Varieties and methods of treatment of intrauterine malnutrition. Intrauterine fetal hypotrophy: causes, classification and therapy

Term hypotrophy occurs when adding two Greek words: hypo - below, trophe - food. Hypotrophy should be understood as one of the types of chronic malnutrition that develops in children at an early age. In hypotrophics, weight may be reduced, or there may be a lack of growth.

From birth, the child begins to significantly gain in body weight, all his organs grow, including the bones of the skeleton. If the baby is not properly fed and cared for, the first signs of malnutrition will immediately begin to appear in the form of a disruption in the functioning of various organs and systems. Most often, malnutrition develops due to a lack of protein and calories in the diet. With the initial lag in body weight, disturbances from the gastrointestinal tract begin, which leads to a violation of the absorption of nutrients. As a rule, children also suffer from a lack of vitamins and trace elements in their diet.

Causes of malnutrition

The causes leading to the occurrence of malnutrition are both internal and external factors. It is customary to distinguish between a primary pathology, in which there is a lack of nutrition, and a secondary one, when, against the background of various diseases or other harmful factors, the nutrients from the food taken are simply not absorbed by the body.

Internal factors include diseases of various internal organs involved in digestion, that is, nutrients, under the influence of any reasons, cannot be absorbed by the body. Here, for example, it is appropriate to say that the violation can be both at the level of the gastrointestinal tract, and at the tissue and cellular level. In this case, various metabolic disorders occur in the cell itself. Cellular energy reserves gradually decrease. In the case of their complete depletion, the natural process of cell death begins.

Internal causes of malnutrition

The immediate internal causes of malnutrition are:

• Encephalopathy that occurs in the fetus during pregnancy. Here we are talking about the fact that during the period of intrauterine development in the fetus, the normal activity of the central nervous system is disturbed, with a secondary disruption of the work of all internal organs and systems.
• Underdevelopment of lung tissue. Insufficient oxygen enrichment of the blood leads to metabolic disorders in the body, and slows down the development of organs and systems.
• Congenital pathology of the gastrointestinal tract - when such phenomena as constipation or vomiting are constantly present (with Hirschsprung's disease, dolichosigma, impaired location of the pancreas).
• Frequent abdominal operations that lead to "short bowel" syndrome. The natural physiological process of food digestion is disturbed.
• Hereditary diseases of the immune system, leading to a decrease in the body's defenses, inability to fight infection.
• Some endocrine diseases. Hypothyroidism is a disease of the thyroid gland, in which growth and metabolic processes in the body slow down. Pituitary dwarfism is a disease of the central organ of the endocrine system, as a result of which a sufficient amount of growth hormone is not produced.
• Metabolic diseases that are inherited. For example, galactosemia (intolerance to milk and dairy products), fructosemia is a similar disease in which the child's body does not absorb the fructose contained in vegetables and fruits. Rarer hereditary pathologies related to metabolic disorders include: leucinosis, Niemann-Pick disease, Tay-Sachs and others.

Unfavorable external factors leading to the emergence and development of malnutrition are less common. However, don't underestimate them. The constant impact of external factors that negatively affect the growth and development of children over a long period is reflected not only in a lack of weight or height, but can lead to rather sad consequences for the general condition and health of the child in the future.

External causes of malnutrition

External factors affecting the development of malnutrition include:
1. nutritional factors. This includes several categories of reasons:

• Firstly, the quantitative underfeeding of the baby occurs due to the underdevelopment of the female breast (flat nipple, inverted nipple) or lack of female milk. On the part of the child, the cause may be: an underdeveloped lower jaw, constant vomiting, a short frenulum at the lower edge of the tongue.
• Secondly, insufficient feeding with mother’s high-quality breast milk, or improper use of the nutrient mixture, late introduction of supplementary feeding or complementary foods to the child, insufficient intake of all necessary and useful ingredients in the baby’s diet also leads to chronic malnutrition and the development of malnutrition.

2. infectious diseases. A bacterial or viral infection can appear at any stage in the life of a pregnant woman or child. The chronic course of diseases such as pyelonephritis, urinary tract infections, intestinal infections can significantly slow down the full development of the child. With these diseases, immunity is reduced, as well as significant depletion of the body and weight loss.
On average, the body spends 10% more energy with mild infectious diseases. And in the case of moderate infectious and inflammatory processes, energy costs increase significantly, and can reach about 50% of the total energy costs of the whole organism.
3. Intestinal lesions , namely its mucous membrane, lead to impaired absorption of nutrients and the development of malnutrition.
4. toxic factors. Long-term exposure to toxic toxic substances, hazardous waste products of chemical production, poisoning with vitamins A or D, drugs - all this has an extremely adverse effect on the body of children, especially infants.

Clinical signs and symptoms of malnutrition by degree

The clinical picture of malnutrition is largely associated with insufficient food intake. In addition, an important place in the symptoms of the disease is occupied by violations of the normal functioning of organs and systems. All clinical signs and symptoms are usually divided into syndromes. Syndrome is a set of symptoms in the defeat of any organ or system.

With malnutrition, there are several main syndromes:
1. The first of these is a syndrome in which the trophic function of organs and tissues is disturbed. Here we are talking about the fact that metabolic processes in the organs and tissues of the body slow down, body weight drops, the subcutaneous fat layer becomes much thinner, the skin becomes lethargic and flabby.
2. Another important syndrome is a syndrome in which there is a violation of digestive functions. The entire digestive tract is affected. Less hydrochloric acid and pepsin are produced in the stomach, and there are not enough enzymes in the intestines to process the food bolus.
The main symptoms of the syndrome of digestive disorders are:

• stool disorder, which can manifest itself both in the form of constipation and diarrhea;
• the chair becomes unformed, shines;
• with a more detailed examination of the stool, I find in it undigested food residues.

3. Syndrome of dysfunction of the central nervous system. Obviously, the lack of nutrition in a child is reflected in his central nervous system. Such children are often restless, they have negative emotions, scream, sleep is disturbed. Also, for a long time, you can notice a clear lag in the development of the child (physical and mental). Decreased muscle tone, children are lethargic, lethargic.
4. The next important syndrome that requires special attention is a syndrome in which hematopoiesis and the protective functions of the immune system are disturbed. A decrease in the number of red blood cells (erythrocytes with hemoglobin) manifests itself in the form of anemia. Decreased resistance to various infections leads to the fact that such children often suffer from chronic inflammatory and infectious diseases, and all symptoms are mild and atypical.

In each individual case, more than one of the above syndromes may be expressed. The manifestations of malnutrition also depend on the predominance of the lack of any component of food. For example, during protein starvation, symptoms of hematopoiesis and a decrease in the body's defenses prevail.

There are three degrees of malnutrition. This separation is necessary for the convenience of assessing the general condition of the child and for planning the amount of treatment. But in reality, the degrees of malnutrition are stages of the same process, following one after another.

Hypotrophy of the first degree

Initially, the body tries to compensate for the lack of nutrients with the accumulated subcutaneous fat layer. Fats from the depot migrate into the blood, pass through the liver and turn into energy to maintain the normal physiological activity of organs and systems.

Initially, fat reserves disappear in the abdomen, then in other places. The degree of depletion of the subcutaneous fat layer is assessed by different methods. The most practical, and at the same time informative method, is the Chulitskaya index. This method is based on measuring the circumference of the shoulder in two different places, then the hips and lower legs, and the child's height is subtracted from the resulting amount. The norm for a child up to a year is 20-25 cm. Another method is to measure the skin fold in four different places: on the abdomen to the left of the navel, on the shoulder, in the area of ​​​​the shoulder blades, and finally, on the thigh from the outside. With normal growth and development of the child, the skin fold is approximately 2-2.5 cm. In the first degree of malnutrition, the Chulitskaya index is 10-15 centimeters, and the skin fold slightly decreases.

Symptoms of hypotrophy of the first degree:

• Fat folds are flabby, muscle tone is reduced, elasticity and firmness of the skin is lost.
• The growth of the child initially corresponds to age norms.
• Body weight is reduced from approximately 11% to 20% of the original.
• General health is normal. There is rapid fatigue.
• There are no disorders of the central nervous system. Sleep disturbing, intermittent.
• The child is a little irritable, may spit up food eaten.

Hypotrophy of the second degree

The changes are the same as in the first degree, but the difference is that they deepen a little, and other characteristic symptoms also appear:

Signs of malnutrition of the second degree:

• The subcutaneous fat layer is very thin on the legs, arms, and may be absent on the abdomen or chest.
• The Chulitskaya index decreases, and varies from one to ten centimeters.
• The skin is pale, dry.
• The skin is flabby, easily shifts into folds.
• Hair and nails become brittle.
• Muscle mass on the limbs decreases, body weight decreases by about twenty to thirty percent, and stunting is also noted.
• Thermoregulation is disturbed, such children quickly freeze, or also quickly overheat.
• There is a high risk of exacerbation of chronic infections (pyelonephritis, otitis media, pneumonia).
• Violation of resistance to the food taken. In connection with trophic disorders of the villi and the intestinal mucosa, digestion is disturbed, in particular the absorption of nutrients. Dysbacteriosis appears, that is, pathogenic bacterial flora predominates. Children appear: increased gas formation, bloating and discomfort in the abdomen. Frequent constipation or diarrhea, often alternating one after another.
• Decreased muscle tone. Due to the significantly reduced muscle tone, the abdomen protrudes outward, and the impression of a frog's abdomen is created.
• The lack of vitamin D and calcium in the body leads to additional development of muscle weakness, the development of symptoms of osteoporosis (washing out of calcium from the bones). At the same time, the bones of the skull become soft, the large and small fontanelles remain open for quite a long time.
• On the part of the central nervous system, a number of pathological disorders similar to those in the first degree of malnutrition are also revealed. Children are restless, cannot fall asleep, often act up. Then the characteristic symptoms of overexcitation of the central nervous system are gradually replaced by lethargy and apathy towards the outside world.

Hypotrophy of the third degree

Reflects the fullness of the clinical picture of the disease. At this degree, violations of the work of all organs and systems are most pronounced. The primary cause of the disease determines the most serious condition of the child, the ineffectiveness of the measures taken to remove the child from this condition, and his further recovery. The third degree of malnutrition is characterized by a strong depletion of the body, a decrease in all types of metabolism.

Characteristic signs and symptoms of hypotrophy of the third degree:

• By appearance, you can immediately determine that there is a chronic lack of nutrition. The subcutaneous fat layer is absent in almost all places, including the face. The skin is dry, pale and so thin that the child looks like a mummy.
• When you try to form a skin fold with your fingers, there is practically no resistance of healthy skin. The elasticity of the skin is so reduced that the fold does not straighten out for a long time after releasing the fingers. Deep wrinkles form all over the body.
• Muscle mass and body weight as a whole are so small that the fatness index according to Chulitskaya is not determined, or is negative. The overall weight loss is 30% or more of normal values.
• On the face, the retraction of the cheeks is visible, the cheekbones protrude forward, the sharpening of the chin is pronounced.
• Manifestations of lack of vital trace elements and vitamins are clearly expressed.
• Lack of iron affects the appearance of cracks in the corners of the mouth (jamming), as well as anemia.
• The lack of vitamins A and C manifests itself in the form of appearance on the mucous membranes: bleeding and atrophy (death, reduction in size) of the gums, stomatitis in the form of small whitish rashes.
• The abdomen is greatly distended due to the weakness of the muscles that support it.
• Body temperature often jumps up and down due to the fact that the thermoregulation center in the brain does not work.
• Immunity is sharply reduced. You can detect signs of sluggish chronic infections. Inflammation of the middle ear - otitis, inflammation of the kidneys - pyelonephritis, pneumonia - pneumonia.
• The child's growth lags behind the average.

Options for the course of malnutrition

A lag in the growth and development of a child can be present at every stage of its development, starting mainly from the second half of pregnancy, and ending with the period of primary school age. At the same time, the manifestations of the disease are characterized by their own characteristics.

Depending on the period of development of hypotrophic manifestations, there are four variants of the course of hypotrophy:

• intrauterine malnutrition;
• hypostatura;
• alimentary insanity.

Intrauterine malnutrition

Intrauterine malnutrition originates in the prenatal period. Some authors call this pathology intrauterine growth retardation.

There are several options for the development of intrauterine malnutrition:
1. Hypotrophic- when the nutrition of all organs and systems is disturbed, the fetus develops very slowly, and does not correspond to the gestational age.
2. Hypoplastic- this variant of development means that along with the insufficient general development of the fetal organism, there is also a certain lag in the maturation and development of all organs. Here we are talking about the fact that organs and tissues at birth are not sufficiently formed, and do not fully perform their functions.
3. Dysplastic the variant of the course of malnutrition is characterized by uneven development of individual organs. Some, such as the heart, liver, develop normally, corresponding to the gestational age, while others, on the contrary, lag behind in their development, or develop asymmetrically.

Hypostatura

Hypostatura - the term originates from the Greek language, and means hypo - below, or under, statura - growth, or size. With this variant of the development of malnutrition, there is a uniform lag both in the growth of the child and in his body weight.

The only difference from true malnutrition is that the skin and subcutaneous fat layer do not undergo strong changes.

Hypostatura, as one of the variants of the course of malnutrition, occurs secondarily in chronic diseases of some internal organs. The development of hypostature is usually associated with transitional periods of growth and development of the child. One of these periods falls on the first six months of a child's life. At the same time, they begin to gradually add food products, milk formulas to mother's milk - in other words, to supplement the child. The appearance of this pathology in the second year of life is associated primarily with congenital chronic diseases. Here are the most common ones:

• Congenital malformations of the cardiovascular system. Violation of blood circulation leads to insufficient flow of oxygen and nutrients to organs and tissues.
• Encephalopathies in combination with endocrine disorders also have an extremely adverse effect on the metabolism in the body, delaying development and growth.
• Bronchopulmonary dysplasia is a disturbed development of the lung tissue during the period of intrauterine development of the fetus. In this case, there are serious complications associated with breathing and the delivery of oxygen to the blood.

As mentioned above, children with hypostature are predominantly stunted. It has been proven that the elimination of the cause that caused this pathology gradually leads to the normalization of the growth of such children.

Kwashiorkor

The term kwashiorkor is commonly used to refer to such a variant of the course of malnutrition, which occurs in countries with a tropical climate, and where plant foods predominate in the diet.

In addition, there are specific disorders in which the body receives less, does not synthesize or does not absorb protein food at all.

Disorders that contribute to the development of kwashiorkor include:

• Long-term indigestion, manifested by persistent unstable stools - in other words, the child has chronic diarrhea.
• In diseases of the liver, its protein-forming function is disrupted.
• Kidney disease, accompanied by increased loss of protein along with urine.
• Burns, excessive blood loss, infectious diseases.

Insufficient consumption of protein products (meat, eggs, dairy) leads to a peculiar course of this pathology, expressed in four main and constant symptoms:
1. Neuropsychiatric disorders- the child is apathetic, lethargic, he has increased drowsiness, lack of appetite. When examining such children, it is often possible to identify a lag in psychomotor development (late in holding his head, sitting, walking, speech is formed with a great delay).
2. Edema due to a lack of protein molecules in the blood (albumin, globulins, etc.). Albumins maintain oncotic pressure in the blood by binding water molecules to themselves. As soon as protein deficiency occurs, water immediately leaves the vascular bed and penetrates into the interstitial space - local swelling of the tissues is formed. In the initial stages of the disease, mainly internal organs swell, but this fact escapes the attention of parents. In the developed (manifest) stages of the disease, peripheral tissues swell. Edema appears on the face, feet, limbs. An erroneous idea is created that the child is healthy and well-fed.
3. Decreased muscle mass. Muscle mass, and with it strength, is significantly reduced. Protein starvation causes the body to borrow its own proteins from the muscles. There is a so-called atrophy of muscle fibers. Muscles become flabby, lethargic. Together with the muscles, the nutrition of the underlying tissues and subcutaneous fat is disrupted.
4. Delay in the physical development of children. It is accompanied by a lack of growth rate, while body weight is reduced much less. Children with kwashiorkor are short, squat, and their physical activity is below normal.

In addition to the constant symptoms, children with kwashiorkor have other signs of the disease that occur with varying frequency.

Common symptoms are:
1. Color change, softening of thinning and, eventually, hair loss on the head. Hair becomes lighter, and in later manifestations of the disease, or in older children, discolored or even gray strands of hair are found.
2. Dermatitis is an inflammation of the superficial layers of the skin. Redness, itching, cracks appear on the skin. Subsequently, the skin in the affected areas exfoliates, and traces remain in this place in the form of light spots.

Rare symptoms include:
1. Dermatosis - red-brown spots of a rounded shape.
2. Hepatomegaly is an abnormal enlargement of the liver. The liver tissue is replaced by adipose and connective tissue. The liver is not able to form enzymes and other active substances necessary for the normal function of the whole organism.
3. Kidney dysfunction. The filtration capacity is reduced. In the blood, harmful metabolic products accumulate.
4. Stool disorders are permanent. The child has persistent diarrhea. The feces are shiny and smell unpleasant.

Summing up the material presented, we can say with confidence that kwashiorkor is a disease that is extremely rare in countries with a temperate climate. Countries located in this geographical latitude have a developed social status and standard of living, therefore, the possibility of malnutrition and a deficiency in the diet of proteins and calories is practically excluded.

Alimentary insanity

Alimentary insanity (exhaustion) occurs in children of primary and secondary school age. With insanity, there is a lack of both proteins and calories.

To establish the cause and make an accurate diagnosis, find out:

• From the history of the onset of the disease, they learn what the body weight of the child was even before the first signs of malnutrition appeared.
• The socio-economic situation in which the child's family is located.
• If possible, find out the daily diet.
• Whether there is vomiting or chronic diarrhea, and how often it occurs.
• Is this child taking any medications? For example, anorexigenic, which suppress appetite, or diuretics, which remove many useful nutrients from the body, including protein.
• Are there any disorders of the central nervous system: stressful situations, alcohol or drug addiction.
• In adolescence, in particular in girls, starting from the age of 12, they find out the presence and evaluate the regularity, frequency and duration of the menstrual cycle.

All of the above factors directly or indirectly affect the state of the body, affect all organs and systems, inhibiting their functional performance. Thus, they predispose to the development of alimentary insanity.

Among all the symptoms that appear with alimentary insanity, permanent and rare symptoms are distinguished.

Permanent symptoms include:

• weight loss reaches up to 60% of normal, age-appropriate;
• decrease in the thickness of the subcutaneous fat layer;
• reduction in the mass of muscle fibers;
• the limbs of the patient become very thin;
• many wrinkles appear on the face, the skin fits all the facial bones and it seems as if this is the face of an old man.

Rare symptoms are:

• Diarrhea is chronic. The chair is liquid, shines, with an unpleasant smell.
• Thinning and clarification of hair, which eventually begin to fall out.
• Exacerbation of chronic infections is a very frequent companion of an organism weakened by malnutrition.
• Thrush is a fungal disease that affects the mucous membranes of the mouth, vagina and urethra. They are manifested by whitish discharge, itching and discomfort in these places.
• Symptoms of multivitamin deficiency, depending on the lack of certain vitamins and minerals.

An objective examination of such children reveals many pathological changes among all organs and systems:

• Eye changes are manifested by inflammation of the eyelids, the formation of new small vessels on the cornea. Grayish plaques appear in the inner corners of the eyes (lack of vitamin A).
• In the oral cavity, inflammatory changes in the mucous membrane and gums are observed. The tongue increases in size (due to a lack of vitamin B 12).
• The heart is enlarged. Insufficient strength of cardiac impulses leads to stagnation of blood in the veins, swelling of the lower extremities appears.
• Weakness of the muscles of the anterior abdominal wall causes a sagging, protruding abdomen. The liver protrudes beyond the lower edge of the right hypochondrium.
• Explicit neurological disorders are manifested in nervousness, increased irritability, muscle weakness, and a decrease in tendon reflexes.

Functional changes reflect the degree of pathological disorders associated with protein-calorie deficiency:

• Memory worsens, mental and cognitive abilities, including working capacity, decrease.
• Decreased visual acuity. A lack of vitamin A causes a decrease in vision at dusk.
• The sharpness of taste sensations is also reduced.
• A lack of vitamin C leads to increased capillary fragility. Small punctate hemorrhages can be seen on the skin after a slight pinch.

Lack of essential fatty acids

If there is a deficiency of essential fatty acids (linoleic and linolenic acids), specific symptoms immediately appear, characteristic of their insufficient consumption. Linolenic and linoleic acids are found in large quantities in vegetable oils (olive, sunflower, soybean).

In most cases, this variant of malnutrition appears in infants who lack the nutrition of mother's milk. Cow's milk and other milk mixtures do not contain essential fatty acids in the amount necessary for the energy and plastic costs of a young organism. Depending on the deficiency of one or another fatty acid, the symptoms of the disease will differ slightly from each other.

With a lack of linoleic acid, the following symptoms appear:

• Dryness of the skin with exfoliation of the superficial stratum corneum.
• Wound healing continues for a long period.
• Thrombocytopenia - a reduced number of platelets (blood cells responsible for its clotting) in the blood. The lack of platelets leads to increased fragility of small vessels, with accidental minor domestic injuries of the skin, bleeding lengthens. Insignificant tweaks cause the appearance of many small-point hemorrhages.
• Prolonged loose stools (diarrhea).
• Periodic exacerbations of infectious diseases (for example, skin or lungs).

Lack of linolenic acid leads to:

• numbness and paresthesia (tingling sensation) of the lower and upper extremities;
• general muscle weakness;
• visual impairment.

In general, the severity of pathological changes and the lag in body weight from growth depend on many reasons, including the duration of protein and calorie starvation in boys and girls. Therefore, timely clarification of the causes leading to the development of alimentary insanity can prevent all pathological consequences.

Diagnosis of malnutrition

Basic provisions

Approaching the stage of diagnosing malnutrition, course options, possible complications from other organs, several points must be taken into account.

Detection of important clinical signs in all major systems involved in the pathological process. This includes the following violations:

• fatness disorders - manifested in the form of thinning of the subcutaneous fat layer and trophic changes;
• digestive disorders - include changes in food resistance;
• metabolic disorders: protein, fat, carbohydrate, mineral, vitamin;
• functional disorders of the central nervous system.

An important and main criterion for diagnosing this pathology is the size of the subcutaneous fat layer. The thinner this layer, the more pronounced the violation of the general condition of the body.

The second point that should not escape the attention of doctors is the differentiation of pathological changes that occur during malnutrition, with other similar diseases, with a decrease in height, body weight, and overall physical development of children.

Symptoms of children with hypostatura are very similar to a disease such as nanism. This is a pathology of the central endocrine organs (hypothalamus and pituitary gland), in which growth hormone, somatotropin, is not produced. With this disease, unlike hypostatura, there are no pathological changes in the form of thinning of the subcutaneous fat layer and other trophic disorders. All organs develop evenly, although they are reduced in size.

Assessment of the child's condition and determination of the degree of pathological changes is also determined by the nature of the feces. Initially, with malnutrition, the stool is scanty, colorless, with a characteristic fetid odor. In the future, violations of the functional ability to process food through the gastrointestinal tract lead to the fact that the stool becomes plentiful, shiny, it contains the remains of undigested food, muscle fibers. Infection with pathogenic bacteria of the intestinal mucosa entails dysbacteriosis (diarrhea, bloating and discomfort in the abdomen).

Due to insufficient intake of protein, the body uses internal reserves (from muscles, adipose tissue), the metabolic products of which are excreted by the kidneys in the form of ammonia. The urine of such patients has the smell of ammonia.

Laboratory research

Due to the fact that with malnutrition there is a variety of pathological changes, laboratory tests will be variable, depending on the predominant lesion of a particular organ. For example, with anemia, there will be a decrease in the number of red blood cells and hemoglobin in the bloodstream.

In biochemical analyzes, signs of impaired liver function, lack of vitamins and trace elements can be detected.

Instrumental diagnostic methods

They are used in cases where there are significant complications from the internal organs. Widespread methods are: electrocardiographic examination of the heart, electroencephalogram of the brain, ultrasound examination of other internal organs.

Ultrasound is used when the borders of the heart are enlarged, the liver is enlarged, or there are other pathological changes in the abdominal cavity.
If necessary, or in doubtful cases, the attending physician prescribes the appropriate instrumental diagnostic method at his discretion.
Diagnosis of malnutrition and the degree of pathological changes is not an easy task, and requires a lot of patience, care and experience from the doctor.

Hypotrophy treatment

To treat malnutrition, it is not enough to take medicines in the form of vitamin preparations, or start intensive feeding. Therapy of such a disease should include a whole range of measures aimed at eliminating the cause of malnutrition, maintaining an optimal balanced diet for age, as well as performing therapeutic measures to eliminate complications associated with malnutrition.

Complex therapy includes:

• Determination of the cause that caused malnutrition, simultaneously with an attempt to regulate and eliminate it.
• Diet therapy, which is selected individually in each specific case, and also depends on the degree of pathological disorders in the body.
• Detection of chronic foci of infection that contribute to the development of malnutrition, as well as their active treatment.
• Symptomatic treatment, which includes the use of multivitamin and enzyme preparations.
• Appropriate regimen with proper care and educational activities.
• Periodic courses of massage and therapeutic exercises.

diet therapy

D Chemotherapy is a fundamental method of treatment for malnutrition. The appointment of appropriate food products depends on many factors, in particular on the degree of exhaustion of the body. But the most important thing in the approach to diet therapy is the degree of damage to the gastrointestinal tract or central nervous system. Not in all cases it happens that with a large decrease in the subcutaneous fat layer, the patient felt bad.
When prescribing diet therapy, several basic principles (stages) are followed:
1. Initially, the resistance of the digestive system to the food consumed is checked. That is, how badly the gastrointestinal tract is affected, and whether food can be fully processed and absorbed by the body.
The period of clarification of food resistance in duration takes from several days with the first degree of malnutrition, up to one and a half to two weeks with the third degree. This process involves the doctor monitoring how the food is absorbed and whether there are any complications in the form of diarrhea, bloating, or other symptoms of a gastrointestinal disorder.
From the first day of treatment, the daily amount of food should not exceed the usual age:

• 2/3 for hypotrophics of the first degree.
• 1/2 for hypotrophics of the second degree.
• 1/3 for hypotrophics of the third degree.

2. The second stage is marked by the fact that the patient is in a transitional stage. In other words, the prescribed complex treatment, together with the appropriate diet, has a beneficial effect on restoring the health of the child.
In this period, there is a gradual compensation of missing trace elements, vitamins and other nutrients. There is a decrease in the number of meals, but the calorie content and quantitative volume increase. Every day, a small amount of the mixture is added to each meal, until the full volume of nutrition is fully restored, in accordance with age.

3. The third period in diet therapy is the stage of enhanced food intake. Only after complete restoration of the functional activity of the gastrointestinal tract, the patient can increase the load of food.
In the third period, intensive feeding is continued, however, with a restriction of protein intake, since the increased intake of protein products is not fully absorbed by the body.
During each stage of diet therapy, the stool is periodically checked for the content of residual dietary fiber and fat (coprogram).

Other, no less important conditions when prescribing a diet are:
1. Reducing the periods between feedings. And the frequency of feeding itself increases several times a day, and is:

• with hypotrophy of the first degree - seven times a day;
• in the second degree - eight times a day;
• in the third degree - ten times a day.

2. The use of easily digestible food. Mother's milk is best, and in the absence of it, milk mixtures are used. The choice of milk formula is made taking into account the individual characteristics of each child, as well as in case of a shortage of one or another nutritional ingredient in the daily regimen of the patient.

3. Maintaining adequate periodic nutritional control. For this purpose, special diaries are kept, where the amount of food eaten is noted. Systematic control is simultaneously performed for stool, diuresis (number and frequency of urination). If nutrient mixtures are administered intravenously, then their amount is also recorded in the diary.

4. Fecal samples are taken several times a week for the presence of undigested dietary fiber and fatty inclusions.

5. Every week, the child is weighed, and additional calculations are made to calculate the required amount of nutrients (proteins, fats and carbohydrates).

The criteria for the effectiveness of dietary therapy are:

• normalization of the condition and elasticity of the skin;
• improving the appetite and emotional state of the child;
• daily weight gain, an average of 25-30 grams.

In the most severe cases, with malnutrition of the 3rd degree, the child cannot eat on his own. In addition, his gastrointestinal tract is significantly damaged, and cannot process food. In such cases, children with malnutrition are transferred to parenteral nutrition (nutrient solutions are injected intravenously). Also, various compositions of minerals and electrolytes (disol, trisol) are used parenterally, which replenish the missing volume of fluid in the body and regulate metabolism.

Care of patients with malnutrition

An integrated approach in the treatment of malnutrition provides for proper care for such children. At home, children with the first degree of malnutrition can be treated, but provided that there are no other concomitant diseases, and the risk of complications is minimal. Inpatient treatment of hypotrophy of 2-3 degrees is carried out in a hospital without fail, together with the mothers of babies.

• The conditions for staying in the wards should be as comfortable as possible, and are as follows: the lighting complied with all regulatory standards, ventilation was carried out twice a day, the air temperature was optimal, within 24-25 degrees Celsius.
• Daily walks in the fresh air serve both as hardening and as a prevention of upper respiratory tract infections (congestive pneumonia).
• Periodic gymnastic exercises and massage courses will help restore reduced muscle tone, and will have a beneficial effect on the general condition of the body.

Correction of the disturbed balance of intestinal microflora is carried out with the use of lacto- and bifidobacteria. These medicines come in the form of capsules that are taken several times a day. These drugs include: bifidumbacterin subtil, yogurt.

Enzyme therapy

Enzyme therapy is used for reduced functional capacity of the gastrointestinal tract. The drugs taken replace the lack of gastric juice; amylases, pancreatic lipases; this group of drugs includes festal, creon, panzinorm, diluted gastric juice.

vitamin therapy

It is an essential part of the treatment of malnutrition. Reception begins with parenteral administration (intravenously, intramuscularly) of vitamins C, B 1, B 6. With the improvement of the general condition, they switch to enteral (through the mouth) intake of vitamins. Subsequently, multivitamin complexes are used in courses.

Stimulant Therapy

Designed to improve metabolic processes in the body. In severe cases, immunoglobulin is prescribed, which protects the body from the increasing harmful effects of pathogenic microorganisms, increases defenses and prevents chronic infection from developing.
Preparations dibazol, pentoxiffilin, ginseng - improve peripheral blood circulation, access of oxygen and nutrients to internal organs and tissues. Activate the work of the central nervous system.

Symptomatic treatment

Each hypotrophic person has some kind of complications. Therefore, depending on the pathological condition, drugs are prescribed that support their performance and functional activity:

• With anemia, iron preparations (sorbifer, totem) are prescribed. If a child has a very low hemoglobin value (below 70 g/l), he is prescribed a red blood cell transfusion.
• With rickets, vitamin D is prescribed, as well as preventive courses of physiotherapy. For this purpose, irradiation with ultraviolet rays using a special quartz lamp is used.

Prevention of the development of malnutrition

1. Even during pregnancy, it is necessary to apply preventive measures for the correct regimen of a pregnant woman. Proper care, proper nutrition and prevention of the influence of harmful environmental factors will minimize the risk of malnutrition at birth.
2. Starting from birth, a very important point in the prevention of malnutrition is the natural feeding of 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.
3. Under conditions of shortage of women's milk, the child is supplemented with nutritious milk mixtures. One of the main rules of supplementary feeding is that it should be done before breastfeeding.
4. Starting from the age of six months, the child must begin to feed. There are several main rules for complementary foods:

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

5. Timely diagnosis of infectious diseases, rickets and other disorders of the gastrointestinal tract, will allow you to start appropriate treatment, and prevent the development of malnutrition.

Summing up the above material, it should be noted that the prognosis for the development of malnutrition depends primarily on the causes that participated in the occurrence of this pathological condition. The 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 alimentary insufficiency, the outcome of the disease is usually favorable.

Before use, you should consult with a specialist.

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

Causes of the disease

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

Intrauterine malnutrition:

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

Extrauterine malnutrition:

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

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

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

Classification

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

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

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

Symptoms of childhood malnutrition

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

I degree

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

II degree

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

III degree

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

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

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

Treatment of the disease

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

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

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

Prevention methods

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

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

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

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

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

Hypotrophy is a chronic malnutrition in babies, which is accompanied by a constant underweight in relation to the age and height of the infant. Often, malnutrition in children affects not only the insufficient development of muscle mass, but also psychomotor aspects, growth retardation, general lagging behind peers, and also causes a violation of skin turgor due to insufficient buildup of the subcutaneous fat layer. Underweight (hypotrophy) in infants usually has 2 causes. Nutrients may enter the child's body in insufficient quantities for proper development or simply not be absorbed. In medical practice, malnutrition is distinguished as an independent type of violation of physiological development, a subspecies of dystrophy. As a rule, small children under the age of one year are susceptible to such a violation, but sometimes the condition persists up to 3 years, due to the peculiarities of the social status of the parents.

Degrees of malnutrition in children and symptoms of the disorder

First degree

The disease is characterized by a slight decrease in appetite, accompanied by sleep disturbance and frequent anxiety. The baby's skin usually remains practically unchanged, but has reduced elasticity and a pale appearance. Thinness is visible only in the abdomen, while muscle tone can be normal (sometimes slightly reduced). In some cases, 1 degree of malnutrition in young children may be accompanied by anemia or rickets. There is also a general decrease in the functioning of the immune system, from which babies get sick more often, look less well-fed in comparison with their peers. Some children may have indigestion leading to diarrhea or constipation.
Often, the 1st degree of violation remains almost imperceptible to parents, and only an experienced doctor can identify it with a thorough examination and diagnosis, during which he must find out if the thinness of the baby is a feature of his physique and a hereditary factor. For some children, height and thinness are inherited from their parents, so a slender young mother should not worry that her baby does not look as well-fed as the rest, if at the same time he is active, cheerful and eats well.

Second degree

It is characterized by a lack of weight in children in the amount of 20-30%, as well as a lag in growth of the baby, on average by 3-4 cm. also the lack of warmth of the arms and legs. With hypotrophy of the 2nd degree in newborns, there is a developmental delay not only in motor, but also mental, poor sleep, pallor and dry skin, frequent peeling of the epidermis. Baby's skin is not elastic, it easily gathers into folds. Thinness is strongly pronounced and affects not only the abdomen, but also the limbs, while the contours of the ribs are clearly visible in the baby. Children with this form of disorder are very often sick and have unstable stools.

Third degree

Babies with this form of impairment are severely stunted, on average up to 10 cm, and have a weight deficit of more than 30%. The state is characterized by severe weakness, an indifferent attitude on the part of the child to almost everything, tearfulness, drowsiness, as well as the rapid loss of many acquired skills. The thinning of the subcutaneous fatty tissue is clearly expressed throughout the body of the child, there is a strong atrophy of the muscles, dry skin, cold extremities. The color of the skin is pale with a grayish tint. The lips and eyes of the baby are dry, cracks are observed around the mouth. Often in children there are various infectious diseases of the kidneys, lungs and other organs, for example, pyelonephritis, pneumonia.

Types of malnutrition

Violation in young children is divided into 2 types.

Congenital malnutrition

Otherwise, the condition is called prenatal developmental delay, which begins even in the prenatal period. There are 5 main causes of congenital disorders:

• Maternal. This group includes insufficient and malnutrition of the expectant mother during pregnancy, her very young or, conversely, old age. Previously appeared stillborn children or miscarriages, the presence of serious chronic diseases, alcoholism, smoking or drug use, as well as severe preeclampsia in the second half of pregnancy can lead to the appearance of a baby with malnutrition.
• Paternal. Caused by hereditary causes on the paternal side.
• Placental. The appearance of hypotrophy of any degree in a newborn can also be affected by poor patency of the vessels of the placenta, their narrowing, anomalies in the location of the placenta, its presentation or partial detachment. Vascular thrombosis, heart attacks, fibrosis of the placenta can also affect the appearance of the disorder.
• Socio-biological factors. Insufficient material support for the expectant mother, her adolescence, as well as work in hazardous and chemically hazardous industries, the presence of penetrating radiation.
• Other factors. Mutations at the genetic and chromosomal level, the presence of congenital malformations, multiple pregnancy, premature birth.

Acquired malnutrition

The causes of such developmental disorders are divided into two types: endogenous and exogenous. Endogenous factors include:

• the presence of diathesis in infancy;
• anomalies of the constitution in babies up to a year;
• immunodeficiency, both primary and secondary;
• congenital malformations, such as perinatal encephalopathy, pyloric stenosis, bronchopulmonary dysplasia, Hirschsprung's disease, "short bowel" syndrome, disorders in the cardiovascular system;
• endocrine disorders, in particular, hypothyroidism, adrenogenital syndrome, pituitary dwarfism;
• the presence of malabsorption syndrome, disaccharidase deficiency, cystic fibrosis;
• anomalies of the metabolic process of hereditary etiology, for example, galactosemia, fructosemia, Niemann-Pick or Tay-Sachs disease.

• diseases caused by infections, for example, sepsis, pyelonephritis, intestinal disorders caused by bacteria (salmonellosis, dysentery, colienteritis), persistent dysbacteriosis;
• improper upbringing, non-compliance with the daily routine. These include improper care for a baby under the age of one year, poor sanitary conditions, malnutrition;
• nutritional factors such as underfeeding of the infant (qualitative or quantitative) with natural feeding can be observed with a flat nipple in the mother. Underfeeding due to a "tight" breast, in this case, the baby cannot suck out the required amount of milk. Vomiting or constant spitting up;
• toxic causes, for example, poisoning, various degrees and forms of hypervitaminosis, feeding with low-quality milk formula or animal milk from the moment of birth (it is not absorbed by the body of the newborn).

Diagnostics

To accurately establish the diagnosis of malnutrition in babies, a set of studies is carried out, which includes:

• Collection of anamnesis. The features of the baby's life, his nutrition, regimen, the presence of possible congenital diseases, medication, living conditions, care, as well as diseases of the parents that can be transmitted to the child at the genetic level are clarified.
• Careful inspection, during which the condition of the baby's hair and skin, his oral cavity, and nails is determined. The child's behavior, mobility, existing muscle tone, general appearance are assessed.
• Body mass index calculation and comparing it with the norms of development based on the weight of the baby at birth and his age at the time of the diagnosis. The thickness of the subcutaneous fat layer is also determined.
• Conducting laboratory research baby blood and urine tests.
• Complete immunological examination.
• Breath tests.
• Ultrasound of internal organs.
• ECG.
• Blood sampling for a complete biochemical analysis.
• The study of feces child for the presence of dysbacteriosis and the amount of undigested fat.

Intrauterine malnutrition can be detected even during pregnancy during the next ultrasound, in which the doctor determines the size of the fetus and the estimated weight. If developmental disorders are detected, the expectant mother is sent to a hospital for a full examination and taking the necessary measures. In newborns, existing malnutrition can be determined by a neonatologist during an examination immediately after the birth of the baby. Acquired developmental disorder is usually detected by a pediatrician during a routine examination and the necessary measurements of height and weight. In this case, the doctor, in addition to conducting research, usually appoints consultations of other specialists, which helps to accurately establish the diagnosis and degree of malnutrition.

Treatment

Therapy for malnutrition is carried out depending on the degree of the disease. Postnatal malnutrition of the 1st degree is treated on an ordinary outpatient basis at home with mandatory strict adherence to all doctor's prescriptions. The second and third degrees require inpatient treatment, where specialists can constantly assess the baby's condition and the results of the treatment, which is aimed at eliminating the existing causes of malnutrition, organizing good care for the baby, and correcting metabolic abnormalities. The basis of the treatment of malnutrition is a special diet therapy, which is carried out in 2 stages. First, possible food intolerances in the infant are analyzed, after which the doctor prescribes a certain balanced diet with a gradual increase in food portions and its calorie content. The basis of diet therapy for malnutrition is fractional nutrition in small portions with a short period of time. The serving size is increased weekly, taking into account the necessary nutritional load during regular monitoring and examinations. In the course of therapy, adjustments are made to the treatment. Weakened babies who cannot swallow or suck on their own are fed through a special tube. Medical treatment is also carried out, in which the baby is prescribed vitamins, enzymes, taking anabolic hormones, adaptogens. In cases of a particularly serious condition of children with malnutrition, they are given intravenous infusions of special protein hydrolysates, saline solutions, glucose and essential vitamins. To strengthen muscle tone, kids are given exercise therapy and UVR, as well as a course of special massage.

Lifestyle of children with malnutrition

During the treatment of the child, parents must strictly comply with all the doctor's instructions. The main factors for the successful cure of the crumbs are the establishment of the correct regimen not only for feeding, but also for playing, sleeping and walking. With proper care and good nutrition, in the absence of metabolic disorders and other congenital (acquired or chronic) diseases, babies quickly gain weight and are quite capable of catching up with the parameters of their healthy peers. It is important to prevent the appearance of malnutrition in infants and it lies in the correct behavior of the future mother during the bearing of the crumbs. Registration at a polyclinic (special center or private clinic) should take place in the early stages of pregnancy, already during the first month. It is important to pass all the scheduled examinations and studies on time, not to miss scheduled appointments and consultations of specialists. A special moment in the prevention of malnutrition in a child is the nutrition of the expectant mother, it must be balanced, provide the body with all the necessary substances not only for its existence, but also for the development of the fetus. Timely examination allows you to identify the existing violation in time and take the necessary measures to eliminate it even before the birth of the crumbs.

How to recognize malnutrition in a child?

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Hypotrophy in children- this is the deviation of the actual body weight from the physiological age norms. This is an alimentary disease, which is characterized by a decrease in the amount or complete absence of the subcutaneous fat layer. In rare cases of hereditary metabolic disorders, malnutrition in children is associated with insufficient muscle mass. Muscular hypotrophy in children is complicated by dysfunctions of internal organs, heart failure and dystrophy subsequently. The classification of malnutrition in children is carried out in accordance with the indicators of the lag in weight gain:

• 1 degree diagnosed with a loss of body weight by 10-20%;
• 2 degree- this is the abandonment of the actual body weight from the physiological age norm by 21-40%;
• 3 degree- loss of more than 42% of normal body weight for age.

Why does fetal hypotrophy develop?

Fetal hypotrophy- this is a condition in which the actual weight of the child in utero is determined below the physiological level corresponding to the gestational age. The main provoking factors:

• toxicosis of pregnancy;
• nephropathy of a pregnant woman;
• a large amount of amniotic fluid;
• infectious diseases of the expectant mother;
• exacerbation of chronic diseases of internal organs;
• nutritional deficiencies in women.

Fetal hypotrophy is diagnosed by ultrasound. After diagnosis, the obstetrician should take measures to eliminate the causes of fetal hypotrophy.

How is malnutrition diagnosed in newborns?

After birth, malnutrition in newborns can be diagnosed at the first examination. The child is weighed and the data of his height and weight are compared. The doctor assesses the condition of the turgor of the skin and the thickness of the subcutaneous fat layer. With deviations from the norm, a diagnosis of underweight is established. In the newborn period, malnutrition in children can develop under the influence of:

• congenital disorders of the development of the digestive system;
• insufficiency of milk in the mother;
• improperly chosen scheme of artificial and mixed feeding;
• enzymatic deficiency;
• lactose intolerance;
• frequent colds and infectious diseases.

When diagnosing, the indicator of body weight gain is of decisive importance.

Symptoms of malnutrition in children

During the diagnosis, the main symptoms of malnutrition in children are distinguished:

• insufficient body weight;
• decrease in physical and mental activity;
• decrease in skin turgor;
• dry mucous membranes and skin;
• reduction in the amount of subcutaneous adipose tissue.

To prescribe the correct method of treatment, the cause of malnutrition should be identified. In newborns, this phenomenon is often associated with nutritional deficiencies or disorders of the gastrointestinal tract.

Treatment of malnutrition in children

Treatment of malnutrition in children begins with the diagnosis and elimination of the causes that form the complex of clinical symptoms. The diet and calorie content of the diet are adjusted. When breastfeeding, attention is paid to the diet of the mother. A high protein intake is recommended. If necessary, the diet of a nursing woman is supplemented with vitamin and mineral complexes. If these measures do not help within 1-2 weeks, then the child is transferred to a mixed type of feeding. The doctor recommends mixtures that are most suitable for the baby in terms of age and type of physiological characteristics. If the malnutrition of newborns is associated with lactose intolerance, then breastfeeding is completely replaced with artificial one using mixtures without milk protein.

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Hypotrophy in children is starvation, quantitative or qualitative, as a result of which significant changes occur in the body. Qualitative starvation is possible with improper artificial feeding, lack of essential nutrients and vitamins, quantitative - with incorrect calculation of caloric content or lack of food resources. Hypotrophy can be the result of acute diseases or the result of a chronic inflammatory process. Wrong actions of parents - lack of regimen, poor care, unsanitary conditions, lack of fresh air - also lead to this condition.

What does a normally developing baby look like?

Signs of normotrophic:

• healthy look
• The skin is pink, velvety, elastic
• A lively look, activity, studies the world around with interest
• Regular increase in weight and height
• Timely mental development
• Proper functioning of organs and systems
• High resistance to adverse environmental factors, including infectious ones
• Rarely cries

In medicine, this concept is used only in children under 2 years of age. According to WHO, malnutrition is not ubiquitous:

• in developed countries, its percentage is less than 10,
• and in developing countries - more than 20.

According to scientific studies, such a deficient condition occurs approximately equally in boys and girls. Severe cases of malnutrition are observed in 10-12 percent of cases, with rickets in a fifth of children, and anemia in a tenth. Half of the children with this pathology are born in the cold season.

Causes and development

The causes of malnutrition in children are diverse. The main factor causing intrauterine malnutrition is toxicosis of the first and second half of pregnancy. Other causes of congenital malnutrition are as follows:

• pregnancy before the age of 20 or after 40 years
• bad habits of the expectant mother, poor nutrition
• chronic diseases of the mother (endocrine pathologies, heart defects, and so on)
• chronic stress
• work of the mother during pregnancy in hazardous production (noise, vibration, chemistry)
• placental pathology (improper attachment, early aging, one umbilical artery instead of two, and other placental circulation disorders)
• multiple pregnancy
• metabolic disorders in the fetus of a hereditary nature
• genetic mutations and intrauterine anomalies

Causes of acquired malnutrition

Internal- caused by pathologies of the body that disrupt food intake and digestion, absorption of nutrients and metabolism:

• congenital malformations
• CNS lesions
• immunodeficiency
• endocrine diseases
• metabolic disorders

In the group of endogenous factors, food allergies and three hereditary diseases that occur with malabsorption syndrome, one of the common causes of malnutrition in children, should be singled out separately:

• cystic fibrosis - disruption of the external secretion glands, affected by the gastrointestinal tract, respiratory system
• celiac disease - gluten intolerance, changes in the work of the intestines in a child begin from the moment gluten-containing foods are introduced into the diet - barley groats, semolina, wheat porridge, rye groats, oatmeal
• lactase deficiency - the digestibility of milk is impaired (lack of lactase).

According to scientific studies, malabsorption syndrome provokes malnutrition twice as often as nutritional deficiencies. This syndrome is characterized primarily by a violation of the chair: it becomes plentiful, watery, frequent, frothy.

External- due to the wrong actions of parents and an unfavorable environment:

All exogenous factors in the development of malnutrition cause stress in the child. It has been proven that light stress increases the need for energy by 20%, and for protein - by 50-80%, moderate - by 20-40% and 100-150%, strong - by 40-70 and 150-200%, respectively.

Symptoms

Signs and symptoms of intrauterine malnutrition in a child:

• body weight below the norm by 15% or more (see below the table of the dependence of weight on the height of the child)
• growth is less by 2-4 cm
• the child is lethargic, muscle tone is low
• congenital reflexes are weak
• thermoregulation is impaired - the child freezes or overheats faster and stronger than normal
• in the future, the initial weight is slowly restored
• umbilical wound does not heal well

Acquired malnutrition is characterized by common features in the form of clinical syndromes.

• Insufficient fatness: the child is thin, but the proportions of the body are not violated.
• Trophic disorders (malnutrition of body tissues): the subcutaneous fat layer is thinned (first on the abdomen, then on the limbs, in severe cases and on the face), the weight is insufficient, body proportions are disturbed, the skin is dry, elasticity is reduced.
• Changes in the functioning of the nervous system: depressed mood, decreased muscle tone, weakened reflexes, psychomotor development is delayed, and in severe cases, acquired skills even disappear.
• Decreased perception of food: appetite worsens up to its complete absence, frequent regurgitation, vomiting, stool disorders appear, the secretion of digestive enzymes is inhibited.
• Reduced immunity: the child begins to get sick often, chronic infectious and inflammatory diseases develop, possibly toxic and bacterial damage to the blood, the body suffers from general dysbacteriosis.

Degrees of malnutrition in children

Hypotrophy of the 1st degree is sometimes practically not noticeable. Only an attentive doctor on examination can identify it, and even then he will first conduct a differential diagnosis and find out if a body weight deficit of 11-20% is a feature of the child's physique. Thin and tall children are usually so due to hereditary characteristics. Therefore, a new mother should not be afraid if her active, cheerful, well-nourished child is not as plump as other children. Hypotrophy of the 1st degree in children is characterized by a slight decrease in appetite, anxiety, sleep disturbance. The surface of the skin is practically not changed, but its elasticity is reduced, the appearance may be pale. The child looks thin only in the abdomen. Muscle tone is normal or slightly reduced. Sometimes they show signs of rickets, anemia. Children get sick more often than their well-fed peers. Stool changes are insignificant: a tendency to constipation or vice versa. Hypotrophy of the 2nd degree in children is manifested by a mass deficit of 20-30% and growth retardation (about 2-4 cm). Mom can find cold hands and feet in a child, he can often spit up, refuse to eat, be lethargic, inactive, sad. Such children lag behind in mental and motor development, sleep poorly. Their skin is dry, pale, flaky, easily folded, inelastic. The child looks thin in the abdomen and limbs, and the contours of the ribs are visible. The stool fluctuates greatly from constipation to diarrhea. These kids get sick every quarter.

Sometimes doctors see malnutrition even in a healthy child who looks too thin. But if the growth corresponds to age, he is active, mobile and happy, then the lack of subcutaneous fat is explained by the individual characteristics and high mobility of the baby.

With hypotrophy of the 3rd degree, growth retardation is 7-10 cm, weight deficit is ≥ 30%. The child is drowsy, indifferent, tearful, acquired skills are lost. The subcutaneous fat is thinned everywhere, pale gray, dry skin fits the baby's bones. There is muscle atrophy, cold extremities. Eyes and lips dry, cracks around the mouth. A child often has a chronic infection in the form of pneumonia, pyelonephritis.

Diagnostics

Differential Diagnosis

As mentioned above, the doctor first needs to figure out whether malnutrition is an individual feature of the body. In this case, no changes in the work of the body will be observed.
In other cases, it is necessary to conduct a differential diagnosis of the pathology that led to malnutrition: congenital malformations, diseases of the gastrointestinal tract or the endocrine system, lesions of the central nervous system, infections.

Treatment

The main directions of treatment of malnutrition in children are as follows:

• Identification of the cause of malnutrition, its elimination
• Proper care: daily routine, walks (3 hours daily, if outside ≥5˚), gymnastics and professional massage, bathing in warm baths (38 degrees) in the evening
• Organization of proper nutrition, balanced in proteins, fats and carbohydrates, as well as vitamins and microelements (diet therapy)
• Medical treatment

Treatment of congenital malnutrition consists in maintaining a constant body temperature in the child and establishing breastfeeding. Nutrition of children with malnutrition Diet therapy for malnutrition is divided into three stages.

Stage 1 - the so-called "rejuvenation" of the diet	that is, they use foods intended for younger children. The child is fed frequently (up to 10 times a day), the calculation of the diet is carried out on the actual body weight, and a diary is kept for monitoring the assimilation of food. The stage lasts 2-14 days (depending on the degree of malnutrition).
Stage 2 - transitional	Medicinal mixtures are added to the diet, nutrition is optimized to an approximate norm (according to the weight that the child should have).
Stage 3 - a period of enhanced nutrition	The calorie content of the diet increases to 200 kilocalories per day (at a rate of 110-115). Use special high-protein mixtures. With celiac disease, gluten-containing foods are excluded, fats are limited, buckwheat, rice, and corn are recommended for nutrition. With lactase deficiency, milk and dishes prepared with milk are removed from products. Instead, they use fermented milk products, soy mixtures. With cystic fibrosis - a diet with a high calorie content, food should be salted.

The main directions of drug therapy

• Replacement therapy with pancreatic enzymes; drugs that increase the secretion of gastric enzymes
• The use of immunomodulators
• Treatment of intestinal dysbacteriosis
• vitamin therapy
• Symptomatic therapy: correction of individual disorders (iron deficiency, irritability, stimulant drugs)
• In severe forms of malnutrition - anabolic drugs - drugs that promote the formation of building protein in the body for muscles and internal organs.

Treatment of malnutrition requires an individual approach. It is more correct to say that children are nursed, not treated. Vaccinations for hypotrophy of the 1st degree are carried out according to the general schedule, for hypotrophy of the 2nd and 3rd degrees - on an individual basis.

Study of the causes and symptoms of malnutrition in children

In one of the somatic hospitals, 40 case histories of children diagnosed with hypertrophy (19 boys and 21 girls aged 1-3 years) were analyzed. The conclusions were obtained as a result of the analysis of specially designed questionnaires: most often, children with malnutrition were born from a pregnancy that proceeded with pathologies, with heredity for gastrointestinal pathologies and allergic diseases, with intrauterine growth retardation.

Common causes of malnutrition in children:	37% - malabsorption syndrome - cystic fibrosis, lactase deficiency, celiac disease, food allergies 22% - chronic diseases of the digestive tract 12% - malnutrition
By severity:	1 degree - 43% 2 degree - 45% 3 degree - 12%
Associated pathology:	20% - rickets in 8 children 10% - anemia in 5 children 20% - delayed psychomotor development
The main symptoms of malnutrition:	dystrophic changes in teeth, tongue, mucous membranes, skin, nails 40% have unstable stools, impurities of undigested food
Laboratory data:	50% of children - absolute lymphocytopenia total protein in 100% of the examined children is normal results of coprological examination: 52% - creatorrhea - violations of the processes of digestion in the stomach 30% - amylorrhea - in the intestines 42% - violation of bile secretion (fatty acids) in children with cystic fibrosis - neutral fat

Prevention of malnutrition in children

Prevention of both intrauterine and acquired malnutrition begins with the struggle for the health of the woman and for the preservation of long-term breastfeeding. The following areas of prevention are tracking the main anthropometric indicators (height, weight), monitoring the nutrition of children. An important point is the timely detection and treatment of childhood diseases, congenital and hereditary pathologies, proper child care, and prevention of the influence of external factors in the development of malnutrition. It should be remembered:

• Mother's milk is the best and irreplaceable food for a baby up to a year old.
• At 6 months, the menu should be expanded with plant foods (see how to properly introduce complementary foods to a child). Also, do not transfer the child to adult food too early. Weaning from breastfeeding up to 6 months of the child is a crime against the baby, if there are problems with lactation, the child does not have enough milk, you must first apply it to the breast and only then supplement it.
• Variety in nutrition is not different types of cereals and pasta throughout the day. A complete diet consists in a balanced combination of proteins (animal, vegetable), carbohydrates (complex and simple), fats (animal and vegetable), that is, vegetables, fruits, meat, dairy products must be included in the diet.
• As for meat - after a year it must be present in the child's diet - this is an indispensable product, there can be no talk of any vegetarianism, only meat contains the compounds necessary for growth, they are not produced in the body in the amount that is needed for full development and health.
• Important!!! There are no safe drugs "just" to reduce or increase a child's appetite.

Table of dependence of weight on height in children under 4 years old

Very strong deviations in the weight of the child are not due to reduced appetite or some individual characteristics of the body - this is usually due to an unrecognized disease or lack of good nutrition in the child. A monotonous diet, nutrition that does not meet age-related needs - leads to a painful lack of body weight. The weight of the child should be controlled not so much by age as by the growth of the baby. Below is a table of the dependence of the height and weight of the baby (girls and boys) from birth to 4 years:

• Norm is the interval between GREEN And BLUE weight value (25-75 centiles).
• Weight loss- between YELLOW And GREEN figure (10-25 centiles), however, it may be a variant of the norm or a slight tendency to reduce body weight in relation to height.
• Weight gain- between BLUE And YELLOW number (75-90 centiles) is both normal and indicates a trend towards weight gain.
• Increased or reduced body weight- between RED And YELLOW The figure indicates both low body weight (3-10th centile) and increased (90-97th centile). This may indicate both the presence of the disease and the characteristics of the child. Such indicators require a thorough diagnosis of the child.
• Painful weight loss or gain- behind RED border (>97 or
  

Fetal hypotrophy is a slowdown in physical development, a discrepancy between the size of the fetus for a certain period of pregnancy. A synonym for the term is intrauterine growth retardation syndrome.

Forms of fetal hypotrophy

There are two forms of this syndrome.

1) Symmetrical form of fetal hypotrophy.

May appear early in pregnancy. With her, the limbs, the organs of the fetus are evenly reduced. That is, the child is smaller than the size that should be at this time.

• chromosomal pathology;
• maternal smoking;
• malnutrition of a pregnant woman;
• intrauterine infection;
• fetal malformations.

2) Asymmetric form of fetal hypotrophy.

Formed after the twenty-eighth week of pregnancy. With it, the development of only some organs is slowed down. The dimensions of the skeleton, brain and limbs correspond to a certain gestational age. And the development of the kidneys and liver lags behind. On ultrasound, an asymmetric form is diagnosed by a small (less than normal) abdominal circumference.

The severity of fetal malnutrition, depending on the severity of developmental delay:

1) Hypotrophy of the fetus of the 1st degree (lag in size varies within two weeks).

This diagnosis is made, but most often they are not taken seriously. The lag in development can only be visible. The mismatch in the size of the fetus is such a feature of the child, confusion in terms. To find out whether this discrepancy is pathological or normal, the study of the placenta, the state of blood flow in it, and computed tomography after 32 weeks of pregnancy helps.

2) Hypotrophy of the 2nd degree (developmental delay for two to four weeks).

This delay is not considered normal. Since it is possible only in violation of the functions of the placenta. With fetal hypotrophy of the 2nd degree, inpatient treatment is indicated.

3) Fetal hypotrophy of the 3rd degree (developmental delay for more than four weeks).

The state of complete exhaustion of the child in the womb. It is classified as an "advanced case" and indicates a serious problem.

Causes of the asymmetric form of fetal malnutrition

The following groups of causes can lead to impaired uteroplacental blood flow and poor nutrition of the fetus:

1) Social and household. This

• the age of the woman (less than seventeen and more than thirty years old);
• bad habits (drinking alcohol, smoking);
• hard physical work, work with pesticides;
• emotional stress.

2) The state of health of the mother. This

• chronic infections (tonsillitis, trachiobronchitis and others);
• pathologies of various organs (diseases of the heart, blood vessels, kidneys, endocrine system).

3) Gynecological diseases, the course of previous pregnancies. This

• irregular menstrual cycle or previous infertility due to hormonal disorders;
• miscarriages in history;
• pathology of the uterus (endometriosis, fibroids, scar after surgery).

4) Difficult course of an existing pregnancy. This

• risk of miscarriage;
• anemia;
• low blood pressure;
• multiple pregnancy;
• exacerbation of chronic infections.

All these causes can disrupt the blood supply to the uterus and fetus. As a result, the child receives insufficient oxygen and nutrients. Oxygen starvation develops, growth rates slow down.

Diagnosis of fetal hypotrophy

Clarifying diagnostic procedures:

• ultrasound, in which fetometry is done (measurement of fetal parameters), the condition of the placenta is assessed; ultrasound results are taken in dynamics (a second study is done after three weeks);
• dopplerometry, in which blood flow is analyzed in the uterine vessels, umbilical cord vessels and cerebral arteries of the fetus;
• ultrasound cardiotocography to assess the cardiovascular activity of the baby (after the thirtieth week of pregnancy).

Consequences of fetal hypotrophy

Babies with intrauterine growth retardation require special attention after birth. In this context, "special attention" means expensive treatment, highly qualified medical personnel and being in well-equipped perinatal centers.

The percentage of lethality in the first seven days fluctuates within forty. About sixty percent of surviving children do not have serious complications. Newborns with symmetrical fetal hypotrophy have a more unfavorable prognosis. The main reason is the reduced ability to grow.

In children with asymmetric malnutrition, normal brain growth is preserved. Accordingly, the forecasts are more favorable.

Possible consequences of fetal hypotrophy:

• frequent infectious diseases (especially in the first year of life);
• lag in physical development, disharmony of proportions;
• rickets;
• delayed psychomotor development;
• neurotic reactions;
• severe and irreversible lesions of the central nervous system (cerebral palsy, progressive hydrocephalus, oligophrenia, etc.).

Treatment of fetal hypotrophy

Therapeutic procedures are selected depending on the degree of malnutrition. The main task of treatment is to correct violations in the mother-child system.

A pregnant woman will have to adjust her lifestyle, nutrition, give up bad habits, and spend more time in the fresh air. It is necessary, if possible, to neutralize provoking factors. In particular, a woman can switch to light work, intensively deal with the treatment of existing infections. Ideally, this should have been done before pregnancy.

Medical treatment is prescribed by a doctor.

Hypotrophy of newborns: causes and symptoms

In newborn babies, malnutrition may develop under the influence of the following factors:

• congenital pathologies of the digestive tract;
• insufficiency of breast milk in the mother;
• incorrect scheme of artificial feeding;
• lactose intolerance;
• frequent infections and colds.

Diagnostic indicator - insufficient weight gain.

Clinical signs of malnutrition in newborns:

• little weight;
• insufficient physical and mental activity;
• reduced skin turgor;
• dry skin and mucous membranes;
• the minimum amount of subcutaneous adipose tissue.

Treatment of hypotrophy of newborns

The first stage is the diagnosis and elimination of the causes.

Next, you need to adjust the nutrition and caloric content of the diet. If the child is breastfed, then all attention is paid to the nutrition of the mother. She needs to eat more protein products, introduce mineral and vitamin complexes.

In the absence of results within two weeks, the child is transferred to a mixed type of feeding. With lactose, breast milk is completely replaced with mixtures.

Hypotrophy is a disease that is diagnosed in children from 0 to 2 years of age. Also, malnutrition can be congenital and manifest itself in a child during intrauterine life. The disease is characterized by an eating disorder, which leads to a lack of body weight of the baby. In this case, the diagnosis is made only if the weight of the child is below normal for his age by 10% or more.

You should not make a diagnosis on your own and try to supplement the child - this is the task of specialists

Causes of the disease

We have already found out that malnutrition in children can be congenital, as well as acquired. What are the main causes of this disease?

Congenital pathology is most often diagnosed in cases of malnutrition of a pregnant woman. Newfangled diets, on which future mothers sit, pose a danger to the fetus. In addition, the baby may suffer if a pregnant woman is diagnosed with placental insufficiency, somatic diseases, and toxicosis.

At risk are women who decide to bear a child at an advanced age or at a young age, as well as if the father and mother are in a related marriage. Often, congenital malnutrition accompanies the development of children with chromosomal mutations, for example, Down syndrome.

Acquired malnutrition can be provoked by several factors. Let's consider each of them separately:

• Underfeeding, and it can be both quantitative and qualitative. In the first case, the child does not receive the required amount of nutrition, in the second case, he is fed with a low-calorie mixture.
• Infectious diseases in young children, as well as their consequences. This is sepsis, constantly recurring diseases of the upper respiratory tract or gastrointestinal tract.
• Developmental defects. Atresia of the biliary tract, heart disease, kidney disease, central nervous system, and other diseases.
• Malabsorption syndrome is a chronic disorder of food digestion processes. As a rule, patients with cystic fibrosis, lactase deficiency, celiac disease or food allergies are at risk (we recommend reading:).

Children with Down syndrome are at risk for malnutrition

How is the disease diagnosed?

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Hypotrophy in children is usually classified as mild, moderately severe, or critical. These three degrees of malnutrition can be diagnosed in newborns and older children.

Degree 1

At first glance, the baby feels satisfactory. If you examine it more closely, you can find a decrease in skin elasticity, a low subcutaneous fat layer on the abdomen. According to the parents, the child's appetite is reduced, weight is growing slowly. Objectively, the doctor notes that body weight is 10-20% lower than normal. A decrease in the level of digestive enzymes can be detected, while the body temperature is normal and the development of motor functions is within the normal range (we recommend reading:).

Degree 2

The child is depressed, his activity is reduced, his appetite is disturbed. The skin is pale, dry, inelastic, weak muscle tone. The subcutaneous fat layer is noticeably reduced on the abdomen, arms and legs, but on the face it is normal. The temperature fluctuates during the day within one degree, which indicates a disorder of thermoregulation. The baby almost does not grow weight (it is 20-30% less than the norm), tachycardia, muffled heart tones may be noted. These symptoms are not the only ones: the child begins to lag behind in development - he lacks the strength to catch up with his peers.

Degree 3

This is the most severe degree of malnutrition, it is diagnosed when the child's general condition is significantly impaired. The baby does not have a subcutaneous fat layer - on the stomach, arms and legs, on the face. The child resembles a skeleton covered with skin. His weight does not increase and may even decrease.

The mood of the baby changes - from lethargy and apathy, he goes into the stage of irritability and tearfulness. Body temperature drops, hands and feet are cold (see also:). Breathing is shallow, heart sounds are muffled, arrhythmia is manifested. The child is constantly spitting up, he has frequent loose stools, urination in small portions. Weight below normal by more than 30%.

The third degree of malnutrition is the complete depletion of the body

Chair with hypotrophy

The classification of stool in malnutrition serves as an additional way to diagnose this disease. The changes are quite pronounced, so we will talk about them separately. The most characteristic types of stool:

• Hungry. Very scanty, dense, dry, almost colorless. In some children, the "hungry" stool becomes green, patches of mucus are noticeable in it, and the smell is putrid, unpleasant. Such a chair often occurs against the background of the development of dysbacteriosis.
• Mealy. This type of stool is usually thin, greenish, with mucus impurities. During a coprological examination, a lot of fiber, starch, neutral fat, mucus and leukocytes are found.
• Protein. The stool is hard, dry, crumbly. The study revealed lime and magnesium salts.

Complications

Hypotrophy is a dangerous condition for a baby. If this disease is not treated, lack of body weight can provoke the development of concomitant serious diseases. The second and third stages often give complications and are accompanied by:

• inflammation of the lungs;
• developmental delay, including mental;
• inflammation of the large and small intestines;
• rickets;

Hypotrophy can lead to the development of rickets

• anemia
• inflammation of the middle ear;
• the development of dysbacteriosis;
• violation of the enzymatic activity of the body.

Treatment

Treatment of malnutrition can be divided into four components. Each of them is important, but the effectiveness will be low if not used in combination:

• The first thing to do is to identify the cause of the disease and eliminate it.
• The next step is to establish proper care for the child. It is important to walk with him at least three hours a day (however, at a temperature not lower than 5˚C), regularly massage, baths with warm water (about 38˚C).
• Optimize the nutrition of a small patient. It is important that the baby receives the necessary amount of proteins, fats, carbohydrates.
• If necessary, use drug therapy.

It is important to optimize the feeding of a child with malnutrition and carry it out by the hour

Also, treatment can be conditionally divided into stages. Each of them requires a thoughtful approach and careful adherence to the doctor's advice:

• stage of adaptation;
• interim period;
• stage of enhanced nutrition.

Child care during recovery

Children with 1 and 2 degrees of malnutrition should be massaged regularly. All exercises must be performed by laying the child on his back, then turning over on his stomach. One of the conditions for the massage is the preparation of the room: a recognized expert in pediatrics, Dr. Komarovsky, notes that the room must be ventilated, and the air temperature is about 22˚С.

The simplest massage techniques:

• stroking hands and feet;
• spreading the arms to the sides and crossing them on the chest;
• massage of the abdomen with circular movements;
• flexion and extension of arms and legs;
• turning over on the stomach;
• the child should reflexively try to crawl, for this you need to put your palm under his heels and lightly press;
• foot massage.

There are other massage techniques that can be used depending on the condition of the child, as well as his age. With caution, massage is performed for those children who have been diagnosed with the 3rd degree of the disease. Stroking should be the main elements of such a massage.

Nutrition

Diet therapy is the main method of treating malnutrition in both newborns and older children. It is necessary to organize a diet in compliance with the recommendations of a doctor. If you feed the baby immediately with the amount of food that is shown to him at this age, you can aggravate the condition, cause vomiting, indigestion, and weakness. We will outline the basic principles for calculating the number of feedings and the daily amount of food - they are unchanged for each stage of the disease.

This period is intended for a smooth transition from a critical state to the process of normalizing weight and setting appetite. Its duration and principles may vary and depend on factors such as the degree of the disease.

The adaptation period is necessary for the normalization of weight and appetite.

With 1 degree of malnutrition, the adaptation period is usually 1-3 days. On the first day, the child can eat 2/3 of the total diet. The number of feedings should not exceed 6-7 times a day. Regardless of the age of the baby, it should be fed only with mother's milk or a mixture.

The second degree of malnutrition implies a longer period of adaptation - up to seven days. The first day is very important - the total amount of the mixture on this day should be within ½ - 2/3 of the norm. In this case, you need to use a mixture intended for children younger than the patient by 2 months. The entire period of adaptation is necessary to gradually increase the number of feedings per day - by one or two. Since it is desirable to treat a baby with 2 degrees of malnutrition in a hospital, the child should receive a 5% glucose solution or glucose-salt preparations through a gastric tube. At the moment of reaching the calculated daily amount of nutrition, the patient proceeds to the next stage - intermediate or reparative.

During the treatment of the third degree of malnutrition, the adaptation period should be even longer - from 10 days to 2 weeks. On the first day, the volume of food eaten should be half the norm, and the number of feedings should be ten. Every day you need to increase the amount of food per day by 100 ml. During the adaptation period, it is necessary to gradually switch to 8 meals a day. This stage can be considered passed when the amount of food eaten per day will be equal to 1/5 of the child's body weight.

The total amount of food eaten should be up to a fifth of the child's weight.

Stage 2 and 3 of therapeutic nutrition

At the second (reparation) stage, the amount of daily food is finally brought to the required norm, according to the weight and age of the child. In addition, special therapeutic mixtures are introduced into the diet.

The third stage involves enhanced high-calorie nutrition. At a rate of 100-120 kilocalories per day, the baby should receive 200. In order to achieve this goal, you can use high-protein mixtures, as well as add cereals from buckwheat, rice and corn to the diet.

Medical therapy

Drug treatment includes vitamin therapy - vitamins C, B12, B6, B1, A, folic acid are prescribed. To improve digestion, enzymes are prescribed: pancreatin, festal, creon, mexase (see also:). Also, the doctor may recommend hormonal and non-hormonal drugs with an anabolic effect. Of particular note are medicines containing L-carnitine, for example, Elkar (more in the article:). This drug is indicated for children with underweight, malnutrition - it stimulates appetite, increases overall tone.

If the baby has a severe form of malnutrition, he will be given a dropper with albumin, glucose, and special nutrition. Also, such patients are infused with blood, plasma, and hormonal preparations are prescribed.

Often this disease is accompanied by intestinal dysbacteriosis, then the doctor will recommend special preparations with beneficial bacteria that will help improve the functioning of the intestine. In addition, it is required to correct the functional disorders of the nervous system, so children are prescribed soothing herbal preparations, valerian, motherwort. Herbs in the form of tincture are given orally, and also added to bath water.

Bath with soothing herbs is very beneficial for the nervous system

Forecast

The first and second stages of the disease respond well to treatment if the cause that led to the deficiency of body weight is identified. Proper nutrition, adequate child care will allow you to get the first results in a month. The prognosis for children diagnosed with the third stage of malnutrition is not so rosy. A lethal outcome is observed in 30-50% of cases, while the rest of the patients with the third stage of malnutrition may well have a history of quite serious diseases.

Prevention

Prevention of malnutrition is to eliminate the possible causes that can lead to such a condition. A pregnant woman should eat right, undergo examinations in a timely manner and give up bad habits. After the baby is born, you should follow the doctor's standard recommendations - breastfeed the newborn or formula if breastfeeding is not possible. It is also important to go outside with the baby every day, treat possible foci of infection in a timely manner, and keep chronic diseases under control.

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

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

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

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

Classification of malnutrition in children

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

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

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

Symptoms of malnutrition in children

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

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

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

Diagnosis of malnutrition in children

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

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

Treatment of malnutrition in children

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

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

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

Forecast and prevention of malnutrition in children

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

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