home Adviсe “formation of eating behavior. Relationship between eating disorders and mental factors. Prevention of bulimia nervosa

“formation of eating behavior. Relationship between eating disorders and mental factors. Prevention of bulimia nervosa

INTRODUCTION

In children early age, mainly in the 1st year of life, due to the physiological characteristics of the body, the most various reasons- errors in nutrition, infection, defects in care, etc., in addition to dysfunction of the digestive system, can lead to significant metabolic disorders. In this case, absorption is disrupted nutrients tissues and cells of the body, the child becomes exhausted and malnutrition. This tendency towards deep eating disorders is characteristic only of a young child; this is not observed in older children.

State Healthy baby

State normal nutrition- “normotrophy”, characterized by physiological height and weight indicators, clean velvety skin, properly developed skeleton, moderate appetite, normal frequency and quality of physiological functions, pink mucous membranes, absence of pathological disorders internal organs, good resistance to infections, proper neuropsychic development, positive emotional attitude.

Dystrophy - is a chronic disorder of both nutrition and tissue trophism, as a result of which the full and harmonious development of the child is disrupted. This disease can develop at absolutely any age, but children under 3 years of age are especially susceptible. Dystrophy is accompanied by the following factors: significant impairment of all metabolic processes, a significant decrease in immunity, a delay in both physical and psychomotor, as well as intellectual development. Chronic eating disorders in children may manifest as various forms depending on the nature of trophic disorders and age.

According to the classification of G.N. Speransky is distinguished:

Children of the first 2 years of life:

Hypotrophy (lack of body weight compared to height)

Hypostature (uniform lag in body weight and height)

Paratrophy (excess body weight in relation to height)

Most common cause Chronic nutritional disorders are protein-energy deficiency in combination with a lack of vitamins and microelements.

Relevance of the topic

The prevalence of digestive and nutritional disorders in children in various countries, depending on economic development, ranges from 7 to 30% (in developing countries 20 - 30%).

Purpose of the study:

To study the types of digestive and nutritional disorders in young children and the risk factors leading to them.

Object of study:

Parents and children with eating disorders

Subject of study:

Digestive and nutritional disorders in young children leading to malnutrition, causes and risk factors.

Research objectives:

1. To study the structure of digestive and nutritional disorders in young children.

2. Draw a conclusion on the theoretical part of the work.

3. Conduct case study to identify risk factors for eating and digestive disorders in young children.

4. Study the problematic issues based on the research results.

5. Draw general conclusions about the work as a whole.

CHAPTER 1

Theoretical part

1.1 Chronic digestive and nutritional disorders - malnutrition

Hypotrophy is a chronic disorder of nutrition and digestion in young children, characterized by the development of wasting with a deficiency of body weight in relation to length. Occurs with a significant decrease in immunity, changes in body weight, skin growth and subcutaneous tissue, as well as disruption of many vital functions of the child’s body.

Malnutrition is distinguished by the degree of body weight deficiency: 1st degree body weight deficiency is 10 - 20% compared to the norm, 2nd degree body weight deficiency is 20 -30% in relation to body length, 3rd degree body weight deficiency is more than 30%.

The occurrence of malnutrition is facilitated by a number of factors related to the mother's health: nephropathy, diabetes mellitus, pyelonephritis, toxicosis of the first and second half of pregnancy, inadequate regimen and nutrition of the pregnant woman, physical and mental stress, alcohol consumption, smoking, medicines, fetoplacental insufficiency, diseases of the uterus leading to impaired nutrition and blood circulation of the fetus.

Milk feeding disorder is observed in children who, up to 10 - 12 months, eat only milk or milk formula without carbohydrate complementary foods. This leads to an excess of proteins, partly fats and a lack of carbohydrates and subsequently to inhibition of cell reproduction and constipation.

The causes of acquired malnutrition may be: insufficient milk supply from the mother (hypogalactia), difficulty sucking with a tight mammary gland, or irregular shape mother's nipples (flat, inverted).

Endocrine diseases: adrenogenital syndrome. Eating disorder: disordered feeding. Insufficient amount of formula milk when mixed and artificial feeding. Feeding too often leads to disruption of food absorption. Prescribing infant formula that is not appropriate for the child's age. Unfavorable sanitary and hygienic conditions play an important role: insufficient exposure to fresh air, rare bathing, improper swaddling.

Infectious diseases: chronic inflammatory diseases, AIDS. Body weight decreases with severe psychosocial deprivation, metabolic disorders, and immunodeficiency states.

Endogenous factors are hereditary metabolic abnormalities (galactosemia, fructosemia), immunodeficiency states, prematurity, birth injuries, congenital malformations (cleft lip, hard palate, pyloric stenosis, congenital heart defects), perinatal damage to the central nervous system, endocrine disorders. Metabolic defects (amino acid metabolism disorders, storage diseases).

The digestion process consists of - food intake - breakdown - absorption - assimilation and deposition - excretion.

Violation of any of these stages leads to starvation of the child with the development of malnutrition.

It is important to disrupt the enzymatic activity of the digestive glands, suppression of secretion gastrointestinal tract, which entails a violation of the breakdown and absorption of nutrients in the intestine, the development of dysbiosis.

The excitability of the cerebral cortex and subcortical centers is impaired, which leads to inhibition of the function of internal organs.

To maintain vital functions, the body uses fat and glycogen reserves from the depot (subcutaneous tissue, muscles, internal organs), then the breakdown of parenchymal organ cells begins. The immunological reactivity of the body decreases sharply, as a result of which infectious diseases easily develop.

1.2. Classification and clinical manifestations of chronic eating disorders

By time of occurrence: prenatal, postnatal, mixed.

By etiology: nutritional, infectious, defects in regimen and diet, prenatal factors, hereditary pathology and congenital anomalies development.

By severity: 1st degree. - light, 2 tbsp. - medium, 3 tbsp. - heavy.

Period: initial, progression, stabilization, convalescence.

Clinical manifestations are grouped into a number of syndromes:

Trophic disorder syndrome - thinning of subcutaneous fat, decreased tissue turgor, deficiency of body weight relative to height, signs of polyhypovitaminosis and hypomicroelementosis.

Syndrome digestive disorders- anorexia, dyspeptic disorders, decreased food tolerance.

Central nervous system dysfunction syndrome - decreased emotional tone, predominance of negative emotions, periodic anxiety (with severe forms malnutrition - apathy), delayed psychomotor development.

Causes of malnutrition in newborns

The reasons why malnutrition may develop in newborns can be divided into internal and external factors.

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

The second include insufficient and improper feeding, late introduction of complementary foods, exposure to toxic substances, including drugs, and morbidity various infections. All these negative external factors leading to malnutrition in newborns. However, they should not be underestimated.

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

Hypotrophy 1st degree:

Body weight deficiency is 10 - 20% compared to the norm (normally more than 60%). (Appendix 1) There is no growth retardation. It is rarely diagnosed and is detected only after a careful examination of the child. It is characterized by slight weight loss, a decrease in the subcutaneous fat layer on the abdomen, and its preservation on the limbs and face. The skin is smooth, elastic, pale. Tissue turgor is reduced. There is slight weakness, sleep disturbance, and loss of appetite. Glycogen depot is not impaired.

At 1 degree there is no malnutrition functional disorders from organs and systems, no clinical manifestations vitamin deficiency. Protective immunity is reduced, a child with grade 1 malnutrition becomes less resistant to infection. Psychomotor development corresponds to age. The stool is normal. Urination is not impaired.

Hypotrophy 2nd degree:

Body weight deficiency is 20 - 30%. The child is 2 - 4 cm behind in growth (Appendix 2) Characterized by significant weight loss, the subcutaneous fat layer on the abdomen almost disappears, is significantly reduced on the chest and limbs, remains on the face, but there is no longer the elasticity of the cheeks characteristic of young children (flabbiness) . The large and small fontanels are wide open, the sagittal and frontal sutures often remain open, and fractures of the clavicle are often detected at birth. There is a decrease in activity, lethargy, adynamia, irritability, and sleep disturbance. Such children have a significantly reduced appetite and periodically vomit.

Glycogen reserves in skeletal muscles, heart muscles, and liver gradually decrease. Appears muscle weakness, decreased muscle mass in the limbs, impaired motor skills.

Marked functional disorders are noted various organs: Central nervous system (production slows down conditioned reflexes);

Gastrointestinal tract (decreased enzymes, dyspeptic disorders);

Cardiovascular system (tachycardia, muffled heart sounds);

Respiratory organs (increased breathing, decreased ventilation);

Increased liver size. The stool is unstable, constipation is replaced by loose stool. Urine smells like ammonia. Thermoregulation is disrupted (children easily become hypothermic and overheated). The skin is pale with a grayish tint, easily folded. Skin elasticity decreases, tissue turgor is reduced. Dry skin and flaking are noted.

Most children have somatic pathology (pneumonia, otitis media, pyelonephritis). Food tolerance is reduced.

Vitamin reserves decrease and appear clinical symptoms polyhypovitaminosis, children often get sick, the disease is severe, and there is a tendency to have a protracted course.

If carbohydrates predominate in food, stool may be liquid with an admixture of mucus, yellow-green in color, and acidic; laboratory testing reveals a lot of starch, fiber, fat, and the presence of leukocytes.

In case of abuse of whole cow's milk, cottage cheese, protein stool (“sheep”) is noted: the stool takes on a soapy-calcareous appearance and brown color, becomes dry in the form of balls, finely crumbles and crumbles, and has a putrid odor.

With quantitative malnutrition, “hungry” stool appears: dry, scanty, discolored, with a putrid, fetid odor.

Hypotrophy 3rd degree (atrophy):

Reflects the entirety clinical picture diseases. Body weight deficiency is more than 30%. The child’s body length is 7–10 cm less than the age norm (Appendix 3) Accompanied by significant impairments general condition child: there is drowsiness, indifference to the environment, irritability, negativism, increased tearfulness, a sharp delay in development, loss of already acquired skills and abilities, complete anorexia.

It is observed mainly in children in the first 6 months of life;

Clinically characterized by severe exhaustion of the child. The subcutaneous fat layer is absent on the abdomen, chest, limbs and face, the skin sags in folds. In appearance, the child resembles a skeleton covered with dry, pale gray skin. The child’s face becomes “senile” and wrinkled.

Signs of dehydration are evident: eyeballs and the large fontanel are sunken, the nasolabial fold is deep, the jaws and cheekbones are protruding, the chin is pointed, the cheeks are sunken, aphonia, dryness of the conjunctiva and cornea, bright coloring of the mucous membrane of the lips, cracks in the corners of the mouth. The tissues completely lose turgor, the muscles are atrophic. Body temperature is reduced to 34 - 32 ° C, the child is prone to hypothermia, the limbs are always cold. Glycogen disappears in the child’s body, and a decrease in protein reserves is gradually observed, and atrophic processes develop in organs and tissues. The muscles become thinner, become flabby, and the central nervous system is delayed. Psychomotor development is delayed. Heart sounds are significantly muffled. Pulse is rare, weak filling. Arterial pressure low. Breathing is shallow, arrhythmic, and apnea appears periodically. The abdomen is enlarged in size due to flatulence, the anterior abdominal wall is thinned, and loops of intestines are visible. The liver and spleen are reduced in size. Dyskinetic disorders are almost always observed: regurgitation, vomiting, rapid loose stool. Urination is rare, in small portions. As a result of blood thickening, hemoglobin and red blood cell levels are within normal limits or increased. ESR is slow. The urine contains a large amount of chlorides, phosphates, urea, and sometimes acetone and ketone bodies are found.

The terminal period is characterized by a triad of symptoms: Hypothermia (34 - 32); Bradycardia (42 - 60 beats per minute); Hypoglycemia; The patient fades away gradually and dies unnoticed.

1.3. Diagnosis of chronic eating disorders

Diagnosis is based on the characteristic symptoms of malnutrition, laboratory methods are auxiliary.

History of complaints and medical history: disturbance of appetite, sleep, change in stool character (scanty, dry, discolored, with a strong unpleasant odor), the child is lethargic, irritable.

General inspection: the skin is pale, dry, low-elastic, the subcutaneous layer is depleted, the fontanelle is sunken, signs of rickets, decreased muscle tone.

Anthropometry:

Lack of body weight and length from the norm.

Control weighing of the child before and after feeding (helps to identify the fact of nutritional deficiency)

Laboratory data:

Blood test: anemia, signs of inflammatory processes (leukocytosis, accelerated ESR), decreased blood sugar (hypoglycemia).

Blood biochemistry:

hypoproteinemia (decrease in the total amount of protein), dysproteinemia (violation of the ratio various types proteins), dyslipidemia (violation of the ratio of different types of fats), hypocholesterolemia (decreased amount of cholesterol), acidosis (“blood acidification”), hypocalcemia (decreased calcium content), hypophosphatemia (decreased amount of phosphates).

Stool analysis: signs of impaired digestion of food, dysbacteriosis.

Urinalysis: elevated creatinine levels, reduced content total urine nitrogen.

1.4. Principles of treatment of chronic digestive and nutritional disorders

Complex therapy includes: Determining the cause that caused malnutrition, simultaneously with an attempt to regulate and eliminate it. Treatment of malnutrition in children involves changing the regime, diet and caloric intake of the child and the nursing mother; if necessary, parenteral correction of metabolic disorders.

basis proper treatment malnutrition is diet therapy. It should be noted that as an insufficient amount food ingredients, and their excess adversely affects the condition of a child suffering from malnutrition. Based on many years of experience in treating children with this disease, representatives of different schools have now developed the following dietary therapy tactics.

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

Symptomatic treatment, which includes the use of multivitamin and enzyme preparations. An appropriate regime with proper care and educational measures. Periodic courses of massage and therapeutic exercises.

Principles of treatment of malnutrition:

Elimination of factors causing fasting, organization of regimen, care, massage, exercise therapy, optimal diet therapy, replacement therapy (enzymes, vitamins, microelements), stimulation of reduced body defenses, treatment concomitant diseases and complications.

Main directions of drug therapy:

Enzyme replacement therapy is carried out mainly with pancreatic drugs, with preference given to drugs combined composition panzinorm, festala. To stimulate digestion processes, gastric juice, pepsin acid, and hydrochloric acid with pepsin are used. For intestinal dysbiosis, biological products - bifidumbacterin, bificol, bactisubtil in long courses.

Parenteral nutrition is carried out in severe forms of malnutrition accompanied by symptoms of malabsorption. Protein preparations for parenteral nutrition are prescribed - alvesin, levamine, protein hydrolysates.

Correction of water and electrolyte disturbances and acidosis. Infusions of glucose-saline solutions and a polarizing mixture are prescribed. Drug therapy includes the administration of enzymes for better absorption of food. Use pepsin with a 1-2% solution of hydrochloric acid, 1 teaspoon 3 times a day before meals, natural gastric juice, 1 teaspoon in 1/4 glass of water 2-3 times before meals, abomin 1/4 tablet or 1/4 2 tablets 2-3 times with meals, pancreatin 0.1-0.15 g with calcium carbonate, panzinorm forte (1/2-1 tablet with meals 3 times a day), festal. Behind last years To enhance intracellular metabolism, improve appetite, protein-synthetic function of the liver, and as a lipotropic agent for malnutrition in children, carnitine chloride 20% is used, 4-5 drops in a 5% glucose solution orally.

1.5. Prevention of chronic eating and digestive disorders

Even during pregnancy it is necessary to use preventive actions By correct regimen pregnant woman. Proper care, proper nutrition and prevention of influence harmful factors environment will minimize the risk of malnutrition at birth. Starting from birth, very important point in the prevention of malnutrition is natural feeding the mother of her baby. Mother's milk contains a huge amount of nutrients and vitamins necessary for a young body, and most importantly - in an easily digestible form.

When there is a shortage of human milk, the baby is supplemented with nutritious milk formulas. One of the main rules of supplementary feeding is that it should be done before breastfeeding.

Starting from the age of six months, the child must begin to be fed. There are several main rules for complementary feeding:

The child must be completely healthy. Consume food according to the child’s age. Complementary foods are introduced gradually, and before breastfeeding. The child eats with a small spoon. Changing one type of feeding is replaced by one type of complementary food. The food consumed should be rich in vitamins and essential minerals.

Timely diagnosis of infectious diseases, rickets and other gastrointestinal disorders will allow the initiation of appropriate treatment and prevent the development of malnutrition. Summarizing the above material, it should be noted that the prognosis for the development of malnutrition depends, first of all, on the reasons that were involved in the occurrence of this pathological condition. Conditions of the external and internal environment, the nature of feeding, as well as the age of the patient - all this plays a big role in the development of malnutrition. With nutritional deficiency, the outcome of the disease is usually favorable.

1.6. Nursing process chronic disorders digestion

Treatment of patients with malnutrition should be staged, complex, taking into account etiological factors and the degree of nutritional disorders.

It must be individual, taking into account the functional state of organs and systems, the presence or absence infectious process and its complications. Treatment of young children with grade I hypotrophy in most cases is carried out at home. Through a detailed questioning of the mother, the cause of the disease should be found out. Most often it is of nutritional origin. The introduction of appropriate supplementary feeding in the form of acidic mixtures, correction of nutrition by prescribing cottage cheese in case of a lack of protein, or increasing the amount of carbohydrates in the diet based on the proper body weight help eliminate the onset of a nutritional disorder. It is necessary to give recommendations to the mother on improving child care (walks, regular hygienic baths, etc.). Children with degree II and III malnutrition must be hospitalized. In this case, provision should be made for placing patients with malnutrition in small wards or semi-boxes in order to protect them from unnecessary contact with children and especially with ARVI patients. The room is ventilated and wet cleaning is carried out twice a day. The temperature should be maintained in the range of 25-26 C.

Organize thorough care of the skin and visible mucous membranes, wash it, and treat the skin with boiled sunflower oil.

Table 1. Problems of a child with eating and digestive disorders

Real problems

Potential problems

Lack or decreased appetite

Impaired motor activity

Weakness, lethargy

Emaciation, weight loss

Poor weight gain

Emaciation

Lag in physical development

Exhaustion

Unstable chair

Stomach ache

Maceration of the skin around the anus

Anxiety, flatulence

Regurgitation, vomiting

Violation of a comfortable state

Dehydration

Weight loss

Priority problem: Regurgitation, vomiting. The expected result is that the frequency of vomiting will decrease and stop.

Nursing intervention plan:

0.25% in age dosage:

up to 3 years - 1 hour. spoon

from 3 to 7 years - 1 d. spoon

over 7 years old - 1 tbsp.

Conclusion to Chapter 1:

When studying the theoretical part, which addresses the issue of malnutrition as a chronic disorder of nutrition and digestion, we considered such issues as: factors for the development of malnutrition, the degree of malnutrition, diagnosis of chronic nutritional disorders, prevention of chronic nutritional disorders and treatment. Chronic eating disorders in children can manifest themselves in various forms depending on the nature of trophic disorders and age. The most common cause of chronic nutritional disorders is protein-energy deficiency in combination with a lack of vitamins and microelements.

Nursing care for chronic digestive and nutritional disorders is one of the the most important conditions get well soon child. Treatment of patients with malnutrition should be staged, complex, taking into account etiological factors and the degree of nutritional disorders. It must be individual, taking into account the functional state of organs and systems, the presence or absence of an infectious process and its complications.

CHAPTER 2

Research part

We conducted our practical research in the outpatient network of the State Healthcare Institution SO “Children's City Clinic” in Balakovo during an industrial practice. We have developed our own online questionnaire and posted it athttps://www.survio.com/en/

73 mothers whose children had digestive and nutritional disorders took part in the survey.

1. When asked about their age, respondents answered as follows (Fig. 1):

Fig. 1 Statistics on the age of surveyed mothers

Conclusion : The highest percentage of mothers surveyed are aged 20-25 years. On average, all respondents are over 22 years of age.

2. When asked about the age of the child, mothers answered (Fig. 2):

Fig. 2 Children's age statistics

Conclusion: The majority of the respondents’ children are under 3 years of age.

3. When asked about toxicosis during pregnancy, respondents answered (Fig. 3):

Fig. 3 Toxicoses during pregnancy

Conclusion: In the first trimester, approximately 76.7% (56) of women surveyed suffered from nausea and vomiting, and 11% (8) throughout pregnancy. There was no toxicosis at all in 12.3% (9) of women. Toxicosis during pregnancy is a risk factor for malnutrition in both the fetus and the newborn.

4. When asked about a genetic predisposition to diabetes mellitus(Fig.4):

Fig.4 Genetic predisposition to diabetes mellitus

Conclusion: Maternal diabetes mellitus has a negative impacton fetal development and delivery. Its appearance on early stages has the most unfavorable outcome. During the period when the development of fetal organs and systems occurs,various pathologies. Gestational diabetes leads to the formation of various pathologies in the fetusThe onset of diabetes later in pregnancy leads toto increase the size of the fetus, which do not meet the deadline. As we see, a small percentage of simplified women have a predisposition to diabetes. 16.4% (12 people) have a genetic predisposition to diabetes. 83.6% (61 people) have no predisposition to diabetes.

5. When asked about following nutritional recommendations during pregnancy, respondents answered as follows (Fig. 5):

Conclusion : A high percentage of many partially complied with the prescribed pregnancy diet. 37.0% (27 people) complied with nutritional recommendations, 50.7% (37 people) partially complied, 12.3% (9 people) did not comply with nutritional recommendations during pregnancy at all.

6. When asked about drinking alcohol during pregnancy (Fig. 6), mothers answered:

Fig.6. Drinking alcohol during pregnancy

Conclusion: 89% (65 people) did not drink alcohol during pregnancy. 11.0% (8 people) drank alcohol during pregnancy, which is a risk factor for the development of gastrointestinal pathology in the child and various disorders in organs and systems in the future.

7. When asked about smoking during pregnancy, respondents answered (Fig. 7):

Fig.7 Smoking during pregnancy

Conclusion: 79.5% (58 people) did not smoke during pregnancy. 20.5 (15 people) – smoked, which is also a risk factor for the development of malnutrition both in the fetus and in the postnatal period in a newborn child.

8. When asked about the duration of breastfeeding, mothers answered (Fig. 8):

Fig.8. Duration of breastfeeding.

Conclusion: Long-term breastfeeding (up to 1.5 years) promotes the full maturation of the child’s gastrointestinal tract. This is important not only in the first months, during the introduction of complementary foods, but also after a year. Since the baby’s gastrointestinal tract needs help, and breast milk facilitates this process.

9. When asked about the time of introduction of complementary foods, respondents answered (Fig. 9):

Fig.9 Introduction of complementary foods

Conclusion : Until six months, all the child’s food and drink needs, in minerals, vitamins and biologically active substances are replenished through breast milk, and no additional products need to be introduced. Large quantity Women were introduced to complementary feeding from 6 months, which is correct. Nevertheless, a certain percentage of women grossly violate the rules for introducing complementary foods by groundlessly starting complementary foods from 1 month, and also by not introducing complementary foods after 6 months.

10. When asked about the shape of the nipples, respondents answered (Fig. 10):

Fig. 10 Shape of mothers' nipples

Conclusion : With flat and inverted breasts, the baby may have difficulty latching onto the breast during feeding. 13.7% (10 people) have flat nipples. 17.8% (13 people) – have inverted nipples. 68.5% (50) – have prominent nipples.

11. To the question about the presence of endocrine diseases in the mother, the following answers were received (Fig. 11):

Fig.11 Endocrine pathology at the mother's.

Conclusion: During the study, we see that endocrine diseases are not so common; in our group, only 10 women out of 73 respondents, which is 13.7%. 86.3% (63 people) do not have endocrine diseases. Endocrine pathology in the mother is a risk factor for the development of nutritional and digestive disorders in the child.

12. When asked about the baby’s full term, the mothers answered (Fig. 12):

Fig. 12. Gestation period

Conclusion : Among the women surveyed, the percentage of children born prematurely is low.All the reasons leading to the birth of premature babies can be combined into several groups. The first group includes socio-biological factors, including being too young or elderly age parents (under 18 and over 40 years old), bad habits of a pregnant woman, insufficient nutrition and unsatisfactory living conditions, occupational hazards, unfavorable psycho emotional background and others. U91.8% (76 people) had a child born full-term, 8.2% (6 people) had a premature baby. Prematurity is one of the main causes of nutritional and digestive disorders in newborns.

13. When asked about the condition of the child’s skin, the mothers answered (Fig. 13):

Fig. 13. Condition of the child’s skin and pancreas

Conclusion : Most women 76.7% (56 people) have pink and smooth skin with good skin tone, this indicates adequate nutrition and proper care. 4.1% (3 people) – children have pale skin, with reduced elasticity. 15.1% (11 people) – children have pale, dry skin. 4.1% (3 people) - children have gray, dry skin that gathers in folds.

14. When asked about the condition of subcutaneous fat tissue, mothers answered (Fig. 14):

Fig. 14 Condition of the child’s subcutaneous fat.

Conclusion : By birth, subcutaneous fatty tissue is more developed on the face (fat corpuscles of the cheeks - Bisha's lumps), limbs, chest, back; weaker on the stomach. In case of illness, the disappearance of subcutaneous fatty tissue occurs in reverse order, i.e. first on the stomach, then on the limbs and torso, in, which is associated with the composition of fatty acids. The good condition of subcutaneous fat is one of the signs of a child’s health. In 5.5% (4 people) - in children, the skin was thinned - subcutaneous fatty tissue on the abdomen, 11.0% (8 people) - in children, fatty tissue was absent/thinned on the abdomen and limbs, 11.0% (8 people) – have well-defined Bisha lumps, 72.6% (53 people) – children have good subcutaneous fatty tissue according to the assessment of a prediatrician.

Fig. 15 Elasticity of the skin.

Conclusion : The elasticity of the skin depends on the condition of the child’s subcutaneous fat. If the subcutaneous fat is in good condition, the fold on the skin gathers well and can be easily straightened. 83.6% (61 people) - a fold on the skin in children gathers well and is easily straightened, 12.3% (9 people) - a fold on the skin in children gathers and is difficult to straighten, 4.1% (3 people) - a fold on Children's skin does not straighten out for a long time, i.e. elasticity is reduced.

16. When asked about the child’s weight gain, mothers answered as follows (Fig. 16):

Fig. 16. Gain in body weight.

Conclusion : Correspondence of weight to the age norm indicates the normal development of the child, since a lag in weight or its excess indicates some kind of violation. 15.1% (11 people) - the body weight of children does not lag behind the norm, 6.8% (5 people ) – children’s body weight exceeds the norm, 8.2% (6 people) – children have a deficit of body weight, 69.9% (51 people) – body weight corresponds to the norm.

17. When asked about the child’s growth, respondents answered (Fig. 17):

Fig. 17. Child's height.

Conclusion : Compliance of growth with the age norm indicates the normal development of the child, since stunting or exceeding it indicates any possible changes or violations. 74.0% (54 people) – children’s growth corresponds to their age, 13.7% (10 people) – children’s growth is 1-3 cm behind the norm, 4.1% (3 people) – children’s growth is significantly behind the norm , in 8.2% (6 people) the height of children exceeds the age norm.

18. When asked about the child’s appetite, the mothers answered (Fig. 18):

Fig. 18. Child's appetite.

Conclusion: Of the 73 women surveyed, 61.1% of children have a good appetite, which indicates that the diet is being followed, there is a sufficient number of feedings and/or quality of food, and there are no disorders of the gastrointestinal tract. 19.2% (14 people) of children have a decreased appetite, 2.7% (2 people) - children have a significantly reduced appetite, 1.4% (1 person) - a child has a sharply decreased appetite, 61.6% (45 people) - children have a good appetite, 15.1% (11 people) - children have a very good appetite.

19. When asked about the nature of the child’s stool, the mother answered (Fig. 19):

Fig. 19. The nature of the baby's stool.

Conclusion : in 41 mothers, the child’s stool is not changed, in 16.4% (12 people) children have unstable stool, in 8.2% (8 people) they have liquefied stool, in 15.1% they sometimes have constipation, and in 1 Mother's child constantly suffers from constipation; one mother's child's stool depends on his diet.

20.When asked about the condition nervous system child's mother answered (Fig. 20):

Rice. 20. State of the child’s nervous system.

Conclusion : 54.8% of mothers deny pathologies in the state of the nervous system. MMeanwhile, the development, behavior and character of the child, and the state of his health largely depend on the creation of the correct, normal conditions for her activities. It is especially important to ensure normal activity of the nervous system in the first years of a baby’s life, at a time when its rapid development occurs. 5.5% (4 people) – children sleep restlessly, 2.7% (2 people) children often have negative emotions, 1.4% (1 person) are lethargic, 2.7% (2 people) children are depressed , 28.8% (21 people) have children who are active and hyperactive.

21. When asked about the child’s congenital (sucking, swallowing) and acquired reflexes, mothers answered (Fig. 21):

Fig. 21 Proportion of answers to the question “Does the child have reflexes?”

Conclusion : A set of unconditioned reflexes that facilitate adaptation to new living conditions: reflexes ensure the functioning of the basic systems of the body. From birth, the child develops adaptive reflexes. With age, the child masters new reflexes, then some disappear. But if by a certain age the child does not develop his characteristic reflex (in accordance with age), then one can judge about some pathology of the central nervous system. 98.6% (72 people) – children have no reflex disorders, 1.4% (1 person) – the child has not previously performed half of the innate reflexes, in this moment the situation returned to normal with treatment.

22. When asked about the child’s muscle tone, respondents answered (Fig. 22):

Fig. 22 Share of answers to the question “ Muscle tone The child has?"

Conclusion : ABOUTA deviation from the norm is muscle relaxation (hypotonicity), increased tension - hypertonicity - maintained even in sleep, and muscle dystonia - uneven tone. Each of these conditions is expressed in its own way, but they all bring discomfort to the baby and require timely treatment. Of the respondents, 72.6% (53 people) of children have no disorders, 11.0% (8 people) of children have decreased muscle tone , 5.5% (4 people) – children have sharply reduced muscle tone, 11.0% (8 people) – increased muscle tone.

23. When asked about the child’s sleep, the mother gave the following answers (Fig. 23):

Fig.23. Child's sleep.

Conclusion: In 71.2% (52 people) of the respondents, children do not have problems with sleep, which indicates the child’s good condition, in 24.7% (18 people) the depth and duration of children’s sleep is reduced, in 4.1% (3 people) – sleep is significantly disturbed.

24. When asked about the child’s immunity, mothers answered (Fig. 24):

Fig.24. Child's immunity

Conclusion: The child's immunity plays an important role, as poor resistance to infections can cause the risk of developing serious illnesses. 60.3% (44 people) of the women surveyed had good immunity in their children. 23.3% (17 people) of children have moderately reduced immunity, 12.3% (9 people) have significantly reduced immunity, and 4.1% (3 people) have severely reduced immunity (observed by an immunologist).

25. When asked about the psychomotor development of the child (according to the doctor’s opinion), the mother answered (Fig. 25):

Fig.25. Psychomotor development of the child.

Conclusion : According to the doctor’s conclusion, in 80.8% (59 people) children correspond to their age in their psychomotor development, in11.0% (8 people) – children are lagging behind in psychomotor development, which may also indicate a disorder of nutrition and digestion in the child due to lack of nutrients or pathology of the gastrointestinal tract; in 8.2% (6 people) psychomotor development exceeds.

26. When asked about the presence of anemia in children, respondents answered as follows (Fig. 26):

Fig.26. The child has anemia.

Conclusion: Most often, anemia in children occurs when their diet contains insufficient amounts of iron, prematurity, negative environmental influences, and the presence of helminths. 65.8% (48 people) of children do not suffer from anemia, 17.8% (13 people) of children are diagnosed with anemia, 16.4% (12 people) find it difficult to answer the question.

CONCLUSION

The normal development of a child is closely related to the activity of his digestive organs. Digestive disorders lead to eating disorders, metabolic disorders, which are often accompanied by dysfunction of many organs and systems.

The primary care provider is in a unique position to diagnose eating and digestive disorders early and prevent their progression over time. early stages diseases. Primary and secondary prevention include the need to screen for eating disorders and measure height and weight as a routine part of annual surveillance activities.

Careful attention must be paid to identifying early symptoms of eating disorders. Early recognition and treatment of eating and digestive disorders can prevent the physical and mental consequences of digestive disorders that lead to the progression of the disease to late stage. Weight and height should be determined regularly. The obtained data regarding height and weight should be entered into pediatric charts in order to promptly determine their delay associated with reduced nutrient intake or weight loss due to illness.

Organization of care for a child with eating and digestive disorders is of great importance. Such children are not so much treated as cared for. It is very important to create a positive emotional tone in a child - it is necessary to pick him up more often (prevention of hypostatic pneumonia), talk to him, walk, create a positive emotional background around the child.

During the course work, we reviewed modern literary scientific data on the problems of digestive and nutritional disorders in young children. Conclusions were drawn on the theoretical section, an author’s questionnaire was created, on the basis of which a study was conducted and conclusions were drawn that confirmed the data from literary sources discussed in Chapter 1. Based on the results research work We identified problematic issues in the knowledge and statements of mother respondents, so we developed material for health education work (booklet “Eating and digestive disorders in children”).

We consider the goals and objectives of the course work to be achieved.

LIST OF REFERENCES USED

Algorithms professional activity nurses (tutorial for students medical schools. Madan A.I.; Borodaeva N.V.; Krasnoyarsk, 2015);

Childhood diseases. Textbook. 20016 (

Medical Encyclopedia, publishing house " Soviet Encyclopedia", second edition, 1989. Moscow;

Pediatrics - textbook for medical universities (P. Shabalov, 20010)

Nursing in pediatrics. Textbook (Sokolova N.G., Tulchinskaya V.D.; Rostov-on-Don, “Phoenix” 20015)

Nursing in pediatrics. Textbook (16th edition, edited by Honored Doctor of the Russian Federation, Professor R.F. Morozova. Rostov-on-Don. “Phoenix” 2016);

Handbook of Pediatrics (Edited by Ph.D. medical sciences A.K. Ustinovich);

Internet sources:

Appendix 3

3 degree of malnutrition and dehydration

Appendix 4

Conducting research in the form of an online survey.

Appendix 5

Questionnaire

Hello, dear Moms! A student is conducting research on digestive disorders in children. I ask you to sincerely answer the questions in the questionnaire. The survey is anonymous. All results will be presented in a generalized form.

1.Your age

2.Child's age

3.During pregnancy did you have toxicosis?

a) Only in the first trimester of pregnancy

b) Throughout pregnancy

c) Your own option

4. Do you have a genetic predisposition to diabetes

a) Yes

b) No

a) Yes

b) Partially

c) No

6.Did you drink alcohol during pregnancy?

a) Yes

b) No

7.Smoked during pregnancy

a) Yes

b) No

8.Until what age was the child breastfed?

9.At what months were complementary foods introduced?

10.Shape of your nipples

a) Flat

b) Retracted

c) Convex

11.If you have endocrine diseases

a) Yes

b) No

12.Was your baby born full term?

a) Yes

b) No

13.The condition of your baby's skin

a) pale, decreased elasticity

b) pale, dry,

c) gray, dry, gathers in folds

d) pink, smooth

14. Condition of subcutaneous fat tissue

a) exhausted on the stomach

b) fatty tissue is absent/depleted on the limbs and abdomen

d) Bisha's lumps (on the cheeks) are well defined

15. Elasticity of the skin

a) the fold on the skin gathers well and straightens out easily

b) the fold on the skin gathers and is difficult to straighten out

c) the fold in the skin does not straighten out for a long time

16. Gain in body weight

a) lags behind the norm

b) absent

c) underweight

d) corresponds to the age norm

17.Child's height

a) appropriate for age

b) is 1-3 cm behind the norm

c) significantly lags behind the norm

d) exceeds age norms

18.Child's appetite

a) reduced

b) significantly reduced

c) sharply reduced

d) good

19.Character of the child’s stool

a) not changed

b) unstable

c) liquefied

d) sometimes constipation

d) your option

20. State of the nervous system

a) anxiety

b) negative emotions

c) lethargy

d) oppression

e) activity and hyperactivity

21.Reflexes in a child

a) not violated

b) reduced

c) sharply reduced

22. Child’s muscle tone

a) not violated

b) reduced

c) sharply reduced

d) increased

23.Child's sleep

a) not violated

b) depth and duration reduced

c) significantly impaired

24. Child's immunity

a) moderately reduced

b) significantly reduced

c) sharply reduced

d) good resistance to infections

25. Psychomotor development of the child according to the conclusion of your doctor

a) appropriate for age

b) is lagging behind

26. Presence of anemia

A) the child is diagnosed with anemia

B) no anemia

B) I find it difficult to answer

Modified barium swallow study, also known as brownie swallow or video oropharyngeal swallow study (VOSS), along with video fluoroscopic swallow study (VFSS) and other studies upper sections digestive tract is used to diagnose eating disorders in children. Auscultation of the neck and swallowing study can help ensure that swallowing is safe.

The pediatrician may be present during such an examination 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 involves observing how the baby eats and trying to recreate the baby's typical feeding situation as closely as possible in order to study the baby's swallowing pattern. So, you may be asked to bring your baby's bottle, spoon or cup, and perhaps the food and drinks your baby would normally consume at home. Barium is mixed with food and drinks, so the taste will not be unpleasant to 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 options). If the food has a taste that satisfies your child, you can hope that the result of the study will be sufficiently informative.

You will be asked to feed the baby or stand with him while he feeds himself. In many institutions, a child psychologist is also present during the study to help ensure that the child feels comfortable during this process.

The pediatrician and radiologist observe how the child swallows foods of different textures and liquid drinks (sometimes the drinks are made thicker). They look for manifestations that may explain the cause of the disorder, such as how the child prepares food and drinks in his mouth for swallowing and how he swallows. They also look for possible signs that food and drinks get into the baby's respiratory tract during eating. At the end of the study, the team watches the recording in slow motion. To avoid missing non-massive aspirations, the recording of the examination 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 examination of swallowing.

This test uses a fiberoptic endoscope (a thin tube with a miniature camera and a light on the end) to look at the baby's pharynx and larynx. The part of the endoscope that is inserted into the child's nose is coated with an anesthetic gel so that the baby does not feel it. The endoscope is inserted through the nose to an area slightly above the larynx.

Once the child is comfortable, they are given food or liquids colored with food coloring to track their passage. As with the modified barium test, the pediatrician carefully observes how the child prepares food and liquids for swallowing and how he swallows to ensure that food and liquids pass safely into the esophagus. Important aspects are the rate of swallowing, the amount of food or liquid that remains in the mouth after the first swallow, and the amount of food and liquid that gets close to respiratory tract or in them. All examinations are recorded, so the pediatrician and other doctors can review the examination whenever necessary to create a treatment plan. These studies may be a little scary, but take comfort in the fact that if your baby needs them, they will help you determine what foods are safe for your baby and work to improve your baby's feeding and swallowing skills.

Diagnosis of eating disorders in children is usually carried out by a pediatrician, and only in in rare cases pediatric nutritionist or occupational therapist. First of all, the specialist must find out the characteristics of the baby’s oral motor skills. He will research them on his own, but will first ask parents about their child’s skills.

In doing so, he will ask the following questions:

Can the baby wrap his lips tightly around the nipple or spoon? Can he keep his lips closed when he sucks from the breast or bottle or chews?

How would you describe your child's eating skills? Does the child know how to chew a bitten piece and gather food into a ball for swallowing? (If your child is unable to do this, you may notice that after swallowing, food remains in the recesses of the mouth or between the gums and cheeks).

Have you noticed that your child loses control of food and liquids before or during swallowing?

Can you describe how a child chews? There are two types of chewing: chomping and rotating. The clucking type means that the jaws move up and down, but the child does not make rotational movements with the jaws. This type of chewing is primitive, but rotational chewing is mature. Rotational chewing helps move food between the teeth and more efficiently collect it from the molars to the tongue before swallowing.

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

Can a child raise his tongue to the roof of his mouth?

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

The doctor uses this information to select foods that best suit the child's motor skills. He will also determine the type of therapy program your baby needs to strengthen the muscles of the face and mouth and improve their function. Your answers to these questions will also help determine whether your child may have a swallowing disorder.

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

Does your child experience hasty swallowing while eating? Does it happen that he choke?

Does it happen that while swallowing a child chokes, coughs and gags?

Is there something about your baby's swallowing that worries you?

Is the baby breathing freely before he starts to eat?

Does his breathing become gurgling when he eats?

Does the child have wet breathing? ( Wet type Breathing means your baby is generally breathing normally, but when he starts to eat, you can literally hear liquid and food pooling in his throat and causing gurgling sounds. Newborns may also experience wheezing in the chest).

Does your child cough while eating?

What kind of breath does the child have after eating: clear, gurgling or moist? Does he have shortness of breath after eating?

This information, as well as what you have learned previously, will help you figure out whether your child's swallowing is appropriate and safe.

Sometimes a child plays by stuffing chew toys into his mouth, this is normal. Thus, the baby reduces his gag 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 pushing objects into the throat that he could choke on. When a child plays, stuffing toys into his mouth, and hiccups at the same time, the trigger zone for this reflex moves further and further to the root of the tongue. This is why the gag reflex in adults is triggered only by irritation of the receptors in the throat.

The pediatrician will also ask you about the following:

How efficiently does your child swallow food and liquids?

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

Can you hear your baby breathing after swallowing?

Ultimately, the doctor will determine whether your child has mastered certain feeding skills and whether the following skills are causing you concern:

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;

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

Eating with your hands;

Eating with appropriate items (spoon, etc.).

Each eating habit is based on those that the child mastered earlier, 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, and will also allow him to make appropriate recommendations for bottle, cup and spoon (if necessary).

In modern culture, such phenomena as healthy eating and lack of physical activity. Children are also susceptible to this. Experts say today's children are the first generation to have poorer health than their parents.

Moreover, when unhealthy eating is combined with a sedentary lifestyle and a culture that values thin bodies, it can lead to eating disorders. According to statistics, 23% of modern girls and 6% of boys suffer from them. Therefore, eating disorders pose a danger to the younger generation. Fortunately, parents are able to prevent them, but to do this it is necessary to intervene as early as possible. Intervention in adolescence when children defend their right to independence, it is less effective.

What can you do to prevent eating disorders in your child? First of all, help him develop healthy body and a healthy attitude towards it.

1. Help your child form right attitude to your body

You should love your body, no matter what you see in the mirror. But under the influence of modern culture, many of us have an obsession with being thin. We judge ourselves greatly for not living up to this ideal image. Therefore, when we see a child begin to gain weight, all our self-judgment kicks in and we project it onto the child, worrying that he will struggle with excess weight throughout his life. Unfortunately, children take on our fears and conclude that something is wrong with them. Parents should develop a healthier attitude towards their own bodies to avoid passing on feelings of shame and inferiority to their children.

2. Explain to your child how the media promotes an ideal body image that has nothing to do with reality.

Explain that images of models on the covers of glossy magazines are always processed in Photoshop and are simply unrealistic. Tell us how the modern beauty industry sets unrealistic beauty standards that people subsequently begin to focus on. Talk to your child about what beautiful appearance in itself does not make a person happy.

3. Show your child an example of good nutrition.

Recognize that your child follows your example in everything. If you drink soda, your kids will too. If you prefer to nibble on carrots rather than chips for a snack, your kids will too. Children take over all your bad and good habits from you. Do you want to change your child and protect him from bad habits? Change your habits. Health, good vitality and appearance will be an additional reward for you in addition to good habits your children.

4. Don't talk about diets

Don't follow any diet, just eat healthy food. Make exercise a regular part Everyday life in your family. Research shows that diets do not give the desired results, but only lead to overeating later on. Diets can also change body chemistry, which can make a person gain weight again and make it much more difficult to lose it the next time. Only constant healthy eating and physical activity helps maintain optimal body weight.

If you want to teach your child self-control, start by teaching him to listen to his own body. Is he hungry or does he eat a lot just out of habit? If your child asks you for sweets, instead of saying “no,” tell your child that you will buy them for him next time: “The candy store will always be here. We will come here on special occasions, not every day.” Research shows that this approach teaches the child to make more informed decisions, while simply refusing leads to the child experiencing desire gets sweets and, as a result, overeats when you buy them for him.

5. Don’t make fun of your child if he has gained excess weight - this will hurt his self-esteem

Instead, get him into regular physical activity and reduce the amount of sugar in his diet. If you decide your child needs to lose weight, special diet must be adhered to by all family members. Changing eating habits is difficult for everyone, so don't expect your child to refuse treats that the rest of the family will eat.

6. Learn more about nutrition

Over the last century, the number of people who are overweight has increased, and this percentage continues to rise. At the same time, the percentage is growing various diseases. The reasons are a sedentary lifestyle, constant stress, overeating and an evolutionary tendency to eat more during periods of abundance.

However, nutritionists say that the main cause of excess weight is processed foods. Lately, people are consuming less saturated fat and more processed foods. Modern products have a long shelf life. They are tasty, but less healthy. They are made using hydrogenated fats, preservatives, corn syrup and carbohydrates stripped of their nutritional properties. All this is very harmful to the body and leads to chronic diseases as we get older. But even from childhood they cause addiction and inflammatory processes in the body.

And of course, most processed foods contain sugar. Research shows that more than 10% of our daily calories come from added sugar, which has negative effects on the entire body. As a result, more fat is deposited in the body than under the influence of other carbohydrates.

7. Avoid junk food and don't stockpile food.

Don't eat junk food or stock up on food unless special occasions. The whole family can suffer from this. If children see adults eating unhealthy food, they will follow suit. They will eat anything, sometimes in secret. Many teenage girls develop bulimia when they secretly eat ice cream and then start vomiting.

8. Encourage your child to eat vegetables

Children usually don't like new foods the first time. But sooner or later they get used to it. Research shows that children are more willing to eat foods that are already familiar to them.

9. Involve your child in sports

Every child needs regular physical activity. When girls play sports, they begin to feel positive about their bodies, and these attitudes continue throughout their lives. When children find a sport they enjoy, there is a high chance that this hobby will stay with them for many years. Instead of telling your child that exercise is necessary to lose weight, tell him that sports changes the body's biochemistry and makes us healthier and happier. Encourage your family to play sports together as a family every weekend.

10. Never comment on other people's appearance.

If you focus on how thin or fat people, then the child concludes that appearance is important and begins to think that people always pay attention to his appearance.

11. If you leave your child with a nanny, tell her what the child can and cannot eat.

Too strict an attitude towards a child causes him

a strong desire to secretly eat unhealthy foods. On the other hand, if the nanny allows him to eat chips and drink soda every day, this will negate all your attempts to teach him to eat healthy.

12. Raise your child

Raising your child can help you reduce the likelihood of your child becoming overweight as an adult.

13. Reduce your stress levels

Children who have high levels of stress hormones are less physically healthy. They are also prone to being overweight.

14. Watch less TV

Children who watch TV for 2 hours or more every day are more likely to be overweight and increased level cholesterol. Probably the reason is not only a sedentary lifestyle associated with watching television, but also advertising of harmful products. Researchers say that children are highly susceptible to advertising, which is why many countries have banned advertising aimed at children (including television).