Causes and signs of protein-energy deficiency, malnutrition, in children. Hypotrophy in children


Hypotrophy in its simplified form is a chronic malnutrition. This pathology most often occurs in children at an early age. A child with malnutrition is severely delayed in growth and weight gain.

From the very first day of life, children rapidly gain weight. Everything grows in them: skeletal bones, muscle tissue, internal organs. If babies do not receive sufficient amounts of nutrition or the diet is prepared incorrectly, this will very quickly affect the development of the body and the functioning of its various systems and organs.

Doctors say that the main reason for the development of malnutrition is a lack of protein in food and insufficient caloric intake in the diet.

The main reasons for the development of malnutrition in children

This pathology can develop under the influence of internal and external factors. Besides, malnutrition can be primary and secondary.

  • Primary malnutrition in children develops due to lack of nutrition.
  • Secondary malnutrition in children appears against the background of internal diseases, in which the absorption of nutrients from food is impaired or becomes impossible.

Internal factors that cause malnutrition in newborns include diseases of the internal organs associated with digestion. Simply put, due to these diseases, nutrients are not fully absorbed. It is worth noting that these are not necessarily diseases of the digestive system. These may be changes at the level of tissues and cells, manifested in metabolic disorders. Because of them, the energy reserves in the cells are depleted, which leads to their death.

Internal causes of pathology

The most common internal causes of malnutrition in children early age are:

Doctors say that internal factors that cause malnutrition in children are much more common than external ones. But this does not mean that the latter should not be paid attention to. In order for malnutrition to occur under the influence of external factors, they must act on the child’s body for a long time. This means that pathology can manifest itself not only in lack of weight and height, but also in more serious disorders that will certainly manifest themselves in the future.

External causes of malnutrition in children

External causes causing this pathology include:

The symptoms of this pathology are mainly determined by a lack of nutrients in the baby’s body. In second place are the symptoms of diseases that cause disturbances in the functioning of various organs. Doctors divide all symptoms into separate syndromes, which combine a set of symptoms that arise from a disease of a particular organ or system.

With malnutrition, 4 main syndromes are identified:

As a rule, each small patient with malnutrition exhibits only one syndrome.

Doctors distinguish 3 degrees of malnutrition. This division helps doctors more accurately determine the child’s condition and choose the right treatment. Degrees replace each other. At each stage of the pathology, additional symptoms appear in young patients.

Hypotrophy 1st degree

In children, it is manifested by a decrease in subcutaneous fat tissue. This is explained by the fact that the body, with a lack of nutrition, tries to compensate for energy costs through subcutaneous fat, which is the best energy storage. Fat from subcutaneous tissue enters the blood, where it is processed into the energy necessary for normal life.

First, fat is lost in the abdominal area, and then from other parts of the body. Assessment of the condition of fatty tissue is carried out using various methods. In recent years, doctors have given preference to the Chulitskaya index, based on measuring the circumference of the shoulders, hips and legs.

Symptoms of 1st degree malnutrition:

  • Decreased muscle tone and skin elasticity.
  • The child's growth does not lag behind age indicators.
  • Body weight is 20% below normal.
  • I feel within normal limits.
  • The child gets tired quickly.
  • The child sleeps poorly and becomes irritable.

Hypotrophy 2nd degree

The initial symptoms are the same as those of the 1st degree of pathology. The main difference is the deepening of previous symptoms and the appearance of new ones.

Main features:

Hypotrophy 3rd degree

At this stage of the disease clinical manifestations become especially acute. There are disturbances in the functioning of all organs and systems. It is very difficult for doctors to bring a small patient out of this state. The severity of primary pathologies determines the possibility of further recovery. Newborns suffer the most severe malnutrition of the 3rd degree.

Characteristic signs of pathology:

Options for the course of pathology

Lack of weight and growth retardation can be observed in a baby at all stages of its development. Moreover, at each stage the pathology has its own characteristics.

Depending on the period in which the pathology develops, Doctors identify 4 variants of its course:

  1. Intrauterine flow.
  2. Hypostature.
  3. Kwishiorkor.
  4. Nutritional insanity.

Intrauterine course

Pathology develops when the child is still in the womb. Doctors distinguish 3 options for intrauterine hypotrophy:

  1. Hypotrophic. All fetal organs do not receive enough nutrients. Because of this, the child grows very slowly.
  2. Hypoplastic. With this variant of pathology, along with a delay in general development the fetus has a disturbance in the maturation of organs.
  3. Dysplastic. Different organs develop unevenly. Some of them correspond to the timing of pregnancy, while others do not correspond.

Hypostature

We are talking about the uniform lag of a newborn child in height and body weight from his peers.

Hypostature is a secondary pathology that develops as a result of diseases of internal organs. It can manifest itself not only in newborns, but also in adolescents.

Most often, hypostatura is provoked by:

  • Heart diseases and circulatory disorders.
  • Encephalopathy complicated by endocrine disorders.
  • Bronchopulmonary dysplasia. This pathology appears during fetal development and manifests itself in insufficient development of lung tissue, which is why the newborn does not receive enough oxygen during breathing.

Kwashiorkor

With this variant of the course of malnutrition, the body receives protein foods in insufficient quantities or is not at all able to absorb protein foods.

The development of kwashiorkor is promoted by:

  • Long-term digestive problems, manifested by unstable stools.
  • Problems with liver function.
  • Kidney diseases.
  • Burns and significant blood loss.
  • Some infectious diseases.

Lack of protein leads to disturbances in the functioning of the central nervous system. The child becomes apathetic, falls asleep as soon as possible, and does not want to eat. He may develop edema due to a lack of albumin and globulin in the blood. His muscle mass is rapidly decreasing.

Nutritional insanity

This course of malnutrition is most often detected in school-age children. This condition is characterized by a lack of proteins and calories. Nutritional insanity is accompanied by the following symptoms:

Conclusion

Hypotrophy in children is quite dangerous disease. The prognosis for recovery depends on what caused the pathology. The earlier the disease is detected, the less damage it will cause to the child’s health.

This pathology can be caused by many reasons related to different periods of a child’s life:

Intrauterine factors

  • nutritional deficiency of the expectant mother;
  • diseases and complications during pregnancy;
  • stress, dangerous habits, unhealthy lifestyle;
  • individual body structure of the mother (weight less than 45 kg, height less than 150 cm);
  • intrauterine infections.

Endogenous factors

  • congenital malformations of the child;
  • impaired absorption of substances in the child’s gastrointestinal tract;
  • immunodeficiency; metabolic problems.

Exogenous factors

  • malnutrition - inappropriate amount of food for the child’s age, low quality of food, imbalance of proteins, fats and carbohydrates;
  • diseases and infections transmitted to the child in utero;
  • poisoning with drugs, food, excess vitamins A and D;
  • errors in creating a daily routine and caring for the child.

Symptoms

When malnutrition occurs, a child exhibits four main syndromes:

  • problems with nutrition (weight decreases, growth may slow down);
  • disruptions in the process of digestion and assimilation of food (vomiting, diarrhea, nausea, loss of appetite, low digestibility of food);
  • pathology of the central nervous system(sleep disorders, problems with muscle tone);
  • high susceptibility to infectious diseases.

Symptoms of malnutrition depend on the stage of the disease:

Light - weight deficit no more than 10-20%.

  • growth is normal;
  • there is practically no subcutaneous fat on the stomach;
  • decreased muscle tone;
  • the skin is less elastic and has a pale tint;
  • mild loss of appetite;
  • initial sleep disorders.

Average - body weight deficiency 20-30%.

  • growth lags behind the norm by 2-4 cm;
  • there are no fat deposits on the stomach, arms, legs;
  • very pale, dry, loose skin;
  • serious problems with appetite, accompanied by vomiting, nausea, regurgitation;
  • decreased muscle tone; changes in smell, color, consistency of stool;
  • hypotension (low blood pressure);
  • tachypnea (rapid breathing); rickets;
  • cold hands and feet;
  • change in the child’s behavior (lethargy, apathy, irritation);
  • long-term and frequent infectious diseases.

Severe - mass deficit exceeds 30%.

  • growth retardation of about 7-10 cm;
  • there is no fat layer on the body;
  • dry, pale, dull, lifeless skin;
  • chapped lips and corners of the mouth;
  • constantly cold extremities;
  • decreased body temperature; lack of appetite, vomiting, frequent episodes of regurgitation;
  • feeling of thirst;
  • stool disorders (constipation or, conversely, very liquid stool);
  • an inverted or severely swollen abdomen;
  • rare urination;
  • sunken eyes and fontanel;
  • pronounced rickets;
  • severely weakened immunity, persistent infectious diseases;
  • deviations in behavior (drowsiness, lack of response to stimuli, loss of acquired skills);
  • arrhythmic, shallow breathing;
  • decreased blood pressure and heart rate.

Diagnosis of malnutrition in a child

With the development of baby malnutrition in the womb, the pathology can be determined using ultrasound screening. After birth, she is discovered by a pediatrician during an examination: weight, height, girth of the head, chest, shoulders, abdomen, hips are measured, and the sufficiency of the fat layer is assessed. If malnutrition is suspected, the child is referred to an appointment with a neurologist, cardiologist, gastroenterologist, infectious disease specialist, or geneticist.

In number diagnostic measures This pathology in children includes procedures such as ultrasound abdominal cavity, ECG, EchoCG, EEG, analysis of coprogram and feces for the presence of dysbacteriosis, blood tests and others.

Complications

Timely treatment of malnutrition has a positive outcome for the child. With severe manifestations of the disease, infant mortality accounts for approximately one third of all cases.

Complications of the disease are caused by weakening child's body and high exposure various diseases, including infectious nature: pneumonia, otitis media, influenza, sepsis, rickets, problems with mental development and others.

Treatment

What can you do

Hypotrophy requires adherence to a certain diet with a subsequent increase in food volumes to age norms. This process should be under the supervision of a physician, but early forms In case of illness, parents can feed the child at home. It is important to maintain a daily routine and organize proper child care.

What does a doctor do

Mild childhood malnutrition can be treated on an outpatient basis; other variants of the disease require hospitalization. The main goal of therapy is to eliminate the causes of disturbances in the child’s nutrition, follow a diet, establish quality care, and correct digestive problems.

When developing a diet, the doctor first clarifies food tolerance and then systematically increases portions and their calorie content to normal daily values ​​in accordance with age. The basic principle of diet therapy for malnutrition in a child is frequent, small meals.

For more comfortable digestion of food, the child may be prescribed enzymes, vitamins, as well as adaptogens and anabolic hormones. At severe form For diseases, children are given special medical solutions intravenously.

In combination with other activities, massage may be useful, physiotherapy, UV therapy.

Prevention

To prevent malnutrition, the child should be examined by a pediatrician every week. The doctor monitors your health and adjusts your diet. You can prevent malnutrition in childhood using simple measures:

  • treatment of diseases during pregnancy;
  • comfortable daily routine and food intake;
  • proper nutrition; control of weight gain and height;
  • timely treatment of other diseases;
  • It is advisable to avoid negative factors that negatively affect the child’s well-being.

Articles on the topic

In the article you will read everything about methods of treating a disease such as malnutrition in children. Find out what effective first aid should be. How to treat: choose medications or traditional methods?

You will also learn how untimely treatment of malnutrition in children can be dangerous, and why it is so important to avoid the consequences. All about how to prevent malnutrition in children and prevent complications.

And caring parents will find on the service pages complete information about the symptoms of malnutrition in children. How do the signs of the disease in children aged 1, 2 and 3 differ from the manifestations of the disease in children aged 4, 5, 6 and 7? What is the best way to treat malnutrition in children?

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

Hypotrophy(Greek hypo - under, below; trophe - nutrition) - chronic eating disorder with underweight. In the Anglo-American literature, instead of the term malnutrition, the term malnutrition is used. The main most common type of malnutrition is protein-calorie malnutrition (PCM). As a rule, such children also have a deficiency of vitamins (hypovitaminosis), as well as microelements. According to

Etiology

There are two groups of malnutrition based on etiology - exogenous and endogenous, although mixed options are also possible. It is important to remember that loss of body weight up to the development of malnutrition is a nonspecific reaction of a growing organism to the long-term effect of any damaging factor. With any disease, children experience: congestion in the stomach, inhibition of the activity of gastrointestinal enzymes, constipation, and sometimes vomiting. This is associated, in particular, with an almost 10-fold increase in the level of somatostatin in sick children, which inhibits anabolic processes. At nutritional reasons primary malnutrition is diagnosed; in case of endogenous malnutrition, secondary (symptomatic) malnutrition is diagnosed.

Exogenous causes of malnutrition

Nutritional factors - quantitative underfeeding in case of hypogalactia in the mother or difficulties in feeding on the part of the mother (flat, inverted nipple, “tight” mammary gland, etc.), the child (regurgitation, vomiting, small lower jaw, “ short bridle» tongue, etc.) or high-quality underfeeding (use of formula inappropriate for age, late introduction of complementary foods, poverty of the daily diet in animal proteins, fats, vitamins, iron, microelements).

Infectious factors - intrauterine generalized infections (and others), intrapartum infections, toxic-septic conditions, and urinary tract infections, intestinal infections, etc. Particularly common causes of malnutrition are infectious lesions gastrointestinal tract, causing morphological changes in the intestinal mucosa (up to villous atrophy), inhibition of the activity of disaccharidases (usually lactase), immunopathological damage to the intestinal wall, dysbacteriosis, contributing to prolonged diarrhea, maldigestion, malabsorption. It is believed that for any mild infectious diseases, energy and other nutritional needs increase by 10%, and for moderate infectious diseases - by 50% of the needs under normal conditions.
ity (BKN). As a rule, such children also have a deficiency of vitamins (hypovitaminosis), as well as microelements. According to , in developing countries, up to 20-30% or more of young children have protein-calorie or other types of malnutrition.

Toxic factors - use when artificial feeding milk formulas with expired shelf life or of poor quality, hypervitaminosis D and A, poisoning, including medicinal ones, etc.

Anorexia as a consequence of psychogenic and other deprivation, when the child does not receive enough attention, affection, psychogenic stimulation of development, walks, massage and gymnastics.

Endogenous causes of malnutrition

Perinatal encephalopathies of various origins

Congenital malformations of the gastrointestinal tract with complete or partial obstruction and persistent vomiting (pyloric stenosis, annular pancreas, dolichosigma, Hirschsprung's disease, etc.), as well as the cardiovascular system.

“Short bowel” syndrome after extensive intestinal resections.

Hereditary (primary) immunodeficiency conditions (mainly T-systems) or.

Primary malabsorption and maldigestion (intolerance to lactose, sucrose, glucose, fructose, celiac disease, exudative enteropathy), as well as secondary malabsorption (allergic intolerance to cow's or soy milk proteins, enteropathic acrodermatitis, etc.).

Hereditary metabolic abnormalities (fructosemia, leucinosis, xanthomatosis, Niemann-Pick and Tay-Sachs diseases, etc.).

Endocrine diseases (adrenogenital syndrome, pituitary dwarfism, etc.).

All clinical symptoms BKN is divided into the following groups of violations:

1. Syndrome of trophic disorders - thinning of the subcutaneous fat layer, a flat growth curve and body weight deficiency and imbalance of physique (L. I. Chulitskaya and F. F. Erisman indices are reduced), decreased tissue turgor and signs of polyhypovitaminosis (A, B„ B2 , B6, D, P, RR).

2. Syndrome of digestive disorders - loss of appetite up to anorexia, unstable stools with a tendency to both constipation and dyspepsia, dysbacteriosis, decreased tolerance to food, signs of maldigestion in the coprogram.
3. Central nervous system dysfunction syndrome - disturbances in emotional tone and behavior, low activity, dominance of negative emotions, sleep and thermoregulation disorders, lagging rates of psychomotor development, muscle hypo-, dystonia.

4. Syndrome of hematopoiesis disorders and decreased immunobiological reactivity - anemia, secondary immunodeficiency states, a tendency to a mild, atypical course of frequent infectious and inflammatory diseases. The main reason for the suppression of immunological reactivity during malnutrition is protein metabolism disorders.

Classification

According to severity, there are three degrees of malnutrition: I, I, III. The diagnosis should indicate the most likely etiology of malnutrition, concomitant diseases, and complications. It is necessary to distinguish between primary and secondary
ny (symptomatic) malnutrition. malnutrition can be the main or concomitant diagnosis and is, as a rule, a consequence of underfeeding. Secondary malnutrition is a complication of the underlying disease that must be identified and treated.

Clinical picture

Hypotrophy I degree

characterized by thinning of the subcutaneous fat layer in all parts of the body and especially in the abdomen. The Chulitskaya body condition index is 10-15. The fat fold is flabby and muscle tone is reduced. There is some pallor of the skin and mucous membranes, a decrease in the firmness and elasticity of the skin. The child's growth does not lag behind the norm, and body weight is 11-20% below normal. The curve of body weight gain is flattened. The child's general health is satisfactory. Psychomotor development corresponds to his age, but he is irritable, restless, easily tired, and sleep is disturbed. There is a tendency to regurgitate.

Hypotrophy II degree

The subcutaneous fat layer is absent on the abdomen, sometimes on the chest, sharply thinned on the limbs, and persists on the face. The Chulitskaya body condition index is 1-10. The skin is pale with a grayish tint, dry, and easily wrinkles. Typical for healthy children transverse folds on inner surface the thighs disappear and flabby longitudinal folds appear, hanging like a bag. The skin is pale, flabby, as if redundant on the buttocks and thighs, although sometimes there is swelling.

As a rule, there are signs of polyhypovitaminosis (marbling, peeling and hyperpigmentation in the folds, brittleness of nails and hair, brightness of mucous membranes, pockets in the corners of the mouth, etc.). reduced. Typically there is a decrease in muscle mass in the limbs. A decrease in muscle tone leads, in particular, to an enlarged abdomen due to hypotonia of the muscles of the anterior abdominal wall, intestinal atony and flatulence.

Body weight is reduced compared to the norm by 20-30% (relative to length), and there is stunting. The curve of body weight gain is flat. Appetite is reduced. Food tolerance is reduced. Characterized by weakness and irritability, the child is restless, loud, whiny or lethargic, indifferent to his surroundings. The face takes on a concerned, adult expression.
life Restless sleep. Thermoregulation is impaired and the child quickly cools down or overheats depending on the temperature environment. Fluctuations in body temperature during the day exceed 1°C.

Many sick children experience otitis media, pneumonia, and other infectious processes, which are asymptomatic. In particular, in clinical picture pneumonia is dominated by respiratory failure, intoxication with mild catarrhal symptoms or their absence and the presence of only shortened tympanitis in the interscapular areas. Otitis is manifested by some anxiety, sluggish sucking, while even with an otoscopic examination of the eardrum it is poorly expressed. The stool in patients with malnutrition is unstable: constipation is replaced by dyspeptic stool.

III degree hypotrophy (marasmus, atrophy)

III degree hypotrophy is characterized by an extreme degree of exhaustion: the child’s appearance resembles a skeleton covered with skin. The subcutaneous fat layer is absent on the abdomen, torso and limbs, and is sharply thinned or absent on the face. The skin is pale gray, dry, sometimes purplish-blue, and the extremities are cold. Skin fold does not straighten out, since there is practically no elasticity of the skin (abundance of wrinkles). Chulitskaya's body condition index is negative. On the skin and mucous membranes there are manifestations of hypovitaminosis C, A, group B. Thrush and stomatitis are detected. The mouth looks bright, large, with cracks in the corners of the mouth (“sparrow’s mouth”).
Sometimes there is weeping erythema of the skin. The forehead is covered with wrinkles. The nasolabial fold is deep, the jaws and cheekbones protrude, the chin is pointed, and the teeth are thin. The cheeks are sunken as Bish's lumps disappear. The child’s face resembles the face of an old man (“Voltaire’s face”). The abdomen is distended, bloated, or intestinal loops are contoured. The stool is unstable: most often constipation, alternating with soapy-lime stools.

Body temperature is often lowered. There is no difference in temperature in the armpit and rectum. The patient quickly cools down during examination and easily overheats. The temperature periodically “for no reason” rises to the digits. Due to sharp decline Immunological reactivity is often detected by otitis media and other foci of infection (colienteritis, etc.), which, as with degree II malnutrition, are asymptomatic. There are hypoplastic and osteomalacia signs of rickets. With severe flatulence, the muscles of the limbs are rigid. There is a sharp decrease in muscle mass.

The weight gain curve is negative, the patient is losing weight every day. Body weight is 30% or more less than the average for children of the same height. The child is sharply retarded in growth. With secondary malnutrition of the third degree, the clinical picture is less severe than with primary malnutrition, they are easier to treat if the underlying disease is identified and there is an opportunity to actively influence it.
Variants of the course of malnutrition

Intrauterine malnutrition - currently according to International classification diseases, this term has been replaced by intrauterine growth retardation (). There are hypotrophic, hypoplastic and dysplastic variants. In the English-language literature, instead of the term “hypotrophic variant of IUGR,” the term “asymmetrical” is used, and the hypoplastic and dysplastic variants are combined with the term “symmetrical IUGR.”

Hypostature (Greek hypo - under, below; statura - height, size)

More or less uniform retardation of the child in height and body weight with a slightly reduced state of nutrition and skin turgor. Both indices of L.I. Chulitskaya (fatness and axial) are slightly reduced. This form of chronic eating disorder is typical for children with congenital heart defects, brain developmental defects, encephalopathies, endocrine pathologies, and bronchopulmonary dysplasia (BPD). The fact that this is a form of chronic eating disorder is confirmed by the fact that PBP is reduced, and after active treatment of the underlying disease, for example, surgery due to congenital heart disease, the physical development of children is normalized. As a rule, children with hypostatura have other signs of chronic nutritional disorder characteristic of stage II malnutrition (trophic disorders and moderate signs of polyhypovitaminosis on the skin, dysproteinemia, deterioration of fat absorption in the intestines, low levels of phospholipids, chylomicrons and a-lipoproteins in the blood, aminoaciduria).

It is important to emphasize that the biological age of the child (bone, etc.) corresponds to his length and body weight. Unlike children with hypostatura, children with hypoplasia (with constitutional growth retardation) do not have trophic disorders: they have pink velvety skin, there are no symptoms of hypovitaminosis, they have good muscle tone, their neuropsychic development corresponds to their age, food tolerance and not broken. After eliminating the cause of hypostatura, children catch up with their peers in physical development. The same situation occurs in hypoplastics, that is, the phenomenon of “canalization” of growth or homeoresis according to Waddington occurs. These terms denote the body’s ability to return to a given genetic development program in cases where the traditional dynamics of child growth were disrupted under the influence of either damaging environmental factors or diseases.

Hypostatura is usually a pathology in children in the second half of the year or the second year of life, but, unfortunately, nowadays there are children with hypostatura already in the first months of life. These are children with bronchopulmonary dysplasia, severe brain damage due to intrauterine infections, alcoholic fetopathy, and “industrial syndrome” of the fetus. Such children are very resistant to therapy and do not have the “canalization” phenomenon. On the other hand, hypostatura must be differentiated from primordial dwarfism (weight and length at birth are very low), as well as other forms of growth retardation, which you should read about in the chapter “Endocrine diseases”.

Kwashiorkor

A peculiar variant of the course of malnutrition in young children in tropical countries, mainly due to nutrition plant foods, with a deficiency of animal proteins. The term is thought to mean "weaned" (usually due to the mother's next pregnancy). At the same time, protein deficiency can also contribute to (or even cause it):

1) decreased protein absorption in conditions accompanied by prolonged diarrhea;

2) excessive protein loss during (), infectious diseases and helminthiasis, burns, large blood loss;

3) decreased protein synthesis with chronic diseases liver.

Symptoms

Constant symptoms kwashiorkora are:

1) neuropsychiatric disorders(apathy, lethargy, drowsiness, lethargy, tearfulness, lack of appetite, delayed psychomotor development);

2) edema (in the beginning, due to hypoproteinemia, internal organs “swell”, then edema may appear on the limbs, face, which creates a false impression of the child’s fatness);

3) reduction muscle mass, up to muscle atrophy, and decreased tissue trophism;

4) lag physical development(more height than body weight).

These symptoms are called D. B. Jelliffe's tetralogy.

Frequent symptoms: hair changes (lightening, softening - silkiness, straightening, thinning, weakening of the roots, which leads to hair loss, hair becomes sparse), (darkening of the skin appears in areas of irritation, but unlike pellagra, in areas not exposed to sun rays, then desquamation of the epithelium occurs in these areas and foci of depigmentation remain, which can be generalized) and signs of hypovitaminosis on the skin, anorexia, moon-shaped face, anemia, diarrhea. In older children, the manifestation of kwashiorkor may be a gray strand of hair or
loss of normal hair color and bleached hair (“flag symptom”), changes in nails.

Rare symptoms: layered pigmented dermatosis (red-brown rounded areas of skin), hepatomegaly (due to fatty infiltration of the liver), eczematous lesions and skin fissures, ecchymosis and petechiae. All children with kwashiorkor have signs of polyhypovitaminosis (A, B, B2, Bc, D, etc.), kidney function (both filtration and reabsorption) is reduced, in the blood serum there is hypoproteinemia (due to hypoalbuminemia), hypoglycemia ( but the glucose tolerance test is of the diabetic type), aminoaciduria, but with a decrease in the excretion of hydroxyproline in relation to creatinine, low activity liver enzymes and pancreatic enzymes.

A characteristic feature of a blood test is not only anemia, but also lymphocytopenia and an increased ESR. In all sick children, blood pressure is significantly reduced, which leads to severe infectious diseases. It is especially difficult for them, so in complex therapy measles, the expert committee recommends that such children be prescribed vitamin A, which leads to a reduction in mortality. They often have subcutaneous septic ulcers, leading to the formation of deep necrotic ulcers. All patients are characterized by intermittent diarrhea with stool unpleasant smell and severe steatorrhea. These children also often have (for example, hookworm infections, etc.).

In conclusion, we emphasize that protein-calorie malnutrition, that is, can also occur in Russia - for example, we observed it in a teenager with chronic active hepatitis.

Nutritional insanity (emaciation)

Occurs in children of preschool and school age - balanced fasting with a deficit of both protein and calories in the daily diet. Constant symptoms of marasmus are weight deficiency (below 60% of standard body weight for age), wasting of muscles and subcutaneous fat, which makes the patients’ arms very thin and their face “senile.” Rare symptoms of marasmus are hair changes, concomitant vitamin deficiency (usually deficiency of vitamins A and B), zinc deficiency, thrush, diarrhea, and recurrent infections.

Trophic status assessment

To assess the trophic status of schoolchildren, you can use the criteria (with some abbreviations) proposed for adults [Rudmen D., 1993]:

Anamnesis. Previous dynamics of body weight.

Typical dietary intake based on retrospective data.

Socio-economic status of the family.

Anorexia, vomiting, diarrhea.
In adolescents, an assessment of puberty, in particular, in adolescent girls, an assessment of menstrual status.

Drug therapy with an assessment of the possible effect on nutritional status (in particular, diuretics, anorexants).

Social adaptation among peers, family, possible signs, psychogenic stress, anorexia, drug addiction and substance abuse, etc.

Physical data.

Skin: pallor, scaly, xerosis, follicular hyperkeratosis, pellagrossa, petechiae, ecchymoses, perifollicular hemorrhages.

Hair: dyspigmentation, thinning, straightening, weakening of hair roots, sparse hair.

Head: rapid thinning of the face (check from photographs), enlargement of the parotid glands.

Eyes: Bitot's plaques, angular inflammation of the eyelids, xerosis of the conjunctiva and sclera, keratomalacia, vascularization of the cornea.

Oral cavity: cheilosis, angular stomatitis, glossitis, Gunter's glossitis, atrophy of the papillae of the tongue, ulceration of the tongue, loosening of the gums, dental dentition.

Heart: cardiomegaly, signs of energy-dynamic or congestive heart failure.

Abdominal cavity: protruding abdomen, hepatomegaly.

Extremities: obvious decrease in muscle mass, peripheral edema, koilonychia.

Neurological status: weakness, irritability, tearfulness, muscle weakness, sore calves, loss of deep tendon reflexes.

Functional indicators: reduced cognitive ability and performance.

Adaptation of vision to darkness, acuity of taste (reduced).

Capillary fragility (increased).

In the presence of the mentioned symptoms and a weight deficit of 20-35% (by body length), a moderate degree of protein-calorie malnutrition and nutritional exhaustion are diagnosed.

In the etiology of moderate forms of malnutrition in children and adolescents, the following may be of decisive importance: chronic stress, excessive neuropsychic stress, neuroses leading to excessive emotional arousal, and insufficient sleep. IN adolescence girls often limit their diet for aesthetic reasons. Malnutrition is also possible due to family poverty. According to radio and television reports, every fifth conscript to the Russian army
in 1996-1997 had a body weight deficit in length exceeding 20%. Frequent symptoms Moderate protein malnutrition includes lethargy, fatigue, weakness, restlessness, irritability, constipation, or loose bowel movements. Malnourished children have short attention spans and perform poorly in school. Such boys and girls are characterized by pale skin and mucous membranes (deficiency anemia), muscle weakness - shoulders are drooping, the chest is flattened, but the stomach protrudes (the so-called “tired posture”), “sluggish posture”, frequent respiratory and other infections, some delayed puberty, caries. When treating such children, in addition to normalizing the diet and a long course of vitamin therapy, an individual approach is required in recommendations for daily routine and lifestyle in general.

Essential fatty acid deficiency

Feeding unadapted for baby food formulas from cow's milk, malabsorption of fats can lead to linoleic and linolenic acid deficiency syndrome: dry and flaky skin, alopecia, small gains in body weight and length, poor wound healing, thrombocytopenia, diarrhea, recurrent infections of the skin and lungs; linolenic acid: numbness, paresthesia, weakness, blurred vision. Treatment: adding vegetable oils to the diet (up to 30% of fat requirements), nucleotides, which are abundant in female and low in cow's milk.

Carnitine deficiency can be hereditary (9 hereditary anomalies with impaired metabolism are known) or acquired (extreme prematurity and prolonged parenteral nutrition, prolonged hypoxia with myocardial damage). Clinically manifested, in addition to malnutrition, by repeated vomiting, enlargement of the heart and liver, myopathy, attacks of hypoglycemia, stupor, coma. This disease in a family is often preceded by the sudden death of previous children or their death after episodes of acute encephalopathy, vomiting with the development of a coma. A typical symptom is a specific odor emanating from the child (sweaty feet, cheese, rancid butter). Treatment with riboflavin (10 mg every 6 hours intravenously) and carnitine chloride (100 mg/kg orally in 4 doses) leads to normalization of the children’s condition.

Deficiencies of vitamins and microelements are described in other sections of the chapter.

Diagnosis and differential diagnosis

The main criterion for diagnosing malnutrition and establishing its degree is the thickness of the subcutaneous fat layer. The diagnostic criteria are detailed in Table. 29. The child’s body weight also needs to be taken into account,
but not in the first place, since with simultaneous growth retardation of the child (hyposomia, hypostatura), a true deficiency in body weight is quite difficult to establish.

The stool of a child with malnutrition is often “hungry”

Hungry stools are scanty, dry, discolored, lumpy, with a putrid fetid odor. Urine smells like ammonia. Hungry stool quickly turns into dyspeptic stool, which is characterized by a green color, an abundance of mucus, leukocytes, extracellular starch, digestible fiber, fatty acids, neutral fat, sometimes muscle fibers. At the same time, dyspeptic symptoms are often caused by the ascent of Escherichia coli into the upper parts of the intestine and increased motility or infection by pathogenic strains, dysbacteriosis.

At differential diagnosis malnutrition, one must keep in mind all those diseases that can be complicated by a chronic nutritional disorder and are listed in the “Etiology” section.

In a patient with hypostatura, it is necessary to exclude different kinds nanism - disproportionate (chondrodystrophy, congenital fragility of bones, vitamin D-resistant forms of rickets, severe vitamin D-dependent) and proportional (primordial, pituitary, thyroid, cerebral, cardiac, etc.). We must not forget about constitutional hyposomy (hypoplasty).

In some families, due to various hereditary characteristics of the endocrine system, there is a tendency for lower growth rates. Such children are proportional: although there is some retardation in height and body weight, the thickness of the subcutaneous fat layer is normal everywhere, tissue turgor is good, the skin is pink, velvety, without signs of hypovitaminosis. Muscle tone and psychomotor development of children correspond to their age.

It is believed that in a healthy child, the body length can fluctuate within 1.5 s from the arithmetic mean body length of healthy children of the corresponding age. If the child’s body length exceeds the specified limits, then they speak of hyper- or hyposomy. Hyposomia within 1.5-2.5 s can be either a normal variant or a consequence of a pathological condition. If the child’s body length is less than the average value minus 3 s, dwarfism is diagnosed.

Hypotrophy can develop in a child with normosomia, as well as with hyper- and hyposomia. Therefore, acceptable fluctuations in body length in children in the first half of life are considered to be 4-5 cm, and subsequently up to 3 years - 5-6 cm; permissible fluctuations in body weight in the first half of the year are 0.8 kg, and subsequently up to 3 years - 1.5 kg (in relation to the arithmetic average body length of the child).

Treatment

In patients with malnutrition, therapy should be comprehensive and include:

1) identification of the causes of malnutrition and attempts to correct or eliminate them;

2) diet therapy;

3) organization of a rational regime, care, education, massage and gymnastics;

4) identification and treatment of foci of infection, rickets, anemia and other complications and concomitant diseases;

5) enzyme and vitamin therapy, stimulating and symptomatic treatment.

Diet therapy

The basis of rational treatment of patients with malnutrition. The degree of decrease in body weight and appetite does not always correspond to the severity of malnutrition due to damage to the gastrointestinal tract and central nervous system.

Therefore, the fundamental principles of diet therapy for malnutrition are three-phase nutrition:

1) period of determining food tolerance;

2) transition period;

3) a period of enhanced (optimal) nutrition.

A large food load, introduced early and abruptly, can cause a breakdown and dyspepsia in the patient due to the insufficient ability of the gastrointestinal tract to utilize nutrients(in the intestine the total pool of epithelial cells and the rate of restorative proliferation are reduced, the rate of migration of epithelial cells from the crypts to the villus is slowed down, the activity of intestinal enzymes and absorption rate).

Sometimes a patient with malnutrition, malnutrition and overnutrition does not have an increase in body weight gain, and a decrease in caloric intake leads to its increase. During all periods of diet therapy, the increase in food load should be carried out gradually under regular monitoring of the coprogram.

The following important principles of diet therapy in patients with malnutrition are:

1) use at the initial stages of treatment only easily digestible food (human milk, and in its absence, hydrolyzed mixtures (Alfare, Pepti-Junior, etc.) - adapted mixtures, preferably fermented milk: acidophilus “Malyutka”, “Malysh”, “Lactofidus” , “Biolakt”, “Bifilin”, etc.), since in patients with hypotrophy they often
intestinal dysbiosis and intestinal lactase deficiency are noted;

2) more frequent feedings (7 - for malnutrition of the first degree, 8 - for malnutrition of the second degree, 10 feedings for malnutrition of the third degree);

3) adequate systematic monitoring of nutrition (keeping a diary with notes on the amount of food eaten at each feeding), stool, diuresis, amount of fluid drunk and administered parenterally, salt, etc.; regular, once every 5-7 days, calculation of the nutritional load for proteins, fats, carbohydrates; twice a week - coprogram).

The period for determining food tolerance in case of I degree malnutrition is usually 1-2 days, II degree - about 3-7 days and III degree - 10-14 days. Sometimes a child does not tolerate lactose or cow's milk proteins well. In these cases, you have to resort to lactose-free mixtures or “plant-based” types of milk.

It is important to remember that from the first day of treatment, the child should receive an amount of fluid corresponding to his actual body weight (see Table 27). The daily volume of formula used on the first day of treatment is usually given: for malnutrition of the first degree, approximately 2/3, malnutrition of the second degree - '/2 and malnutrition of the third degree - '/3 of the proper body weight. The caloric intake in this case is: for stage I malnutrition - 100-105 kcal/kg per day; II degree - 75-80 kcal/kg per day; III degree - 60 kcal/kg per day, and the amount of protein, respectively, is 2 g/kg per day; 1.5 g/kg per day; 0.6-0.7 g/kg per day. It is necessary that from the first day of treatment the child does not lose body weight, and from the 3-4th day even with severe degrees malnutrition began to increase it by 10-20 or more grams per day. The missing amount of fluid is administered enterally in the form of glucose-saline solutions (Oralit, rehydron, citroglucosolan, worse - vegetable decoctions, raisin drinks, etc.). In the absence of commercial preparations for rehydration, you can use a mixture consisting of 400 ml of 5% glucose solution, 400 ml isotonic solution, 20 ml of 7% potassium chloride solution, 50 ml of 5% sodium bicarbonate solution. To increase the effectiveness of such a mixture, 100 ml of an amino acid mixture for parenteral nutrition (10% aminon or aminoven, alvesin) can be added to it.

Especially if a child has diarrhea, it is necessary to remember that all mixtures and solutions given orally have a low osmolarity (approximately 300-340 mOsm/l). Rarely (with severe diarrhea, vomiting, gastrointestinal obstruction) it is necessary to use parenteral nutrition. It must be remembered that the daily amount of potassium (both with enteral and with parenteral nutrition) should be 4 mmol/kg (that is, 1-1.5 times higher than normal), and sodium - not more
more than 2-2.5 mmol/kg, because patients easily retain sodium, and they always have a potassium deficiency. Potassium “supplements” provide about 2 weeks. It is also advisable to correct solutions with calcium, phosphorus, and magnesium preparations.

Restoring the normal volume of circulating blood, maintaining and correcting impaired electrolyte metabolism, stimulating protein synthesis are the tasks of the first two days of therapy for severe malnutrition. During parenteral nutrition, solutions of amino acids (aminoven, etc.) must also be added. During the period of determining food tolerance, gradually (approximately 10-20 ml per feeding daily) increase the amount of the main mixture, bringing it at the end of the period to the amount due to the actual body weight (in the first year of life approximately '/5 of the actual weight, but no more 1 l).

Intermediate period.

At this time, medicinal mixtures are added to the main mixture (up to ‘/3 of the total volume), that is, those mixtures that contain a larger amount of food ingredients compared to breast milk or adapted formulas, reduce the number of feedings, increase the volume and ingredients of food to what the child would receive for the proper body weight. An increase in the food load with proteins, carbohydrates and, last of all, fats should be carried out under the control of its calculation (the amount of proteins, fats and carbohydrates per 1 kg of body weight per day in food eaten) and under the control of coprograms (once every 3-4 days ). An increase in the amount of proteins is achieved by adding protein mixtures and products (protein enpit, low-fat kefir, kefir 5, cottage cheese, yolk, etc.); carbohydrates (inclusion of sugar syrup, cereals); fat (fat enpita, cream). 100 g of dry protein enpit contains 47.2 g of protein, 13.5 g of fat, 27.9 g of carbohydrates and 415 kcal.

After proper dilution (15 g per YuOgvody), 100 g of liquid mixture will respectively contain 7.08 g of protein, 2.03 g of fat, 4.19 g of carbohydrates and 62.2 kcal. A 15% fat enpit diluted in the same way will contain in 100 g: proteins - 2.94 g, fats - 5.85 g, carbohydrates - 4.97 g and 83.1 kcal. The criteria for the effectiveness of dietary treatment are: improvement of emotional tone, normalization of appetite, improvement of the condition of the skin and tissue turgor, daily weight gain of 25-30 g, normalization of the L. I. Chulitskaya index (fatness) and restoration of lost psychomotor development skills along with the acquisition of new ones , improved digestion of food (according to the co-program).

It should be borne in mind that the optimal ratio between dietary protein and energy for protein utilization at the initial stage is: 1 g of protein per 150 non-protein kilocalories, and therefore, simultaneously with the protein load, it is necessary to increase the amount of carbohydrates, because an increase in the fat load in patients with eating disorders poorly tolerated.

Already in the transition period, children begin to be introduced to complementary foods (if this is appropriate by age and they received them before the start of treatment), but cereals and vegetable purees are prepared not with whole, but with half-and-half cow's milk or even with vegetable broth to reduce the load of lactose and fats. The carbohydrate load during the transition period reaches 14-16 g/kg per day, and after that they begin to increase the fat load, using whole kefir, bifilin, yolk porridge additives, vegetable oil, fat enpite.

During the period of enhanced nutrition, the child receives about 140-160 kcal/kg per day for malnutrition of the first degree, P-III degrees- 160-180-200 kcal/kg per day. At the same time, proteins make up 10-15% of calories (in healthy people 7-9%), that is, about 3.5-4 g/kg body weight. Large amounts of protein are not digested and are therefore useless; in addition, they can contribute to metabolic acidosis and hepatomegaly. During the initial period of increased protein nutrition, the child may experience transient tubular distal acidosis (in children with constipation, Leathwood's syndrome increases) and sweating. In this case, sodium bicarbonate solution is prescribed at a dose of 2-3 mmol/kg per day orally, although you should also think about reducing the protein load.

The main criterion for the effectiveness of diet therapy is: improvement of psychomotor and nutritional status and metabolic rates, achievement of regular body weight gain of 25-30 g/day, and not calculated diet indicators

The above is a treatment regimen for patients with malnutrition using diet. However, each sick child requires an individual approach to the diet and its expansion, which is carried out under the mandatory control of coprogram, body weight curves and sugar curves. The curve of body weight during the period of treatment of a patient with malnutrition can be stepped: the rise corresponds to the deposition of nutrients in the tissues (deposition curve), the flat part corresponds to their absorption (absorption curve).

Organization of care.

Patients with stage I malnutrition in the absence of severe concomitant diseases and complications can be treated at home. Children with degree II and III malnutrition must be admitted to the hospital with their mother. The patient should be in a bright, spacious, regularly ventilated room. The air temperature in the room should not be lower than 24-25 °C, but not higher than 26-27 °C, since the child easily cools and overheats. If there are no contraindications to walking ( heat, otitis media) you should walk several times a day at an air temperature of at least -5 °C. At lower air temperatures, a walk on the veranda is organized. In autumn and winter, when walking, put a heating pad on your feet. It is very important to create a positive tone in the child - to pick him up more often (prevention of hypostatic pneumonia). Attention should be paid to preventing cross-infection - placing
patient in isolated boxes, regularly irradiate the ward or box with a bactericidal lamp. Warm baths (water temperature 38 °C) have a positive effect on the course of malnutrition, which should be carried out daily if there are no contraindications. Massage and gymnastics are mandatory in the treatment of children with malnutrition.

Identification of foci of infection and their sanitation is a necessary condition successful treatment patients with malnutrition. To combat the infection, physiotherapy is prescribed (do not use nephro-, hepato- and ototoxic!), and, if necessary, surgical treatment.

Correction of dysbiosis.

Considering that almost all patients with malnutrition have dysbacteriosis, it is advisable to include a course of bifidumbacterin or bificol in the complex of treatment measures for 3 weeks.

Enzyme therapy is widely used as a temporary replacement therapy in the treatment of patients with malnutrition, especially during the period of determining food tolerance. For this purpose, abomin, gastric juice diluted with water, festal, mezim, etc. are used. If the coprogram shows an abundance of neutral fat and fatty acids, then creon, panzinorm, pancitrate, etc. are additionally prescribed.

Vitamin therapy is an integral part of the treatment of a patient with malnutrition, and vitamins are first administered parenterally, and then per os. In the first days, vitamins C, B, B6 are used. The initial dose of vitamin B6 is 50 mg per day. The dose and duration of treatment with vitamin B6 is best determined using the reaction of urine to xanthurenic acid (with ferric chloride). A positive reaction indicates a deficiency of vitamin B6 in the body. In the 2-3rd periods of treatment of malnutrition, alternating courses of vitamins A, PP, B15, B5, E, folic acid, B12 are carried out.

Stimulating therapy consists of prescribing alternating courses of apilak, dibazole, pentoxyl, metacil, ginseng, pantocrine and other drugs. In case of severe malnutrition with a layer of infection, immunoglobulin is administered intravenously. As a stimulating therapy, you can also use a 20% solution of carnitine chloride, 1 drop per 1 kg of body weight, 3 times a day orally (diluted with boiled water). For this purpose, you should not use blood and plasma transfusions, prescribe anabolic steroids (Nerobol, Retabolil, etc.), glucocorticoids.

Symptomatic therapy depends on the clinical picture of malnutrition. In the treatment of anemia, it is advisable to use folic acid, iron preparations (if they are poorly tolerated, iron preparations are administered parenterally), and when hemoglobin is less than 70 g/l, red blood cells or washed ones are transfused. For grade I malnutrition in excited children, mild sedatives are prescribed.
All children with malnutrition have pathogenetically and, which manifests itself as symptoms of hyperplasia of osteoid tissue only during the period of increased nutrition and increased body weight gain, therefore, after the end of the period of clarification of food tolerance, ultraviolet irradiation is prescribed. Therapy for symptomatic malnutrition, along with diet therapy and other types of treatment, should primarily be aimed at the underlying disease.

Treatment of malnutrition in different children should be differentiated. Perseverance is required from the doctor A complex approach to the patient, taking into account his individual characteristics. It is rightly said that patients with malnutrition are not cured, but nursed.

Forecast

Depends primarily on the cause that led to malnutrition, the possibilities of its elimination, the presence of concomitant and complicating diseases, the age of the patient, the nature, care and environmental conditions, the degree of malnutrition. With nutritional and nutritional-infectious malnutrition, the prognosis is usually favorable.

Prevention

Natural, early detection and rational treatment of hypogalactia, proper nutrition with its expansion in accordance with age, sufficient fortification of food, organization of age-appropriate care and regimen, and prevention of rickets are important. Are very important early diagnosis and proper treatment of rickets, anemia, infectious diseases of the respiratory system, gastrointestinal tract, kidneys, endocrine diseases. An important element in the prevention of malnutrition are also measures aimed at antenatal protection of the health of the fetus.

Malnutrition in children is a diagnosis associated with malnutrition of a child, which is accompanied by insufficient weight gain in accordance with age and height. Most often occurs in children under three years of age, and can occur in newborns. This condition is dangerous because it entails other serious disruptions in the body, including lag mental development. Therefore, it is important to know about this disease and its symptoms in order to detect its manifestations in time.

We can talk about malnutrition in young children when the lack of body weight is 10% of the age norm or more. Depending on the severity of the disease, there are three degrees.

The first degree is usually invisible, it can be missed, mistaking it for a feature of the physique. Or, on the contrary, the baby may indeed be thin by nature, so a doctor can identify grade 1 malnutrition in children. Its symptoms include:

  • decreased appetite;
  • sleep disorders;
  • anxiety;
  • possible decrease in muscle tone;
  • pale skin and decreased elasticity;
  • the child may look thin in the abdominal area;
  • rarely – signs of anemia or rickets.

Hypotrophy of the 2nd degree in children will already be noticeable to parents by the following signs:

  • weight deficiency from 20 to 30%;
  • growth retardation (3-4 cm);
  • poor sleep;
  • lethargy, lethargy;
  • poor appetite, frequent regurgitation;
  • stool disorders - constipation and diarrhea;
  • cold extremities;
  • poor skin condition: pallor, flaking and dryness;
  • pronounced thinness of body;
  • delay in psychomotor development;
  • tachycardia and shortness of breath are possible;
  • frequent colds.

With the third degree of the disease, the child’s condition becomes almost critical:

  • weight deficiency more than 30%;
  • growth retardation 8-10 cm;
  • the bones are covered with skin;
  • skin is gray, dry;
  • drowsiness, tearfulness, apathy;
  • in infants – retraction of the fontanel;
  • loss of previously acquired skills;
  • muscles atrophy;
  • mental underdevelopment;
  • chronic infections are possible (pyelonephritis, pneumonia);
  • cracks in the corners of the lips;
  • bowel irregularities, frequent vomiting.

Types of malnutrition

In addition to the degrees of development, malnutrition is divided according to the time of onset of the disease into intrauterine (congenital) and acquired.

Congenital malnutrition

This type of pathology is also called intrauterine, and develops while the mother is carrying a child. The reasons for this type of occurrence:

  • toxicosis in the mother in the first and second trimester of pregnancy;
  • fetoplacental insufficiency;
  • bad habits of a pregnant woman, poor nutrition;
  • chronic diseases of the expectant mother (heart, endocrine, diabetes, pyelonephritis, etc.);
  • stress;
  • genetic abnormalities of the fetus;
  • mother's work in hazardous work during pregnancy;
  • problems with the placenta;
  • —fetal hypoxia—;
  • intrauterine infection.

Intrauterine disease after birth can be determined by the following symptoms: too little weight and height, impaired thermoregulation, decreased muscle tone, slow healing of the umbilical wound, poor expression of reflexes.

Acquired malnutrition

The causes of this type of pathology can be divided into external and internal. Internal causes include various diseases and pathologies in a child, including congenital ones (metabolic disorders, endocrine diseases, immunodeficiency, developmental defects, food allergies, lactase deficiency, celiac disease, cystic fibrosis), birth injuries, and cerebral palsy. Also, children who often suffer from infectious diseases (acute respiratory infections, intestinal infections) may be prone to the development of malnutrition.

External causes do not depend on the child’s health status, but are determined by an environment unfavorable for development, wrong actions parents:

  • insufficient feeding (breast milk or formula);
  • improper latching of the nipple during breastfeeding and, as a result, lack of milk;
  • poor nutrition for a nursing mother;
  • unbalanced diet;
  • too low-calorie food;
  • late introduction of complementary foods;
  • exceeding the norm of vitamins taken (especially A and D);
  • taking certain medications;
  • poisoning;
  • lack of parental attention, walks in the fresh air;
  • lack of activities with the child in the form of massage and gymnastics, rare bathing, poor sleep.

Diagnostics

Having suspected malnutrition, the pediatrician will conduct a diagnosis and prescribe a series of tests. Thus, the baby will be examined to determine the condition of his skin, nails and hair, muscle tone, and the thickness of the subcutaneous fat layer. The doctor will interview the parents about the child’s usual condition: how he eats, sleeps, behaves, how he is cared for. The congenital diseases discussed above will be important: their presence can help confirm the child’s diagnosis.

In addition, you will need to take tests and undergo research:

  • general urine and blood tests;
  • stool analysis;
  • blood chemistry;
  • Ultrasound of the abdominal organs;
  • heart examination using electrocardiogram, echocardiography;
  • electroencephalogram - examination of the brain.

Consultations with a number of pediatric specialists may also be required: neurologist, cardiologist, gastroenterologist, geneticist, etc.

Treatment of malnutrition in children

Once an accurate diagnosis has been established, the doctor will prescribe treatment, which includes:

  • eliminating the cause that caused malnutrition;
  • establishing proper nutrition for the child, following a certain diet;
  • ensuring proper care from parents;
  • drug therapy (vitamins, immunomodulators, probiotics, drugs to improve the production of stomach enzymes);
  • massage and ultraviolet irradiation may be prescribed.

The diet for this diagnosis is as follows:

  1. Initially, from 2 days to 2 weeks, the baby is fed food intended for younger children. The calculated food intake is divided into 9-10 meals.
  2. Then the food is adjusted to the patient’s age-appropriate weight, and special mixtures are added.
  3. The next stage includes increasing the calorie content of food consumed; nutrition should be enhanced.

As for intrauterine pathology, for treatment, first of all, they establish breast-feeding so that the baby receives enough nutrients, and also monitors his body temperature and maintains it at the right level.

Lifestyle of children with malnutrition

When diagnosing this disease or suspecting its occurrence due to certain factors, you need to adhere to a certain lifestyle. Besides balanced nutrition with sufficient (and sometimes increased) calorie content, the required amount of vitamins and microelements, the parents of such a child must provide him with the necessary care and adherence to a daily routine: daily walks (at least 3 hours), therapeutic massage, gymnastics, nightly bathing.

Prevention of pathology is of great importance. And it should begin even before the birth of the child. A pregnant woman should eat a healthy, complete and balanced diet and follow the doctor’s instructions regarding the use of vitamin complexes. After the baby is born, you need to monitor his nutrition, and be sure to try to establish breastfeeding, which provides him with everything necessary for normal growth and development.

It is necessary to monitor the child’s height and weight, visit a pediatrician to monitor these indicators and regular examinations of the baby. After 6 months, complementary foods must be introduced into the child’s diet in accordance with the standards and recommendations of the WHO. The baby’s diet should include a variety of healthy foods: cereals, meat, vegetables and fruits, dairy and fermented milk products.

How to recognize malnutrition

Parents should closely monitor the condition of their child and notice any changes in his behavior, eating and other habits, and general condition.

Loss of appetite and sleep, excessive weight loss, skin problems, lethargy and apathy - all these signs should alert you.

If you suspect insufficient weight gain and growth, you should definitely show your child to a pediatrician. You should not ignore monthly trips to the clinic for weighing and examination: this way, a doctor with many years of experience will be able to recognize an incipient disease that young parents may miss.

Video: complementary feeding and norms for a child’s height and weight as part of the prevention and diagnosis of malnutrition

Proper nutrition of a child plays a very important role important role in the process of its growth and development. Therefore, to prevent malnutrition, it will be useful to learn the basic rules for introducing complementary foods for the little ones, which in the future will provide the basis for proper eating habits.

Also pay attention to this short video, which clearly demonstrates the norms for height and weight of babies depending on age. Such data will also help you figure out whether everything is okay with the child, and also not to panic too much if your child does not fall into the standard parameters of the hospital tables.

It is very important to monitor the normal development of your baby from birth so as not to miss the alarm bells of the onset of any disease. Knowing more about such a pathology as malnutrition, you will be attentive to his condition and provide your baby with proper care and the right diet. If you have encountered such an unpleasant problem, please share your experience in the comments. Tell us what the doctors advised and prescribed to you, how you coped with the illness. And may your children always be healthy!

There is nothing worse for parents than their child's illness. And when a baby is sick, inexperienced parents often cannot cope with it in time, because they do not know the main symptoms of the disease and what they can lead to. This article will talk about this pathological condition, like malnutrition, which is common in infants.

What is malnutrition? Types of malnutrition and the main danger.

Hypotrophy is a chronic nutritional disorder in a child, which is characterized by an energy and/or quality deficiency of nutrients, which leads to a deficiency in the baby’s body weight, impairment of his physical and intellectual development, pathological changes in all organs and systems. The disease mainly affects children under 3 years of age. In different countries, the frequency of malnutrition varies from 2 to 30%, which depends on the economic and social development of the country.

There are two types of malnutrition:

  • congenital;
  • acquired.

Congenital or intrauterine malnutrition is a nutritional disorder that occurs during the period of intrauterine development of the child.

The main causes of congenital fetal malnutrition:

  • insufficiency of uteroplacental circulation;
  • chronic fetal hypoxia;
  • chromosomal and genomic mutations;
  • pathology of pregnancy;
  • constitutional characteristics of the mother’s body (small height, body weight, age);
  • mother's bad habits;
  • Poor nutrition of a pregnant woman.

Acquired malnutrition is a chronic nutritional disorder of a child, which is characterized by a slowdown or cessation of the increase in the baby’s body weight, a violation of normal body proportions, thinning and disappearance of subcutaneous fatty tissue, disruption of digestive processes, a decrease in the body’s resistance to infections, and a predisposition to various diseases and delayed neuropsychic development. It is this type of malnutrition that occurs most often and brings a lot of grief to young parents, so further we will talk about this disorder.

Physiological weight loss in newborns

Before you panic because your baby has stopped gaining weight after birth or has lost several hundred grams, you need to be aware of the phenomenon of physiological weight loss in newborns.

It occurs in all babies, regardless of their birth weight. The mechanism of this phenomenon is as follows. Before birth, everyone becomes highly active metabolic processes in the fetus’s body, which provides it with the necessary energy during childbirth and in the first hours of independent life. Also, in the first days of a baby’s life, his body loses more fluid than it consumes (with breathing, bowel movements, evaporation through the skin).

A newborn loses weight until approximately the 4th day of life, from the 5th day the baby should begin to gain weight again and by 7-10-14 days his weight should again be the same as at birth, if this does not happen, then you need to look for the reason (this phenomenon is already considered pathological and requires intervention). The norm for weight loss is up to 7% of the original, if more, then this is already a pathology.

Proper child care, early breastfeeding, and sufficient fluid intake into the child’s body prevent large weight loss. If physiological weight loss has not occurred, then you need to think about possible reasons. Most often this is due to congenital disorders of the excretory system, which causes fluid to accumulate in the child’s body.

Etiology of acquired malnutrition

There are many reasons for acquired malnutrition and it is not always possible to establish why a child does not gain weight.

The main causes of acquired malnutrition:

  • nutritional factors (quantitative or qualitative malnutrition of the infant, violation of the feeding regime, use of low-energy formulas for feeding);
  • diseases digestive tract child;
  • chronic and acute infectious diseases (pneumonia, ARVI, sepsis, intestinal infections, etc.);
  • poor child care;
  • hereditary diseases;
  • congenital malformations;
  • constitutional anomalies (diathesis);
  • neuroendocrine diseases.

Clinical signs and degrees of malnutrition

The clinical picture of the disorder is dominated by 4 main syndromes.

1. Trophic disorder syndrome.

Includes such signs as deficiency of weight and/or body length for the child’s age, various disorders body proportions, gradual thinning and disappearance of subcutaneous fatty tissue, the skin becomes dry, inelastic, and over time the child’s muscles also become thinner.

2. Syndrome of central nervous system disorder.

Includes violations emotional state(the child cries all the time) and reflex activity(all reflexes weaken). The baby sucks poorly or refuses at all, muscle tone is reduced, the baby moves little, does not roll over, does not hold his head well, etc. The baby's sleep is disturbed, he does not maintain a stable body temperature.

3. Syndrome of decreased food tolerance.

Over time, the child's appetite decreases until anorexia develops, and he refuses to breastfeed. Disorders of the digestive tract develop (regurgitation, unstable stool, vomiting).

4. Syndrome of decreased body resistance (immunological reactivity).

The child becomes prone to frequent inflammatory and infectious diseases.

Depending on the severity of signs of the disease and loss of body weight, 3 degrees of malnutrition are distinguished.

Hypotrophy 1st degree:

  • weight deficit is 10-20%;
  • the child's condition is satisfactory;
  • The pancreas becomes moderately thinner only on the abdomen;
  • tissue turgor is moderately reduced;
  • the skin is pale, its elasticity is slightly reduced;
  • no growth retardation;
  • psychomotor development is not impaired;
  • food tolerance is not impaired;
  • immunological reactivity is normal.

Hypotrophy 2nd degree:

  • body weight deficiency 20-30%;
  • the child's condition is moderate;
  • The pancreas becomes thinner on the abdomen, limbs and torso;
  • tissue turgor is reduced;
  • the skin is pale, dry, its elasticity is reduced;
  • growth retardation is 1-3 cm;
  • psychomotor development slows down;
  • immunological and food tolerance decreases.

Hypotrophy 3 degrees:

  • weight deficit is more than 30%;
  • complete disappearance of PFA;
  • the child's condition is serious;
  • tissue turgor is sharply reduced;
  • elasticity skin absent, ulcers and cracks appear on the skin;
  • growth lags behind by 3-5 cm;
  • significant delay in psychomotor development;
  • immunological and food tolerance is sharply reduced.

Principles of treatment of malnutrition

Hypotrophy of the 1st degree is treated in outpatient setting, and grades 2 and 3 - only in a hospital.

Main directions of therapy:

  • eliminating the cause of malnutrition;
  • diet therapy;
  • correction of metabolic disorders;
  • organizing proper care;
  • therapy of concomitant diseases.

The basis for the treatment of malnutrition is diet therapy, which has 3 stages: elimination of the syndrome of reduced food tolerance, increasing food loads, and complete elimination of malnutrition in the child. A gradual increase in calorie content and volume of food leads to an improvement in the child’s condition; he gradually begins to
gain weight. If children have a weakened sucking or swallowing reflex, they are fed with a tube. The missing volume of fluid is administered intravenously.

As part of the treatment, doctors prescribe enzymes, vitamins, microelements, and drugs to normalize intestinal microflora, anabolic hormones.

The prognosis for grade 1 and 2 malnutrition is favorable if you consult a doctor in a timely manner and diet therapy is started on time. With grade 3 malnutrition, despite intensive treatment, mortality reaches 20-50%.

To prevent this condition from occurring in your baby, it is enough to follow a few recommendations. Visit your local pediatrician regularly to examine your child and take all anthropometric measurements. Adhere to all the principles of proper nutrition for your child, introduce supplementary feeding and complementary feeding on time. It is necessary to monitor the dynamics of the child’s weight gain, organize proper care, eliminate risk factors for the development of malnutrition.

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