skin, spasm of peripheral vessels, filiform pulse, cerebral edema, clonic tonic convulsions.

Toxic-septic forms of pneumonia are characterized by the addition of septic, purulent foci in the form of pleurisy, otitis media, meningitis, pyelitis, etc. Abscessing pneumonia may develop,

In young children, acute pneumonia with proper, timely treatment usually ends in recovery at 2-3 weeks from the onset of the disease. However, in children suffering from rickets, malnutrition, exudative diathesis, pneumonia can take a sluggish, protracted course, exacerbate. In severe pneumonia, death is possible.

Complex treatment:

Fight against infection and toxicosis;

Elimination of respiratory failure;

Restoration of the functions of organs and systems;

Increasing the reactivity of the child's body.

When prescribing treatment, one should take into account not only the underlying disease, but also concomitant diseases, as well as the organization of intensive care for threatening clinical syndromes.

Mode matters a lot. It is necessary to ensure a constant supply of fresh air, often change the position of the child in the crib, periodically carry it in your arms. Walking for 10-15 minutes in fresh, cool air, in places protected from the wind, has a good effect. It is advisable to take the child for a walk in your arms. With a positive reaction to the walk, the children quickly calm down, fall asleep: shortness of breath and cyanosis decrease. In case of a negative reaction (in premature babies, malnutrition, with toxic forms of pneumonia), the child should be immediately brought into the room.

In addition, in the fight against respiratory failure, inhalation of humidified oxygen is indicated, the duration and frequency of procedures are determined individually depending on the patient's condition. It is necessary to provide rational nutrition according to the age of the child: if he is breastfed, with severe cyanosis, it is advisable to temporarily feed the patient only with expressed mother's milk, since attachment to the breast and the act of sucking can aggravate the phenomena of respiratory failure. The child needs to drink plenty of water.

Antimicrobial therapy includes the appointment of antibiotics and sulfa drugs. Basic principles of antibiotic treatment:

Immediate use of antibiotics immediately after the diagnosis of pneumonia;

To increase the efficiency, the appointment of two antibiotics with a different spectrum of action in accordance with the scheme of rational combinations of antibiotics according to A. M. Marshak;

Determining the dose of antibiotics depending on body weight, age of the child and the severity of the process; changing the combination of antibiotics in the absence of the effect of therapy within 3-5 days;

The duration of the course of treatment is 7-10 days, in some cases up to 15 days;

Before prescribing treatment, determining the sensitivity of the flora of the upper respiratory tract to antibiotics for the relative direction of therapy;

Taking into account the side effects of antibiotics and its timely prevention by simultaneously prescribing antihistamines, antiallergic drugs (diphenhydramine, diprazine, suprastin), a complex of vitamins, especially group B, when using antibiotics orally, as well as antifungal drugs.

Sulfanilamide preparations are used in combination with antibiotics at the rate of 0.2 g/kg of body weight per day in cases where the appointment of antibiotics alone does not give a clear effect. In severe, toxic forms of pneumonia, in combination with antibiotics, corticosteroid drugs are prescribed - prednisone in a short course of 0.5 mg / kg of body weight per day for 7-15 days with a gradual decrease in the daily dose. Stimulating therapy is carried out according to indications against the background of a sluggish, protracted course of pneumonia or during the recovery period with malnutrition, rickets, anemia (plasma transfusion, administration of gamma globulin). According to the indications, children with acute pneumonia are prescribed cardiac agents, mainly cardiac glycosides, sulfokamphokain, expectorant mixtures, mustard wraps, and during the recovery period - physiotherapy exercises, breathing exercises, massage. After the severity of the condition is removed, concomitant diseases are treated - rickets, malnutrition, anemia, exudative diathesis.

Prevention of acute pneumonia includes, first of all, an increase in the reactivity of the body, rational nutrition of the child, correct air and temperature conditions in the room. Pneumonia prolonged and recurrent. Prolonged forms are pneumonia, in which clinical and morphological recovery occurs on the 2-4th month from the onset of the disease. Recurrent pneumonias have an undulating course, the next exacerbation begins against the background of an unresolved process in the lung tissue, and the total duration of the disease is within 1-2 years.

Causes: a prolonged and recurrent course of pneumonia can be caused by improper treatment due to either late diagnosis, or too short courses of antibiotics that do not provide clinical recovery, or, conversely, excessively long treatment with massive doses of antibiotics, which, like treatment with insufficient doses of them, can contribute to the allergization of the body, predisposing to recurrence of the disease. A protracted and recurrent course is observed in children suffering from rickets, malnutrition, anemia, in children with malformations of the bronchopulmonary and cardiovascular systems, foreign bodies in the bronchi.

Recurrent pneumonia is more often observed in children with chronic foci of infection in the upper respiratory tract - chronic adenoiditis, tonsillitis, sinusitis and ethmoiditis. In young children, adenoiditis plays a major role. Often these children suffer from exudative diathesis and are often overweight. The disease is accompanied by a prolonged, painful, paroxysmal cough, especially when falling asleep, at night and upon awakening. Children sleep with their mouths open, snoring breathing, persistent rhinitis and recurring pneumonia - up to 18 times a year, quickly passing and proceeding like adenosinus pneumopathies and lung allergies, sometimes with an asthmatic component. Bronchoscopy often reveals diffuse or focal endobronchitis. An x-ray examination reveals a cloudy background of the lung tissue - a "vascular tide", eosinophilic infiltrates without distinct structural changes in the lung tissue. In such children, a chronic carriage of adenoviruses, staphylo- and streptococci has been established. They can be a source of infection for surrounding children.

Treatment depends on the underlying cause of the protracted, recurrent bronchopulmonary process. With pneumonia against the background of rickets, malnutrition and anemia, it is necessary to treat the underlying disease simultaneously with pneumonia. With fermentopathy, enzyme replacement therapy is simultaneously prescribed. And with adenosinus pneumopathies, conservative or surgical sanitation of the nasopharynx is necessary, with severe adenoiditis - adenotomy. With frequent tonsillitis, otitis media and uncompensated chronic tonsillitis, adenotonsillectomy is indicated. With chronically current endobronchitis, bronchological sanitation, electroaerosols, physiotherapy procedures are carried out. With severe allergies accompanying prolonged or recurrent pneumonia, antibiotics should be used with extreme caution, and biostimulants (blood, plasma, gamma globulin) are contraindicated.

Pneumonia, chronic, nonspecific. A disease with a chronically relapsing course, it is based on organic changes in the respiratory organs (chronic bronchitis, bronchial deformity, pneumosclerosis) and functional disorders of the respiratory organs and other systems of the central nervous system, cardiovascular system, etc.

The immediate cause is acute pneumonia that developed as a complication of measles, whooping cough, influenza, repeated acute respiratory infections, chronic bronchitis, bronchial asthma, congenital malformations of the bronchopulmonary system, foreign bodies in the bronchi. In the formation of chronic pneumonia, the role of pneumonia transferred in the first year of life is especially great.

The weakening of the protective mechanisms of the child, allergic mood and constant sensitization due to focal chronic infection (tonsillitis, sinusitis, etc.), unfavorable living conditions, climatic conditions, poor nutrition, etc. predispose to chronic pneumonia.

Symptoms: with the development of pneumosclerosis, limited to a segment or lobe of the lung, conditions are created for repeated inflammatory processes, each of which enhances sclerotic changes at the site of the lesion and contributes to the further spread of the process. During the period of exacerbation, the leading symptoms are bronchitis or sluggishly current, prolonged pneumonia. In contrast to acute pneumonia, general intoxication and temperature reaction are less pronounced. There is a lag in physical development, polyhypovitaminosis, chest deformity, shortness of breath and cyanosis of the nasolabial triangle, aggravated by physical exertion. Percussion in the lungs reveals persistent emphysema with areas of shortened sound (foci of pneumosclerosis), more often in the paravertebral regions. Harsh breathing, no wheezing.

In severe chronic pneumonia, when, in addition to pneumosclerosis, there are deforming bronchitis or bronchiectasis, there is a constant wet cough with sputum. The cough is worse in the morning and on exertion. Sputum is usually mucopurulent, odorless. Due to the poor drainage function of the bronchi in children, sputum stagnation can often occur and, as a result, short-term temperature rises (“temperature candles”) and intoxication phenomena. It should be borne in mind that young children do not know how to cough up sputum and usually swallow it. A motley picture is determined percussion, alternating sections of a shortened sound with sections of a box sound. Gradually, different-sized moist rales are heard, respectively, to the affected areas of the lungs, both during the period of exacerbation and outside it. On radiographs, emphysema, deformation of the bronchovascular pattern, peribronchitis, foci of pneumosclerosis are detected.

Treatment is necessary pathogenetic, staged, taking into account the duration of the disease and the phase of the process (exacerbation or remission). During the period of exacerbation, the child must be hospitalized, providing a long stay in the fresh air, high-calorie nutrition and a large amount of vitamins. Stimulating therapy and hyposensitizing drugs (diphenhydramine, diprazine, suprastin) are recommended.

Antibacterial therapy: it is advisable to use broad-spectrum antibiotics and semi-synthetic penicillin preparations, to combine antibiotics with sulfanilamide preparations. Initially, antibiotics can be administered intramuscularly and in the form of aerosols, then only aerosols can be prescribed. Electric aerosols of antibiotics are effective, since the drug enters directly into the deep sections of the bronchopulmonary system, is quickly absorbed into the blood and lymph, provides a prolonged action of the antibiotic and a direct effect on the infectious onset. The duration of antibiotic therapy is determined by the severity of the process, on average it ranges from 10 to 25 days. To improve the drainage function of the bronchi, aerosols with bronchodilators and proteolytic enzymes are recommended. Physiotherapy exercises, breathing exercises and physiotherapy procedures are necessary. During an exacerbation of the disease, UHF currents, inductothermia, calcium and copper electrophoresis are recommended, during remission - ultraviolet irradiation, oxygen and pearl baths, massage, gymnastics, spa treatment.

In the presence of bronchiectasis, bronchoscopy is recommended for better rehabilitation of the bronchial tree. If the localization of bronchiectasis is strictly limited, but the process tends to spread, it is necessary to raise the question of surgical treatment, especially in the presence of saccular bronchiectasis.

Prevention of chronic pneumonia consists of measures aimed at improving and strengthening the child's body. Timely rehabilitation of foci of chronic infection, complex treatment of acute pneumonia, especially in young children, is necessary.

Rickets. This is a general disease of the whole organism with a metabolic disorder (primarily calcium and phosphorus) and a significant disorder in the functions of many organs and systems. Rickets affects children mainly in the first 2-3 years of life, but the disease can also occur at a later age, especially during periods of increased growth of the child. The immediate cause of the development of rickets is often hypovitaminosis D, which occurs when there is insufficient intake of vitamin D from food or as a result of insufficient formation of it in the body. The increased need for vitamin D is also important during periods of increased growth of the child, especially in the first year of life, and in case of prematurity - in the first months of life.

Predispose to the development of rickets incorrect, especially one-sided or artificial, feeding; poor child care; insufficient exposure to fresh air; frequent respiratory or gastrointestinal diseases; deficiency of vitamins A, group B and ascorbic acid.

It should be borne in mind that even mild forms of rickets reduce the resistance of the child's body, leading to frequent respiratory diseases. Pneumonia in children with rickets has a severe, protracted course. Against the background of rickets, other diseases of childhood are more difficult. Rickets is often accompanied by dystrophy, anemia. In this regard, the problem of rickets remains highly relevant.

Rickets is divided into the following phases: initial, peak, convalescence, residual effects. The severity can be mild, moderate and severe. The nature of the course is acute, subacute and recurrent.

The initial phase of the disease develops in full-term children at 2-3 months of age and is characterized by neuromuscular disorders. The child becomes restless, sleeps poorly, becomes irritable. Sweating, skin itching appear, so the child constantly rubs his head on the pillow and the hair on the back of the head is wiped off, the back of the head seems to be “balding”. When the child is deployed, a sour smell of sweat is felt, the ammonia smell of urine intensifies. Muscle tone gradually decreases, the development of static functions is delayed, and appetite decreases.

These symptoms are associated with impaired phosphorus-calcium metabolism and gradually developing acidosis. The initial phase of rickets is characterized by an increased excretion of phosphorus in the urine and a decrease in its level in the blood from 0.005 to 0.0025-0.003 g / l with a normal or even elevated level of calcium (0.010-0.011 g / l) in the blood and increased leaching of it from the bones . If treatment is not carried out, rickets passes into the next phase - the peak phase, or "blooming" rickets. During this period, all internal organs and the skeletal system are involved in the process. The child is pale, pastose, eats poorly, gains little weight, his muscular hypotension and muscle atrophy, tissue flabbiness increase. Changes in the neuropsychic sphere are intensifying: children are sharply inhibited, the development of conditioned reflexes and static functions is delayed. In the blood, there is a further decrease in the content of phosphorus (up to 0.0018-0.0020 g / l) and calcium (up to 0.007-0.008 g / l), acidosis increases.

The leaching of calcium from the bones leads to their softening. The flat bones soften first: compliance of the fontanel edges, occipital bones, sternum and ribs occurs. As a result of these changes, the back of the head is flattened, the sternum is pressed or protrudes forward ("shoemaker's chest" or "chicken breast"), the pelvic bones are flattened and deformed, and the limbs are bent. Uneven and increased growth of the growth cartilage in the absence of deposition of calcium salts in it leads to an increase in the parietal and frontal tubercles (“tower”, “square”, “gluteal” skull), thickening of the wrists (“bracelets”) and the ends of the bone part of the ribs (“rosary "). On radiographs of the bones, osteoporosis and "blurring", indistinct contours of the growth zones are determined. As a result of impaired bone growth, teething, closure of fontanelles and the appearance of ossification nuclei are delayed. Due to profound changes in tissue metabolism and trophism, increased permeability of the vascular wall, the state of internal organs is disturbed. In the lungs, a pre-pneumonic state, tissue swelling, increased exudation, and a tendency to bronchospasm are observed. Hypotension of the heart muscle is pronounced, tachycardia, muffled heart sounds are noted, and blood pressure is reduced. The appetite is reduced, the processes of digestion and absorption in the intestine are disturbed - the stool is unstable, plentiful. The abdomen increases in volume (“froggy”), the divergence of the rectus abdominis muscles is pronounced. Enlarged peripheral lymph nodes, liver and spleen.

With appropriate treatment, sweating, irritability, and anxiety gradually disappear, the child begins to eat and sleep well, gains weight, static and motor functions are restored, and the content of phosphorus and calcium in the blood is normalized. However, residual effects - deformation of the skull and skeleton, muscle hypotension, looseness of the articular-ligamentous apparatus, flat feet persist for a long time, interfering with the harmonious development of the child. The flat rachitic pelvis in girls further creates unfavorable conditions for childbirth, etc. This is the phase of convalescence.

Depending on the severity of clinical manifestations, three degrees of rickets are distinguished. The first degree (mild) is characterized by moderate neuromuscular and bone changes, corresponds to the initial phase of rickets or the beginning of the rampant phase. Timely and adequate treatment leads to recovery. In the second degree (moderate) there are more clear symptoms of damage to the nervous system, a lag in the development of static functions, bone changes and functional disorders of the internal organs are clearly expressed. Rickets of the second degree develops in one and a half to two months from the onset of the disease, that is, in the fifth month of life, and corresponds to the phase of the height of the disease. The third degree (severe) is characterized by a sharp lethargy, a significant lag in the development of static functions or their complete loss, severe muscle hypotension. The child sits in a typical position, leaning his hands on bent legs, as if holding himself. The "rachitic hump" in the lumbar spine and the "jackknife" symptom are pronounced - the body lies freely between the legs. The skeleton is sharply deformed. Shortness of breath, "puffing" breathing and changes in various organs characteristic of the peak phase are pronounced. Rickets of the third degree develops at 6-7 months of illness.

Rickets can have an acute course, especially in children of the first months of life, premature and rapidly growing. In this case, there is a rapid progression of all the symptoms of the disease. A subacute course is more often observed in debilitated children, with malnutrition, anemia, as well as in the prevention or treatment of rickets with vitamin D in an insufficient dose. The disease develops slowly, its symptoms are detected most often only in the second half of life.

The relapsing course of the disease is characterized by the change of periods of exacerbations by periods of clinical remission, which is usually observed in children who are often ill and improperly fed. A continuous sluggish progression of the process is also possible with improper and insufficient treatment, the absence of anti-relapse prevention.

Late rickets develops in children older than 4 years. This usually occurs during periods of rapid growth, with non-compliance with the regime of the day, nutrition, long-term illnesses accompanied by persistent acidosis. Some symptoms of late rickets are mistakenly interpreted as phenomena of vegetative dystonia, especially if they occur during the child's sexual development, but they are based on a violation of phosphorus-calcium metabolism (hypophosphatemia) and polyhypovitaminosis. Adolescents often complain of fatigue, irritability, poor sleep, absent-mindedness, sweating, decreased appetite, vague pain in the limbs, tachycardia, they are predisposed to diseases of the upper respiratory tract. These signs may be characteristic of late rickets. Muscular hypotension and looseness of the articular-ligamentous apparatus associated with rickets lead to "school" postural disorders and the development of flat feet. Bone changes in late rickets are rare. From this it follows that it is always necessary to remember the possibility of late rickets, timely check the phosphorus-calcium metabolism and correctly carry out non-specific prophylaxis during all periods of increased growth of the child.

Prevention of rickets is carried out in children under 2 years of age. It consists of specific and non-specific prophylaxis. The latter is carried out for all children without exception, and especially during periods of increased growth of the child. The time and methods of carrying out specific prophylaxis depend on the degree of term of the child, the time of year, the presence or absence of birth trauma, kidney disease and endocrine disorders.

Prenatal prophylaxis: a pregnant woman must strictly observe the daily regimen, eat a varied and nutritious diet, walk a lot in the fresh air. In the last two months of pregnancy, specific prophylaxis is necessary (only in the autumn-winter season) - irradiation with quartz, inside fish oil, 1 tablespoon 1 time per day. Women under 25 can be given vitamin D 2 in oil solution from 500 to 2000 IU daily. These activities are carried out sequentially.

postpartum prophylaxis. During this period, the mother should continue all preventive measures for 1-2 months in order to stabilize the content of vitamin D in breast milk.

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Diseases of the neonatal periodChapter 8

EXAM QUESTIONS

FOR THE SPECIALTY OF PEDIATRICS

For 5th year students of the Faculty of Medicine

DISEASES IN YOUNG CHILDREN

1. Dynamics of weight and growth of a child in different periods of childhood, examination methods.

2. Significance of assessment of physical development for the diagnosis of childhood diseases. Causes of retardation in physical development.

3. Development of the central nervous system and motor skills in a child.

4. Evaluation of the neurological status of the newborn, its significance in the diagnosis of diseases.

5. Causes, delays in psychomotor development. The value of assessing the neuropsychic and motor development of young children for the diagnosis of diseases.

6. Significance of the newborn's Apgar score. Causes of asphyxia in newborns, clinical principles of therapy.

7. Significance of genetic and hereditary factors in the pathology of childhood. prenatal diagnosis.

8. Intrauterine malnutrition, causes, diagnosis, principles of treatment, prevention.

9. Characteristics of a premature baby, organization of the stages of nursing, feeding.

10. Periods of childhood.

11. Characteristics of the early neonatal period, assessment of the condition of the newborn, Apgar scale, disease prevention.

12. Clinic of "borderline" conditions in a newborn child in the early neonatal period. Differential diagnosis with diseases.

13. Characteristics of the period of infancy, pathology of infancy.

14. Characteristics of the period of milk teeth. Disease prevention.

15. Feeding a newborn baby.

16. Breastfeeding, its benefits.

17. Causes of hypogalactia in women, diagnosis, prevention, treatment.

18. Mixed feeding. Characteristics of dairy products used for supplementary feeding, rules for its introduction.

19. Timing of the appointment of complementary foods and the introduction of vitamins for various types of feeding. Their significance for the development of the child.

20. Characteristics of dairy products used in the nutrition of children of the 1st year of life.

21. Dry milk mixtures in the nutrition of children of the 1st year of life, their characteristics.

22. Canned foods in the nutrition of children of the 1st year of life.

23. Calculations of the needs of the main food ingredients for different types of feeding of children of the 1st year of life. Correction of deficiency of protein, fats, carbohydrates.

24. Features of water-salt metabolism in children, calculations of water needs in young children .

25. Hypotrophy, etiology, classification, clinic, treatment depending on the cause.

26. Hypotrophy in infants, etiology, pathogenesis, clinic, diagnosis, treatment.

27. Development of the musculoskeletal system in children. Research methods. Semiotics of lesions of the musculoskeletal system in children.

28. Vitamin D and its importance for the development of a healthy child.

29. Rickets: etiology, pathogenesis, clinic, diagnostics, differential diagnosis.

30. Rickets: treatment, prevention.

31. Spasmophilia, etiology, pathogenesis, classification, clinic, treatment, prevention.

32. Anatomical and functional features of hematopoiesis in children. physiological anemia.

33. The formation of hematopoiesis in children. Blood formula in different age periods.

34. Physiological jaundice of newborns. Diagnostic tactics of a doctor in icteric syndrome in newborns.

35. Iron deficiency anemia in young children: etiology, pathogenesis, clinic, diagnosis, treatment, prevention.

36. Hemolytic disease of the newborn: classification, causes of development, pathogenesis, clinic.

37. Hemolytic disease of the newborn: diagnosis, treatment, prevention.

38. Intrauterine circulation. Anatomical and physiological features of the cardiovascular system in children. Methods of examination.

39. Anatomical and functional features of the skin, subcutaneous tissue in young children.

40. Disease of the skin and subcutaneous tissue in newborns: etiology, clinic, treatment.

41. Omphalitis: etiology, clinic, diagnosis, complications, treatment, prevention.

42. Significance of anatomical and physiological features of the skin and subcutaneous tissue in young children in the development of diseases. Omphalitis, vasculitis of umbilical vessels, clinic, complications.

43. Anatomical and physiological features of the digestive system in children. Differential-diagnostic tactics of a physician in regurgitation syndrome in newborns.

44. Semiotics of diseases of the digestive tract in infancy.

45. Differential diagnosis in vomiting syndrome in newborns.

46. ​​Anatomical and physiological features of the respiratory system in children. Diagnostic tactics of a doctor in the syndrome of respiratory disorders in newborns.

47. The formation of immunity in children.

48. Lymphatic-hypoplastic diathesis: causes, manifestations, tactics of a pediatrician.

49. Allergic diathesis: causes, manifestations, tactics of a pediatrician. Predisposition to various diseases.

50. Sepsis of the newborn: etiology, "risk groups".

51. Sepsis of newborns: pathogenesis, clinic, treatment, prevention.

52. Pneumonia in newborns: etiology, pathogenesis, clinic, treatment.

53. Anatomical and functional features of the urinary system in young children.

54. Nervous-arthritic diathesis: pathogenesis, clinic, diagnosis, treatment, prevention.

55. Nervous-arthritic diathesis: metabolic crisis, its treatment.

INTRODUCTION

Dear Colleagues!

The training of students in a medical college (school) ends with a final certification, which includes issues of pediatrics with childhood infections. This guide will help you prepare for your upcoming assessment.

In preparation for certification, you should:

1. Check your knowledge by answering the test tasks in all sections and compare your answers with the standards. Use criteria to evaluate knowledge

91-100% correct answers - "excellent";

81-90% of correct answers - "good";

71-80% of correct answers - "satisfactory";

70% or less of correct answers - "unsatisfactory".

2. In case of an unsatisfactory assessment, the training material should be re-worked.

3. Repeat the solution of test tasks.

We wish you success!

Requirements of the state educational standard
to the level of training of specialists in the field of pediatrics
with childhood infections for the specialty 0401 "General Medicine"

The paramedic must:

- know: the main clinical manifestations of individual nosological forms, the features of their course; basics of deontological communication with a sick child and relatives; step-by-step standards for providing medical care to children; prevention methods for major diseases of childhood; stages of newborn screening;

- be able to: collect anamnesis; conduct an objective examination; diagnose pathology of childhood; determine the tactics of managing patients; provide emergency assistance; to take material for laboratory research and evaluate the results; draw up medical documentation; calculate the dose of drugs for the treatment of major diseases; carry out express diagnostics in case of hypervitaminosis D and diabetes mellitus;

- own skills: caring for children with various diseases; manipulations: intradermal, subcutaneous, intramuscular, intravenous injections; setting cans, mustard plasters, applying compresses; body temperature measurements; preparation and conduct of medicinal and cleansing enema, therapeutic baths; gastric lavage and gastric and duodenal sounding; counting the pulse rate and respiratory movements; measurement of blood pressure; instillation of drops in the nose, eyes, ears; carrying out oxygen therapy and para-oxygen inhalations; use of centile tables.

SAFETY TESTS

1. When providing emergency care to a child with a "pink" type of hyperthermic syndrome, it is contraindicated

a) warming up

b) the use of craniocerebral hypothermia

c) application of an ice pack to the area of ​​large vessels

d) wiping the skin with a 40-50% solution of ethyl alcohol

2. In the set of medicines for emergency care for stenosing laryngotracheitis,

a) thermopsis tincture

b) tincture of valerian

c) prednisolone, hydrocortisone

d) vikasol

3. The main antipyretic drug in pediatric practice, used to combat hyperthermic syndrome

a) analgin

b) paracetamol

c) pipolfen

d) baralgin

4. Decisive in emergency care for true croup is the introduction

a) an antibiotic

b) antidiphtheria serum according to Bezredko

c) diphtheria vaccine

d) toxoid

5. For the relief of convulsive syndrome in children, apply

a) dimedrol i / m

b) phenobarbital tablets

c) seduxen tablets

d) seduxen in/m or/in

6. Anaphylactic shock in children most often occurs after administration

a) penicillin

b) insulin

c) iron supplements

d) vitamin B 1

7. When providing emergency care to a child with anaphylactic shock, he should be given

a) horizontal position on the side, cover with heating pads

b) semi-sitting position, impose heating pads

c) position with the lowered head end, apply an ice pack to the head

d) sitting position, apply an ice pack to the head

8. The most effective means for stopping anaphylactic shock in a child

a) adrenaline, prednisolone

b) papaverine, dibazol

c) eufillin, ephedrine

d) lasix, magnesium sulfate

9. When providing emergency care to a child with hyperglycemic (diabetic) coma,

a) insulin

b) penicillin

c) biseptol

d) furagin

10. When providing emergency care to a child with hypoglycemic coma, a solution is used

a) sodium chloride

b) gemodez

c) novocaine

d) glucose

Sample answers

1. a

2. in

3. b

4. b

5. g

6. a

7. a

8. a

9. a

10. g

ORGANIZATION OF THERAPEUTIC AND PREVENTIVE CARE FOR CHILDREN
AT A Feldsher-Obstetrical Point

Organization of the work of a paramedic at the FAP

1. The frequency of prenatal patronage by a paramedic

2. The first prenatal care is carried out by a paramedic at the gestational age before (weeks)

3. The second prenatal patronage is carried out by a paramedic at the gestational age before (weeks)

4. Patronage of a newborn is carried out by a paramedic

a) once a week

b) 2 times a week

c) once a month

d) twice a month

5. Patronage of children aged 1 to 2 years is carried out by a paramedic

a) once a month

b) 1 time in 2 months.

c) 1 time in 3 months.

d) 1 time in 6 months.

6. Healthy children with normal physical and neuropsychic development, who do not have chronic pathology, belong to the health group

7. Children with congenital developmental defects or with chronic pathology in the stage of compensation belong to the health group

8. Children with severe congenital malformations or severe chronic pathology in the stage of decompensation belong to the health group

9. The card of preventive vaccinations is a form

10. A child's developmental history is a form

Sample answers

1. b

2. a

3. g

4. a

5. in

6. a

7. b

8. g

9. in

10. a

Stages and periods of childhood

ANATOMICAL AND PHYSIOLOGICAL FEATURES OF THE ORGANS AND SYSTEMS OF THE CHILD

1. The duration of the period of intrauterine development is (in weeks of pregnancy)

2. The duration of the neonatal period is (in months)

3. The newborn has a physiological

a) hypertonia of the extensor muscles

b) hypertension of the flexor muscles

c) hypotension of the flexor muscles

d) muscle normotonia

4. A large fontanel in a child closes at the age (months)

5. Thoracic kyphosis occurs in a child aged (months)

6. The number of milk teeth in a child of 1 year

7. The sebaceous glands begin to function with age

a) intrauterine

8. The capacity of the bladder in a newborn baby is (in ml)

9. The vocabulary of a one-year-old child is

10. The child recognizes the mother, distinguishes her from other persons from the age

11. The least developed sense organ in a newborn

a) vision

b) touch

12. The child begins to walk with age

b) 11-12 months

c) 13-14 months

d) 15-16 months

14. The number of lymphocytes in an infant is normally (in%)

15. The number of neutrophils in an infant is normally (in%)

16. The thickness of the subcutaneous fat layer at the level of the navel at an early age is

17. Frequent recurrent purulent and fungal diseases, infections of the upper respiratory tract in children are manifestations

a) hypovitaminosis

b) excess nutrition

c) immunodeficiency

d) overheating

18. The change of milk teeth to permanent ends

a) by 3-4 years

b) 5-7 years old

c) 11-12 years old

d) 13-14 years old

Sample answers

1. g	2. a	3. b	4. in	5 B	6. in	7. a	8. a	9. in	10. a
11. a	12. b	13. a	14 g	15. b	16. b	17. in	18. in

NUTRITION FOR A HEALTHY CHILD

1. It is preferable for a child of the first year of life to provide feeding

a) natural (breast)

b) mixed

c) artificial

d) parenteral

2. The advantage of breast milk over cow's

a) high protein content

b) high content of vitamins

c) high calorie content

d) the optimal ratio of nutrients

3. The first attachment to the breast of a healthy full-term newborn is carried out

a) after 2-3 hours

b) immediately after birth

c) after 6-8 hours

d) after 10-12 hours

4. Types of supplementary feeding to an infant

a) adapted mixture

c) vegetable puree

d) cottage cheese

5. Control feeding of the child is carried out to determine

a) body weight

b) the amount of sucked milk

c) the amount of food

d) the amount of supplementary feeding

6. The frequency of feeding a child for 3 months. during the day with artificial feeding

7. The interval for 5 meals a day is (per hour)

8. Meat in the form of a steam cutlet in the child's menu is introduced from age

9. Daily volume of milk for children of the first 10 months. life does not exceed (l)

10. Decreased secretory ability of the mammary glands is called

a) hypogalactia

b) galactorrhea

c) agalactia

d) mastitis

11. Egg yolk is introduced on time (months)

12. Cottage cheese is introduced into the diet of an infant from the age (months)

13. Fruit juices are given to a baby in the first half of the year.

a) before breastfeeding

b) after breastfeeding

c) between breastfeeds

d) overnight

14. Fruit juices and applesauce are introduced into the diet of an infant to provide him

a) proteins

b) fats

15. Egg yolk is given to an infant to provide

a) proteins

b) carbohydrates

c) water soluble vitamins

d) fat soluble vitamins

16. The introduction of a new food that gradually replaces breastfeeding is

a) supplement

b) food

c) artificial feeding

d) mixed feeding

17. Purpose of introducing complementary foods

a) meeting the increased need for nutrients

b) meeting the need for fats

c) providing the need for carbohydrates

d) meeting the need for table salt

18. The first food for a normal weight baby is

a) fruit juice

b) vegetable puree

c) milk porridge

19. Formula supplementation should be given

a) before breastfeeding

b) between breastfeeds

c) after breastfeeding

d) doesn't matter

20. The second food for an infant is

a) fruit juice

b) vegetable puree

c) milk porridge

21. The temperature of the mixture during artificial feeding should be

22. Minced meat is introduced into the diet of an infant at the age (months)

23. The third complementary foods are administered to an infant aged (months)

24. The third food for an infant is

a) fruit juice

b) vegetable puree

a) during the hot season

b) during the cold season

c) in diseases

d) during preventive vaccinations

26. With artificial feeding, women's milk substitutes are used

a) fruit juices

b) vegetable puree

c) fruit puree

d) milk mixtures

27. A sign of underfeeding an infant is

a) slight weight gain

b) frequent urination

c) large stools

d) fever

28. Factors contributing to the act of sucking

a) Bish's lumps, big tongue

b) Bish's lumps, small tongue

c) profuse salivation, large tongue

d) profuse salivation, small tongue

29. The capacity of the stomach in a newborn is (in ml)

30. The tendency of children to spit up is due to

a) poor development of the cardiac sphincter

b) good development of the cardiac sphincter

c) poor development of the pyloric sphincter

d) good development of the pyloric sphincter

31. With natural feeding, the intestines of the child are dominated by

a) bifidobacteria

b) Escherichia coli

c) lactobacilli

d) enterococci

32. With artificial feeding in the intestines of a child, the following prevail:

a) bifidobacteria, lactobacilli

b) Escherichia coli, enterococci

c) staphylococci, pneumococci

d) Proteus, Pseudomonas aeruginosa

a) fluid restriction

b) protein restriction

c) fluid intake 20 minutes before feeding

d) taking spices 20 minutes before feeding

34. Indication for the transfer of a child to artificial feeding

a) spontaneous leakage of milk

b) lack of milk

c) Difficulty in milk production

d) fast flow of milk

35. Indication for the introduction of supplementary feeding to a child

a) hypogalactia

b) paratrophy

c) vomiting

d) dysphagia

36. Sweet adapted mixtures include

a) "Bona"

b) Narine

c) 2/3 cow's milk

d) whole kefir

37. Complementary foods begin to be given to the child

a) before breastfeeding

b) after breastfeeding

c) completely replacing one breastfeeding

d) between breastfeeds

38. The purpose of supplementing a child is to ensure

a) lack of nutrients

b) increase the intake of salt

c) reduce the intake of salt

d) increase fat intake

Sample answers

1. a	2. g	3. b	4. a	5 B	6. a	7. b	8. a	9. b	10. a
11. in	12. in	13. b	14. in	15. g	16. b	17. a	18. b	19. in
20. in	21. g	22. a	23. g	24. g	25. b	26. g	27. a	28. a	29. a
30. a	31. a	32. b	33. in	34. b	35. a	36. a	37. a	38. a

NEWBORN AND CARE

1. A full-term child is considered to be born at the gestational age (in weeks)

2. The average body weight of a full-term newborn is (in g)

3. The average body length of a full-term newborn is (in cm)

4. The umbilical cord falls off in a newborn at term (day of life)

5. For the prevention of ophthalmic rhea, a solution is used

a) furatsilina

b) sodium chloride

c) sodium sulfacyl

d) polyglucin

6. The initial weight loss of the newborn is observed in the first (days of life)

7. Physiological weight loss of a newborn is up to (in %)

8. The duration of physiological erythema in a newborn is (days)

9. Sexual crisis in a newborn is manifested:

a) an increase in body temperature

b) weight gain

c) breast enlargement

d) decrease in body temperature

10. Manifestations of a sexual crisis in a newborn disappear after

a) 2-3 days

b) 1–2 weeks

c) 5–6 days

d) 5–6 weeks

11. Physiological jaundice in a full-term newborn disappears at term (days of life)

12. The air temperature in the neonatal ward should be (in deg. C.)

13. To prevent diaper rash, the folds of the skin of a newborn are treated

a) sterile vegetable oil

b) saline

c) a solution of furacilin

d) polyglucin solution

14. The umbilical cord residue in a newborn is treated daily with a solution

a) 70% ethyl alcohol, 5% potassium permanganate

b) 70% ethyl alcohol, 5% iodine

c) 90% ethyl alcohol, 3% potassium permanganate

d) 90% ethyl alcohol, 3% iodine

15. The umbilical wound in a newborn is treated with a solution:

a) 2% sodium bicarbonate

b) 3% hydrogen peroxide

d) 5% sodium chloride

16. To cleanse the nasal passages of a newborn, use

a) dry cotton flagella

b) dry cotton flagella lubricated with sterile oil

c) cotton balls

d) gauze balls

17. To clean the external auditory canals in young children, use

a) dry cotton flagella

b) flagella lubricated with sterile oil

c) cotton balls

d) gauze balls

18. The oral cavity of a healthy newborn is treated

a) cotton ball

b) cotton-gauze ball

c) gauze ball

d) not processed

19. The water temperature for a hygienic bath for a newborn is

a) 25 degrees C

b) 30 degrees C

c) 37 degrees C

d) 40 degrees C

20. The duration of a hygienic bath for a newborn is (in minutes)

Sample answers

1. g	2. in	3. in	4. in	5. in	6. b	7. a	8. a	9. in	10. b
11. in	12. in	13. a	14. a	15. b	16. b	17. a	18. g	19. in	20. b

DISEASES OF CHILDHOOD

Diseases of young children

PREMATURE CHILDREN

1. Premature is a baby at gestational age (week)

2. Gestational period for first-degree prematurity (weeks)

d) less than 29

3. A premature newborn has

a) loud cry

b) muscle hypertonicity

c) muscle hypotension

d) spontaneous motor activity

4. Edema of the subcutaneous tissue in premature babies is

a) lanugo

b) stridor

c) sclerema

5. Most common entry gate in neonatal sepsis

a) nasopharynx

b) conjunctiva

c) digestive tract

d) umbilical wound

6. Nuclear jaundice in a newborn is due to high levels in the blood

b) bilirubin

c) glucose

d) cholesterol

7. Infectious skin disease of the newborn

a) prickly heat

b) pemphigus

c) mischief

d) erythema

8. Criteria for switching a preterm infant from tube feeding to bottle feeding

a) the appearance of a sucking reflex

b) weight gain

c) an increase in Bish's lumps

d) disappearance of physiological dyspepsia

9. The ideal food for premature babies is

b) "Narine"

c) whole kefir

d) breast milk

10. For the treatment and care of weeping diaper rash, it is recommended

a) treatment with 2% iodine solution

b) lotions with 0.5-1% resorcinol solution

c) 2% solution of brilliant green

d) 5% potassium permanganate solution

ASPHYXIA OF NEWBORN

11. Asphyxia of a newborn of mild degree is characterized by the Apgar scale (in points)

12. Common causes of fetal hypoxia

a) anemia in pregnancy

b) previous abortions

c) errors in the diet of a pregnant woman

d) mechanical injury

13. The first stage of resuscitation in case of asphyxia of the newborn

a) artificial lung ventilation

b) closed heart massage

c) correction of metabolic disorders

d) restoration of airway patency

14. The second stage of resuscitation in case of asphyxia of the newborn

a) restore airway patency

b) restoration of external respiration

c) correction of hemodynamic disorders

d) correction of metabolic disorders

BIRTH INJURIES

15. The main cause of birth injury of the central nervous system in children

a) hypoxia

b) hypercapnia

c) hypoproteinemia

d) hyperglycemia

16. Directly to the occurrence of birth trauma in children leads

a) discrepancy between the size of the fetal head and the mother's pelvis

b) chromosomal disorder

c) violation of protein metabolism

d) hyperglycemia

17. External cephalohematoma is a hemorrhage

a) in the soft tissues of the head

b) above the dura mater

c) under the dura mater

d) under the periosteum

18. To reduce cerebral edema in case of birth injuries of the central nervous system, use

a) heparin

b) polyglucin

c) furosemide

d) prednisolone

19. To maintain cardiac activity in a child with a birth injury of the central nervous system,

a) hypothiazide

b) glucose

c) prednisone

CHRONIC DISORDERS OF NUTRITION IN CHILDREN OF EARLY AGE (Zaitseva G.I., Aleksandrova N.I., 1981)

Criteria for the diagnosis of malnutrition

Hypotrophy I st.

1. Weight deficit from 10 to 20%.
2. The weight curve is flattened.
3. The length of the body corresponds to the age.
4. The Chulitskaya index (3 shoulder circumferences + thigh circumference + lower leg circumference - body length) is 15-10.
5. The skin is pale, tissue turgor is flabby, the subcutaneous fat layer on the abdomen is reduced.
6. Appetite is preserved, food tolerance is not impaired.

Hypotrophy II st.

1. Weight deficit from 21 to 30%.
2. Lagging body length by 2-3 cm.
3. The Chulitskaya index is 10-8.
4. The skin is pale, paraorbital cyanosis, the skin is dry, easily folds, hanging down.
5. The subcutaneous fat layer on the abdomen is absent, reduced on the limbs, preserved on the face.
6. Muscular hypotension.
7. Osteoporosis, osteomalacia as a consequence of exacerbation of rickets.
8. Instability of body temperature, temperature fluctuation during the day is ± 1.
9. Decreased immune defense (often - otitis media, respiratory infections, pneumonia, unstable stools).
10. Decreased appetite and food tolerance.
11. Decreased enzymatic activity of gastric, pancreatic, intestinal juices.
12. Hypoproteinemia, hypocholesterolemia.

Hypotrophy III Art.

1. Weight deficit by 31% or more.
2. Wrong weight curve type.
3. Body length lag more than 3 cm.
4. The Chulitskaya index is 8-6.
5. There is no subcutaneous fat layer (“skeleton covered with skin”).
6. The skin is pale dry, marble pattern, the folds do not straighten out.
7. Jaws, sunken eye sockets are contoured.
8. Often - thrush, stomatitis, flatulence.
9. Muscular hypotension, polyhypovitaminosis.
10. Osteoporosis, osteomalacia.
11. Subfebrile body temperature.
12. Anemia.
13. Deafness of heart tones, tachycardia, systolic murmur.
14. Decrease or disappearance of static and motor skills.
15. A sharp drop in immune protection, the addition of a secondary infection.
16. Tolerance to food is sharply reduced, there is no appetite.
17. The transition from life to death is almost imperceptible (“the patient dies like a dying candle”).

CONSTITUTIONAL ANOMALIES IN CHILDREN

Definition of the concept of “constitution” (a set of geno- and phenotypic properties and characteristics of an organism that determine the possibility of its protective and adaptive reactions aimed at maintaining homeostasis during changes in the external environment).
Diathesis (anomalies of the constitution) is a feature of the reactivity of the body, characterized by peculiar inadequate reactions to common stimuli and a predisposition to certain pathological processes and diseases.
Allocate:

1. Exudative-catarrhal (allergic),
2. lymphatic-hypoplastic,
3. neuro-arrhythmic diathesis.

Diagnostic criteria for exudative catarrhal diathesis

1. allergic predisposition.
2. Tendency to recurrent catarrhal processes of the skin and mucous membranes of the respiratory tract, gastrointestinal tract, eyes, genitals.
3. Violations of neuroendocrine adaptation, 2 forms:
4. Immune, when clinical manifestations are the result of an immune reaction of varying degrees according to the "antigen-antibody" type.
5. Non-immune, due to the level of histamine, serotonin and similar substances in the blood.

Pathogenetic classification of exudative-catarrhal diathesis(Malakhovsky Yu.V., 1979)

Genetically determined exudative-catarrhal diathesis
I option:

1. Inherited dysgammaglobulinemia in the form of a high level of IgE (reagins).
2. Violation of microcirculation, cell proliferation under the influence of reagins.
3. Unfavorable family history: atopic bronchial asthma, eczema, neurodermatitis, polyvalent allergy.
4. Transformation of skin changes into neurodermatitis, childhood eczema.
5. Sharp sensitivity of the child's skin to derivatives of the dermis of animals (woolen fabrics, dandruff, animal hair, feather bed, down pillows).
6. Skin reaction to sharp sounds (due to closely located nerve receptors in the skin, vasoconstriction).

II option (transient):

1. It occurs in 85% of cases, due to the late maturation of the proteolytic enzyme systems of the gastrointestinal tract.
2. Deficiency of secretory IgA.
3. Often food allergies.
4. The intensity of allergic reactions decreases by the age of 2.

Non-immune forms of exudative-catarrhal diathesis

1. liberal option:
2. The activation of histamine and biologically active substances occurs with the help of liberators, the role of which is performed by obligate food allergens.
3. Allergic reactions proceed according to the immediate type in the form of acute or recurrent urticaria, Quincke's edema, bronchospasm.

II. Histamine variant:
In the blood, low activity of histaminase, low histamine-pectic activity of blood, low titers of lysozyme, complement, low activity of phagocytes.
Separate forms:

1. Mostly skin: allergic constitutional dermatitis (persistent diaper rash, gluteal erythema, milk scab, gneiss), limited and disseminated childhood eczema, neurodermatitis of infancy.

Severity			The nature of the flow
Light (1st.) Moderate (II degree) Heavy (III degree)	Elementary Razgar Reconvalescence Residual effects		Acute Subacute Recurrent
Acute (in the form of neurotoxicosis or toxicosis with dehydration I-II stage) Chronic		nervous Gastrointestinal renal Cardiovascular		Clinical manifestations Residual phenomena

1. Combined - dermorespiratory syndrome, dermointestinal syndrome, dermomucosal syndrome.

The phases can be divided into latent, manifest and recurrent forms.

CLASSIFICATION OF RICKITIS (Dulitsky S.O., 1947)

For each degree of severity, all periods of rickets are characteristic.
Diagnostic criteria
I degree:

1. It can be observed in the neonatal period, but more often at 2-3 months of life.
2. Changes in the nervous system: anxiety, shuddering, sleep disturbance.
3. The duration of the initial period is 2-3 weeks, without therapy it goes into the peak period.
4. In acute course, softening of the bone tissue appears, in subacute - osteomalacia (growth of osteoid tissue).
5. The level of calcium remains within the normal range, excretion of ammonia and phosphates in the urine does not increase.

II degree:

1. Changes in the nervous system persist.
2. Involvement in the process of bone tissue with irreversible changes (rosary beads, bracelets, tubercles).
3. Violation of the general well-being of the child.
4. Involvement in the pathological process of the respiratory system, the cardiovascular system.
5. development of anemia.
6. Muscular hypotension.

III degree:

1. Sharp violations of the nervous system - lethargy, loss of motor skills that he previously owned.
2. Sharp bone deformity, changes in the internal organs - cardiovascular, respiratory systems, gastrointestinal tract.
3. Anemia.
4. Dystrophy.

Flow:

Acute - more often in the first half of life, especially in children born with a large weight. The initial period quickly passes into the peak period. The softening of the bones is quickly replaced by the growth of osteoid tissue.
Subacute - slow onset of symptoms. The proliferation of osteoid tissue predominates. Associated with malnutrition. Against the background of intercurrent diseases, it quickly passes into an acute course.
Recurrent - most often due to improper treatment of rickets. The period of exacerbation and improvement replace each other. Common in premature babies.
Laboratory Criteria:

1. In the general analysis of blood - hypochromic anemia of varying severity.
2. In the biochemical analysis of blood - an increase in alkaline phosphatase, hypophosphatemia, hypocalcemia.

Changes increase in parallel with the severity of rickets.

Criteria for the diagnosis of hypervitaminosis D

Hypervitaminosis D is a disease caused by the toxic effect of vitamin D, characterized by intoxication of varying degrees, damage to a number of organs and systems, and the development of hypercalcemia.
In the diagnosis, several leading clinical syndromes and laboratory changes are distinguished.

1. Clinical criteria for diagnosis:
2. Syndrome of toxicosis.

Toxicosis I degree - loss of appetite, irritability, sleep disturbance, delayed weight gain, subfebrile temperature.
Toxicosis II degree - pallor of the skin, vomiting, weight loss, functional disorders of the internal organs and systems.
Toxicosis III degree - anorexia, persistent vomiting, dehydration, significant weight loss, complications in the form of pneumonia, pyelonephritis, myocarditis, pancreatitis.

1. Syndrome of functional disorders of the nervous system.

Lethargy, apathy, alternating with anxiety, irritability,
drowsiness, sleep disturbance, sweating, hyperesthesia, meningism, encephalitic reactions, depression of consciousness, convulsions.

1. Cardiovascular syndrome.

Tachycardia, muffled heart sounds, systolic murmur, cyanosis, shortness of breath, liver enlargement, slight edema. ECG changes - expansion of the QRS complex, lengthening of PQ, flattening of the T wave, biphasic in lead V-4.

1. Gastrointestinal syndrome.

Decreased appetite up to anorexia, vomiting, persistent constipation, much less often - loose stools. Enlargement of the liver and spleen.

1. renal syndrome.

Dysuric phenomena, polyuria, oliguria is possible up to anuria, azotemia.

1. Changes in the skeletal system.

Consolidation of the bones of the skull, early overgrowth of the large fontanel, craniostenosis.
II. Laboratory Criteria:

1. Leukocytosis, increased ESR.
2. Biochemical changes: hypercalcemia, hypophosphatemia, hypomagnesemia, hypokalemia; an increase in the content of citrates and cholesterol; metabolic acidosis. In the urine - an increase in calcium (Sulkovich's test is sharply positive). Feces contain neutral fat.

Diagnosis example: Hypervitaminosis D, gastrointestinal form; period of clinical manifestations, chronic course.
Classification of hypervitaminosis D (Papayan A.V., Plyaskova L.M., 1976)

DIAGNOSIS CRITERIA FOR SPASMOPHILIA

Spasmophilia is a disease caused by a violation of mineral metabolism, hypofunction of the parathyroid glands, manifested by increased excitability of the neuromuscular apparatus with the development of clonic-tonic convulsions.
In diagnosis, the main place is given to a correctly collected anamnesis, analysis of clinical and laboratory data.

1. Anamnestic data.

From the data of the anamnesis, improper artificial feeding, abuse of cow's milk, cereal and flour dishes, little exposure to fresh air, lack of prevention of rickets are revealed.
II. Clinical signs.
Spasmophilia always develops in children with rickets. As a rule, both rickets and spasmophilia affect children up to 2-3 years of age.
Clinically allocate latent and overt spasmophilia.

1. Symptoms of latent spasmophilia indicate increased neuromuscular excitability.

Symptoms of latent spasmophilia:
a) Khvostek's symptom - a symptom of the facial nerve, tapping at the exit site of the facial nerve causes convulsive contraction of the mimic muscles of the face;
b) Weiss symptom - irritation of the exit site of the trigeminal nerve (rough irritation at the external auditory canal) causes a contraction of the facial muscles;
c) Trousseau's symptom - compression of the neurovascular bundle on the shoulder causes convulsive contraction of the muscles of the hand - "obstetrician's hand";
d) Lust's symptom - a peronial symptom, tapping below the head of the fibula causes dorsiflexion and dilution of the toes;
e) Maslov's symptom - an injection in the heel causes breathing to stop instead of speeding it up (breathing is recorded on a pneumograph);
f) Erb's symptom - the short circuit of the cathode on the muscle causes its convulsive contraction at a current strength of less than 5 mA.

1. Symptoms of explicit spasmophilia:

a) laryngospasm - convulsive spasm of the glottis during inhalation, accompanied by a "cock's cry" and the development of an attack of cyanosis;
b) carpo-pedal spasm - tonic convulsions of the muscles of the extremities;
c) general clonic convulsions of the muscles of the body, mimic muscles of the face (epileptiform convulsions) with loss of consciousness;
d) expiratory apnea - cessation of breathing on exhalation with the development of an attack of general cyanosis.
Perhaps convulsive contraction of the heart muscle, leading to the death of the child.

1. Laboratory diagnostics.
2. Hypocalcemia (up to 1.2-1.5 mmol/L), the amount of inorganic phosphorus is relatively increased.

- an increase in the numerator or a decrease in the denominator in the Gyorgy formula.

1. Some children have alkalosis.

Differential diagnosis is carried out with hyperthermic convulsions, complicated by pneumonia, meningitis, viral diseases, epilepsy.
Diagnosis example: Spasmophilia is obvious, carpo-pedal spasm.
Spasmophilia classification (1946)

1. Latent form (symptoms of Khvostek, Trousseau, Erb).

II. Explicit form (laryngospasm, carpo-pedal spasm, general convulsions).

Sepsis in young children

Criteria for the diagnosis of sepsis in young children
Sepsis is a common infectious disease with the presence of foci of purulent infection and intoxication, occurring against the background of a reduced reactivity of the body (transient or genetic immunodeficiency).
When diagnosing sepsis in children, it is important to identify microsymptoms of infection (in the antenatal, intranatal and post-anal period), maternal diseases, genital pathology, violations of the birth act (long anhydrous period, etc.).
Diagnostic criteria

1. Clinical signs.
2. Severe general symptoms of the disease:

a) intoxication - pale gray or dirty icteric skin tone, adynamia, muscle hypotension, sluggish sucking or refusal of the breast, weight loss, dysfunction of the gastrointestinal tract;
b) disorder of microcirculation and development of hemorrhagic syndrome (possible small petechiae or bleeding);
c) fever (the range between morning and evening temperatures is more than
1C;
d) enlarged lymph nodes, possible enlargement of the liver and spleen;
e) tachycardia, muffled heart sounds.

1. The presence of several foci of infection with the same type of pathogen, sequentially arising and having a hematogenous origin.

II. laboratory signs.

1. Hematological:

a) leukocytosis, neutrophilia with a shift to the left and toxic granularity of neutrophils;
b) anemia (sometimes late) - a decrease in the amount of hemoglobin and the number of red blood cells;
c) increased ESR.

1. Bacteriological - isolation of positive blood culture at least 2 times with seeding of the same type of flora.
2. Serological - agglutination reaction (increase in antibody titer by 3-4 times or more). The titer of staphylolysins is above 1:100.
3. Immunological - hypogammaglobulinemia, lack of IgA, decreased IgG synthesis, decreased nonspecific immunity.

The clinical picture depends on the general and focal symptoms and is determined by two forms - septicemia and septicopyemia. The diagnosis is made taking into account the manifestation of the disease, the duration of the course and severity, if possible, the removal of the etiology.
Differential diagnosis is carried out depending on the clinical manifestations with a small staphylococcal infection, leukemia, hemolytic disease, toxoplasmosis, galactosemia.

Diagnosis example: Primary sepsis (staphylococcal), septicopyemia (osteomyelitis of the right thigh, purulent otitis media, bilateral abscess pneumonia). Acute course. Height period.

PROJECT FOR THE CLASSIFICATION OF SEPSIS IN INFANT CHILDREN (Vorobiev A.S., Orlova I.V., 1979)

Genesis	Etiology	Entrance gates	Form of the disease		Period of illness
Primary Secondary (due to immunodeficiency)	Staphylococcus Streptococcus E. coli Blue-green pus stick Mixed Other infectious factors	umbilical wound Leather Lungs Digestive tract Middle ear Cryptogenic sepsis	Septicemic Septicopyemic (specify all lesions)	Acute Subacute lingering Lightning	Elementary Razgar Repair Dystrophic