What is malnutrition of the 1st degree in children. Biochemical examination reveals

In order to develop, he needs a full-fledged. If a growing body receives little nutrients, then growth slows down.

The body directs nutrients to those systems that are vital. The rest either stop developing or develop very slowly. In infancy, developmental delays are a guarantee of disability in adulthood.

Dystrophy, or, as it is also called, hypotrophy, is the same condition that develops with insufficient. Now we will find out what malnutrition is, how it develops and whether it can be avoided negative consequences malnutrition in infants.

What is malnutrition and how often does it occur in children?

Hypotrophy is a rare phenomenon in developed countries. According to the World Health Organization, for every hundred infants there are seven to eight babies with malnutrition.

In developing countries, this figure is much higher - as many as twenty children out of every hundred suffer from malnutrition. Hypotrophy can only be diagnosed in children under two years of age; upon reaching this age, the body begins to develop differently.
In simple terms, malnutrition is the consequences of starvation. It doesn't matter who - the mother or the baby. Mother's milk is the only complete food for an infant, and if the mother eats poorly, the child will suffer more than she does.

Hypotrophy is a condition that develops when there is a lack of nutrients in the body. There are quantitative and qualitative shortages. Quantitative is when there is little food.

High-quality develops in the case of incorrectly selected artificial. Mother's milk in sufficient quantities cannot lead to a quality deficiency.

Classification and reasons

Hypotrophy can be intrauterine or acquired. Intrauterine hypotrophy develops when the baby's mother suffers severe toxicosis in the first and second trimesters. As for the degrees, there is a special classification that determines the severity of malnutrition in a baby.

Hypotrophy 1 (mild) degree can be diagnosed in children. In this case, growth occurs normally, the baby does not reach 10% of normal weight.

Hypotrophy of the second (medium) degree- the condition is more severe. In this case, the weight deficit is already from 20 to 30%. The second degree poses a threat to the baby’s development, and if the lack of weight is not compensated for within a month and a half, regressive processes will begin.

Third (severe) degree malnutrition is characterized by a serious lack of mass - from 30% and above, as well as an almost complete cessation of growth. The causes of malnutrition are varied - from developmental defects to the quality of child care.

If a mother eats poorly or has bad habits, all this will affect her child. The baby will be frail and underweight if the mother has serious chronic diseases such as heart disease or work disorders endocrine system.

Did you know? No matter how small a newborn baby's hand may seem, it is so strong that it can support the entire weight of his body. Grasp reflex- one of the unconditioned and very important reflexes both for a human child and for many young marsupial animals.

The physiological causes of quantitative deficiency are a sluggish sucking reflex, in which the child cannot drink enough milk, irregular shape nipples and increased density mammary glands.

In addition to the obvious lack of food in women, the causes of acquired malnutrition are infectious diseases accompanied by intestinal disorders, an unfavorable ecological environment and a lack of maternal care.

Maternal care means constant attention, physical contact, communication, frequent walks and sincere affection. The stronger the stress, the higher the need for additional nutrition will be, which should compensate for energy loss.

Clinical manifestations

Congenital malnutrition is diagnosed immediately external signs- lack of subcutaneous adipose tissue, weak turgor, large folds of skin on the neck, sides and buttocks that do not straighten out for a long time.

The more the baby’s ribs and joints protrude, and the shoulder blades are visible under the skin, the more developed dystrophy is. Laboratory tests of children with dystrophy usually show a lack of calcium and potassium in the plasma fluid, a decreased number of platelets, as well as low level blood sugar.

Acquired malnutrition can be diagnosed only some time after the child has been at home with his parents.

As we have already found out, the causes of dystrophy can be not only the inattention of parents, but also physiological factors, therefore, the more often the child is examined by the pediatrician, the lower the possibility of malnutrition reaching a dangerous stage.

Important! In the second degree of malnutrition, the subcutaneous fat layer leaves the entire body, but remains on the face. As long as this layer of fat remains, the child can be brought out of the state of exhaustion without consequences.

There are three stages of malnutrition. At first, the baby begins to show signs of anxiety. He becomes more nervous and capricious, begins to noticeably lose weight - the fat layer on the abdomen becomes thinner.

Skin circulation at this stage is still stable, so skin color remains normal, but a decrease in appetite will alert any attentive parent. In this case, there is nothing to worry about; breastfeeding and good care will help the baby quickly gain normal weight.

The second stage of malnutrition is characterized by impaired activity of the baby. He becomes lethargic and drowsiness increases. Shortness of breath and tachycardia are possible, as well.

Another sign of second-degree malnutrition is a growth lag of two to three centimeters from the norm. The skin of children begins to turn pale and peel, and the muscle tone and the eating disorder becomes chronic.
The layer of adipose tissue begins to melt away, this is especially noticeable on the abdomen and limbs. Third degree hypotrophy is characterized by thinning of the subcutaneous fat layer both on the face and throughout the body.

The skin color turns from pale to gray, the folds in the skin do not straighten out. The eyes become sunken, the facial features, on the contrary, become sharper, and the baby stops responding to stimuli.

At the last stage of malnutrition, the child develops inflammatory diseases- , . It is possible that urination, on the contrary, becomes less frequent.

There are several diagnostic methods: instrumental, laboratory and general. During a general diagnosis, the pediatrician draws conclusions about the presence of symptoms of malnutrition based on observations.

He evaluates the baby’s fatness (the presence of fat folds on the neck, sides and limbs) and his digestive function. The latter is characterized by the quality of feces - their color, smell and structure. In a child who suffers from dystrophy, the feces have foul odor, often contain undigested food and even particles of muscle fibers.

Finally, the pediatrician checks the functioning of the central nervous system by observing the child's reaction to external stimuli.

Did you know? There are as many as sixty more bones in the body of a newborn baby than in the body of an adult!

Laboratory tests are prescribed starting from the second stage of malnutrition, when the risk increases pathological changes in organism.

Test results differ by different stages malnutrition, and a blood test best shows possible disorders - it gives an idea of ​​the protein balance, the stability of the immune system and possible inflammatory processes.

Instrumental diagnostics are used when malfunctions are suspected internal organs and organ systems. First of all, the functioning of the heart is checked - the doctor conducts an electrocardiographic study.

Increased feeding will also not be a treatment, since the entire body has already suffered. This requires a competent approach to nutrition, vitamin therapy and medical supervision.

Treatment of first-degree malnutrition can be carried out at home, after first registering with a pediatrician. With the second and third degree of malnutrition, it is necessary to go to the hospital and strictly follow all medical recommendations, which relate to the normalization of nutrition, daily routine, drug therapy and therapeutic massages.

Important! Frequent fractional feeding of the child speeds up his recovery, in contrast to abundant, but rare tricks food. The more severe the degree of exhaustion, the more often you need to feed the baby. For the first stage of the disease, six to seven times a day is enough, for the second- eight to ten and for the third- ten to twelve feedings per day.

This is the main method of treating malnutrition: without it drug therapy and massages don't make sense. The higher the degree of exhaustion, the more gentle the doctor will select and prescribe food products.

First, the degree of damage to the digestive and central nervous systems is checked, because thinning of the subcutaneous fat layer is not the main indicator of the degree of damage to dystrophy.

Resistance to products is tested experimentally. If the child has reached the age at which complementary foods can be given, he is gradually introduced into the diet and monitored for bloating and disorders. To treat breastfed children, maternal nutrition is adjusted.

Infants should not be given a lot of food at once. The higher the degree of exhaustion, the smaller portions its restoration begins. At the second stage of diet therapy Special attention pay attention to micro- and macroelements entering the body.
During the transitional stage, nutrition in children early age should replenish the body's need for calories and food volume for accelerated recovery from malnutrition. The child begins to be fed less often, but more plentifully.

The last stage is characterized by enhanced feeding. The child is given a lot of food when functionality digestive tract completely restored.

It is necessary to limit the protein component of food, as it is the most difficult to digest, but ensure nutritional value - weight gains at this stage are very intense.

Frequent stool analysis is a prerequisite for monitoring recovery. The amount of undigested dietary fiber and fat elements show how you need to adjust your diet.

Did you know? During the first two years of life, a child sleeps unstably, and therefore his parents do not receive approximately four and a half thousand hours of proper sleep during this time.- this equates to almost half a year of life.

Medications

Medication therapy includes vitamin therapy, enzyme therapy and therapy that stimulates the body's metabolic processes. Vitamin therapy enriches the body with substances that are lacking more than others - C, B1 and B6.

First, subcutaneous and intramuscular administration of solutions is practiced. After the digestive function returns to normal and vitamin complexes stop transiting, enteral administration (by mouth) is prescribed.

Stimulating therapy is carried out with drugs that strengthen the immune system (up to immunoglobulin at the most severe stages), increase blood circulation and stimulate oxygen transport throughout all tissues.

Massage and exercise therapy

Exercise therapy is physical therapy. It, together with massage, is used to improve tissue metabolism, stimulate blood circulation, and disperse lymph. Physical education strengthens muscles and ligaments and affects the baby’s joints - they become flexible and mobile again.

In a comprehensive physical therapy therapy and massage play the role of a general tonic, normalize metabolic processes and thereby restore the excitability of the central nervous system, which begins to transmit normal food reflexes.

Important! Physiotherapy can be active or passive. Active movements include movements that the baby performs himself, reacting to stimuli. Passive exercise is performed by the hands of a qualified pediatrician or trained parents.

A woman should stop drinking alcohol, avoid drinking alcohol, including passive alcohol, stay in the fresh air and undergo regular examinations with a gynecologist.

Did you know? Babies have no joints at birth kneecaps. There's simply no need for them- at this age, children cannot support themselves in an upright position. Finally knee joints are formed only six months after birth.

After birth, you need to keep the baby in the best conditions - provide him with breastfeeding or purchase balanced ones if there is no milk. A nursing mother must monitor her diet, because everything she eats will turn into food for the baby.

The pediatrician will tell you when you can introduce complementary foods to breast milk, and this should be done gradually, checking the child’s reaction to individual foods. In addition to nutrition, it is necessary to ensure that the baby stays frequently sunlight and fresh air.
These natural factors cause strong young children. Hypotrophy is not a death sentence, and with careful care you can return your baby to normal in a short time. It is necessary to monitor the nutrition of a nursing mother and enrich her diet with vitamin complexes.

Complementary foods should be introduced based on medical prescriptions and observing changes in the baby’s well-being. Knowing the symptoms and signs of malnutrition, you can understand when the baby began alarming symptoms, and seek help from a pediatrician.

Only competent medical care will save the baby from progressive malnutrition and give him the opportunity to develop correctly.

The word is of Greek origin; "hypo" - "below, under" and "trophe" - "nutrition". Hypotrophy is chronic disorder nutrition. The basis of the disease is exhaustion of the body. This term is used only in relation to a child in the first years of life. From this article you will learn what degrees of malnutrition exist in children. We will also tell you everything about the causes of malnutrition in children, the treatment of malnutrition in children, and the preventive measures that you can take to protect your baby from the disease.

Causes of malnutrition in children

Hypotrophy is a chronic nutritional disorder accompanied by a violation of the trophic function of the body, digestion, metabolism, dysfunction of various organs and systems with a delay in physical, motor-static and neuropsychic development.

There are congenital or prenatal malnutrition, in the development of which factors that act unfavorably during uterine development play a role, and acquired malnutrition (postnatal), which develops in children born with normal indicators body weight and length. This form of malnutrition in infants and young children can develop as a result of exposure to a number of unfavorable factors.

Etiology of malnutrition

There are three main factors: nutritional, infectious, constitutional.

Nutritional factor In the development of dystrophy, it can manifest itself as quantitative or qualitative starvation, defects in the organization of the child’s nutrition.

Quantitative fasting, as the name itself indicates, there is a condition where the child receives insufficient volume of breathing and energy value food. Currently, in children in the first months of life, malnutrition can develop as a result of hypogalactia, with difficulties feeding the mother’s breast (“tight” mother’s breast, flat and inverted nipple), sluggish sucking, errors in feeding technique, with early transfer of the child to artificial feeding, due to untimely introduction of complementary foods, “habitual” regurgitation and vomiting.

Quality fasting occurs when an incorrect ratio of individual ingredients (proteins, fats and carbohydrates) is observed in the child’s food, due to the inferiority of the qualitative composition of breast milk, monotonous feeding during the introduction of complementary foods (especially cereals), with a deficiency of proteins and fats, a deficiency of vitamins and minerals (untimely and insufficient introduction of vegetable and fruit juices, vegetable complementary foods).

In recent years, toxic factors have become important in the etiology of malnutrition - pollution food products salts heavy metals(lead, arsenic), pesticides that react with sulfhydryl groups of protein molecules, suppress protein synthesis, cause depression enzymatic activity. Toxic factors cause variants of dystrophy with primary metabolic disorders in a cage. The cause of malnutrition can be hypervitaminosis A and D.

Infectious factor– acute and chronic gastrointestinal infections (salmonellosis, coli infection, dysentery, etc.), chronic infections (tuberculosis, syphilis, dysentery), frequent acute respiratory viral infections, pyelonephritis and infection urinary tract, HIV infection. During infections, toxins and metabolic products lead to disruption of intracellular metabolism, the development of hypovitaminosis (qualitative starvation also occurs), and a decrease in appetite (quantitative starvation also occurs).

Constitutional factor in the etiology of malnutrition - these are congenital anomalies of the gastrointestinal tract, birth defects heart disease, immunodeficiency conditions, enzymopathies (a group of diseases caused by hereditary metabolic defects), diseases of the endocrine system, perinatal encephalopathies of different origins. Congenital anomalies of the gastrointestinal tract include: dolichosigma, Hirschsprung's disease, biliary atresia, pylorospasm, birth defects: cleft palate, cleft palate upper lip. Diseases of the endocrine system include adrenogenital syndrome, hypothyroidism, diabetes, pituitary dwarfism.

With constitutional factors in the development of malnutrition, insufficient absorption of food is observed in terms of both quantity and quality due to a violation of the functional properties of the body's cells.

Currently, malnutrition at birth as a manifestation of intrauterine growth retardation is of independent importance in the etiology of malnutrition.

Pathogenesis of malnutrition

A lack of food or a qualitative change in it leads to disruption of the assimilation processes (intracavitary hydrolysis, membrane digestion and absorption are disrupted), to the distortion of enzymatic reactions, to disruption of vital nutrition. important organs, and above all the central nervous system. As a result of dysfunction of the central nervous system, dysfunction of the subcortical areas of the brain occurs, which leads to worsening trophic disorders. Thus, the main pathogenetic link of malnutrition is intracellular starvation. With insufficient nutritional intake, the body begins to use its depots to maintain basal metabolism and the specific dynamic action of food. First of all, the glycogen depot begins to be utilized, but it is restored by switching to the consumption of energy fat, therefore, first of all, a decrease in the fat depot is observed. With longer exposure harmful factor In the body, the fat depot is used up and glycogen cannot be replenished in the absence of fat, the glycogen depot gradually decreases, and then the body begins to consume its own proteins. When there is a deficiency of protein in a child’s diet, there is an increase in protein-energy deficiency, a slowdown in growth due to a decrease in the synthesis of liver somatomedins, worsening enzyme disorders and damage to immunological mechanisms, worsening weight loss and atrophic processes.

With protein deficiency, atrophy of the thymus is observed and lymphoid tissue, decreased number of T-lymphocytes, impaired bactericidal and phagocytic function of neutrophils. The content of immunoglobulins in the blood serum decreases, especially IgM and IgA. Cellular disruption, weakening humoral immunity cause a high frequency and severe course of bacterial and other infections in patients with malnutrition, and the development of septic and toxic-septic conditions in them. Simultaneously with the consumption of glycogen and protein depots, the body gradually utilizes the vitamin depot, which leads to the development of hypo- or avitaminosis.

With the consumption of endogenous proteins, dysfunction occurs endocrine glands: decreased function thyroid gland(decrease in the level of basal metabolism), pituitary gland (growth disturbance), insular apparatus of the pancreas. As a result of exchange shifts, the acid-base balance, is developing metabolic acidosis, endogenous toxicosis.

Under conditions of disruption of enzymatic processes in the body, a decrease in the activity of many enzymes in the blood, cells, and tissues, lipid peroxidation increases. Lipid peroxides have an effect on the body of a sick child toxic effect, damage the membranes of cells and their organelles. As a result, destabilization of cell membranes develops, their barrier function, a change in the constancy of the internal environment of the body increases the dysfunction of organs and systems. Most children with malnutrition experience a disturbance of the intestinal biocenosis, most often caused by the microbes Proteus, Klebsiella and their associations with hemolytic coli, fungi of the genus Candida.

Causes of malnutrition in a newborn

Among the reasons include improper feeding, especially in infants in the first six months of life, poor quality care for them, constant violations daily routine or lack of a daily routine as such, frequent illnesses of the baby (acute infectious diseases, chronic infections, acute gastrointestinal diseases and so on.)

Among the causes, infectious and nutritional factors come first, followed by anomalies of the gastrointestinal tract, and hereditary metabolic disorders.

Cause of malnutrition in a child: congenital factors

Hypotrophy in little girls and boys can be congenital (intrauterine), caused by exposure to the fetus various factors accompanied by circulatory disorders in the placenta, intrauterine infection of the fetus:

• diseases and occupational hazards in the mother during pregnancy,
• gestosis and toxicosis,
• malnutrition,
• smoking and drinking alcohol during pregnancy,
• mother's age is over 35 and under 20 years.

Cause of malnutrition in a child: feeding

With natural feeding, the most common cause is malnutrition, due to a lack of milk from the mother or due to sluggish breastfeeding. The cause of the development of malnutrition in artificial feeding There may be an imbalance of nutrition in terms of calorie content or chemical composition of food. For example, with unilateral milk feeding(kefir, milk) the baby receives an excess of proteins and salts and a lack of carbohydrates. In this case, the baby is constipated, the stool becomes clayey and foul-smelling. Predominant feeding of children with cereals with diluted milk causes the so-called mealy eating disorder, associated with an excess of carbohydrates and a lack of proteins and salts (the stool becomes liquid).

With the disease, the function of the digestive organs decreases, shifts occur in protein, fat, carbohydrate, water-salt and vitamin metabolism, anemia develops, immunity changes and various infections occur.

The reason why malnutrition occurs in a child:

1. Sometimes muscle wasting occurs in healthy babies who lead sedentary lifestyle life, with limited mobility in postoperative period or severe somatic pathology.
2. Muscle atrophy accompanies flaccid paralysis, in particular, occurring with the paralytic form of poliomyelitis. The causes of muscle atrophy lie in hereditary degenerative diseases of the muscular system, chronic infections, metabolic disorders, disorders of the trophic functions of the nervous system, long-term use of glucocorticoids, etc. Local muscle atrophy can form with prolonged immobility associated with joint diseases, damage to tendons, nerves or the muscles themselves.

There are three degrees of malnutrition - I, II, III.

First degree hypotrophy in children is marked by a weight loss of no more than 20%; however, there is no growth retardation. His subcutaneous fat layer is preserved everywhere, however, it is somewhat thinner on the trunk and limbs. Skin elasticity is slightly lower than that of healthy baby. The skin and visible mucous membranes may be slightly pale. The general condition does not suffer.

Hypotrophy of the 2nd degree in children there is a lag in weight from 20 to 40%; There is also a growth retardation - up to 3 cm. The skin is dry, inelastic, easily gathers into thin folds, and these folds are difficult to straighten. The subcutaneous fat layer thins to a large extent on the torso, buttocks and limbs. Weight loss becomes noticeable on the face. The muscles also become thinner and their tone is impaired. If the baby had any motor skills by this time, they may disappear. Appetite can be sharply reduced or, conversely, very well expressed.

A child with grade III hypertrophy is characterized by a very significant weight loss - 40% or more; growth retardation is also significant. The baby’s subcutaneous fat layer is absent everywhere, this layer is not present on the face either, which is why the latter takes on the appearance of an old man’s face - the eyes sink (since the fat in the eye sockets disappears), wrinkles form on the forehead and cheeks, cheekbones stand out, the chin becomes sharpened, as a result of which the face gains triangular shape. You can often see an expression of suffering on the face.

Clinical signs of malnutrition: the baby’s skin completely loses its elasticity, becomes dry, and flakes; Over time, trophic disorders appear on the skin - ulcers form on the back of the head, buttocks and other places. On the torso and limbs the skin hangs in folds. The muscular system also undergoes significant changes: the muscles become thin and flabby, however, their tone is increased. The tummy may be sharply swollen due to intestinal atony and flatulence or, on the contrary, retracted.

Treatment of malnutrition

The treatment is complex. Very important: high-quality care for the baby from the mother, strict adherence to the daily routine, proper nutrition appropriate for age, proper upbringing. It is necessary to eliminate the factor and cause that led to the disease as quickly as possible. If necessary, therapy is carried out to increase appetite. Great importance It has speedy recovery normal functioning of all organs and systems. In some cases, the doctor resorts to stimulating therapy. If malnutrition in a baby occurs due to improper feeding, due to serious violations of the rules for introducing complementary foods, or due to a monotonous diet, the doctor makes amendments to the baby’s food.

Caring for a child during treatment for malnutrition

Patients with grade I malnutrition are treated at home under the supervision of a local pediatrician without changing the usual regimen appropriate for their age.

Treatment of malnutrition in children of degrees II and III is carried out in a hospital setting with the obligatory organization of a gentle regime: the child should be protected from all unnecessary stimuli (light, sound, etc.). It is advisable to keep the child in a box with the creation of an optimal microclimate (air temperature 27-30 ° C , humidity 60-70%, frequent ventilation); the mother is hospitalized along with the child. During walks, you need to hold the child in your arms and make sure that the hands and feet are warm (use heating pads, socks, mittens). Increasing emotional tone should be achieved by treating the patient kindly, using massage and gymnastics. In case of III degree malnutrition, especially with muscle hypertonicity, massage is carried out with great caution and only stroking.

Diet for malnutrition in children

Diet forms the basis of rational treatment of dystrophy (primarily malnutrition). Diet therapy for the treatment of malnutrition can be divided into two stages:

• determining tolerance to various foods;
• a gradual increase in the volume of food and correction of its quality until the physiological age norm is reached.

The first stage lasts from 3-4 to 10-12 days, the second - until recovery.

1. "Rejuvenation" diet - the use of food products intended for boys and girls more younger age(breast milk, adapted fermented milk formulas based on protein hydrolysates);
2. Fractional meals- frequent feeding (for example, up to 10 times a day for stage III disease) with a decrease in the amount of food per meal;
3. Weekly calculation of food load by the amount of proteins, fats and carbohydrates with correction in accordance with the increase in body weight;
4. Regular monitoring of the correctness of treatment (keeping a food diary indicating the amount of food, fluid consumed, diuresis and stool characteristics; drawing up a “weight curve”, coprological examination, etc.)

How is malnutrition treated in children using nutritional calculations?

Calculation of nutrition for malnutrition of the first degree is carried out for the proper (age-appropriate) body weight of the child with full satisfaction of his needs for the main components of food, microelements and vitamins. In case of illness of II and III degrees, in the first 2-3 days the amount of food is limited to 1/3 - 1/2 for the required body weight. Subsequently, it is gradually increased to 2/3 - 3/5 daily ration healthy child. The missing amount of nutrition is replenished with liquid - vegetable and fruit juices, 5% glucose solution. Upon reaching the required amount of food for age, the amount of proteins and carbohydrates is calculated for the proper body weight, and fats - for the actual one. If a child does not have dyspepsia while increasing the amount of food, and body weight increases (usually this occurs 1 - 12 days after the start of treatment), a qualitative nutritional correction is gradually carried out, all ingredients are calculated for the proper body weight (proteins and fats - 44.5 g/kg, carbohydrates - 1316 g/kg).

Enzyme therapy for the treatment of malnutrition in a child

Enzymes are necessarily prescribed for any degree of disease, both due to an increase in the nutritional load during treatment and due to a decrease in the activity of the patient’s own gastrointestinal enzymes. Enzyme therapy is carried out for a long time, changing drugs: rennet enzymes (abomine), pancreatin + bile components + hemicellulase (festal), with a large amount of neutral fat and fatty acids in the coprogram - pancreatin, panzinorm. The use of vitamins, primarily ascorbic acid, pyridoxine and thiamine, is also pathogenetically justified. Stimulating therapy includes alternating courses of royal jelly (apilak), pentoxyl, ginseng and other agents. During development infectious disease Ig is administered.

Prevention of malnutrition

It is easier to prevent the causes of malnutrition from occurring than to treat it later. Prevention measures are as follows:

• organizing proper child care;
• strict adherence to diet;
• timely and sufficient administration of vitamins;
• hardening procedures (hardening with air, sunlight and water);
• proper upbringing of the baby (provides a positive emotional state);
• also ensures the restoration and development of necessary conditioned reflexes);
• prevention of infectious diseases.

It is advisable to divide the prevention of malnutrition into antenatal and postnatal.

1. Antenatal prevention includes family planning, health education of parents, the fight against abortion, treatment of diseases of the expectant mother, especially diseases of the genital area, protecting the health of the pregnant woman [ balanced diet, adherence to a daily routine, walks in the fresh air, transfer to light work (in unfavorable working conditions), avoidance of smoking and others bad habits].
2. Postnatal prevention of malnutrition includes natural feeding with its timely correction, adherence to the regime and rules of child care, proper upbringing, prevention and treatment of infectious and intercurrent diseases, dispensary observation with monthly (up to 1 year) weighing and body length measurement.

Treatment prognosis malnutrition depends primarily on the possibility of eliminating the cause that led to the development of dystrophy, as well as on the presence of concomitant diseases. With primary nutritional and nutritional-infectious dystrophy, the prognosis is quite favorable.

Nutrition for children with malnutrition

The basis of treatment for all forms of malnutrition is the organization proper nutrition. The difficulty of nutrition lies in the fact that their need for essential nutrients and calories is increased, and their tolerance to food, especially fat, is reduced. Therefore, the success of treatment depends on an individual approach to each sick child.

Nutrition in the treatment of stage I malnutrition

The first feeding for full-term infants with congenital malnutrition of the first degree should be done immediately in the delivery room, for premature infants, depending on the degree of prematurity, no later than 12 hours after birth. In the intervals between feedings, be sure to feed the baby 5% glucose (1/4 of the total amount of food).

The volume of breast milk per feeding for newborns and premature infants with stage I disease is on the first day - 10 ml, on the 2nd - 15-20 ml, on the 3rd - 20-30 ml, on the 5th - 7th day - 50-90 ml.

Nutrition during treatment of malnutrition II - III degree

In case of malnutrition of the II - III degree, sluggish sucking or refusal to feed, they begin to feed from 1/3-1/2 the volume required at this age, gradually increasing the amount of milk to normal.

The daily amount of food for newborns aged 2 to 8 weeks should be approximately 1/5 of the actual body weight, from 2 to 4 months - 1/5 - 1/6, from 4 to 6 months - 1/7, from 6 up to 9 months - 1/8 part.

• In the first months of life, a person suffering from malnutrition is prescribed 7 - 8 feedings per day, from 3 - 4 months - 6, from 5 months, if the condition allows - 5. During the first 2 - 3 months of the baby's life, it is necessary to provide breast milk, and in its absence - with adapted mixtures, preferably acidophilic and fermented milk. Protein correction is carried out with cottage cheese, kefir, fat correction - with vegetable oil introduced into complementary foods. Carbohydrates are corrected with sugar syrup, fruit juices, and purees.
• Complementary feeding is introduced against the background of positive dynamics of body weight in the absence of acute concomitant diseases during the treatment period. It is necessary to carefully observe the principle of gradualness when introducing each new type of food. Fruit juices are prescribed at 2 months, fruit puree - from 2.5 months. Juices are introduced gradually: at first a few drops, and by 2 - 3 months their volume is increased to 30 ml.
• Children who have been diagnosed with malnutrition and who are breastfed from 3 months can be given egg yolk as a product containing complete protein, fat, mineral salts - calcium, phosphorus, iron, vitamins A, D, B1, B2, PP. You should start with 1/8 of the yolk and gradually increase the portion to half the yolk per day.
• From 4 months of age, the diet of a patient with malnutrition must include cottage cheese. If the child did not receive it earlier for the purpose of correction and treatment, then the introduction begins with 5 g (half a teaspoon), gradually increasing the portion by 6 - 7 months to 40 g.
• At the age of 3.5 months with natural and 2.5 months with artificial feeding, if the condition allows, complementary foods are introduced in the form of cereals - starting with 5%, then 8% and finally 10% concentration. It is preferable to use buckwheat and rice flour. About a month after introducing the porridge, they begin to introduce vegetable puree, starting with 1-3 teaspoons and increasing the portion over 10-12 days to 100-150 g. You can use canned food for complementary feeding vegetable purees from different vegetables for baby food.
• From 4 months of life, vegetable oil should be introduced into the diet of a child who has malnutrition (starting from 1 g and increasing the portion by 8-9 months to 5 g), from 5 months - butter (starting from 2 g and increasing the portion to 5 g by 8 months), from 7 - 7.5 months add meat (mainly beef) in pureed form (starting from 5 g and increasing the portion to 30 g per day, and by 9 months - up to 50 g, by a year - up to 60 - 70 g).
• At 7 months add meat broth(20-30 ml) with white crackers (2-3 g). The broth should be given during the day before vegetable puree.

Feeding a baby with malnutrition that has developed due to hereditary disorders metabolism, is built taking into account its cause:

• When treating celiac disease, products containing gluten are excluded: wheat flour, semolina, starch;
• The main method of treating a baby with lactose deficiency is to exclude milk from the diet (including mother's milk) and dishes prepared with fresh milk. These children should be given dairy products: acidophilus mixtures, kefir, acidophilus milk, low-lactose mixtures;
• For cystic fibrosis, a diet with limited fat and increased protein is prescribed. The need for fats should be covered primarily by vegetable oils(corn, sunflower), rich in unsaturated fatty acids.

Now you know everything about the causes, degrees and methods of treating malnutrition in young 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 internal diseases, in which the absorption of nutrients from food is disrupted 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 young children are:

Doctors say that internal factors, causing 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

TO external reasons that cause 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, causing disturbances in the work of various organs. Doctors divide all symptoms into individual syndromes, combining a set of symptoms that occur during the disease separate body or systems.

With malnutrition, 4 main syndromes are identified:

As a rule, everyone little patient with malnutrition, only one syndrome appears.

Doctors distinguish 3 degrees of malnutrition. This division helps doctors more accurately determine the child’s condition and select correct 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. Various 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 secondary pathology, developing 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 food in insufficient quantities or not at all able to absorb protein products.

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 children school age. This condition is characterized by a lack of proteins and calories. Nutritional insanity is accompanied by the following symptoms:

Conclusion

Hypotrophy in children is a rather 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.

Update: December 2018

Hypotrophy in children is starvation, quantitative or qualitative, as a result of which significant changes occur in the body. Qualitative fasting is possible due to improper artificial feeding, lack of essential nutrients and vitamins, quantitative fasting - due to incorrect calculation of calorie content or lack of food resources.

Hypotrophy may be a consequence of previous acute diseases or the result of chronic inflammatory process. Wrong actions of parents - lack of routine, poor care, unsanitary conditions, lack of fresh air– also lead to this condition.

What does a baby who is developing normally look like?

Signs of normotrophic:

• Healthy looking
• The skin is pink, velvety, elastic
• Lively look, active, exploring the world around him 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 widespread:

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

According to scientific research, this deficiency condition occurs approximately equally in both boys and girls. Severe cases malnutrition is observed in 10-12 percent of cases, and in a fifth of children it is accompanied by rickets, and in a tenth by anemia. Half of the children with this pathology are born during the cold season.

Causes and development

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

• 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, etc.)
• chronic stress
• mother's work during pregnancy in hazardous work (noise, vibration, chemicals)
• pathology of the placenta (improper attachment, early aging, one umbilical artery instead of two and other placental circulatory disorders)
• multiple pregnancy
• hereditary metabolic disorders in the fetus
• genetic mutations and intrauterine anomalies

Causes of acquired malnutrition

Domestic- 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, it is worth highlighting separately food allergies and three hereditary diseases, which occur with malabsorption syndrome - one of common reasons malnutrition in children:

• cystic fibrosis - a disorder of the exocrine glands, affecting the gastrointestinal tract and respiratory system
• , changes in a child’s intestinal function begin from the moment gluten-containing products are introduced into the diet – barley grits, semolina, wheat porridge, rye cereal, oatmeal
• — the digestibility of milk is impaired (lactase deficiency).

According to scientific research, malabsorption syndrome provokes malnutrition twice as often as nutritional deficiency. This syndrome is characterized primarily by impaired stool: it becomes copious, watery, frequent, and foamy.

External- caused by incorrect actions of parents and unfavorable environment:

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

Symptoms

Signs and symptoms of intrauterine hypotrophy in a child:

• body weight below normal by 15% or more (see below table of the relationship between weight and height of the child)
• height is 2-4 cm less
• the child is lethargic, muscle tone is reduced
• innate reflexes are weak
• thermoregulation is impaired - the child freezes or overheats faster and stronger than normal
• subsequently the original weight is slowly restored
• umbilical wound does not heal well

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

• Lack of nutrition: the child is thin, but the body proportions are not disturbed.
• 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 mass is insufficient, the 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 food perception: appetite worsens to the point of its complete absence, frequent regurgitation, vomiting, stool disorders appear, and the secretion of digestive enzymes is inhibited.
• Decreased 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 dysbiosis.

Degrees of malnutrition in children

Hypotrophy of the first degree is sometimes almost invisible. Only an attentive doctor can identify it during an examination, and even then he will first conduct a differential diagnosis and find out whether an 11-20% body weight deficit is a feature of the child’s physique. Thin and tall children are usually so due to hereditary characteristics. Therefore, a young mother should not be alarmed if her active, cheerful, well-nourished child is not as well-fed as other children.

Hypotrophy 1st degree in children it is characterized by a slight decrease in appetite, anxiety, and sleep disturbances. The surface of the skin is practically unchanged, but its elasticity is reduced, and the appearance may be pale. The child looks thin only in the abdominal area. Muscle tone is normal or slightly decreased. Sometimes signs of rickets and anemia are found. Children get sick more often than their well-fed peers. Changes in stool are minor: tendency to constipation or vice versa.

Hypotrophy 2nd degree in children it manifests itself as a 20-30% weight deficit and stunted growth (about 2-4 cm). The mother may notice that the child has cold hands and feet, he may burp frequently, refuse to eat, be lethargic, inactive, and sad. Such children are lagging behind in mental and motor development and sleep poorly. Their skin is dry, pale, flaky, wrinkles easily, and inelastic. The child appears thin in the abdomen and limbs, and the outline of the ribs is visible. Stool fluctuates greatly from constipation to diarrhea. Such children get sick every quarter.

Sometimes doctors see malnutrition even in healthy child who looks too thin. But if the height corresponds to his 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.

For malnutrition of the 3rd degree growth retardation 7-10 cm, weight loss ≥ 30%. The child is drowsy, indifferent, whiny, acquired skills are lost. The subcutaneous fat is thinned everywhere, pale gray, dry skin stretches over the baby’s bones. There is muscle atrophy, the limbs are cold. The eyes and lips are dry, there are cracks around the mouth. A child often develops a chronic infection in the form of pneumonia or 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 functioning of the body will be observed.
In other cases, it is necessary to carry out a differential diagnosis of the pathology that led to malnutrition: congenital defects, diseases of the gastrointestinal tract or endocrine system, damage to the central nervous system, infections.

Treatment

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

• Identifying the cause of malnutrition and eliminating it
• Proper care: daily routine, walks (3 hours daily, if it’s ≥5˚ outside), gymnastics and professional massage, swimming 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)
• Drug treatment

Treatment of congenital malnutrition consists of maintaining the child's constant temperature body and establishing breastfeeding.

Nutrition for children with malnutrition

Diet therapy for malnutrition is divided into three stages.

Main directions of drug therapy

• Pancreatic enzyme replacement therapy; drugs that increase the secretion of gastric enzymes
• Use of immunomodulators
• Treatment of intestinal dysbiosis
• Vitamin therapy
• Symptomatic therapy: correction of individual disorders (iron deficiency, increased excitability, 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 would be more correct to say that children are nursed rather than treated. Vaccinations for malnutrition of the 1st degree are carried out according to a general schedule, for malnutrition of the 2nd and 3rd degrees - on an individual basis.

Research into 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 1-3 years old) were analyzed. The conclusions were obtained as a result of the analysis of specially designed questionnaires: most often, children with malnutrition were born from pregnancies that occurred with pathologies, with heredity for gastrointestinal tract pathologies and allergic diseases, with intrauterine growth retardation.

Prevention of malnutrition in children

Prevention of both intrauterine and acquired malnutrition begins with the fight for the woman’s health and for maintaining long-term breastfeeding.

The following areas of prevention are tracking basic anthropometric indicators (height, weight), monitoring children’s nutrition.

An important point is the timely detection and treatment of childhood diseases, congenital and hereditary pathologies, proper care for the child, preventing the influence of external factors in the development of malnutrition.

Things to remember:

• Mother's milk is the best and irreplaceable food for a baby up to one year old.
• At 6 months the menu should be expanded with plant food(cm. ). Also, do not switch your child to adult food too early. Weaning a child from breastfeeding before 6 months is a crime against the baby; if problems arise, you must first put him to the breast and only then supplement him.
• Variety in nutrition is not different types porridge and pasta throughout the day. A nutritious diet consists of a balanced combination of proteins (animal, vegetable), carbohydrates (complex and simple), fats (animal and vegetable), that is, the diet must include vegetables, fruits, meat, and dairy products.
• As for meat - after a year it must be present in the child’s diet - this is an irreplaceable product, there can be no talk of any vegetarianism, only meat contains compounds necessary for growth, they are not produced in the body in the quantities needed for full development and health.
• Important!!! There are no safe medications “just” to reduce or increase a child’s appetite.

Table of weight versus height in children under 4 years of age

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

• Norm- this is the interval between GREEN And BLUE weight value number (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 decrease body weight in relation to height.
• Weight gain- between BLUE And YELLOW number (75-90 centiles) is both normal and indicates a tendency towards weight gain.
• Increased or decreased body weight- between RED And YELLOW the number indicates both low body weight (3-10th centile) and increased body weight (90-97th centile). This may indicate both the presence of a 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<3 центиля). Ребенок с таким весом нуждается в установлении причины гипотрофии или ожирения и корректировки питания и назначения лечения, массажа и пр. , поскольку это является проявлением какого-либо заболевания и опасно негармоничным развитием органов, систем организма, снижению сопротивляемости к инфекциям и негативным факторам окружающей среды.

Hardly considered rare today. This condition is accompanied by chronic eating disorders, in which the baby’s weight lags behind the norm by more than 10%. Hypotrophy can be either intrauterine or develop after the birth of the child. So what are the causes and symptoms of this pathology?

Causes of intrauterine hypotrophy in a child

In some cases, disturbances in normal nutrition appear during the fetus. Such a child is born with noticeable symptoms - he weighs much less than normal. Sick children are frail with poorly developed fat layers and flaky skin.

To begin with, it is worth noting that the mother’s nutrition plays a significant role in the development of the fetus, and it is worth taking into account not only the quantity, but also the quality of food consumed. A pregnant woman's diet should be varied and contain the main groups of nutrients.

On the other hand, malnutrition may also be associated with metabolic disorders in the placenta. These include insufficient blood circulation, early and late severe toxicosis. Sometimes the reasons lie in unfavorable environmental conditions. The risk of developing malnutrition increases with constant stress.

Causes of malnutrition in a child after birth

Often children are born completely healthy, but in the next few weeks you can notice a sharp weight loss. Quite often, malnutrition in infants is associated with insufficient nutrition. For example, subcutaneous fiber deficiency is sometimes the result of too little breast milk (or formula). Do not forget that a nursing mother must also eat properly, since the quality and satiety of milk depends on this.

On the other hand, the cause of malnutrition may be a disorder in the digestive system. Intestinal infections, dysbacteriosis and some other diseases are often accompanied by vomiting and diarrhea, which, accordingly, creates a lack of nutrients. Risk factors include damage to the nervous system or heart muscle, as well as trauma or congenital anatomical abnormalities in the structure of the oral cavity, as this prevents the child from eating normally.

Symptoms and forms of malnutrition in a child

Of course, the signs of this pathology directly depend on its severity.

• First degree hypotrophy in children is accompanied by a lag in weight gain of approximately 10-15%. The amount of subcutaneous fat decreases mainly in the thighs and abdomen.
• The second degree of malnutrition is characterized by a decrease in the layer of subcutaneous fat not only on the torso, but also on the limbs. The delay in mass in this case is 15-30%.
• If the baby’s body weight is more than 30% below normal, then doctors talk about the third, severe degree of malnutrition. The fat layer disappears on the torso, limbs and face.

Treatment of malnutrition in children

Of course, such a condition requires medical attention. First of all, the doctor must determine what is causing such an eating disorder. Drug treatment is necessary in cases where malnutrition is the result of certain developmental defects, infectious or chronic diseases. If the reasons lie in insufficient nutrition, then you need to adjust the diet of the baby or nursing mother. But the diet should be compiled individually by the attending physician - additional food should be introduced gradually. Additional intake of mineral and vitamin complexes, walks in the fresh air, as well as regular therapeutic exercises will have a positive effect on the child’s condition.