Chronic eating disorders in children. Stages of natural feeding. Nursing process in chronic digestive disorders

Diagnosis of disorders eating behavior children are usually treated by a pediatrician, and only in rare cases pediatric nutritionist or occupational therapist. First of all, the specialist must find out the features of the oral motor skills of the baby. He explores them on his own, however, he will first ask the parents about the skill of their child.

In doing so, he will ask the following questions:

Is it possible for the baby to tightly wrap their lips around the nipple or spoon? Can he keep his lips closed when he suckles or bottles or chews?

How would you describe your child's eating habits? Does the child know how to chew a bitten off piece and collect food in a lump for swallowing? (If the child fails, you may notice that after swallowing food remains in the recesses of the mouth or between the gums and cheeks).

Have you noticed that the child loses control of food and liquid before or during swallowing?

Can you describe how the baby chews? There are two types of chewing: chewing and rotational. Chunking type means up and down movements of the jaws, while the child does not make rotational movements with the jaws. This type of chewing is primitive, but rotational is mature. Rotational chewing allows food to be moved between the teeth and more efficiently collected from the molars onto the tongue before swallowing.

Can the child move the tongue to the sides of the mouth to move food around the mouth?

Can a child raise their tongue to the palate?

Can a child form a groove in the tongue when swallowing liquid?

The doctor uses this information to select meals that best match the child's motor skills. He will also determine the type of therapeutic program that the baby needs to strengthen the muscles of the face and mouth and improve their function. Your answers to these questions will also help you find out if your child may have a swallowing problem.

It is also important for the doctor to learn about your child's breathing before, during and after meals:

Does the child have hasty acts of swallowing while eating? Does he choke?

Does the child choke, cough and choke while swallowing?

Is there anything about a child's swallowing that worries you?

Does the child breathe freely before he starts eating?

Does his breath become gurgling while eating?

Does the child have a wet type of breath? ( wet type breathing means that the baby is breathing normally, but when he starts to eat, you can literally hear the liquid and food collect in his throat and cause gurgling sounds. Newborns may also experience wheezing in the chest).

Does the child cough while eating?

What kind of breath does the child have after eating: clean, gurgling or wet? Does he get short of breath after eating?

This information, and what you've learned so far, will help you figure out if your child's swallowing is adequate and safe.

It happens that a child plays by stuffing chew toys into his mouth, this is normal. Thus, the baby reduces its vomiting reflex, which gives him the opportunity to move on to the next stage of nutrition. The gag reflex is triggered by irritation of the receptors on the surface of the tongue, its purpose is to protect the child from moving objects into the throat that he can choke on. When a child plays with toys in his mouth and hiccups at the same time, the trigger zone of this reflex moves further and further towards the root of the tongue. That is why the gag reflex in adults is triggered only by irritation of the receptors in the throat.

Your pediatrician will also ask you about the following:

How effectively is your child swallowing food and liquids?

Does the child need to swallow several times to clear the throat? If so, how many sips does it take?

Can you hear the baby breathe after swallowing?

In the end, the doctor will find out if the child has mastered certain feeding skills and if the following development causes concern for you:

Drinking from a bottle;

Drinking from a cup (what type of cup do you use - open or with a lid and tip?);

Drinking through a straw;

Food from a spoon (what type of spoon do you use?);

Food with hands;

Eating with appropriate items (spoon, etc.).

Each food habit is based on those that the child has mastered before, therefore, it is important for the expert to find out when the normal course of this process was interrupted. Your answers to the questions will help him understand this, as well as make appropriate bottle, cup, and spoon recommendations (if needed).

If we talk about the causes of eating disorders in children (not including the group of newborns), then there may be several of them:

• the presence or onset of the development of colds, rotovirus infection;
• the presence of other pathological processes in the body;
• defects in the structure of the face and jaw;
• stressful conditions.

But the listed reasons speak of a decrease in appetite and the refusal of the child to eat. However, an eating disorder can also be manifested by overeating. The manifestation of this form of eating disorder include: nervous and mental disorders.

In addition, such disorders may be associated with changes that have arisen in the brain and metabolic anomalies.

Symptoms

Symptoms of an eating disorder in a child include:

• refusal of food;
• binge eating;
• change in taste preferences (perverted taste);
• decrease in summer weight or increase in body weight.

Signs of an eating disorder may be accompanied by other symptoms, which may more clearly show the presence of a malfunction of an organ or an entire system, or the presence of mental disorders child.

Diagnosis of an eating disorder

First of all, the doctor listens to the child and his parents, studying the existing complaints about the patient's eating behavior. Often a child, especially a teenager, does not see any problem, so it is important to carry out conversations with parents. Important information is how the child's behavior changes during the day (maybe he eats at night), how long ago the problems with eating behavior began and after what events.

• Next, the doctor analyzes the anamnesis of the child's life. In a conversation with parents, the doctor finds out if there have been similar cases in the family ( hereditary factor), whether the child had head injuries, whether he plays sports.
• An indispensable step in the presence of alarming signs is to perform a physical examination of the patient, in which the doctor determines the change in the child's body weight. With a prolonged lack of nutrition, the doctor notes such signs as pallor and dryness of the skin and mucous membranes. When overeating, the patient's obesity is observed, which can be at different stages.
• Among laboratory tests you may need to donate blood, feces, urine, often in connection with an eating disorder disorder called biochemical analysis blood, and a blood glucose test.

You may also need the help of a neurologist, psychotherapist, dentist, jaw surgeon and other narrow specialists.

Complications

The presence of the consequences of eating behavior in a child is due to a variant of such a disorder.

• So, for example, if there is a fact of a decrease in appetite, a permanent decrease in body weight can occur, this complication can lead to cachexia (a state of severe exhaustion, life-threatening), with increased appetite obesity may occur.
• The integrity of the skin may be impaired due to lack of nutrients cracks form on the skin with reduced appetite, when overeating, scars may appear on the skin due to rapid stretching with a strong increase in the patient's body weight.
• suffer protective functions body (weakened immune system).
• All activities are disrupted internal organs due to lack useful substances or excess adipose tissue.
• violated mental activity, for example: memory decreases, learning deteriorates, the speed of thinking slows down due to a lack of nutrients when you refuse to eat.

• Feeling of psychological discomfort, including sleep disturbance.

With timely medical care consequences and complications can be avoided.

Treatment

What can you do

If you notice unusual eating behavior in your child, you should contact your doctor. Is it not possible to force him to exhort him to eat something or, on the contrary, to abstain from food? Perhaps the problem is not in his character, transitional age or personal taste, but much deeper?

Parents should be alerted by a change in the child's weight, obsession with a certain idea related to nutrition, aggressiveness when they try to convince him.

What does a doctor do

The main principle of getting rid of an eating disorder is to treat the cause of this ailment.

Therefore, in each individual case, their methods are used. So in case of food failure, look at what reasons led to this. For physiological problems drug therapy, surgery may be indicated.

If a child has a disruption endocrine system, then the endocrinologist prescribes treatment.

With psychogenic - the child should be observed and corrected by a psychiatrist or neurologist.

In case of overeating, diet therapy may be prescribed.

Prevention

Preventive measures cannot completely eliminate the occurrence of this problem, but will reduce the risk of their occurrence. It is necessary to ensure that the child sleeps fully, walks a lot, spends time in the fresh air, useful moderate physical exercise, it is important not to have bad habits teenagers. All this can affect the child's appetite and improve his eating behavior. An important aspect is the stability of the psychological background. Indeed, sometimes eating disorders arise as a kind of protest against something.

Articles on the topic

Show all

Users write about this topic:

Show all

Arm yourself with knowledge and read this useful informative article about the disease of eating disorder in children. After all, being parents means studying everything that will help maintain the degree of health in the family at the level of “36.6”.

Find out what can cause the disease, how to recognize it in a timely manner. Find information about what are the signs by which you can determine the malaise. And what tests will help to identify the disease and make the correct diagnosis.

In the article you will read all about the methods of treating such a disease as eating disorders in children. Specify what effective first aid should be. How to treat: choose drugs or folk methods?

You will also find out what can be dangerous untimely treatment eating disorders in children, and why it is so important to avoid the consequences. All about how to prevent eating disorders in children and prevent complications.

And caring parents will find on the pages of the service full information about the symptoms of eating disorders in children. How do the signs of the disease in children at 1.2 and 3 years old differ from the manifestations of the disease in children at 4, 5, 6 and 7 years old? What is the best way to treat eating disorders in children?

Take care of the health of your loved ones and be in good shape!

Diseases of the digestive system and eating disorders occupy one of the first places in frequency among all diseases of early childhood, especially in the 1st year of life. The frequency, as well as the severity of the lesion, are determined by the anatomical and physiological features gastrointestinal tract, nervous system, metabolic state in young children.

However, it should be borne in mind that with proper feeding and care of the child, favorable environmental conditions, these diseases in young children are extremely rare.

The term "nutrition" should be considered as a physiological concept, which includes a set of processes occurring in the body that lead to the construction of new tissues and support the basic metabolism: food intake, digestion, absorption from the intestine, cell and tissue metabolism (assimilation and dissimilation) . Violation of one of these processes entails an eating disorder.

Proper nutrition is especially great importance in early childhood due to increased growth, which is biological feature this age period.

Eating disorders can occur acutely in acute digestive disorders and are referred to as dyspepsia-diseases similar in their main symptom, acute diarrhea. In other cases, malnutrition develops gradually, depending on a number of endogenous and exogenous factors, they are called chronic eating disorders, or malnutrition.

Diseases of the gastrointestinal tract are a common pathology, especially in young children. Their prevalence in our country has been significantly reduced due to the introduction into practice rational nutrition and other preventive measures.

At the VIII All-Union Congress of Children's Doctors (1962), a classification of diseases of the gastrointestinal tract in young children was adopted, which has found wide application.

CLASSIFICATION OF GASTROINTESTINAL DISEASES IN YOUNG CHILDREN

I. Diseases of functional origin

A. Dyspepsia

1. Simple dyspepsia

2. Toxic dyspepsia

3. Parenteral dyspepsia (not registered as an independent disease) B. Dyskinesia and dysfunction

1. Pylorospasm

2. Atony of various parts of the stomach and intestines

3. Spasmodic constipation

4. Partial ileus

II. Diseases of infectious origin

1. Bacterial dysentery

2. Amoebic (amebiasis) dysentery

3. Salmonella

4. Intestinal co-infection

5. Intestinal form of staphylococcal, enterococcal and fungal infections

6. Viral diarrhea

7. Intestinal infection of unknown etiology

III. Malformations of the gastrointestinal tract

1. Pyloric stenosis, megaduodenum, megacolon

2. Atresia (esophagus, intestines, anus)

3. Diverticula and other malformations

Let us first focus on diseases of a functional nature.

Currently, dyspepsia (literal translation - indigestion) is much less common compared to the 30-50s, which is mainly due to advances in child feeding. Most often, these diseases are observed in children of the 1st year of life, especially up to 6 months of age.

The gastrointestinal tract of a young child is subject to great demands due to intensive growth and development. For 1 kg of weight, a child receives relatively more food than an adult, and this causes high work intensity. digestive system when the development of functional abilities has not yet been completed. In addition, it must be taken into account that the metabolism of a young child is extremely labile. That is why nutritional factors play an important role in the occurrence of dyspepsia in infants.

At breastfeeding dyspepsia develop much less frequently than with mixed and artificial.

There are two main forms of acute dyspepsia: simple and toxic.

simple dyspepsia

Simple dyspepsia (indigestion) most often develops with: 1) erratic feeding, non-compliance with the intervals between feedings; 2) inappropriate feeding - non-compliance with the correlative relationships between proteins, fats, carbohydrates during the introduction of complementary foods; 3) insufficient content of vitamins in food; 4) non-compliance water regime, especially during the hot season; 5) overheating and inconsistency of the child's clothing with high ambient temperature. All these violations are much more common with mixed and artificial feeding.

Clinic. The general condition of the child is slightly disturbed. In rare cases, subfebrile temperature is observed. At the beginning of the disease, regurgitation appears, and then there may be vomiting 1-2 times a day. These are protective reactions, due to which part of the excess or underdigested food is removed from the stomach. The chair becomes more frequent up to 6-8 times a day, sometimes more, it is liquid, yellowish or greenish in color with white lumps (lime salts, fatty acids, bacteria), with mucus in the form of transparent, vitreous threads, acid reaction.

There is bloating due to flatulence, accompanied by discharge of gases with an unpleasant odor. The child may be restless due to pain in intestinal colic. Tongue dry, covered with white coating.

Some decrease in body weight is noted. The duration of the disease is 5-7 days, there are usually no complications. The course of simple dyspepsia depends mainly on timely and properly conducted treatment, on the possibility of eliminating adverse factors environment.

Treatment. Assign a hungry pause in order to create functional rest for the gastrointestinal tract and eliminate the substrate for bacterial decomposition of food. Within 6-8 hours the child receives only liquids at the rate of 150-170 ml/kg per day. Give weak tea, rice water, sweetened water, 5% glucose solution, rosehip infusion, vegetable broths, isotonic sodium chloride solution and Ringer's solution. Drinking is given in small portions to avoid vomiting. After hunger, breastfeeding is prescribed with some limitation of the duration (7-10 minutes) of each feeding for 2-3 days. The missing amount of food is made up by drinking. With artificial feeding of children, especially under the age of 6 months, it is necessary to provide expressed human milk. Only in the complete absence of women's milk, sour mixtures are prescribed (VRMK, V-kefir). In the first 2 days give approximately half, and then ^3 of the usual amount

food for each feeding and the total volume is supplemented with the introduction of a drink.

In the future, daily increase the amount of food, taking into account the general condition of the child. After the normalization of the stool and appetite, they switch to age-appropriate food. Complementary foods are also introduced in small portions.

From medications, vitamins of groups B and C are prescribed a solution of hydrochloric acid with pepsin (Acidi hydrochlorici diluti 1 ml, Pepsini 1.5, Aq. destill. 100 ml) 1 teaspoon 3 times a day before meals or gastric juice (Succus gastrici naturalis ) no "/2 teaspoons, dissolved in 5-10" ml of water, 3 times a day before meals. At the same time, concomitant diseases are treated - rickets, malnutrition, etc. It is also necessary to eliminate care defects that contributed to the disease.

In the absence of parenteral foci of infection ( otitis media, pneumonia, stomatitis) antibiotics or sulfanilamide preparations should not be prescribed.

Toxic dyspepsia

Toxic dyspepsia, like simple dyspepsia, is caused in most cases by nutritional disorders and is functional disease. However, there is a significant difference between simple and toxic dyspepsia: with simple dyspepsia, the functional activity of the gastrointestinal tract is disturbed, the general condition is disturbed relatively little, with toxic dyspepsia, the entire body suffers, in pathological process the nervous system is involved, metabolism is deeply disturbed - a “metabolic catastrophe” develops.

Toxic dyspepsia can develop from simple dyspepsia under the influence of a number of exogenous and endogenous factors (too short a hungry pause, too fast a transition to regular food, insufficient fluid supply, irrational feeding, overheating, care errors, etc.). At the same time, some pediatricians believe that toxic dyspepsia (toxic syndrome) can occur in any disease in response to exposure to microbial toxins or non-physiological food decomposition products.

Clinic. The clinical picture of toxic dyspepsia is similar to the manifestations of the toxic syndrome that occurs with any intestinal infection in young children. The general condition of patients with toxic dyspepsia is always severe. Vomiting becomes frequent and indomitable, comes even from a spoonful of water. The chair is also frequent, watery, with a large diaper wetting radius, does not contain stool. Symptoms of toxicosis and exsicosis develop rapidly and in parallel

(dehydration). The initial excitation is replaced by lethargy, weakness, at times blackout or loss of consciousness occurs, stereotypical movements of the tongue, hands appear, the pose of a “conductor” or “swordsman” appears, a masculine face, a stopped, distant look, and rare blinking are noted. The conjunctival reflex and pupillary reaction to light weaken and fade away. Tendon and skin reflexes are also weakened. The pallor of the skin due to spasm is replaced by cyanotic marbling (stasis) or purple spots on rear surface body and limbs. The pulse is frequent, weak filling, and sometimes it is difficult to determine. Heart sounds are significantly muffled, especially the I tone at the top.

Breathing at the beginning is quickened, superficial, then becomes deep, without pauses (breathing of the “driven beast”).

Along with the manifestations of toxicosis, there are signs of dehydration of the child's body. The decrease in body weight in 1-2 days can reach 500-800 g and even more. There is a drop in tissue turgor, the skin becomes dry, gathers in poorly straightened folds. Facial features are sharpened. Large fontanel sunken, sunken eyes. There may be some pastosity and sclerema, especially on the limbs, which is an indicator of a deep metabolic and trophic disorder. The mucous membrane of the oral cavity acquires a bright color, the sclera become dry.

With toxic dyspepsia, body temperature may rise to 38-39 ° C due to intoxication and dehydration of the body. However, usually the temperature increase is short-lived (2-4 days); if it is delayed, then you should think about an infection.

Diuresis is sharply reduced, sometimes anuria may occur. Albuminuria (up to 1 g/l), cylindruria, and sometimes glucosuria are noted in the urine.

Blood thickening develops: the amount of hemoglobin, erythrocytes, leukocytes increases; ESR is usually low-1-2 mm/h.

The course of toxic dyspepsia depends on the state of the child's body and on the timeliness rational treatment. At proper treatment toxicosis and exsicosis are eliminated in 3-4 days from the start of treatment, complete recovery occurs in 2-3 weeks.

If a 24-hour fasting-water pause with a daily need for fluid does not lead to detoxification and if an elevated body temperature persists for several days, then intestinal infections (coli infection, salmonellosis, etc.) should be considered.

In addition, with toxic dyspepsia, there is usually a parallelism between the degree of toxicosis and exicosis, with intestinal

In other infections, such parallelism is not observed, either toxicosis or exsicosis prevails.

In previous years, mortality in toxic dyspepsia was very high, at present, with timely hospitalization of a sick child and timely full treatment, mortality is calculated in tenths of a percent.

Treatment. With toxic dyspepsia, treatment is carried out in a hospital. The fight against dehydration (rehydration) and toxicosis are carried out according to general principles treatment of toxic syndrome (see, "Dysentery and coli infection").

Hungry-water pause is prescribed for 12-20 hours, and sometimes longer. Its duration depends on the severity of toxicosis and the nutritional status of the child. The principles of its implementation are the same as for simple dyspepsia, only liquids are given in teaspoons of 5-10 ml every 5-10 minutes. After a hunger-water pause, dosed feeding is prescribed. On the 1st day, the child receives 100 ml of expressed human milk - 10 ml (two teaspoons) every 2 hours, only 10 times a day. The missing volume of food, according to age, is replenished by the introduction of liquid and by infusion. When vomiting stops, already from the 2nd day of treatment, the child can be given vegetable decoctions (from cabbage, carrots, potatoes): they are rich in mineral salts, alkalis, trace elements, have a pleasant taste and increase the secretion of gastric juice. The amount of women's milk is increased by 100-200 ml per day, respectively, this volume of fluid is reduced. By the 3rd-5th day, the child should receive up to 500 ml of food. From that time on, they begin to apply it to the breast for several minutes 1-2 times a day. With an increase in a single dose of food to 50-60 ml, the intervals between meals are increased to 2 "/2, and then to 3 and 3" / 2 hours. Gradually, the child is transferred to a full-fledged diet appropriate for age.

If the child is bottle-fed, then it is necessary to provide him with donor milk, and only in its absence, use sour mixtures. They are given in the same quantities and in the same sequence as expressed human milk.

Pylorospasm, pyloric stenosis

Pylorospasm refers to dyskinesia and develops in connection with spasms of the pylorus muscles. It is believed that this is due to the abundant supply of nerves to the pyloric part of the stomach.

Clinic. From the first days there is frequent but not excessive vomiting. The amount of milk excreted during vomiting is less than the amount sucked out by the child at the last feeding. On some days there may be no vomiting. The child becomes restless for periods. The body mass curve is flattened, post-

hypotrophy develops foamy, constipation appears. The disease must be differentiated from pyloric stenosis.

Treatment. Reduce the amount of women's milk per feeding and increase the frequency of feeding up to 8-10 times a day. It is recommended to give a small amount (1-2 teaspoons) of 8-10% semolina 2-3 times a day before feeding. The mother's food must be enriched with vitamins, especially group B. Vitamin b] is given to the child at 0.005 g orally 2-3 times a day or administered intramuscularly (0.5-1 ml of a 2.5% solution 1 time per day). Atropine is prescribed at a dilution of 1: 1000 (1-2 drops 4 times a day) or aminazine (3-4 drops of a 2.5% solution per 1 kg of body weight per day in 3 divided doses). A patch of mustard plaster is recommended on the stomach area before feeding. To combat dehydration, parenterally administered saline solutions and 5% glucose solution.

pyloric stenosis- malformation of the gastrointestinal tract. The disease occurs predominantly in boys. The muscular layer of the pylorus is thickened, of a dense, cartilaginous consistency, the lumen is narrowed.

Clinic. The disease develops gradually. Regurgitation, which appears in a child at the age of 2-3 weeks, turns into profuse vomiting with a fountain. In this case, the amount of vomit exceeds the amount of food taken before. Prolonged repeated vomiting leads to exhaustion and dehydration of the child's body. One of the striking symptoms is the peristalsis of the stomach with the acquisition of an hourglass shape, which is visible when feeding a child or when superficial palpation belly. A sick child has rare urination, constipation, dyspeptic, "hungry" stools can be observed. This condition should first of all be differentiated from pylorospasm.

Pylorospasm

1. Vomiting from birth

2. The frequency of vomiting varies by day

3. The amount of milk excreted during vomiting is less than the amount of sucked milk

4. Constipation, but sometimes the stool is independent

5. The number of urination is reduced (about 10)

6. Skin is not very pale

7. The child is noisy

8. Body weight does not change or decreases moderately

9. Body weight at admission is greater than at birth

pyloric stenosis

1. Vomiting from 2-3 weeks old

2. The frequency of vomiting is more constant

3. The amount of milk excreted during vomiting, more quantity sucked milk

4. Almost always severe constipation

5. The number of urination is sharply reduced (about 6)

6. Sharp pallor of the skin

7. The child is calm

8. A sharp decrease in body weight

9. Body weight at admission is less than at birth

The diagnosis of pyloric stenosis is confirmed by X-ray examination. Introduced into the stomach barium slurry with pylorospasm after 4-5 hours is in the intestine, while with pyloric stenosis, barium remains in the stomach for 24 hours or longer if it is not excreted with vomiting.

Treatment of pyloric stenosis is usually surgical.

In the complex treatment of toxic dyspepsia, careful individual child care is of great importance: wide access fresh air, careful care of the skin and mucous membranes, moisturizing the sclera of the eyes by instillation of sterile oil, cleanliness of linen, care items, etc.

When a child is brought out of a state of toxicosis, enzymes are used to increase the body's resistance (pepsin with hydrochloric acid, pancreatin), vitamins of the group IN, apilac etc.

Hypotrophy

The concept of "chronic eating disorders", or "dystrophy", includes pathological conditions characterized by either excessive or reduced body weight compared to the norm. The first forms are called "paratrophy". The second forms, which are more common, are combined under the name "hypotrophy", they are characterized by weight loss, a decrease in food tolerance and a decrease in immunity.

Hypotrophy is inherent in young children (up to 2 years), in older children they occur only under extremely unfavorable conditions.

Children with malnutrition are especially susceptible to diseases. Quite often, malnutrition is a background against which all infectious and inflammatory processes are more difficult.

With the increase in the material and cultural level of the population, the implementation of systematic medical control over the feeding and development of children in the first years of life, the organization of a wide network of dairy kitchens, the incidence of malnutrition among young children has significantly decreased. Currently, children with severe forms of malnutrition (grade III) are very rare, but mild and moderate malnutrition (grades I and II) continue to be common diseases among young children.

The causes of malnutrition in young children are numerous and varied, they can be conditionally divided into the following groups: 1) alimentary; 2) infectious; 3) relating to adverse environmental conditions.

In previous years, defects in child feeding played a leading role in the etiology of malnutrition.

The most important among the alimentary causes of malnutrition is malnutrition in violation of the correct ratio

individual ingredients in food. Insufficient introduction of proteins, fats, carbohydrates, mineral salts, vitamins can lead to the development of malnutrition. Of the greatest importance is protein deficiency, which adversely affects the growth and development of the body, leads to profound changes in metabolism, causes a violation of the enzymatic functions of the liver and other organs.

Deficiency of vitamins (A, C, group B, etc.) can be the cause of malnutrition, since they are regulators of all life processes; established their close relationship with hormones and enzymes.

Nutritional deficiencies can be of a different nature, but the cause of malnutrition during breastfeeding is most often malnutrition or partial starvation, which can be observed when the mother does not have enough milk due to temporary or permanent hypogalactia. Sometimes a child receives an insufficient amount of milk or as a result of the presence of malformations in him (pyloric stenosis, splitting hard palate, non-closure of the upper lip, congenital heart disease, Hirschsprung's disease, etc.), or due to defects in the mammary gland in the mother (flat, inverted, split nipple, tight breasts, etc.).

Less often, during breastfeeding, deviations of a qualitative nature can be observed, when the amount mother's milk enough, but it is inferior in its composition, mainly in terms of fat and protein content.

In addition to malnutrition, erratic feeding is important in the occurrence of malnutrition, early feeding without medical indications, errors in feeding technique, etc.

Much more often, feeding defects (quantitative and qualitative) play an etiological role in the development of malnutrition in children who are on mixed and mainly artificial feeding. Hypotrophy in such children most often develops with monotonous and prolonged feeding. cow's milk, flour products. Hypotrophy can also occur in children receiving highly fat-free food for a long time.

All nutritional factors are very significant in the development of malnutrition in the 1st half of life, but their role is also significant in later life child.

At present, due to the widespread implementation of preventive measures, chronic eating disorders of alimentary etiology are much less common. In recent years, the infectious factor has begun to play the main role in the development of this pathology in young children. The most important in the occurrence of malnutrition are frequently recurring acute respiratory infection and influenza, often resulting in lung, ear, and kidney complications.

The constant presence of purulent foci in the body of a child leads to a violation of metabolic processes.

Hypotrophy very often develops in children due to infectious gastrointestinal diseases, especially chronic dysentery and coli infection.

The direct cause of malnutrition in children can be congenital enteropathy of a different nature, in particular cystic fibrosis of the pancreas, celiac disease, and tuberculosis.

The infectious factor plays an important role in the occurrence of malnutrition in children of the 2nd half of life, especially in the 2nd year of life. This is facilitated by the great contact of children with others.

Poor living conditions (cramped, damp, poorly ventilated room), wrapping, leading to overheating of the child, incorrect daily routine, insufficient use of air, lack of favorable conditions for sleep, pedagogical neglect and many other defects in the organization of the environment can lead to the development of malnutrition. Combined with a violation of the diet, these factors usually contribute to the frequent illness of the child. Hypotrophy occurs especially easily in premature babies with the slightest disturbance in the organization of the environment.

In conclusion, it must be emphasized that all of the listed causes of malnutrition are so closely intertwined with each other, so mutually influence each other, that it is sometimes difficult to determine what is primary and what is secondary.

Clinic. With the development of malnutrition, functional disorders appear in the activity of systems and organs (primarily the gastrointestinal tract, the nervous system), changes in metabolism, and a decrease in general and local resistance. Distinguish malnutrition I, II and III degree.

With malnutrition of the 1st degree, the general condition of the child remains satisfactory and he does not give the impression of a patient, especially when the child is dressed or wrapped. However, an objective study reveals signs of malnutrition. The subcutaneous fat layer becomes thinner on the abdomen and trunk, so the fold at the level of the navel is only 0.8 cm or less.

The color of the skin and visible mucous membranes may be normal or slightly pale. At the same time, the elasticity of muscles and skin, characteristic of healthy child. Body weight vs. normal indicators may be less by 10-20%; with regard to such parameters of physical development as height, circumference chest, they usually remain within the normal range. Sleep, appetite and stool are either preserved or slightly disturbed,

With malnutrition of the II degree, the body weight deficit can reach 20-30%. At the same time, these children also show a slight (2-4 cm) growth retardation. The subcutaneous fat layer disappears on the trunk, limbs and decreases on the face. The skin loses its elasticity, it easily gathers into folds on inner surface thighs, shoulders and buttocks. Skin acquire a pale or gray color, become dry, lethargic, in some areas it is possible to detect pityriasis peeling, pigmentation. Hair becomes stiff and sparse. Skin turgor is significantly reduced, in most cases there is muscle hypotension. Body temperature loses its monothermicity, temperature fluctuations can reach 1 °C or more.

As a rule, appetite is significantly reduced, some children have an aversion to food, and with force-feeding, vomiting. Often there are dyspeptic disorders.

Nervous system such a child is characterized by instability: excitement, anxiety, causeless crying are replaced by lethargy, apathy, weakness. Sleep in most patients is restless. There is a lag in the development of motor functions: children later begin to sit, stand, walk, sometimes acquired motor skills are lost.

Quite often, children with II degree malnutrition develop infectious and inflammatory processes in the ears, lungs, urinary tract, and it should be noted that all diseases proceed sluggishly, torpidly.

Hypotrophy of the III degree is characterized by a sharp decrease in the subcutaneous fat layer on the face and its complete disappearance on the trunk and limbs. The child's face becomes small and takes on a triangular shape, an senile appearance. Curved body weight with hypotrophy III degree continues to fall progressively. The child's body weight deficit exceeds 30%. The growth retardation is also significant (by 4-6 cm or more). Such children have a characteristic appearance. The skin is pale gray, flabby, dry, in places with scaly peeling, hemorrhages, hanging in folds on the inner surface of the thighs, shoulders, buttocks; folded, it does not straighten out (Fig. 27). Visible mucous membranes are dry, bright red, easily vulnerable, often develop thrush, stomatitis, ulceration, difficult to therapeutic effects. Muscles become atrophic, their tone is increased. Initially, these children are restless, irritable, whiny, later lethargy, indifferent, apathetic attitude to the environment increases, they sleep a lot, do not show a feeling of hunger at all. Often, all previously acquired motor skills are completely lost. In some cases, the formation of motor skills and the development of speech slow down dramatically. Characterized by an almost constant decrease

Rice. 27. III degree hypotrophy in a 4-month-old child.

Body temperature. Breathing is disturbed - it is superficial, arrhythmic, slow, atelectasis often develops, pneumonia occurs, occurring atypically (without fever, cough, pronounced catarrhal phenomena). Heart sounds in most cases are muffled, the pulse weakens and slows down to 60-80 per minute. The limbs are usually cold to the touch.

The abdomen is drawn in or swollen. Appetite sharply decreases, sometimes a complete aversion to food develops, and often regurgitation or even vomiting appears as a protective reflex. The stool is usually liquid, quickened, reminiscent of dyspeptic; constipation is less common. Diuresis in these children in most cases is reduced.

This degree of malnutrition is gradually accompanied by manifestations of vitamin deficiency (A, C, group B), however, sharp pronounced rickets are not observed due to a delay in growth processes.

Children with malnutrition are very susceptible to all kinds of diseases that occur in them for a long time, peculiarly, severely, often accompanied by complications. Such most frequent illnesses like influenza, acute respiratory infection, pneumonia, otitis media, otoanthritis, occur in children with severe degrees of malnutrition atypically, often latently, for a long time, with short remissions and frequent outbreaks, without fever, without obvious clinical symptoms, without changes in the side peripheral blood. It is quite clear that the diagnosis of infectious diseases in such children presents certain difficulties.

In the presence of any local focus with malnutrition, general septic and toxic conditions easily occur. At the same time, sepsis also proceeds atypically, in some cases

teas without an increase in body temperature, without characteristic changes in the blood, without bacteriological confirmation.

A disease of any nature contributes to a further increase in malnutrition in a child.

The reduced reactivity of children with malnutrition is also manifested in their reduced food tolerance. Often a child with malnutrition II and III degree responds to the usual food load with a paradoxical reaction: instead of weight gain, it falls, vomiting appears, frequent liquid stool, and sometimes even toxicosis develops. This indicates a reduced resistance of the gastrointestinal tract. Based on this, when prescribing a diet, care must be taken and consistency.

Over the last 10-15 years etiological structure malnutrition in young children has undergone significant changes. Everywhere there is a significant reduction in the number of children with malnutrition due to irrational feeding and care defects. The number of children with malnutrition, which has developed as a result of infectious diseases, is also decreasing, but to a lesser extent. However, at the same time, the significance of harmful factors acting at various stages of embryonic and fetal development and causing the occurrence of intrauterine malnutrition began to be more clearly revealed.

Prenatal malnutrition is understood as acute and chronic intrauterine metabolic disorders that appear already at birth or in the neonatal period. These metabolic disorders can develop with toxicosis of pregnancy, hypertension anemia, heart disease, endocrine glands, tuberculosis and other diseases of the mother. Harmful can be acting environmental factors (irrational nutrition of a pregnant woman, radioactive substances, X-rays, chemicals, certain drugs, etc.).

At a normal gestational age, children with this pathology have reduced indicators of physical development. And this primarily concerns body weight, the deficit of which, compared with normal values, can range from 200 to 900 g. Because of this, the subcutaneous fat layer may be insufficiently expressed or completely absent, depending on the degree of malnutrition.

Significantly less often, growth deficiency is also detected, which is not so pronounced (from 1.5 to 3 cm) and occurs only with severe degrees of the disease.

Usually the skin has a pale pink color with a slight cyanotic tint, it is dry, thin, with translucent veins on the abdomen and chest, with abundant pityriasis peeling. These children, as a rule, have a large physiological loss of body weight (more than 10-15%), delayed

restoration of the original mass, more pronounced and longer physiological jaundice, later falling off of the remainder of the umbilical cord and healing of the umbilical wound.

The prognosis for malnutrition depends on the severity of the disease, the age of the child and the presence of complications.

With hypotrophy of the I degree, with timely diagnosis and proper treatment, recovery occurs in a relatively short term. Hypotrophy II degree in modern conditions in the vast majority of cases proceeds favorably, however, the treatment of these children usually requires at least 4-6 weeks. With hypotrophy of the III degree, the prognosis is always serious.

Treatment. Whole complex medical measures in case of malnutrition, it should be built taking into account the severity of the disease and the individual reactivity of the child. A large place in the treatment of malnutrition is given to the organization of the environment, the elimination of the causes that led to the development of the disease.

To get a child out of a state of malnutrition of the first degree, it is enough to eliminate its cause and establish a proper, vitamin-enriched diet for the child, taking into account his age. This is not enough for the treatment of malnutrition II and even more so III degree. In addition to eliminating the cause of the pathology, a complex of therapeutic measures is needed, among which the leading place is occupied by proper nutrition. The two-phase power supply method is widely used. The first phase is careful feeding to establish the child's endurance to food, the second phase is enhanced nutrition, which should not only cover the vital need for food, but also restore depleted reserves.

Diet therapy for malnutrition in children is differentiated depending on its degree. With malnutrition of the I degree, the calorie content and volume of food can be either normal or somewhat reduced for some time, depending on appetite. The correct ratio of individual food ingredients(up to 1 year, proteins, fats and carbohydrates should be in a ratio of 1:3:6, after 1 year - 1:1: 3-4) and enrichment with vitamins.

If the control calculation reveals a deficiency of one or another ingredient, it is necessary to correct the nutrition, providing the child with the appropriate physiological norms amount of proteins, fats, carbohydrates.

The missing amount of protein can be replenished with ordinary cottage cheese, “Health” cottage cheese or protein preparations (“Enpit”, “Kasecit”). Fat deficiency is best corrected fish oil, as well as cream and at an older age - butter. To make up for the missing amount of carbohydrates, sugar syrup, cereals, vegetable, fruit dishes are used.

In case of malnutrition of the II degree, within 5-7 days, 2 / s or Uz of the necessary daily calories. They give women's milk or sour mixtures (acidophilic mixture, "Baby", "Kid", kefir, etc.), and the number of feedings is increased to 7-8. During this period of limited nutrition, the missing amount of food is replenished either with 10% rice water with 5% glucose solution or Ringer's solution (100-200 ml) with 5% glucose solution, or vegetable broth from cabbage, carrots, turnips, beets ( rich content mineral salts). When breastfeeding, the addition of cottage cheese is indicated, starting with 5 g per day with gradual increase up to 10 g 2-3 times a day, as well as B-kefir or kefir 1-3 teaspoon 3-5 times a day.

After 5-7 days, when the condition improves, the caloric content and volume of food are gradually brought to normal, while the amount of food ingredients and calorie content is calculated for the proper body weight of the child.

With hypotrophy III degree, the first 5-7 days give \ ^h or Uz daily calories calculated for average body weight (actual body weight + 20% of this weight). The amount of food missing in terms of volume is replenished with liquids (vegetable decoctions, 5% glucose solution, vitamin juices, tea). Appoint only women

Parents often blame themselves for overlooking the symptoms of their child's eating disorder. I usually try to help them alleviate the guilt, as it is neither productive nor justified.

While eating disorders are fairly common in our culture, the likelihood of an individual child developing one is quite low, and most parents ignore the signs of an incipient disorder. However, in retrospect, many parents are able to identify some of the alarms and do not regret your poor knowledge in this matter.

Eating disorders in children and adolescents often present differently than adults, and there is a lack of information even among medical professionals. As a result, chances are often missed. early diagnosis during the onset of the disorder. This is unfortunate, since early treatment is the key to a successful recovery.

In the process of illness in children and adolescents, the symptoms characteristic of adult patients may not appear. For example, the youngest sufferers are less likely to binge and exhibit compensatory behaviors such as self-induced vomiting, diet pills, and laxatives.

So what are the symptoms parents should be aware of?

1) Poor weight gain and slow growth the child in the appropriate active growth age

Adult patients may think that they are fat, go on a diet and lose weight in a way that will be noticeable from the outside. For children, however, weight loss may not be observed. Instead, the pathology may manifest itself only as a lack of growth or a lack of weight expected at this age. Monitoring the growth of a child is the business of pediatricians, but not all specialists are competent in identifying eating disorders. It is a good idea for parents to pay attention to changes in weight and growth dynamics. Some doctors mistakenly refer only to standard tables, which can lead to omissions in the diagnostic process. It is very important to compare the height and weight of the child with his past performance.

2) Reduction in food intake or refusal to eat for unclear reasons or without explanation

Younger children are less likely to express concerns about body image, instead they may "sabotage" attempts to give them enough food to support growth and development.

A number of clever explanations for rejection include a sudden dislike of previously loved foods, a lack of hunger, or unclear goals to become healthier. Children may also complain of abdominal pain.

3) Hyperactivity or restlessness

In the case of adults, we would see unnecessary physical exercise, however, in children, activity is much less targeted. You won't see them working out for hours at the gym or jogging in the neighborhood, instead they will become hyperactive and restless, moving erratically and without a specific goal. Dr. Julia O'toole describes compulsive exercise or motor restlessness as "relentless." Parents often say that their children cannot sit still in one place. This condition can be similar to ADD, and parents do not have thoughts about possible development eating disorders.

4) Increased interest in cooking and/or watching cooking shows on TV

Another misunderstood symptom is an increased interest in cooking. Contrary to popular belief, and often contrary to what they say out loud, people with restrictive eating disorders do not poor appetite they are actually hungry and think about food all the time. Adults can cook for others and read or collect recipes. In children, we can also observe a similar hobby in the form of watching cooking shows on TV. Parents are often initially pleased with the child's interest in food, but this may well be a sublimation of hunger. People who do not eat enough food are obsessed with food, and children and adults can replace the process of eating food with other food-related activities.

Eating disorders usually develop in adults, but there are documentary evidence cases of disorders in children from 7 years of age. Weight loss in a growing child should be taken with great care, even if the child has had excess weight. If you are concerned that your child has an eating disorder or if they have any of the above symptoms, talk to your pediatrician. If your doctor doesn't take your concerns seriously, trust your parental instincts and seek medical advice. extra help see a specialist, you should also learn more about eating disorders. A useful resource for parents is the F.E.A.S.T. website.

Translation - Elena Labetskaya, IntuEat Center for Intuitive Eating ©

Modified Barium Swallow Test, also known as Cake Swallow or Video Oropharyngeal Swallow Test (VOSS) along with Video Fluoroscopy Swallow Test (VFSS) and other tests upper divisions digestive tract is used to diagnose eating disorders in children. Auscultation of the neck and examination of swallowing will ensure that it is safe.

The pediatrician may be present during such an examination along with the radiologist and will take the recording with him to show it after the examination is completed. You can find a radiologist on the website https://doc.ua/doctors/kiev/all/radiolog. It consists of observing how the baby eats and trying to recreate the typical feeding situation of the baby as closely as possible in order to learn the baby's swallowing pattern. So, you may be asked to bring your child's bottle, spoon, or cup, and possibly food and drink that the child usually consumes at home. Barium is mixed with food and drinks, so the taste will not be unpleasant for the child. (Barium can be mixed into juices, infant formula, chocolate milk, puddings, sauces, spaghetti sauces, smooth soups, or even a sandwich, to name a few). If the food has a taste that satisfies your child, you can hope that the result of the study will be quite informative.

You will be asked to feed the baby or stand with him when he eats himself. Many institutions also have a child psychologist present during the study to help ensure that the child feels comfortable during the process.

The pediatrician and radiologist watch as the child swallows food of various textures and liquid drinks (sometimes drinks are made thicker). They look for manifestations that can explain the cause of the disorder, such as how the child prepares food and drinks in the mouth for swallowing and how he swallows. They are also looking for possible signs that food and drinks get into the baby's airways while eating. At the end of the study, the team reviews the tape in slow motion. In order not to miss a non-massive aspiration, the study record is reviewed frame by frame by at least two specialists. You will be allowed to be present during the study, the results will be explained and all your questions will be answered.

Endoscopic study of swallowing.

This study uses a fiber optic endoscope (a thin tube with a miniature camera and a flashlight at the end) to view the child's throat and larynx. The part of the endoscope that is inserted into the child's nose is covered with an anesthetic gel so that the baby does not feel it. The endoscope is inserted through the nose to a site slightly above the larynx.

Once the child is comfortable, they are given food or liquids colored with food coloring to trace their passage. As with the modified barium study, the pediatrician carefully observes how the child prepares food and liquid for swallowing and how he swallows to ensure that food and liquid pass safely into the esophagus. Important aspects are the speed of swallowing, the amount of food or liquid that remains in the mouth after the first sip, and the amount of food and liquid that comes close to respiratory tract or in them. All examinations are recorded, so the pediatrician and other doctors can review the examination each time it is needed to make a treatment plan. These studies may scare you a little, but take comfort in the fact that, if the baby needs them, they will determine what food is safe for the baby and work to improve his feeding and swallowing skills.