home Audience 6 Hypotrophy 1 tbsp. Chronic eating disorders in young children. Therapeutic measures for malnutrition

Hypotrophy 1 tbsp. Chronic eating disorders in young children. Therapeutic measures for malnutrition

Word of Greek origin; "hypo" - "below, under" and "trophe" - "food". Hypotrophy is a chronic eating disorder. The basis of the disease is the depletion of the body. This term is used only in relation to the child of the first years of life. From this article you will learn what degrees of malnutrition exist in children. We will also tell you all about the causes of malnutrition in children, the treatment of malnutrition in a child and the preventive measures that you can take to protect your baby from the disease.

Causes of malnutrition in children

Hypotrophy is a chronic eating disorder, accompanied by a violation of the trophic function of the body, digestion, metabolism, dysfunction of various organs and systems with a delay in physical, motor-static and neuropsychic development.

There are congenital malnutrition or prenatal, in the development of which factors that act unfavorably during uterine development play a role, and acquired malnutrition (postnatal), which develops in children born with normal weight and body length. This form of malnutrition in infants and young children can develop as a result of exposure to a number of adverse factors.

Etiology of malnutrition

There are three main factors: alimentary, infectious, constitutional.

Alimentary factor in the development of dystrophy, it can manifest itself as quantitative or qualitative starvation, defects in the organization of the child's nutrition.

Quantitative fasting, as the name itself shows, there is a condition when the child receives insufficient breathing volume and the energy value of food. At present, in children of the first months of life, malnutrition can develop due to hypogalactia, with difficulties in breastfeeding the mother (“tight” breast of the mother, flat and inverted nipple), sluggish sucking, errors in feeding technique, with an early transfer of the child, artificial feeding, due to untimely introduction of complementary foods, "habitual" regurgitation and vomiting.

Quality fasting occurs when an incorrect ratio of individual ingredients (proteins, fats and carbohydrates) is observed in the child’s food, due to the inferiority of the qualitative composition of breast milk, monotonous feeding with the introduction of complementary foods (especially cereals), with a deficiency of proteins and fats, a deficiency of vitamins and minerals (untimely and insufficient introduction of vegetable and fruit juices, vegetable complementary foods).

In recent years, toxic factors have been important in the etiology of malnutrition - these are food contamination with salts of heavy metals (lead, arsenic), pesticides that react with sulfhydryl groups of protein molecules, inhibit protein synthesis, and cause inhibition of enzymatic activity. Toxic factors cause variants of dystrophy with primary metabolic disorders in the cell. Hypotrophy can be caused by hypervitaminosis A and D.

infectious factor- acute and chronic gastrointestinal infections (salmonellosis, coli infection, dysentery, etc.), chronic infections (tuberculosis, syphilis, dysentery), frequent acute respiratory viral infections, pyelonephritis and urinary tract infection, HIV infection. In infections, toxins, metabolic products lead to a violation of intracellular metabolism, the development of hypovitaminosis (qualitative starvation also occurs), and a decrease in appetite (quantitative starvation also appears).

constitutional factor in the etiology of malnutrition, these are congenital anomalies of the gastrointestinal tract, congenital heart defects, immunodeficiency states, enzymopathies (a group of diseases caused by hereditary metabolic defects), diseases of the endocrine system, perinatal encephalopathies of various origins. Congenital anomalies of the gastrointestinal tract include: dolichosigma, Hirschsprung's disease, atresia of the bile ducts, pylorospasm, congenital defects: splitting of the hard palate, non-closure of the upper lip. Diseases of the endocrine system include adrenogenital syndrome, hypothyroidism, diabetes mellitus, pituitary dwarfism.

With constitutional factors in the development of malnutrition, insufficient digestion of food is observed in terms of both quantity and quality due to a violation of the functional properties of body cells.

At present, malnutrition at birth as a manifestation of intrauterine growth retardation is of independent importance in the etiology of malnutrition.

Hypotrophy pathogenesis

A lack of food or a qualitative change in it leads to a disruption in the processes of assimilation (intracavitary hydrolysis, membrane digestion and absorption are disturbed), to a distortion of enzymatic reactions, to malnutrition of vital organs, and above all the central nervous system. Due to dysfunction of the central nervous system, dysfunction of the subcortical areas of the brain occurs, which leads to aggravation of trophic disorders. Thus, the main pathogenetic link of malnutrition is intracellular starvation. With insufficient nutrition, the body begins to use its depots to maintain the basal metabolism and the specific dynamic action of food. First of all, the glycogen depot begins to be utilized, however, it is restored by switching to the consumption of energy fat, therefore, first of all, a decrease in fat depot is observed. With a longer exposure to a harmful factor on the body, the fat depot is used up and glycogen cannot be replenished in the absence of fat, the glycogen depot gradually decreases, and then the body begins to use its own proteins. With a protein deficiency in the child's diet, there is an increase in protein-energy deficiency, growth retardation due to a decrease in the synthesis of liver somatomedins, aggravation of enzyme disorders and damage to immunological mechanisms, aggravation of weight loss, atrophic processes.

With protein deficiency, atrophy of the thymus and lymphoid tissue, a decrease in the number of T-lymphocytes, a violation of the bactericidal and phagocytic function of neutrophils are observed. The content of immunoglobulins in blood serum decreases, especially IgM and IgA. Violation of cellular, weakening of humoral immunity cause a high frequency and severe course of bacterial and other infections in patients with malnutrition, the development of septic and toxic-septic conditions in them. Simultaneously with the consumption of glycogen and protein depot, the body gradually utilizes the vitamin depot, which leads to the development of hypo- or beriberi.

With the consumption of endogenous proteins, a violation of the functions of the endocrine glands occurs: a decrease in the function of the thyroid gland (decrease in the level of basal metabolism), the pituitary gland (growth disturbance), and the insular apparatus of the pancreas. As a result of metabolic shifts, the acid-base balance is disturbed, metabolic acidosis and endogenous toxicosis develop.

Under conditions of violation of enzymatic processes in the body, a decrease in the activity of many enzymes in the blood and cells, tissues, lipid peroxidation is enhanced. Lipid peroxides have a toxic effect on the body of a sick child, damage the membranes of cells and their organelles. As a result, destabilization of cell membranes develops, their barrier function worsens, a change in the constancy of the internal environment of the body enhances the dysfunction of organs and systems. In most children with malnutrition, there is a violation of the intestinal biocenosis, most often caused by Proteus microbes, Klebsiella and their associations with hemolytic Escherichia coli, fungi of the genus Candida.

Causes of malnutrition in a newborn

Among the reasons are improper feeding, especially in infants of the first six months of life, poor-quality care for them, constant violations of the daily routine or lack of a daily routine as such, frequent illnesses of the baby (acute infectious diseases, chronic infections, acute gastrointestinal diseases, etc.). P.)

Among the causes in the first place are infectious and nutritional factors, then anomalies of the gastrointestinal tract, hereditary metabolic disorders.

The cause of malnutrition in a child: congenital factors

Hypotrophy in little girls and boys can be congenital (intrauterine), due to the impact on the fetus of various factors, accompanied by circulatory disorders in the placenta, intrauterine infection of the fetus:

diseases and occupational hazards in the mother during pregnancy,
gestosis and toxicosis,
malnutrition,
smoking and alcohol consumption during pregnancy,
mother's age is over 35 and under 20 years old.

Cause of malnutrition in a child: feeding

When breastfeeding, the most common cause is malnutrition, due to a lack of milk from the mother or due to sluggish suckling at the breast. The reason for the development of malnutrition during artificial feeding may be a violation of the balance of nutrition in terms of calorie content or chemical composition of food. For example, with one-sided milk feeding (kefir, milk), the baby receives an excess of proteins and salts and a lack of carbohydrates. At the same time, the baby is constipated, the stool becomes clay and fetid. The predominant feeding of children with cereals in diluted milk causes the so-called mealy eating disorder associated with an excess of carbohydrates and a lack of proteins and salts (the stool becomes liquid).

With the disease, the function of the digestive organs decreases, changes occur in protein, fat, carbohydrate, water-salt and vitamin metabolism, anemia develops, immunity changes and various infections accumulate.

The reason why hypotrophy occurs in a child:

Sometimes muscle hypotrophy occurs in healthy babies who lead a sedentary lifestyle, with limited mobility in the postoperative period or severe somatic pathology.
Muscle atrophy accompanies flaccid paralysis, in particular, arising from the paralytic form of poliomyelitis. The causes of muscle atrophy lie in hereditary degenerative diseases of the muscular system, chronic infections, metabolic disorders, disorders of the trophic functions of the nervous system, prolonged use of glucocorticoids, etc. Local muscle atrophy can form with prolonged immobility associated with diseases of the joints, damage to tendons, nerves, or the muscles themselves.

There are three degrees of malnutrition - I, II, III.

Hypotrophy of the 1st degree in babies is marked by a lag in weight of no more than 20%; there is no lag in growth. The subcutaneous fat layer is preserved everywhere, however, it is somewhat thinned on the trunk and limbs. The elasticity of the skin is slightly lower than that of a healthy baby. The skin and visible mucous membranes may be slightly pale. The general condition does not suffer.

Hypotrophy of the 2nd degree in children there is a lag in weight from 20 to 40%; there is also a lag in growth - up to 3 cm. The skin is dry, inelastic, easily gathers into thin folds, and these folds are poorly straightened. The subcutaneous fat layer is largely thinned on the trunk, buttocks and limbs. Weight loss becomes noticeable on the face. Muscles also become thinner, their tone is disturbed. If the baby had any motor skills by this time, they may disappear. Appetite can be sharply reduced or, conversely, very well expressed.

A child with III degree hypertrophy is characterized by a very significant lag in weight - by 40% and more; also significantly stunted. The subcutaneous fat layer in the baby is absent everywhere, this layer is also absent on the face, which is why the latter takes on the appearance of an senile face - the eyes sink (because the fat in the eye sockets disappears), wrinkles form on the forehead and cheeks, cheekbones stand out, the chin is sharpened, resulting in a face takes on a triangular shape. Often you can see the expression of suffering on the face.

Clinical signs of malnutrition: the baby's skin completely loses elasticity, becomes dry, flaky; over time, trophic disorders appear on the skin - ulcers form on the back of the head, buttocks and in other places. On the trunk and limbs the skin hangs in folds. The muscular system also undergoes significant changes: the muscles become thin and flabby, however, their tone is increased. The tummy can be sharply swollen due to intestinal atony and flatulence, or, on the contrary, drawn in.

Hypotrophy treatment

The treatment is complex. Very important: high-quality care for the baby by the mother, strict observance of the daily routine, proper nutrition, appropriate for age, proper upbringing. It is necessary to eliminate the factor and cause that led to the disease as soon as possible. If necessary, therapy is carried out to increase appetite. Of great importance is the speedy restoration of the normal functioning of all organs and systems. In some cases, the doctor resorts to stimulation therapy. If malnutrition in a baby arose due to improper feeding, due to serious violations of the rules for the introduction of complementary foods, due to monotonous nutrition, the doctor makes adjustments to baby food.

Caring for a child during treatment for malnutrition

Patients with hypotrophy of the first degree are treated at home under the supervision of a district pediatrician without changing the usual regimen corresponding to their age.

Treatment of malnutrition in children of II and III degrees is carried out in a hospital with a mandatory organization of a sparing regimen: the child should be protected from all unnecessary stimuli (light, sound, etc.) It is desirable to keep the child in a box with the creation of an optimal microclimate (air temperature 27-30 ° C , humidity 60-70%, frequent airing); the mother is hospitalized with the child. During walks, the child should be held in his arms, make sure that the hands and feet are warm (using heating pads, socks, mittens). An increase in emotional tone should be achieved by gentle treatment of the patient, the use of massage and gymnastics. With malnutrition of the III degree, especially with muscle hypertonicity, massage is carried out with great care and only stroking.

Diet for malnutrition in children

Diet is the basis of rational treatment of dystrophy (primarily malnutrition). Diet therapy for the treatment of malnutrition can be divided into two stages:

clarification of the tolerance of various foods;
a gradual increase in the volume of food and correction of its quality until the physiological age norm is reached.

The first stage lasts from 3-4 to 10-12 days, the second - until recovery.

"Rejuvenation" of the diet - the use of food products intended for boys and girls of younger age (breast milk, sour-milk adapted mixtures based on protein hydrolysates);
Fractional nutrition - frequent feeding (for example, up to 10 times a day for grade III disease) with a decrease in the amount of food at one time;
Weekly calculation of the food load by the amount of proteins, fats and carbohydrates with correction in accordance with the increase in body weight;
Regular monitoring of the correctness of treatment (keeping a food diary indicating the amount of food, fluids drunk, diuresis and stool characteristics; compiling a "weight curve", scatological examination, etc.)

How is malnutrition treated in children using nutrition calculation?

The calculation of nutrition for malnutrition of the I degree is performed for the proper (age-appropriate) body weight of the child with full satisfaction of his needs for the main components of food, trace elements and vitamins. In case of disease II and III degrees in the first 2-3 days, the volume of food is limited to 1/3 - 1/2 for the required body weight. Subsequently, it is gradually increased to 2/3 - 3/5 of the daily diet of a healthy child. The missing amount of nutrition is replenished with liquid - vegetable and fruit juices, 5% glucose solution. Upon reaching the age-appropriate amount of food, the amount of proteins and carbohydrates is calculated for the required body weight, and fats for the actual one. If the child does not have dyspepsia in the process of increasing the amount of food, and the body weight increases (usually this happens after 1-12 days from the start of treatment), a qualitative correction of nutrition is gradually carried out, all ingredients are calculated on the proper body weight (proteins and fats - 44.5 g/kg, carbohydrates - 1316 g/kg).

Enzyme therapy for the treatment of malnutrition in a child

Enzymes must be prescribed for any degree of the disease, both due to an increase in the nutritional load during treatment, and in connection with a decrease in the activity of the patient's own gastrointestinal enzymes. Enzyme therapy is carried out for a long time, changing drugs: rennet (abomin), pancreatin + bile components + hemicellulase (festal), with a large amount of neutral fat and fatty acids in the coprogram - pancreatin, panzinorm. The use of vitamins, primarily ascorbic acid, pyridoxine and thiamine, is also pathogenetically justified. Stimulant therapy includes alternating courses of royal jelly (apilac), pentoxyl, ginseng and other agents. With the development of an infectious disease, Ig is injected.

Prevention of malnutrition

It is easier to prevent the causes of malnutrition than to treat it later. The preventive measures are as follows:

organization of proper child care;
strict observance of the diet;
timely and sufficient intake of vitamins;
hardening procedures (hardening with air, sunlight and water);
proper upbringing of the baby (provides a positive emotional state);
also ensures the restoration and development of the necessary conditioned reflexes);
prevention of infectious diseases.

Prevention of malnutrition should be divided into antenatal and postnatal.

Antenatal prevention includes family planning, health education of parents, the fight against abortion, treatment of diseases of the expectant mother, especially diseases of the genital area, health care of the pregnant woman [rational nutrition, adherence to the daily routine, walks in the fresh air, transfer to light work (under adverse working conditions) , exclusion of smoking and other bad habits].
Postnatal prevention of malnutrition includes natural feeding with its timely correction, compliance with the regimen and rules for caring for the child, proper education, prevention and treatment of infectious and intercurrent diseases, dispensary observation with monthly (up to 1 year) weighing and measuring body length.

Treatment prognosis malnutrition depends primarily on the possibility of eliminating the cause that led to the development of dystrophy, as well as on the presence of concomitant diseases. With primary alimentary and alimentary-infectious dystrophy, the prognosis is quite favorable.

Nutrition for children with malnutrition

The basis of treatment for all forms of malnutrition is the organization of proper nutrition. The complexity of nutrition lies in the fact that their need for essential nutrients and calories is increased, and food tolerance, especially to fats, is reduced. Therefore, the success of treatment depends on an individual approach to each sick child.

Nutrition in the treatment of malnutrition I degree

The first feeding for full-term infants with congenital malnutrition of the 1st degree should be carried out immediately in the delivery room, for premature infants, depending on the degree of prematurity, no later than 12 hours after birth. In between feedings, be sure to give your baby 5% glucose (1/4 of the total amount of food).

The volume of breast milk per feeding for newborns and premature infants with disease of the I degree is 10 ml on the first day, 15-20 ml on the 2nd, 20-30 ml on the 3rd, 5-7th days - 50-90 ml.

Nutrition during the treatment of malnutrition II - III degree

With malnutrition II - III degree, sluggish sucking or refusal to feed, they begin to feed from 1/3-1/2 of the volume needed at this age, gradually increasing the amount of milk to normal.

The daily amount of food for newborns aged 2 to 8 weeks should approximately be 1/5 of the actual body weight, from 2 to 4 months - 1/5 - 1/6, from 4 to 6 months - 1/7, from 6 up to 9 months - 1/8 part.

Feeding a baby with malnutrition, which has developed against the background of hereditary metabolic disorders, is built taking into account its cause:

In the treatment of celiac disease, products containing gluten are excluded: wheat flour, semolina, starch;
The main method of treating a baby with lactose deficiency is the exclusion from the diet of milk (including mother's) and dishes prepared with fresh milk. These children should be given fermented milk products: acidophilic mixtures, kefir, acidophilic milk, low-lactose mixtures;
In cystic fibrosis, a diet with a restriction of fat and an increase in protein is prescribed. The need for fats should be covered mainly by vegetable oils (corn, sunflower), rich in unsaturated fatty acids.

Now you know everything about the causes, degrees and methods of treating malnutrition in young children.

Very often in children there is a pathological malnutrition, which is accompanied by a small increase in body weight compared to the norm in relation to age and height. If this gap is more than 10%, malnutrition is diagnosed, which most often manifests itself before 3 years.

In pediatrics, this disease is considered as an independent type of dystrophy. Since malnutrition in young children is accompanied by very serious disorders in the body (failure of metabolic processes, decreased immunity, lag in speech and psychomotor development), it is important to identify the disease in a timely manner and begin treatment.

Correctly identified causes of malnutrition will help doctors prescribe the best treatment in each case. Factors of the prenatal or postnatal period can lead to a pathological malnutrition of a child.

Intrauterine malnutrition:

unfavorable conditions for the normal development of the fetus during its gestation (bad habits of a woman, malnutrition, non-compliance with the daily regimen, environmental and industrial hazards);
somatic diseases of the expectant mother (diabetes mellitus, nephropathy, heart disease, hypertension) and her nervous breakdowns, constant depression;
pregnancy pathologies (, toxicosis, premature birth, placental insufficiency);
intrauterine infection of the fetus, its hypoxia.

Extrauterine malnutrition:

congenital malformations up to chromosomal abnormalities;
fermentopathy (, lactase deficiency);
immunodeficiency;
constitutional anomaly;
protein-energy deficiency due to poor or unbalanced nutrition (underfeeding, sucking difficulties with flat or inverted nipples in the mother, hypogalactia, insufficient amount of milk formula, abundant regurgitation, micronutrient deficiency);
poor nutrition of a nursing mother;
some diseases of the newborn do not allow him to actively suckle, which means - to eat fully: cleft palate, congenital heart disease, cleft lip, birth trauma, perinatal encephalopathy, cerebral palsy, pyloric stenosis, alcohol syndrome;
frequent SARS, intestinal infections, tuberculosis;
unfavorable sanitary and hygienic conditions: poor child care, rare exposure to the air, rare bathing, insufficient sleep.

All these causes of childhood malnutrition are closely interrelated, have a direct impact on each other, thus forming a vicious circle that accelerates the progression of the disease.

For example, due to malnutrition, malnutrition begins to develop, while frequent infectious diseases contribute to its strengthening, which, in turn, leads to malnutrition and weight loss by the child.

Classification

There is a special classification of malnutrition in children, depending on the lack of body weight:

Hypotrophy of the 1st degree is usually detected in newborns (in 20% of all infants), which is diagnosed if the child's lag in weight is 10–20% less than the age norm, but growth rates are absolutely normal. Parents should not worry about such a diagnosis: with timely care and treatment, the baby recovers in weight, especially when breastfeeding.
Hypotrophy of the 2nd degree (average) is a decrease in weight by 20–30%, as well as a noticeable lag in growth (by about 2–3 cm).
Hypotrophy of the 3rd degree (severe) is characterized by a lack of mass, exceeding 30% of the age norm, and a significant lag in growth.

The above three degrees of malnutrition suggest different symptoms and treatments.

Symptoms of childhood malnutrition

Usually, the symptoms of malnutrition in newborns are determined already in the hospital. If the disease is acquired, and not congenital, attentive parents, according to some signs, even at home will be able to understand that their child is sick. Symptoms depend on the form of the disease.

I degree

satisfactory state of health;
neuropsychic development is quite consistent with age;
decreased appetite, but within moderate limits;
pale skin;
reduced tissue turgor;
thinning of the subcutaneous fat layer (this process begins with the abdomen).

II degree

impaired activity of the child (excitation, lethargy, lag in motor development);
poor appetite;
pallor, peeling, flabbiness of the skin;
decreased muscle tone;
loss of tissue turgor and elasticity;
disappearance of the subcutaneous fat layer on the abdomen and limbs;
dyspnea;
tachycardia;
frequent otitis, pneumonia, pyelonephritis.

III degree

severe exhaustion;
atrophy of the subcutaneous fat layer on the entire body of the child;
lethargy;
lack of response to banal stimuli in the form of sound, light and even pain;
a sharp lag in growth;
neuropsychic underdevelopment;
pale gray skin;
dryness and pallor of the mucous membranes;
muscles atrophy;
loss of tissue turgor;
retraction of the fontanel, eyeballs;
sharpening of facial features;
cracks in the corners of the mouth;
violation of thermoregulation;
frequent regurgitation, vomiting, diarrhea, candidal stomatitis (thrush);
alopecia (baldness);
hypothermia, hypoglycemia or may develop;
infrequent urination.

When malnutrition is detected in a child, an in-depth examination is carried out to clarify the causes of the disease and appropriate treatment. For this, consultations of children's specialists are appointed - a neurologist, a cardiologist, a gastroenterologist, a geneticist, an infectious disease specialist.

Various diagnostic studies are carried out (ECG, ultrasound, EchoCG, EEG, coprogram, biochemical blood test). Based on the data obtained, therapy is already prescribed.

Treatment of the disease

On an outpatient basis, treatment of malnutrition of the I degree in young children is carried out, inpatient - II and III degrees. The main activities are aimed at:

normalization of nutrition;
diet therapy (gradual increase in calorie content and volume of food consumed by the child + fractional, frequent feeding);
compliance with the regime of the day;
organization of proper child care;
correction of metabolic disorders;
drug therapy (enzymes, vitamins, adaptogens, anabolic hormones);
in the presence of a severe form of the disease, intravenous administration of glucose, protein hydrolysates, vitamins, saline solutions is prescribed;
massage with elements of exercise therapy.

With timely treatment of the disease of I and II degrees, the prognosis is favorable, but with hypotrophy of the III degree, a lethal outcome is noted in 50% of cases.

Prevention methods

Prevention of malnutrition in children involves a weekly examination by a pediatrician, constant anthropometry and nutritional correction. You need to think about the prevention of such a terrible disease even while carrying a baby:

observe the daily routine;
eat on time;
correct pathologies;
exclude all adverse factors.

After the birth of the crumbs, an important role is played by:

high quality and balanced;
timely and correct introduction of complementary foods;
body weight control;
rational, competent care of the newborn;
treatment of any, even spontaneously occurring concomitant diseases.

Having heard such a diagnosis as malnutrition, parents should not give up. If the child is provided with normal conditions for the regimen, care and nutrition, quick and effective treatment of possible infections, severe forms can be avoided.

Hypotrophy in newborns is one of the varieties of chronic malnutrition.

From the very moment of their birth, babies begin to actively gain weight. All their organs grow, all body systems continue to develop. If the child is not enough to feed and take care of the child incorrectly, then the first signs of a violation will appear quite quickly.

The described pathology is the most common and most significant variant of dystrophy. Babies of the first 3 years of life are especially susceptible to this disease. The prevalence of this condition among the child population depends on the level of socio-economic development of countries and ranges from 2-7 to 30%.

As a rule, we are talking about malnutrition when there is a lag in body weight from the age norm by more than 10%. The disease in question is accompanied by profound disturbances in the process, suppression of immunity, and a lag in psychomotor and speech development.

Causes of malnutrition in newborns

The reasons as a result of which malnutrition in newborns may develop can be divided into internal factors and external ones.

The first includes encephalopathy, due to which the work of all organs is disrupted; underdevelopment of the lung tissue, leading to an insufficient supply of oxygen to the body and, as a result, to a slowdown in the development of organs; congenital pathology of the digestive tract and other pathological conditions.

The latter include insufficient and improper feeding, late introduction of complementary foods, exposure to toxic substances, including drugs, and the incidence of various infections. All these negative external factors leading to hypotrophy of newborns, the photo of which is located below, are quite rare. However, they should not be underestimated.

Malnutrition in children can be of two types: congenital and acquired. The first develops while the baby is in the womb. The second occurs after the baby is born.

Manifestations of the described disease can be mild, moderate or severe, which corresponds to three degrees of the pathology in question.

Intrauterine malnutrition of the 1st degree in newborns

Hypotrophy of a newborn of the 1st degree is manifested by a slight change in appetite, which is usually accompanied by sleep disturbances and frequent anxiety. This degree is considered the easiest. In this case, the lag in body weight is no more than 20%, and there are no deviations in growth. The integuments of the baby's skin, as a rule, do not undergo any changes, with the exception of the appearance of some pallor and reduced elasticity. Thinness is noted only in the tummy area. Muscle tone is usually preserved, sometimes slightly reduced.

In some cases, intrauterine malnutrition of the 1st degree in newborns occurs with anemia or rickets. The activity of the immune system as a whole is reduced. Children from this often get sick, outwardly they do not seem as well-fed as their peers. Some babies may experience digestive disorders such as diarrhea or constipation.

Often, hypotrophy of the 1st degree in newborns is not noticed at all by parents. The disease can only be detected by an experienced specialist during a thorough examination with diagnostics.

At the same time, the doctor will definitely find out if the thinness of the child does not belong to his physiological characteristics. The fact is that high growth and thinness could be inherited by the baby. And it is quite possible that you should not worry at all about the fact that the child does not look so well-fed, if at the same time the baby remains active, he is cheerful enough and eats quite well.

2nd degree of malnutrition in a newborn child

The second degree of the described pathology in terms of severity is medium. It includes lagging behind the norm both in weight and in body length. At the same time, weight is reduced by an average of 20-30%, growth by 30-40 mm, which, unlike the first degree of the disease, does not go unnoticed by parents.

This degree of malnutrition of newborns may be accompanied by frequent regurgitation, the baby is lethargic, he is reluctant to eat food or refuses it altogether, moves little, feels sad, his hands and feet are cold.

With the described variant of pathological changes in infants, developmental delay occurs not only physically, but also mentally. Sleep impairments are observed. The skin becomes dry and pale, often flaky, loses its elasticity and folds easily.

Thinness is more pronounced and affects not only the stomach, but also the limbs. With hypotrophy of the second degree, the contours of the ribs are clearly visible in the baby. Babies with a similar form of violation are very often exposed to various kinds of diseases. The chair of such kids is characterized by instability.

Hypotrophy of the 3rd degree in newborns

Hypotrophy of the newborn of the 3rd degree is the most severe of the described options. Deviations in body weight in this case reach more than 30%. The growth deficit is significant, on average it is about 10 cm. The child is weak, drowsy and tearful, indifferent to almost everything. Many acquired skills in the baby are lost.

The thinning of the subcutaneous fat layer is largely expressed throughout the body. On the part of the muscles, severe atrophy is noted. The baby's hands and feet are cold. The skin is dry, the color is pale with a grayish tinge. The eyes and lips of the baby are dry, cracks form around the mouth.

Often, children with a similar pathology variant develop various infectious lesions of certain organs, in particular, the kidneys (pyelonephritis), lungs (), etc.

Treatment of malnutrition in newborns

The diagnosis of the described pathology is established not only according to the medical examination.

In order to objectively assess the severity of hypotrophy of the newborn, the baby's body weight is determined and the baby's body length is measured. In addition, the thickness of the skin fold is determined, and the circumference of the shoulders and hips is determined.

The therapy of the pathological condition under consideration always depends on the cause that led to its development, on the severity of the disease, as well as on the nature and type of dysfunction of internal organs formed as a result of the disease.

To save the baby from malnutrition, it is necessary not only to take vitamin medications or start enhanced feeding. Treatment of this disease usually involves a whole range of measures aimed at eliminating the cause of the disease, maintaining optimal age-appropriate nutrition, and also aimed at combating complications.

With pathology of the 1st degree, the baby can be treated at home. Hypotrophy of the 2nd degree in newborns, and even more so, the 3rd degree of the disease is necessarily treated in a hospital.

The fundamental therapeutic method for this disease is diet. The first step is to test stability. At the same time, the doctor monitors how the child digests food, whether there is diarrhea, bloating, etc.

The second stage includes the gradual compensation of missing nutrients, including trace elements and. The number of meals decreases, the volume and calorie content increases.

At the third stage of diet therapy, the food load increases. This is done only after the full restoration of the function of the stomach and intestines. At the same time, protein intake is limited. The criteria for the effectiveness of treatment are daily weight gain of 25-30 grams, restoration of appetite and general condition of the baby, normalization of the skin condition.

With malnutrition of the 3rd degree in newborns, independent food intake often becomes impossible. Plus, the baby's digestive tract is severely damaged and unable to process food. Based on this, such children are transferred to intravenous nutrition, which is used as various solutions that replenish the volume of fluid and regulate metabolism.

An obligatory component of the therapy of the described pathology is the intramuscular or intravenous administration of vitamins. The most basic in this case are vitamins C, B1 and B6. Subsequently, multivitamin complexes are prescribed.

The lack of gastric juice is replaced with enzyme preparations, of which Festal or Panzinorm is most often prescribed. To improve metabolic processes resort to stimulating therapy. Assign Pentoxifylline or ginseng preparations. In severe cases, resort to the help of immunoglobulin.

With the development of rickets, physiotherapy and vitamin D are used. In case of anemia, iron preparations are prescribed.

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- chronic malnutrition, accompanied by an insufficient increase in body weight of the child in relation to his height and age. Hypotrophy in children is expressed by the child's lag in weight, growth retardation, lag in psychomotor development, underdevelopment of the subcutaneous fat layer, and a decrease in skin turgor. Diagnosis of malnutrition in children is based on examination data and analysis of anthropometric indicators of the child's physical development. Treatment of malnutrition in children involves changing the regimen, diet and caloric intake of the child and the nursing mother; if necessary, parenteral correction of metabolic disorders.

General information

Hypotrophy in children is a lack of body weight due to a violation of assimilation or insufficient intake of nutrients in the child's body. In pediatrics, malnutrition, paratrophy and hypostatura are considered as independent types of chronic eating disorders in children - dystrophy. Hypotrophy is the most common and significant variant of dystrophy, to which children of the first 3 years of life are especially susceptible. The prevalence of malnutrition in children in different countries of the world, depending on the level of their socio-economic development, ranges from 2-7 to 30%.

Hypotrophy in a child is said to be when the body weight lags by more than 10% compared to the age norm. Hypotrophy in children is accompanied by serious disturbances in metabolic processes, decreased immunity, and retardation of psychomotor and speech development.

Causes of malnutrition in children

A variety of prenatal and postnatal factors can lead to chronic malnutrition.

Intrauterine malnutrition in children is associated with adverse conditions that disrupt the normal development of the fetus. In the prenatal period, pathology of pregnancy (toxicosis, preeclampsia, fetoplacental insufficiency, premature birth), somatic diseases of the pregnant woman (diabetes mellitus, nephropathy, pyelonephritis, heart defects, hypertension, etc.), nervous stress, bad habits, malnutrition of women, industrial and environmental hazards, intrauterine infection and fetal hypoxia.

Extrauterine malnutrition in young children may be due to endogenous and exogenous causes. The causes of the endogenous order include chromosomal abnormalities and congenital malformations, fermentopathy (celiac disease, disaccharidase lactase deficiency, malabsorption syndrome, etc.), immunodeficiency states, constitutional abnormalities (diathesis).

Exogenous factors leading to malnutrition in children are divided into alimentary, infectious and social. Alimentary influences are associated with protein-energy deficiency due to insufficient or unbalanced nutrition. Hypotrophy in a child may be the result of constant underfeeding associated with difficulty sucking with an irregular shape of the mother's nipples (flat or inverted nipples), hypogalactia, insufficient amount of milk formula, profuse regurgitation, qualitatively malnutrition (microelement deficiency), poor nutrition of a nursing mother, etc. The same group of reasons should include diseases of the newborn itself, which do not allow him to actively suckle and receive the necessary amount of food: cleft lip and palate (cleft lip, cleft palate), congenital heart defects, birth trauma, perinatal encephalopathy, pyloric stenosis, cerebral palsy, alcohol fetal syndrome etc.

Children suffering from frequent acute respiratory viral infections, intestinal infections, pneumonia, tuberculosis, etc. are prone to the development of acquired malnutrition. An important role in the occurrence of malnutrition in children belongs to unfavorable sanitary and hygienic conditions - poor child care, insufficient exposure to fresh air, rare bathing, insufficient sleep .

Classification of malnutrition in children

Thus, according to the time of occurrence, intrauterine (prenatal, congenital), postnatal (acquired) and mixed malnutrition in children are distinguished. The development of congenital malnutrition is based on a violation of the uteroplacental circulation, fetal hypoxia and, as a result, a violation of trophic processes leading to intrauterine growth retardation. In the pathogenesis of acquired malnutrition in children, the leading role belongs to protein-energy deficiency due to malnutrition, disturbances in the processes of food digestion or absorption of nutrients. At the same time, the energy costs of a growing organism are not compensated by food coming from outside. With a mixed form of malnutrition in children, alimentary, infectious or social influences join the adverse factors that acted in the prenatal period after birth.

According to the severity of underweight in children, hypotrophy of I (mild), II (medium) and III (severe) degrees is distinguished. Hypotrophy of the 1st degree is said when a child lags behind in weight by 10-20% of the age norm with normal growth. Hypotrophy of the II degree in children is characterized by a decrease in weight by 20-30% and a growth lag of 2-3 cm. With hypotrophy of the III degree, the body weight deficit exceeds 30% of the due age, there is a significant lag in growth.

During malnutrition in children, the initial period, the stages of progression, stabilization and convalescence are distinguished.

Symptoms of malnutrition in children

With malnutrition of the first degree, the condition of the children is satisfactory; neuropsychic development corresponds to age; there may be a mild decrease in appetite. A close examination reveals pallor of the skin, a decrease in tissue turgor, thinning of the thickness of the subcutaneous fat layer on the abdomen.

Hypotrophy of the II degree in children is accompanied by a violation of the child's activity (excitation or lethargy, lag in motor development), poor appetite. The skin is pale, scaly, flabby. There is a decrease in muscle tone, elasticity and tissue turgor. The skin easily gathers into folds, which are then poorly straightened. The subcutaneous fat layer disappears on the abdomen, trunk and limbs; on the face - saved. Children often present with shortness of breath, hypotension, and tachycardia. Children with hypotrophy II degree often suffer from intercurrent diseases - otitis, pneumonia, pyelonephritis.

Hypotrophy III degree in children is characterized by a sharp depletion: the subcutaneous fat layer atrophies throughout the body and on the face. The child is lethargic, adynamic; practically does not react to stimuli (sound, light, pain); sharply lags behind in growth and neuropsychic development. The skin is pale gray, the mucous membranes are dry and pale; the muscle is atrophic, tissue turgor is completely lost. Exhaustion and dehydration lead to retraction of the eyeballs and fontanel, sharpening of facial features, the formation of cracks in the corners of the mouth, and impaired thermoregulation. Children are prone to regurgitation, vomiting, diarrhea, decreased urination. In children with hypotrophy of the III degree, conjunctivitis, candidal stomatitis (thrush), glossitis, alopecia, atelectasis in the lungs, congestive pneumonia, rickets, anemia are often noted. In the terminal stage of malnutrition, children develop hypothermia, bradycardia, and hypoglycemia.

Diagnosis of malnutrition in children

Intrauterine fetal malnutrition, as a rule, is detected during ultrasound screening of pregnant women. In the process of obstetric ultrasound, the dimensions of the head, length and estimated weight of the fetus are determined. With a delay in intrauterine development of the fetus, the obstetrician-gynecologist sends the pregnant woman to the hospital to clarify the causes of malnutrition.

In newborns, the presence of malnutrition can be detected by a neonatologist immediately after birth. Acquired malnutrition is detected, a study of the coprogram and feces for dysbacteriosis, a biochemical blood test, etc.).

Treatment of malnutrition in children

Treatment of postnatal malnutrition of the 1st degree in children is carried out on an outpatient basis, malnutrition of the II and III degrees - in a hospital. The main measures include the elimination of the causes of malnutrition, diet therapy, the organization of proper care, and the correction of metabolic disorders.

Diet therapy for malnutrition in children is implemented in 2 stages: clarification of food tolerance (from 3-4 to 10-12 days) and a gradual increase in the volume and calorie content of food to the physiological age norm. The implementation of diet therapy for malnutrition in children is based on fractional frequent feeding of the child, weekly calculation of the food load, regular monitoring and correction of treatment. Feeding children with weakened sucking or swallowing reflexes is carried out through a tube.

Drug therapy for malnutrition in children includes the appointment of enzymes, vitamins, adaptogens, anabolic hormones. With severe malnutrition, children are given intravenous administration of protein hydrolysates, glucose, saline solutions, and vitamins. With malnutrition in children, massage with elements of exercise therapy, UVI is useful.

Forecast and prevention of malnutrition in children

With timely treatment of hypotrophy of I and II degrees, the prognosis for the life of children is favorable; with malnutrition III degree mortality reaches 30-50%. To prevent the progression of malnutrition and possible complications, children should be examined weekly by a pediatrician with anthropometry and nutrition correction.

Prevention of prenatal fetal malnutrition should include adherence to the regimen of the day and nutrition of the expectant mother, correction of the pathology of pregnancy, exclusion of the impact on the fetus of various adverse factors. After the birth of a child, the quality of nutrition of a nursing mother, the timely introduction of complementary foods, the control of the dynamics of an increase in the body weight of a child, the organization of rational care for a newborn, and the elimination of concomitant diseases in children become important.

Hypotrophy in children is a pathological violation of weight gain, which affects the overall development (physical and psychological). There is also a decrease in skin turgor and growth retardation. As medical practice shows, such an ailment occurs in children under 2 years of age.

Etiology

Hypotrophy in young children can be accompanied by various diseases or develop as an independent disease. The most common etiological factors include the following:

unbalanced diet;
underfeeding or overfeeding a child;
improperly selected mixtures;
viral or infectious diseases;
endocrine diseases;
hereditary pathologies;
disorders in the digestive tract - incomplete absorption of nutrients;
genetic predisposition of the fetus.

Hypotrophy at an early age can also develop in a child when eating poor-quality baby food. It should also be noted that malnutrition in newborns can develop both with artificial and breastfeeding. That is why it is very important for the mother herself to eat right and, in general, take good care of her health.

There are also perinatal etiological factors in the development of fetal hypotrophy:

malnutrition during pregnancy (intrauterine malnutrition);
chronic illnesses of the mother both before pregnancy and during childbearing;
alcohol abuse, smoking;
frequent stress, nervous strain.

In the same subgroup, you can add features of the constitution of the mother herself. If the weight of a pregnant woman is not more than 45 kg, and the height is not more than 150 cm, there is a risk of developing fetal malnutrition.

Symptoms

The clinical picture of fetal hypotrophy manifests itself in the form of a malfunction of several systems at once. First of all, symptoms in the gastrointestinal tract appear:

bloating;
refusal to eat, poor appetite;
nausea and vomiting;
drastic weight loss.

As the disease progresses, the clinical picture is supplemented by the following symptoms:

bad sleep;
impaired coordination of movements;
decreased muscle tone;
sudden mood swings in a child;
emotional unstable background.

Also, against the background of such a clinical picture in young children, the protective functions of the body are sharply reduced. Therefore, a child up to a year becomes easily vulnerable to any infections and viral pathological processes.

Classification

According to the international classification, there are such types of malnutrition:

intrauterine (perinatal or congenital form);
postnatal (acquired form);
mixed type.

According to the degree of development, malnutrition in children can occur in the following forms:

light;
average;
heavy.

Hypotrophy of the fetus of the 1st degree does not pose a significant threat to the health of the child. In this case, the deviation from the required weight is no more than 10–15% even with normal growth for this age.

The second degree means a deviation in weight up to 30% and a lag in growth of 3–5 cm.

With malnutrition of the third degree, there are significant deviations in weight - from 30% or more, a significant lag in growth. At this stage of development of the pathological process, malnutrition in a child may be accompanied by other diseases. The most common ailments are:

As practice shows, fetal malnutrition in the third stage almost always leads to the development of rickets.

Diagnostics

If during pregnancy a woman undergoes a timely examination, then fetal hypotrophy will be detected at an early stage of development. If such a pathology is suspected, the pregnant woman is sent for an ultrasound examination and screening is done.

As for already newborn children or toddlers, pathological deviations in development will certainly be noticeable by a pediatrician during examination.

Diagnostic measures for suspected malnutrition in a child include the following activities:

measurement of the circumference of the head, abdomen;
measurement of the thickness of the skin and fat.

It is also obligatory to consult with medical specialists of other profiles:

geneticist;
cardiologist;
neurologist;
endocrinologist.

Depending on the age of the child, instrumental diagnostics may be needed:

coprogram.

Only on the basis of the tests obtained, the doctor can finally establish the diagnosis and prescribe the correct course of treatment.

Treatment

Treatment of the disease depends on the type of disease and the stage of development of the disease. If we are talking about intrauterine malnutrition (during pregnancy), then therapy is primarily aimed at the expectant mother herself. Treatment may include the following activities:

balanced diet;
taking drugs to eliminate pathology;
taking enzymes to improve digestion.

In most cases, if the pathology is detected in the second or third trimester of pregnancy, the treatment takes place in a hospital.

Treatment of children (newborns and up to a year) also takes place in a hospital. So that the child does not develop muscle hypotrophy, bed rest is prescribed. Comprehensive therapy includes the following:

food according to a special diet;
taking vitamin preparations;
courses of special massage and exercise therapy;
biological additives.

In addition, it is very important how the child will be looked after. According to official statistics, malnutrition in children and during pregnancy is most often observed in socially disadvantaged families.

Diet

The diet is prescribed only by the attending physician based on the individual characteristics of the patient and the stage of development of the disease:

in the first degree - meals at least 7 times a day;
in the second degree - 8 times a day;
at the third - 10 times a day.

As for the list of products, they are chosen based on what the patient's digestive system can digest.

Prevention

Preventive methods are especially important during pregnancy. It is very important for a future mother to eat fully and in a timely manner, since the health of the baby depends on it. Also, during pregnancy, a woman should be regularly examined for the timely detection of pathology.

Today, the best prevention of malnutrition in newborns is careful planning of pregnancy.

For newborns, preventive measures are as follows:

the nutrition of the baby should be complete and only of the best quality;
weight gain and height increase should be constantly monitored;
the child should be examined by a pediatrician in a timely manner;
complementary foods should be introduced gradually starting with small doses;
foods should have all the necessary vitamins and minerals.

With the above symptoms, you should immediately consult a doctor and in no case self-medicate. Delay, in this case, can result in a child's disability or death.

Forecast

Hypotrophy in a child at the first or second stage responds well to treatment and practically does not cause complications. As for the pathological process at the third stage of development, a lethal outcome is observed in 30–50% of all cases.

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