Young children often exhibit particular sensitivity to food and environmental changes. A fragile body cannot cope with a large number of irritants, reacting to them with the appearance of diathesis. This pathology frightens parents, because its treatment can be difficult. Diathesis cannot be called a disease. This phenomenon is considered the first sign of the presence of factors irritating the immune system in the body. Why does it occur? How to treat this pathology?

general information

The term “diathesis” is usually understood as a pathology of the body that causes a predisposition to certain diseases. This concept was first introduced into pediatrics at the beginning of the 20th century. The level of development of science at that time did not provide accurate ideas about the genetic and molecular mechanisms of diseases. Therefore, the term “diathesis” was used to denote a predisposition to something. Today, the doctrine of this pathology is of more historical interest, but is still used in pediatrics.

Diathesis is not an independent disease or syndrome, but a feature of the body. It is closely related to hereditary, environmental, and age factors. In modern pediatric practice, it is customary to distinguish three forms of constitutional anomalies:

• neuro-arthritic (tendency to joint inflammation, atherosclerosis, diabetes and obesity);
• lymphatic-hypoplastic (predisposition to pathologies of the lymph nodes, infectious diseases);
• exudative-catarrhal (tendency to allergic reactions).

These are the most common forms in which diathesis can manifest itself. Photos of small patients with this diagnosis are practically the same, because in their pure form, various variants of pathology are rare. Typically, a child has a combination of several disorders at the same time with a clear predominance of one of them.

Causes of diathesis

The key cause of constitutional abnormalities is the immaturity and weakness of the digestive system. Due to a deficiency of certain enzymes, the newborn’s intestines are not able to effectively break down food components. The permeability of the walls of this organ in a child’s body is several times higher than in an adult. As a result, unbroken food molecules penetrate into the baby’s blood. As a result, antibodies begin to be produced. Thus, diathesis gradually develops.

The causes of this pathology may lie in individual intolerance to certain types of protein. Genetic predisposition to allergic reactions also contributes to the appearance of this constitutional feature. Abuse of drugs/herbs and poor diet during pregnancy can affect the health of the baby.

The abrupt introduction of complementary foods also often results in diathesis (photos of the pathology are presented in the article). Foods that are most likely to cause this disorder in children include the following:

• citrus;
• cow's milk protein;
• red vegetables and fruits;
• chocolate, honey, nuts.

If the baby is breastfed and the mother does not follow the principles of proper nutrition, in 80% of cases diathesis occurs in the child. Your doctor should tell you how to treat this disorder. Initially, it is necessary to determine which product causes the allergic reaction. In the vast majority of cases, the pathology goes away on its own after the child’s digestive system develops.

Symptoms of exudative-catarrhal diathesis

This form of the disorder is often called allergic diathesis. The child is a month old, and the doctor has already made such a diagnosis? Don't worry ahead of time. The fact is that this pathology occurs in every third baby.

Its most common clinical manifestation is. At its core, this disease is a food allergy. Its development is due to omissions in a woman’s diet both during pregnancy and during breastfeeding. Allergic diathesis is one of the most common pathologies among children. Pediatricians explain this trend by the imperfection of the digestive system of the child’s body. Against the background of certain age-related characteristics, various aggressive substances penetrate into the blood from the intestines, which cause a reaction of the immune system. In 75% of cases, this anomaly goes away on its own after the first year of the child’s life.

What does diathesis look like? Symptoms in most cases are associated with disruption of the gastrointestinal tract, damage to the skin and mucous membranes. The digestive tract reacts to the appearance of an allergen with bloating and intestinal colic. External signs of diathesis include facial redness, skin rashes and diaper rash. In adolescents, this form of pathology is also not uncommon. Its appearance is usually indicated by allergic rhinitis, atopic dermatitis, and conjunctivitis.

Symptoms of lymphatic-hypoplastic diathesis

Lymphatic-hypoplastic diathesis accounts for about 10% of cases of all constitutional anomalies. Its development is caused by a violation of the endocrine function of the adrenal cortex. The trigger for the onset of the disease can be toxicosis or birth trauma. What does diathesis look like?

Babies with this diagnosis have a disproportionate physique: short neck, elongated limbs, wide chest. Already in the first months of life, such children experience proliferation of lymph nodes, enlargement of the liver and spleen. Their muscles are poorly developed and their skin is pale. Such children get tired very quickly and often suffer from infectious diseases. The characteristic features of the constitution are clearly expressed from the first months of life. With favorable development, they disappear by puberty. For some, symptoms of thymic-lymphatic status persist throughout their lives.

Symptoms of neuro-arthritic diathesis

This form of pathology is caused by a violation of the metabolism of uric acid and individual purine compounds. Toxic products gradually accumulate in the body, affecting the functioning of the central nervous system, joints and other systems. Nervous diathesis begins to manifest itself already in the first year of a child’s life. These require constant attention from parents. After one year, children with this diagnosis are ahead of their peers in mental development. They have good memory and learning abilities. The other side of the coin is sleep disturbances, enuresis, and poor appetite.

Medical examination and confirmation of diagnosis

Diathesis is not an independent disease. Therefore, children with manifestations of constitutional anomalies can be patients of different specialists - a pediatrician, nephrologist, endocrinologist, dermatologist. Laboratory research methods are used to confirm the final diagnosis. All young patients undergo blood and urine tests to determine the level of glucose, cholesterol, and uric acid. It is mandatory to examine stool for dysbacteriosis. In case of lymphatic-hypoplastic diathesis, an ultrasound scan of the lymph nodes, liver and spleen is additionally performed.

If a child is diagnosed with diathesis, what should he do? This is exactly the question that arises among parents. You can get rid of insidious symptoms with the help of a strict diet, medications and avoidance of direct contact with allergens. Sometimes standard therapy is supplemented with traditional medicine recipes.

Doctors recommend strictly following the prescribed diet. In addition, it is necessary to take care of the baby's skin. For example, seborrheic crusts should be periodically removed, after softening them with Vaseline. It is recommended to pay special attention to the baby's clothing. It is better to purchase vests and blouses from natural materials. When washing, use special hypoallergenic powders and products.

What needs to be changed in nutrition?

Mother's milk is considered the ideal food for a newborn. Its unique composition creates a kind of barrier against foreign organisms in the child’s body. However, in some children, even breast milk causes allergies and provokes diathesis on the cheeks. Treatment in this case is based on the mother. All foods that could cause rashes on the child’s skin should be excluded from the diet. It is recommended to pay special attention to garlic, meat, fish, chicken and mushrooms. The amount of fermented milk products in the diet can be increased. You should diversify your diet with vegetables, low-fat cheese, and fruit juices.

If the child is on mixed and artificial feeding, parents are also forced to make adjustments to the diet. If you are allergic to cow's milk protein compounds, this drink should be avoided. In such cases, children are transferred to fermented milk formulas. If such a diet turns out to be ineffective, mixtures based on soy protein are introduced into the baby’s diet. A positive effect from their use is observed no earlier than after 2-3 weeks. Pediatricians recommend introducing complementary foods from four months. It starts with a one-component vegetable puree or porridge with a soy mixture. From six months you can give your baby meat purees. It is recommended to exclude egg yolk, fish and seafood from the diet. Pasta is introduced a little later.

Diet therapy is the main method of combating a disorder such as diathesis. Treatment of children is based on replacing foods that provoke an allergic reaction with equivalent ones. The choice of a specific diet is determined by the doctor, taking into account the individual characteristics of the small organism. It should be followed until the symptoms of the disease disappear.

Drug therapy

An important stage of treatment is drug therapy. Medicines are designed to eliminate unpleasant symptoms and alleviate the child’s condition. For catarrhal and allergic diathesis, the following remedies are considered especially effective:

Treatment of any form of pathology can only be prescribed by a specialist. The action of medications is aimed at reducing the external manifestations of the disease. Most of them contain hormonal substances. Therefore, they should be used with caution and only as prescribed by a doctor.

The course of treatment for lymphatic-hypoplastic diathesis additionally includes taking synthetic adaptogens and vitamins. During development, glucocorticoids are prescribed.

Treatment at home

Diathesis is a disease that is almost impossible to get rid of without home treatment and traditional medicine. However, before starting a course of therapy, you should consult your doctor.

During periods of exacerbation of pathology, daily baths are recommended for young patients. When a small amount of potassium permanganate is added to the water, and for diaper rash, a herbal infusion is added. To prepare it, you need to mix equal parts of string, sage and starch. Then pour a tablespoon of herbal mixture into a glass of boiling water and leave for about 20 minutes. After this, the broth should be filtered and added to water.

After a bath, pediatricians recommend lubricating the skin folds with warm vegetable oil. Furacilin lotions are used to treat allergic rashes. Half the tablet is diluted in a glass of water, and then a cotton pad is moistened in the solution and wiped over the baby’s skin. To relieve itching, use soda lotions. A teaspoon of baking soda should be diluted in a glass of warm water. Then a cotton pad should be moistened with liquid and gently applied to the inflamed area.

To care for affected areas of the skin, pediatricians recommend using special medicinal cosmetics with moisturizing ingredients. Pharmaceutical companies today do not offer many options for products designed specifically to eliminate the external consequences of diathesis. Cosmetic creams help relieve swelling and itching, and get rid of rashes. However, almost all drugs contain substances that can cause new allergic reactions in especially sensitive babies.

Preventive measures and prognosis

Catarrhal diathesis is considered the safest form of pathology. If you follow the doctor's recommendations on nutrition and treatment, its symptoms disappear without a trace. The neuro-arthritic and lymphatic-hypoplastic variants of the disease require a different attitude. In this case, serious therapy and constant monitoring of the child’s condition are required. At the initial stage of any form of diathesis, there are no pathogenic microbes on the skin, that is, the inflammation is aseptic. Complications appear over time if the baby does not receive proper care and treatment. Through scratching, pathogenic microflora can enter wounds on the skin. As a result, the affected area becomes inflamed and pyoderma develops. If the diet is not followed and constant contact with allergens, symptoms of the pathology can be observed in adolescence. In this case, manifestations of constitutional anomalies indicate a weakness of the immune system and inadequate functioning of the internal organ systems.

To avoid the above-mentioned consequences, it is necessary to take care of the prevention of diathesis and treat it correctly. To prevent this disease, doctors recommend:

• maintain a hypoallergenic diet during pregnancy;
• wash children's underwear with special powders;
• care for your baby's skin;
• harden the child, strengthen his immune system;
• visit a doctor as soon as possible;
• identify the allergen and eliminate contact with irritating substances.

Diathesis is primarily a signal to parents about problems in the child’s body. Its manifestations should not be ignored and considered a harmless phenomenon. The first symptoms of the disorder should be a reason to contact a pediatrician. Only timely treatment and proper care for the baby can help in the fight against this pathology. Otherwise, the likelihood of developing complications increases. The most dangerous among them can be considered pyoderma.

Take care of your baby's health from the very first days of his life. Modern medicine helps to cope with any disturbances in the functioning of a small organism. Often this does not require the use of serious medications; it is enough to just adjust your diet. Be healthy!

The constitution (organization) of children is a certain set of morphological and functional properties of the organism that determine its reactivity in the conditions of a specific habitat. It is the result of the child's phenotypic development under the influence of environmental factors. The finally formed constitution as a morphofunctional concept already refers to the puberty period.

As the child develops through the stages of ontogenesis, the morphological and functional characteristics of the constitution do not change significantly. A number of characteristics have a stable, genetically determined specificity, for example, blood groups, the HLA system, etc. Constants such as, for example, the levels of hemoglobin and leukocytes cannot be used as a reliable characteristic of the constitution. However, the direction and degree of change in these signs from the influence of external factors can serve as a constitutional characteristic of a given individual.

Multifactorial characteristics are essential: body type, type of nervous activity, functioning of metabolism, autonomic system, immunity, etc. They are formed under the influence of both genetic and environmental factors in the process of ontogenesis.

Therefore, there is a need to highlight the human constitution for the concept of individual development and the body’s response to the influence of environmental factors.

In pediatrics, there is a somatoscopic characteristic of the main types of constitution (according to V. G. Shtelko and A. D. Ostrovsky, 1928). According to this classification, all people are divided into four types of constitutions: asthenoid, thoracic, muscular, digestive. Representatives of different types of constitutions are characterized by an unequal pace of somatic development, which is also a constitutional type. For example, boys of the muscular type and girls of the digestive type develop more intensively. Children of the asthenoid type are characterized by minimal rates of sexual development. The muscular type of constitution is characterized by maximum development of muscle strength. Adolescents of different constitution types have different biochemical parameters.

Children with different constitutions have different immunological reactivity and tolerate certain diseases differently. Thus, obesity is often observed in children of the digestive type, and gastrointestinal diseases are observed in children of the asthenoid type.

There are many intermediate forms in this classification. However, the somatoscopic characteristics of the main types of constitution are of very important clinical importance in the assessment of both healthy and sick children.

Diathesis is an anomaly of the constitution that determines the inadequate (abnormal), often hyperergic reactivity of the child’s body.

Diathesis as a feature of constitution and reactivity determines an individual’s predisposition to certain diseases.

In pediatrics, exudative-catarrhal, lymphatic-hypoplastic and neuroarthritic diathesis are distinguished.

Exudative-catarrhal diathesis

The body responds to ordinary irritants with changes in the skin and mucous membranes in the form of hyperergic inflammation with the formation of an exudative rash. Irritants include physical, chemical and nutritional factors. This type of diathesis affects 50% of children in the first two years of life. In approximately 25% of children, diathesis occurs due to allergies (atopic diathesis); in the remaining 25%, non-immune diathesis develops due to increased sensitivity to external stimuli of mast cells or due to insufficient activation of histamine in the skin and mucous membranes.

Clinically, diathesis is manifested by diaper rash in the inguinal, buttock, and axillary folds when using low-quality diapers and synthetic detergents. If harmful factors are not excluded, then seborrheic eczema appears on the scalp in the form of gneiss (fatty seborrheic scales), and a milky scab appears on the cheeks. Often, against the background of acute respiratory diseases, children develop obstructive (shortness of breath) syndrome of the upper respiratory tract, diarrhea, and inflammation of the mucous membranes of the urinary system.

Prevention of this condition lies in the proper organization of children's nutrition (high-quality selection of food products for complementary feeding), compliance with the rules of child care.

If a breastfed child shows signs of exudative diathesis, you need to pay attention to the mother’s nutrition. It is necessary to exclude from the diet foods that are obligate (obligatory) allergens: spices, spicy foods, cocoa, chocolate, yellow-orange fruits, cheeses, smoked meats, sausages. Be sure to limit sugar and cow's milk. It is necessary to decide what was the factor in the occurrence of exudative diathesis, and, if possible, remove it.

If a child is bottle-fed or mixed-fed and has increased sensitivity to cow's milk, then formulas that do not contain cow's protein are used. Porridges and vegetable purees are prepared using vegetable broths with minimal addition of sugar.

Food allergens and histamine liberators, which cause various disorders in children and mothers, play a great role in the occurrence of diathesis. Most often, these disorders occur in gastrointestinal diseases. Therefore, in cases of damage to the gastrointestinal tract in a nursing mother, the child is advised to take courses of drugs that normalize intestinal flora (Bifidum- and Lactobacterin, Bactisubtil, Hilak-Forte, etc.). Individual child care and the use of detergents and toiletries suitable for children are also of great importance.

Lymphatic-hypoplastic diathesis

Some children have an abnormal reaction of the organs of the lymphoid system (thymus, lymph nodes, spleen). Some components of the macrophage system and the sympathetic adrenal system are also affected in combination. This disease occurs in children aged 2 to 6 years. The incidence of the disease is approximately 5%. The genesis of the condition is unclear. Sometimes transient immune disorders are detected.

Children suffering from this diathesis usually have a lymphoid appearance: excess body weight, pastiness and decreased turgor of tissues and muscles, pale skin. Hyperplastic peripheral lymph nodes are detected, and thymic hyperplasia (thymomegaly) is characteristic. In peripheral blood there is lymphocytosis and monocytosis. Upon examination, hyperplasia of the palatine tonsils and adenoids are determined, which impair the patency of the upper respiratory tract. This contributes to the frequent occurrence of rhinitis and otitis media. Neuropsychic development is impaired. Often such phenomena are combined with skin manifestations of allergies in the form of rashes. Children are prone to infectious diseases that are sluggish (protracted).

This type of diathesis is treated with adaptogens, drugs that affect the specific resistance of the body, immunotherapy is recommended (Eleutherococcus, ginseng, potassium orotate, vitamins of groups B, A, C and E). The child should be under the supervision of an ENT doctor for the purpose of routine sanitation of the nasopharynx.

Neuroarthritic diathesis

With this diathesis, the reactivity of the nervous system changes. The disease is more common among schoolchildren. The pathogenesis is based on liver dysfunction, leading to disturbances in the metabolism of purine bases and fat metabolism. In children, serum uric acid levels most often increase (hyperuricemia) and episodes of ketoacidosis occur.

In adults, hyperuricemia leads to the deposition of uric acid salts in the synovial membranes of the joints, and gout develops. Such manifestations are rare in children.

The anamnesis of these children more often than others reveals cases of gout, urolithiasis, obesity, early atherosclerosis, diabetes mellitus, and migraine.

Children with neuroarthritic diathesis have increased nervous excitability. Often these are child prodigies, asthenics with symptoms of skin and respiratory allergies.

Violation of fat metabolism is manifested by attacks of acetonemic vomiting. Provoking factors for this condition can be: infection, stress, excessive dietary intake of fats, smoked meats, chocolate and other foods rich in purine bases.

An attack of acetonemic vomiting begins against the background of complete health, suddenly uncontrollable vomiting occurs, abdominal pain and fever occur. The attack can last for several days, so the child experiences dehydration, weight loss, dry skin and mucous membranes, thirst, and oliguria. With acidosis, frequent and noisy breathing, the smell of acetone from the mouth and vomit. Laboratory tests reveal hyperuricemia, signs of ketosis and metabolic acidosis in the patient. Urine has low pH values ​​and increased uric acid content.

For neuroarthritic diathesis, children are prescribed sedatives, their diet is adjusted, excluding fats of animal origin (meat fat, fatty fish), liver, kidneys, brains, cocoa, chocolate products, spinach, green peas. Preference is given to a dairy-vegetable diet.

In case of an attack of acetonemic vomiting, the child must be hospitalized. Solutions of glucose, sodium bicarbonate with the addition of vitamin B 12, ascorbic acid, and essentiale are administered intravenously. After the cessation of vomiting, alkaline minerals are prescribed in accordance with the indicators of the acid-base state of the blood or the reaction of the blood and urine to acetone.

Constitution is a set of relatively stable morphological and functional properties of a person, determined by heredity, age and long-term intense environmental influences, which determines the functional abilities and reactivity of the body.

Diathesis is a genetically determined feature of the body that determines the uniqueness of its adaptive reactions and predisposes it to a certain group of diseases. Diathesis is not a disease, but a predisposition, which under certain environmental conditions can transform into a disease.

Allergic diathesis is a constitutional anomaly characterized by the body’s predisposition to allergic and inflammatory diseases. This constitutional anomaly is quite common. It is usually detected at the age of 3 - 6 months and lasts for 1 - 2 years; in most children it subsequently disappears. Atopic diathesis is distinguished, associated with an allergic reaction to food and non-infectious antigens in contact with the mucous membrane of the respiratory tract. Autoimmune diathesis, where there is increased sensitivity of the skin to UV irradiation, a significant increase in the level of ? -globulins in the blood, frequent detection of LE-cells, antinuclear factors in a state of complete clinical well-being, polyclonal activation of B-lymphocytes, as well as T-helpers with a decrease in the activity of T-suppressors, increased levels of immunoglobulins M in the blood. Infectious-allergic diathesis, where There are long periods of increased ESR and low-grade fever after acute respiratory viral infections and nasopharyngeal diseases.

Etiology, pathogenesis, clinical picture, treatment similar to exudative-catarrhal diathesis.

Exudative-catarrhal diathesis is a peculiar state of reactivity in young children, characterized by a tendency to recurrent infiltrative-desquamatous lesions of the skin and mucous membranes, the development of pseudo-allergic reactions and the protracted course of inflammatory processes, with lymphoid hyperplasia, lability of water-salt metabolism.

Etiology and pathogenesis are not fully understood, but hereditary predisposition, as well as the influence of environmental factors, play an important role. A positive family “allergic history” is detected in 2/3 – 3/4 of children with allergic diathesis. In such children, a high level of immunodepth E in the blood or excessive secretion and release of histamine from mast cells, its insufficient inactivation, which determines the tendency to allergic reactions, is determined. Provoking factors may be toxicosis of the first and second half of pregnancy, infectious diseases, use of medications during pregnancy, violation of the pregnant woman’s diet, especially in the last months of pregnancy (monotonous diet with excessive consumption of one of the obligate allergens - eggs, honey, confectionery, milk, tangerines), as well as during breastfeeding. Even in the prenatal period, a child can become diaplacentally sensitized to allergens circulating in the mother’s body. In the extrauterine period, allergens are transmitted with breast milk and food through the intestinal wall, which has increased permeability, especially in infants, especially after gastrointestinal diseases, as well as during the period of recovery from various diseases, with weight loss and exhaustion. A potential sensitizing agent can be food that has not been subjected to heat treatment (egnog, berries whipped with protein, etc.), as well as products such as fish, nuts and some others that do not reduce their allergenic properties when cooked. Allergization can also be caused by ordinary foods if the child receives them in excess (overfeeding), especially with a monotonous set of nutrients. Foods that are consumed in a particular season or infrequently become allergens when they are included in the diet in large quantities (berries, vegetables, nuts, etc.), as well as when foods that are not age-appropriate are introduced into the diet (caviar, shrimp, chocolate and etc.). Disordered eating, abuse of sweets, spicy, salty foods, and the introduction of many new foods into the child’s diet in a short period of time are important. A child with allergic diathesis easily becomes hypersensitive not only to nutrients, but also to external allergens such as wool and house dust.

Allergens can enter a child’s body through the skin and mucous membranes (conjunctiva, etc.), as well as during numerous injections and vaccinations. In children with allergic diathesis, disturbances in cortical-subcortical relationships are detected, parasympathetic mood or dystonia of the autonomic nervous system is detected, functional changes in the liver in the form of metabolic disorders (fat, carbohydrate, protein, water, salt, vitamin, acid-base acid), which is not indifferent to the body in the process of its adaptation to the external environment and nutrition.

The development of an allergic reaction is accompanied by an increase in a number of biologically active substances in the blood: histamine, serotonin, leukotrienes, etc. Autoallergic processes, which most likely arise secondary to the disease process, play a certain role in the pathogenesis. The development of autoallergenic processes with the constant entry of autoallergens into the blood contributes to a more torpid course of allergic diathesis.

Clinic. Such children are characterized by high birth weight, especially if this is the first child in the family; Diaper rash that appears early and persists for a long time under conditions of proper care; disappearing and reappearing seborrhea of ​​the scalp; significantly exceeding the age norm of body weight gain and its large fluctuations under the influence of unfavorable conditions; positive skin tests for exogenous allergens in the absence of any clinical manifestations of allergic diathesis.

On examination, attention is drawn to a puffy pale face, excess body weight, decreased tissue turgor (pasty type) or thinness, geographic tongue, abdominal pain, and flatulence.

In the first year of life, children with increased nervous excitability, irritability, sleep disorders, and decreased appetite are capricious and nervous. Children do not tolerate heavy physical activity. Often, children with immunoglobulin A deficiency develop chronic foci of infection, enlargement of peripheral lymph nodes, spleen, prolonged low-grade fever, and protracted course of infectious diseases.

Gneiss is found only in infants: dirty gray or brown seborrheic scales in the form of a cap or shell on the scalp, mainly on the crown and crown. The course of gneiss is usually favorable, but in some children it transforms into seborrheic eczema (swelling, redness, weeping, increased crusting), which often spreads to the ears, forehead, and cheeks.

The most common symptom of allergic diathesis, especially in children of the first year of life, is a milk scab (or crust): on the skin of the cheeks, often near the ears, redness and swelling, sharply demarcated from healthy skin, form, often with signs of peeling. In some children, milk eschar is accompanied by itching and can sometimes transform into eczema.

A persistent form of diaper rash - intertrigo - is one of the important symptoms of allergic diathesis. Diaper rash can be dry; in other cases, maceration of the skin is observed (usually in obese, pasty infants). The most severe form of allergic diathesis should be considered childhood eczema, which occurs in older children. In older children it can transform into neurodermatitis.

Diagnosis is established on the basis of anamnesis and clinical data.

Differential diagnosis carried out with true eczema, erythroderma, dermatitis, immunodeficiency, psoriasis, and malabsorption syndrome.

Treatment. There is no standard diet. A balanced diet and breastfeeding are necessary, although the presence of allergens is possible. The mother's diet should be low in carbohydrates, fats, table salt and possible allergens. In some cases (fat breast milk), expressed breast milk is pasteurized (for 30 minutes at a temperature of 65 ° C) and the top film is removed or the milk is placed in the refrigerator for 3 to 4 hours, and then the cream is skimmed, after which it is pasteurized. Older children are advised to exclude jelly, mousse, pork, beef broth, fish, eggs in any form, legumes, nuts, spices, seasonings (moderately limit fats and proteins, liquid). Among porridges, preference is given to buckwheat; in the evening, vegetables, salads, and casseroles are recommended. If eczema is the result of consuming an allergen, then it can subside within 24 hours with the following diet: dishes of rice water, 1 dish of fruit (not yellow), 1 dish of vegetables (potatoes), 1 dish of rice with fruit juice (not yellow color). On each subsequent day, a new dish is added to this basic diet under the control of the dynamics of the disease. If dysbiosis is diagnosed against the background of allergic diathesis, then 10-day courses of Lactobacterin and Bifidumbacterin may be effective. Prescribed medications that help reduce itching and permeability of the vascular wall, sedatives: 3 - 5% sodium bromide solution, diphenhydramine or antihistamines in age-appropriate dosages. Vitamins B 5, B 6, B 12, B 15, A, C are also prescribed (ascorbic acid can increase itching) in therapeutic doses for at least 3 to 4 weeks. Local treatment: first lotions, after swelling and weeping disappear - ointment therapy. In addition, moderately warm baths (not higher than 38 ° C) are prescribed for 10 - 15 minutes with wheat bran or potato flour (400 - 600 g per bath), with oak bark, string, celandine, with the addition of lagochilus, potassium permanganate (up to light pink color). Apply general ultraviolet irradiation from 1/4 to 1 erythemal dose 15 - 20 times (daily or every other day). Elimination of foci of secondary infection also improves the general condition of the patient.

Prevention. Rational nutrition for pregnant and nursing mothers, especially if they have allergies, with the consumption of moderate amounts of varied, well-cooked foods, excluding eggs from the diet, limiting milk (up to 1 - 2 glasses per day), sugar, honey, chocolate, sweets, nuts, as well as sausages, sausages, canned fish. Organization of child nutrition in accordance with age.

During illness and convalescence, it is recommended to give the child well-processed food in moderation and avoid introducing new foods. It is necessary to comply with the rules of vaccination, which is preferably carried out only during the period of remission and after appropriate preparation. An infant needs hygienic care. It is better to avoid using perfumes, shampoos, and eau de toilette. The prognosis is favorable if all preventive and treatment measures are followed.

Lymphatic diathesis (lymphatic-hypoplastic) is a hereditarily caused deficiency of the lymphatic system associated with reduced function of the thymus gland as the main organ that controls the maturation of lymphocytes; characterized by generalized persistent enlargement of lymph nodes, dysfunction of the endocrine system (hypofunction of the adrenal glands, sympathoadrenal system, etc.), a tendency to allergic and hyperergic reactions and infectious diseases. One of the manifestations of lymphatic diathesis may be a pathology of local immunity of the mucous membranes, insufficiency of the synthesis of secretory immunoglobulins.

Clinic. Dysplastic physique - often a short body, somewhat elongated limbs. The skin is pale, the skin fold is flabby, the muscles are poorly developed, its tone is reduced, and the tissues are pasty. The lymph nodes are enlarged, the tonsils and adenoids are hyperplastic and loose. Adenoids after adenotomy are prone to re-growth. X-rays show enlargement of the thymus gland in 70% of cases, which can cause obstruction of bronchial obstruction. There is a tendency to arterial hypotension. In the blood - slight leukocytosis, lymphocytosis, monocytosis, anemia, neutropenia.

Diagnosis is established on the basis of anamnesis, the characteristic appearance of the child, and the detection of hyperplasia of the lymph nodes and thymus gland.

Differential diagnosis carried out with immunodeficiency states.

Treatment. Maintaining a daily routine, sufficient time in the fresh air, hardening procedures, massage, gymnastics, physiotherapy, vitamin therapy. Prescription of adaptogens and agents that stimulate the body's defenses and adrenal function (dibazole, metacil, aloe, eleutherococcus, ginseng). In case of persistent viral infection and the presence of chronic foci of infection, a course of Viferon is prescribed.

Prevention. Rational nutrition for pregnant women and proper feeding of the child in accordance with age. Maintaining a daily routine, walking, hardening, massage and gymnastics. Constant use of adaptogen plants (Eleutherococcus, etc.) in combination with vitamins (separate courses of 2 weeks).

Forecast favorable if treatment and preventive measures are followed.

Neuro-arthritic diathesis is characterized by increased nervous excitability, a tendency to ketoacidosis, and subsequently a predisposition to the development of obesity, interstitial nephritis, urolithiasis, atherosclerosis, diabetes mellitus, gout. Disorders of uric acid metabolism are the leading, but not the only laboratory marker.

Etiology. On the one hand, the formation of inheritance of pathological properties of metabolism, on the other hand, disturbances in nutrition in the family, work and rest regime, and environment.

Pathogenesis. Of particular importance are the high level of excitability at any level of reception, impaired purine metabolism with an increase in their content in the blood and urine, low acetylating ability of the liver and other undeciphered mitochondrial defects.

Clinic. Already in infancy, increased nervous excitability is noted; with age, children become even more excitable. Mental development is ahead of age norms: they are inquisitive, animated, remember what they hear or read. Sometimes such children have night terrors, tics, choreo-like attacks, and emotional lability. Periodically or suddenly, after a short period of illness, attacks of headache, nausea, vomiting, abdominal pain, and the smell of acetone from the mouth may occur, which indicates the development of an acetonemic crisis. During a crisis, the level of ketone bodies, ammonia, and uric acid in the blood increases, and the pH decreases.

Diagnosis is established on the basis of anamnesis, clinical and laboratory data.

Differential diagnosis carried out with neuroses, rheumatism, diabetes, etc.

Treatment. Rational regime and diet, hardening, walks, physical education. Avoid mental stress, limit TV viewing. At the initial symptoms of an acetonemic crisis or its precursors, give sweet tea, fruit juices, and alkaline mineral water to drink. It is advisable to hospitalize the child in a hospital. They do a cleansing enema and gastric lavage to improve the removal of ketone bodies from the intestines. Essentiale or vitamin B12 are prescribed; for acetonemic vomiting, treatment is aimed at combating acitosis and enhancing the excretion and utilization of ketone bodies: a 5% glucose solution and a 0.9% sodium chloride solution are administered. Prevention: adherence to the child’s daily routine, balanced nutrition, protecting the child from mental stress.

Anomaly of the constitution (diathesis)* is an inherited, congenital or acquired state of unstable balance of neuroendocrine regulation, metabolic processes and other functions of the child’s body, characteristic of children in the first years of life, which can lead to unusual, pathological reactions to ordinary influences.

Publisher's note. The concept of “diathesis”, or “constitutional anomalies”, was introduced into clinical pediatrics at the end of the 19th and beginning of the 20th centuries. The term “diathesis” corresponds to the concept of “hereditary predisposition”. The introduction of the term “diathesis” was due to insufficient information about heredity, genetic and molecular mechanisms of disease development, and insufficient development of laboratory and other diagnostic methods. The development of genetics and molecular biology has made it possible to decipher many aspects of heredity and predisposition to diseases [see, for example, “Catalog of Hereditary Human Diseases (OMIM, Online Mendelian Inheritance in Man,< http://www. ncbi.nlm.nih.gov/Omim/>)» ]. Currently, the doctrine of diathesis represents a kind of “tribute to tradition” and has been preserved exclusively in domestic pediatrics. In foreign literature and medical practice, diathesis is not identified, nor are they included in the International Classification of Diseases (ICD-10). It should be clearly understood that diathesis is not a separate nosological form and, strictly speaking, not even a syndrome. This is a set of clinical and paraclinical signs that can be caused by many reasons, but one way or another contribute to the development of certain diseases or pathological reactions. For example, the so-called atopic (exudative-catarrhal) diathesis combines allergic reactions in young children with predominant manifestations on the skin and mucous membranes, usually transient, but in some cases later transforming into chronic allergic diseases. Neuro-arthritic diathesis consists of various disorders of purine metabolism, primarily gout and similar conditions such as Lesch-Nyen syndrome. Even more heterogeneous is the lymphatic-hypoplastic (lymphatic) diathesis, which includes a large group of undifferentiated primary immunodeficiencies, cases of thymomegaly of various etiologies, etc. Psychasthenic diathesis is an unfortunate name for constitutional psychasthenia (anancastic personality disorder), vegetodystonic is a set of forms of primary autonomic failure, atherosclerotic - various primary hyperlipidemias, etc. Thus, combining a wide variety of diseases or conditions under the stereotyped mask of “diathesis” is methodologically incorrect, although to some extent justified for practical reasons, since methods of treatment and especially prevention can be quite stereotypical.

The classic definition of constitutional anomalies was given in 1926 by the domestic pediatrician M.S. Maslov: “We talk about constitutional anomalies when the body’s functions are in a state of unstable equilibrium, and the body itself has such individual, congenital, inherited, and sometimes acquired properties that predispose it to pathological reactions to external harm, making it in what - degree prone, predisposed to known diseases and to the severe course of his illnesses.” Yu.E. Veltishchev (1985) describes diathesis as a polygenic (multifactorial) inherited tendency to diseases, objectively recognizable deviations from the normal phenotype.

The authors believe that up to 90% of chronic diseases in adults develop precisely against the background of diathesis. Currently, there are more than 20 diathesis, but their combinations are not excluded, as well as options that are unique to an individual.

The diathesis itself, as a rule, does not have clinical manifestations, and they can be considered as borderline conditions, a “pre-disease”, which can, under the influence of damaging factors, transform into a disease or not manifest itself at all. To identify diathesis, it is necessary to analyze the child’s family (genealogical) history and perform laboratory tests to identify markers of a suspected diathesis (for example, increased concentrations of IgE in atopic diathesis, uric acid in uric acid diathesis, the presence of certain major histocompatibility complex (HLA) Ags in diabetic or autoimmune diathesis ).

Congenital anomalies, delayed maturation of individual systems (especially enzymatic ones), instability of metabolic processes, perinatal pathology of the central nervous system, endocrine dysfunction, unfavorable living conditions, and irrational feeding can cause the manifestation of some diathesis at an early age. Such specifically “children’s” diathesis, more often called constitutional anomalies, include exudative-catarrhal (atopic), lymphatic-hypoplastic (lymphatic) and neuro-arthritic (uric acid) diathesis, as well as their combined forms and individual variants of constitutional anomalies. At the same time, the constitution is understood as a complex of morphological, functional and reactive properties of the body that determine the nature of the latter’s reaction to external influences.

The following factors are considered common causes for the development of constitutional anomalies: heterochronism in the maturation of blood cells, enzymes and functions of the liver, kidneys and other organs; naru-

suppression, slowing and distortion of the immune response; hypo- and dyscorticism, leading to a disorder of the endocrine regulation of metabolic and immunological processes.

The criteria that allow children to be classified as at risk for the formation of constitutional anomalies are as follows.

Burdened heredity.

Diseases, medications, poor nutrition of the mother during pregnancy.

Unfavorable course of pregnancy and childbirth.

Infectious diseases and the use of a large number of drugs.

Improper feeding.

General clinical manifestations of all constitutional anomalies:

Violation of adaptation, both functional and social;

A decrease in all the body’s defenses and frequent illnesses;

Respiratory diseases occurring with an asthmatic component, bronchial asthma;

Exudative and any other skin rashes;

Enlarged lymph nodes, tonsils, adenoids;

Metabolic disorders, paralysis or dystrophy.

EXUDATIVE-CATARHAL DIATHESIS

Exudative-catarrhal diathesis* is a peculiar condition of the child’s body, accompanied by a tendency of the skin and mucous membranes to the occurrence of infiltrative-desquamative processes, lymphoid hyperplasia, lability of water-salt metabolism, a tendency to allergic reactions, inflammatory and infectious diseases.

Exudative-catarrhal diathesis is detected in 40-60% of children in the first year of life, even in those who are breastfed. In most cases, manifestations of exudative-catarrhal diathesis gradually disappear (with a rational attitude of parents and doctors towards it) by 2-3 years. However, 20-25% of these children subsequently develop allergic diseases, which indicates that allergic (atopic) diathesis occurred under the guise of exudative-catarrhal diathesis.

Allergic (atopic) diathesis is distinguished as a separate form of constitutional anomaly or as a true immune variant of exudative-catarrhal diathesis. Its development is genetically linked

* The term “exudative-catarrhal diathesis” was introduced into clinical pediatrics in 1905 by A. Cherny.

caused by hyperproduction of IgE. The families of these children report frequent allergic diseases in relatives.

Etiology and pathogenesis

The etiology and pathogenesis of exudative-catarrhal diathesis are associated with morphofunctional immaturity of the gastrointestinal tract in young children. Low enzyme activity, deficiency of local (IgA) and blocking (IgG) Ig lead to incomplete breakdown of food proteins and their absorption through the increased permeability of the intestinal wall into the blood. There they play the role of foreign Ags, causing hyperproduction of IgE, activation of the immune system, pathochemical and pathophysiological phases of an immediate allergic reaction with the release of biologically active substances (histamine, leukotrienes, kinins, serotonin, etc.).

The sensitivity of children's tissues to histamine is higher than that of adults. Histamine can be released both as a result of the entry of foreign Ags into the blood (cow's milk, eggs, citrus fruits, strawberries, etc.), and under the influence of meteorological factors, unfavorable environmental conditions, vitamin deficiency, infectious diseases, etc. In this case, the development of allergic reactions passes through the immunological phase. The functional immaturity of the endocrine glands, in particular dyscorticism, leads to peculiar metabolic disorders - the predominance of mineralocorticoids over glucocorticoids, unstable water-salt metabolism, and metabolic acidosis. Low immunological activity of the body contributes to frequent diseases and compensatory hyperplasia of the lymphoid apparatus.

Clinical picture

In the first month of life, children with exudative-catarrhal diathesis develop “gneiss” (seborrheic crusts on the head), persistent diaper rash on the buttocks and in skin folds, later - redness and infiltration of the skin of the cheeks (“milk scab”), erythematous spots on open parts body, itchy nodular rash (strophulus) on the extremities. The language takes on the appearance of a “geographical map”. At older ages, various allergic rashes appear. Tissue turgor is reduced. Paratrophy is typical for such children; The weight gain curve is unstable; excess body weight is easily replaced by insufficient body weight. Regional lymph nodes are usually enlarged. The stool is frequent and unstable. Prolonged blepharitis, conjunctivitis, rhinitis, otitis, acute respiratory viral infections often develop; obstructive bronchitis may appear in the second year of life.

Data from additional research methods are not very informative. Eosinophilia and increased concentration of IgE in the blood are detected.

The course of exudative-catarrhal diathesis is wavy, exacerbation can be caused by any factor - nutritional, meteorological, infectious, vaccination, neuropsychic stress. Infectious skin lesions often overlap (Fig. 7-1 on the inset).

Diagnosis and prognosis

The diagnosis of exudative-catarrhal diathesis is made according to the anamnesis and the results of an objective examination. Differential diagnosis must be carried out with atopic diathesis. The prognosis is favorable. With true atopic (autoimmune) diathesis, the development of allergic diseases and autoimmune processes is possible.

LYMPHATIC-HYPOPLASTIC DIATHESIS

Lymphatic-hypoplastic diathesis* is a constitutional anomaly accompanied by diffuse hyperplasia of lymphoid tissue (generalized enlargement of the lymph nodes and thymus gland), dysfunction of the endocrine system, a sharp change in the body’s reactivity and a decrease in the child’s immunity and adaptation to environmental conditions. The prevalence of lymphatic-hypoplastic diathesis is lower than exudative-catarrhal diathesis and is 10-12%, and among patients with sepsis and pneumonia - 30%.

Etiology and pathogenesis

The occurrence of lymphatic-hypoplastic diathesis is associated with primary damage to the adrenal cortex. Hypocortisolism leads to the development of arterial hypotension and muscle hypotension, intolerance to stressful situations; as a result of activation of the pituitary gland, a decrease in the formation of ACTH and an increase in growth hormone occur. In addition, dysfunction can be genetically determined or caused by unfavorable conditions of intra- and extrauterine development (prolonged hypoxia, asphyxia during childbirth, serious illnesses, intoxications, etc.). Damage to the walls of the third ventricle and the pituitary gland due to hypoxia or asphyxia during childbirth can lead to disruption of the central regulation of the internal glands

* The concept of “lymphatic-hypoplastic diathesis” was introduced into clinical practice by the Austrian pathologist A. Paltauf and pediatrician T. Escherich in 1889-1890.

secretion, including the adrenal cortex, dysfunction of the sympathoadrenal system. A decrease in the synthesis of catecholamines and glucocorticoids by the adrenal glands leads to dyscorticism, the predominance of mineralocorticoids and secondary (compensatory) hyperplasia of lymphoid tissue, including the thymus. In children, instability of water-salt metabolism, intolerance to stressful situations, easily occurring microcirculation disorders, and high permeability of the vascular walls are noted. The consequence of this is the rapid development of toxicosis, hyperproduction of mucus in the bronchial tree, and the early development of obstructive syndrome. In some cases, lymphatic-hypoplastic diathesis includes a hereditary defect of the immune system (unclassified immunodeficiency) with a decrease in both humoral and cellular immunity, which contributes to the development of frequent acute respiratory viral infections and severe bacterial diseases. Lymphatic-hypoplastic diathesis develops by 2-3 years of life and, as a rule, ends by puberty.

Clinical picture

Children with lymphatic-hypoplastic diathesis are usually born large, pasty, grow quickly, easily lose and gain body weight; Their tissue turgor and muscle tone are reduced. Lethargy and adynamia are noteworthy, simulating a lag in psychomotor development, fatigue, and decreased blood pressure. Children do not tolerate changes in environment and family troubles. Frequent respiratory diseases are severe, often accompanied by hyperthermia, impaired microcirculation and neurotoxicosis. Skin rashes (in 30% of children) are similar to those with exudative-catarrhal diathesis, but are usually located on the buttocks and lower extremities. Diaper rash occurs in skin folds and marbling of the skin. The physique is disproportionate, with long limbs, the distribution of subcutaneous fat is uneven (more on the lower part of the body). The majority of children with lymphatic-hypoplastic anomalies of the constitution constitute the group of “frequently ill” children. They usually have enlarged all groups of peripheral lymph nodes and tonsils (“peripheral lymphatism”), and hepato-splenomegaly is often detected. In 70% of children, the thymus gland is enlarged (according to X-ray examination). In such children, multiple signs of dysembryogenesis are revealed: hypoplasia of the heart and large vessels, kidneys, external genitalia, endocrine glands, minor malformations, which allows us to call this diathesis lymphatic-hypoplastic.

Laboratory research

Absolute and relative lymphocytosis, neutro- and monocytopenia are detected in peripheral blood. A biochemical blood test reveals a decrease in glucose concentration, an increase in the concentration of cholesterol and phospholipids. The immunogram determines a decrease in IgA, IgG, the number of T- and B-lymphocytes, a violation of the T-helper/T-suppressor ratio, and an increase in the concentration of circulating immune complexes (CIC). A decrease in the concentration of thymus factors in the blood and 17-ketosteroids in the urine is detected.

The diagnosis of lymphatic-hypoplastic diathesis is established on the basis of clinical manifestations, confirmed by the laboratory markers listed above and an enlargement of the thymus gland during X-ray examination. Differential diagnosis is carried out with exudative-catarrhal diathesis, sometimes with blood diseases and HIV infection (see chapter “HIV infection”).

Forecast

Mortality in children with thymomegaly and lymphatic-hypoplastic diathesis in the first year of life is 10%. Typically, the signs of this type of diathesis disappear during puberty, but in some individuals all the signs of diathesis (thymic-lymphatic status) persist for life.

NERVOUS-ARTHRITIC DIATESIS

Neuro-arthritic diathesis* is a genetically determined metabolic disorder, primarily of uric acid and purine bases, manifested by increased excitability of the central nervous system, spastic and allergic symptoms. Neuro-arthritic diathesis is observed in 2-5% of children, i.e. much less frequently than the above diathesis.

Etiology

Neuro-arthritic diathesis is currently commonly associated with both hereditary factors (defect in the metabolism of purine bases, increased synthesis of uric acid, low acetylating ability of the liver, etc.) and environmental influences:

* The concept of “neuroarthritic diathesis” was introduced into clinical practice by J. Comby in 1901-1902.

overload of protein (primarily meat) products in the diet of a pregnant woman and a young child. Family genetic history indicates that in families of probands, neurasthenia, gout, urinary and cholelithiasis are detected with the same frequency (18-22%). In these families, atherosclerosis and coronary heart disease, essential arterial hypertension, migraine, diabetes, diseases of the respiratory system, stomach and duodenum are 2.5 times more likely.

Pathogenesis

In neuro-arthritic diathesis, hyperuricemia is of leading importance. The increase in the concentration of uric acid and urate in the blood and tissues is either primary in nature (mutations in the genes encoding metabolic enzymes - phosphoribosyltransferase and urate oxidase) or develops secondary (for example, with increased breakdown of purines and pyrimidines due to hemolytic diseases). Clinical manifestations of hyperuricemia include gout, nephrolithiasis, arthritis and neurological disorders. The effect on the central nervous system of increased concentrations of uric acid and urate, as well as concomitant acidosis, leads to the development of excessive excitability in the child. With hyperuricemia of various origins, various disorders of carbohydrate and protein metabolism are also possible. Decompensation often occurs at school age during stressful situations, changes in nutritional patterns, and physical overload.

Clinical picture

Clinical manifestations depend on the age of the patients and are represented by a variety of syndromes: neurasthenic, metabolic, spastic, skin. Rare manifestations of this form of diathesis can be persistent low-grade fever, odor intolerance and various idiosyncrasies.

In the first months of a child’s life, poor weight gain and unstable stools are often noted. As a result of decreased appetite, dystrophy easily develops, but it is possible, especially in teenage girls, and excessive development of subcutaneous fatty tissue up to obesity. Hyperplasia of lymphadenoid tissue is less pronounced than in other diathesis, but usually all groups of lymph nodes are palpable (moderately enlarged, dense).

Neurasthenic syndrome observed most often (84%). In the first year of life, it is manifested by the predominance of excitation processes: children are often restless, loud, fearful, small and poor.

xo are sleeping. The stimulating effect of purine metabolism products on the central nervous system promotes earlier mental and emotional development. Children quickly master speech, show curiosity and interest in their surroundings, remember well what they read or were told, and begin to read early. However, the external well-being and good development of children are accompanied by emotional lability, sleep disturbances, night terrors, SVD, and persistent anorexia. In addition, tics, logoneurosis, obsessive cough, habitual vomiting, aerophagia, and enuresis are possible.

Metabolic disorder syndrome. This syndrome is expressed in transient, often nocturnal, joint pain (due to the crystallization of sodium urate in the intra-articular fluid), while gouty arthritis never develops in childhood. Characteristic symptoms include dysuric disorders not associated with hypothermia or infection, saluria (usually of a mixed nature - urates, oxalates, phosphates are detected). It should be noted that in this form of diathesis, periodic acetonemic vomiting may occur. Acetonemic vomiting develops in children aged 2-10 years (more often in girls) and completely stops by puberty. The causes of an attack may be an error in diet, a stressful situation, or physical overload. Vomiting occurs suddenly or after a short (up to 24 hours) period of warning signs (malaise, headache, refusal to eat, smell of acetone from the mouth, constipation, weakly acholic stool). Vomiting quickly becomes uncontrollable, often accompanied by thirst, dehydration, intoxication, hyperthermia, weight loss, agitation, shortness of breath, tachycardia, and in rare cases, symptoms of meningism and convulsions. Exhaled air and vomit have the smell of acetone. The attack lasts from several hours to 1-2 days, rarely up to 1 week. In most cases, vomiting stops as suddenly as it started; The child is recovering quickly. After an attack, the enlarged liver can be palpated for several days. Acidosis, accumulation of acetone and ketone bodies, ammonia, often low concentrations of glucose, sodium and chlorine, as well as neutrophilic leukocytosis with a decrease in the number of eosinophils, monocytes and lymphocytes, and a moderate increase in ESR are detected in the blood. Acetone is detected in the urine at the time of the attack, and urobilinuria is pronounced after the attack.

Spastic syndrome manifested by bronchospasm, migraine-like headaches, a tendency to arterial hypertension and cardialgia, renal, hepatic and intestinal colic, constipation, and the development of spastic membranous colitis.

Asthmatic bronchitis in this group of children occurs with mild secretion, responds well to treatment with bronchodilators, but in some children it transforms into the atopic form of bronchial asthma.

Skin syndrome.Allergic skin rashes are observed relatively rarely; they appear in older age in the form of urticaria (as well as angioedema), prurigo, neurodermatitis, dry and seborrheic eczema. The mucous membranes, like the skin, are affected less frequently than in other forms of diathesis. Only some children have a tendency to ARVI with obsessive sneezing, coughing, and symptoms of bronchospasm.

Laboratory research

An increase in the concentration of uric acid is detected in the blood. The concentration of urates, oxalates and phosphates in the urine is increased.

Diagnosis and differential diagnosis

Diagnosis is based on the presence of metabolic disorders in the family history, signs of increased excitability of the child’s central nervous system, severe metabolic disorders, a tendency to spasms, and allergic diseases. Differential diagnosis is carried out with chronic tuberculosis intoxication (with a positive Mantoux test), minimal cerebral dysfunction syndrome.

Forecast

The prognosis is determined by the possibility of early formation in adults of atherosclerosis, essential arterial hypertension, gout, metabolic arthritis, diabetes, cholelithiasis and urolithiasis, atopic bronchial asthma. In this regard, the earliest possible detection of purine metabolism disorders is of particular importance.

DIFFERENTIAL DIAGNOSIS OF DIATESIS

The distinctive features of the most common diathesis in children - exudative-catarrhal, lymphatic-hypoplastic and neuro-arthritic - are presented in Table. 7-1.

Table 7-1.Clinical characteristics of the main diathesis

TREATMENT FOR DIATHESIS

In the treatment of constitutional anomalies, as well as in their prevention, the main role belongs to diet, care and education (Table 7-2).

Table 7-2.Non-drug methods of treatment and prevention of diathesis in children

Medications used for constitutional anomalies are presented in Table. 7-3.

Table 7-3.Drug therapy for diathesis

PREVENTION OF DIATESIS

Prevention of constitutional anomalies should begin before the birth of the child and continue after childbirth.

Regular monitoring of a woman’s health, especially during pregnancy.

Prevention or treatment of gestosis and any diseases of the expectant mother.

Compliance with a protective hygienic regime by a pregnant woman.

Rational hypoallergenic nutrition for a pregnant woman.

Proper management of childbirth and early attachment of the baby to the breast.

Natural feeding with careful, slow and gradual introduction of its correction products (each new nutritional component is introduced separately, starting with small quantities).

Exclusion from the diet of a nursing mother and child of obligate allergens, extractive substances, spicy, spicy, smoked dishes.

Using only natural fabrics for children’s clothing, baby soap when washing the child and washing his linen.

Hardening, massage, gymnastics.

The use of adaptogens upon admission to children's institutions.

Strict adherence to instructions for vaccination or drawing up an individual schedule of preventive vaccinations.

Hemorrhagic syndrome

Bleeding

Laboratory data

Leukemia

Clinic acute leukemia

5 periods: pre-leukemic, acute, remission, relapse and terminal.

The skin is pale, characterized by hemorrhoids.S. (hemorrhages - from petechiae to ecchymosis), bleeding from the mucous membranes, typically the periphery of the lymph nodes, especially the cervical, submuscular, and inguinal. Rare manifestations of acute leukemia – change skin and subcutaneous cells in the form of leukemoids, necrotic. defeat skin and mucous membranes of the mouth. For acute leukemia may involve the lungs, central nervous system, and sex. organs and eyes, but this is typical for relapses of the disease, but if these symptoms appear. in the beginning. period - then this is a bad prognosticator. sign. Changes in the lungs occur under the “mask” of bronchitis, pneumonia, and pleurisy. X-ray revealed diffuse. changes in the interstitium of the lungs in the form of darkening.

Damage to the central nervous system (neuroleukemia) is characterized by leukemic “meningitis”, “meningoencephalitis”, or “encephalitis”. Common to all forms is the general brain. and mening. symp-we, clonic-tonic convulsions. Characteristic but striking. ChMN. Leukemia defeat in the hypothalamic region occurs in the form of diencephalic S. (thirst, polyuria, obesity, hyperthermia). Involvement of the genital organs in the leukemia is determined by palpation and compaction of the testicles and spermatic cords in boys and ovaries in girls.

Syndromes: intox, anemia, bone joint, proliferative (hyperplastic), hemorrhoids (myeloblastic).

In case of lymphoid variants, the destruction of leukemia proliferation. it occurs not only in the bone marrow, but also outside it, appearing in the periphery. l / u, liver and spleen.

For acute myel. leukemia proliferation of leukemia. as only in the bone marrow, > expressed S. bone marrow deficiency present. blastn. infiltration, anemia, granulocytopenia with inf. complication.

In children of the 1st year of life, signs of delay. leukemia can begin with t 0, sudden appetite (anorexia), increasing pallor, dyspnea. Spicy leukemia in children under 1 year of age is severe with extramedullary localizations of the disease, regardless of the type of disease.

Variants of the course of exacerbation (relapse) acute. leukemia in children is distinguished by its diversity, these may be cases similar to /I/ the acute period, but there may be first changes only in the bone marrow puncture, without a clinic.

Diagnostics: The main thing is the sign of blast cells in the bone marrow punctate and their appearance in the peripheral blood. In the hemogram: NV, E-ov, platelets. Depending on the number of leukocytes, cases with the Nth number of leukocytes, a decrease (1.0 x 10 9 / l and<), повышенным (20,0 х 10 9 /л до 1,0 х 10 12 /л) кол-вом лейкоцитов.

The absolute indicator is the appearance of blast cells. However, there may be cases where they are absent in the periphery. blood.