Treatment of malnutrition in young children. Hypotrophy in young children: the main symptoms

Sometimes it happens that babies look thin. This may be due to malnutrition.

Hypotrophy in children under one year old is an eating disorder of an early age child, which is characterized by a stop or slowdown in the growth of body weight (more than 10% of the age standard), progressive thinning of the subcutaneous tissue, violations of body proportions, digestive and metabolic disorders, and a decrease in the body's defenses , a tendency to develop other diseases, delayed physical and neuropsychic development. This disease is one of the most common types of dystrophy. With malnutrition, the main energy metabolism, there is a delay in physical and neuropsychic development.

Causes of congenital and acquired malnutrition in infants

The disease is classified according to the factors of occurrence.

Congenital malnutrition in an infant is associated with toxicosis at the beginning of pregnancy, fetal hypoxia, impaired placental circulation in the uterus in the expectant mother, processes that lead to developmental delay in the womb. Somatic diseases of the woman in labor, poor conditions for the full growth of the fetus, and its infection can also play a negative role.

Acquired malnutrition in one-year-old children appears due to a lack of energy and protein. There are many factors that contribute to the onset of the disease. IN more they are caused by organic pathologies, malformations. In addition, limited nutrition, impaired digestion of food, immunodeficiency, lactation insufficiency, frequent diseases, lack of proper care for the newborn - these are all among the causes of acquired malnutrition in young children.

In the case of a mixed form, negative external factors (infections, social causes) are added to the adverse events that were in the prenatal period.

The causes of malnutrition in babies are quite diverse, closely related and affect each other, so the disease develops quickly. Factors are internal and external. Among the causes of malnutrition in children of the first year of life and early age, the following can be distinguished:

1. Negative conditions for the development of the fetus.
2. Pathologies during childbearing.
3. Violation of the diet.
4. Infectious - acute and chronic diseases, including .
5. Defects in care and upbringing - lack of attention, lack of systematic walks, bathing, massage and gymnastics.
6. Anomalies of the constitution and others.

A very common cause is malnutrition precisely in terms of the amount of food. It can be observed from the first day of a newborn's life. It is connected with the fact that the woman in labor does not produce enough breast milk, her mammary gland is tight, and it is difficult for the newborn to suck food out of it, although sluggish sucking is possible (for example, in premature infants born in asphyxia or with intracranial birth trauma, having other malformations). It is important that forcing a child to eat by force, you can also cause the ailment in question in him. The disease in most children is associated with nutritional deficiency nutrients: proteins, fats, carbohydrates, vitamins, microelements, gross violations of all types of metabolism. Such cases are possible if the nutrition of the newborn is mixed: breast milk and formulas.

Internal causes of malnutrition in young children are divided into congenital (developmental internal organs) and hereditary (immunodeficiency, metabolic disorders, etc.).

A significant role in the development of the disease can be played by unfavorable environment(external factor). It includes a violation of sanitary and hygienic standards, a lack of time spent in the fresh air and light. Also, the external factor includes improper care of the baby.

Signs of malnutrition 1, 2 and 3 degrees in newborns

Clinically, there are 3 degrees of malnutrition in young children. The leading symptom is a lack of body weight with relatively normal growth. The course of the disease is divided into periods:

1. Elementary.
2. Progression.
3. Stabilization.
4. Reconvalescence.

If signs of the disease are detected on initial stage, with proper care and proper treatment, the baby quickly gains desired weight especially when breastfeeding.

With malnutrition in young children, a large number of manifestations of various symptoms can be noted. Most important feature- this is a malnutrition, as a result of which the weight of the baby decreases, there is a slowdown in growth. Also, a consequence of poor appetite and malnutrition is a change in the functions of the central nervous system (muscle tone weakens, restless sleep, emotional condition unstable). Another significant symptom is the deterioration of food digestion (possible vomiting, poor appetite bowel function slows down). The body becomes very susceptible to infectious diseases.

Take a look, below are photos depicting the manifestation of hypotrophy of varying severity in children:

Hypotrophy 1 degrees characterized by the fact that there is a lack of body weight by approximately 1/10 - 1/5 of the established norm, but at the same time, the baby is not inferior to peers in terms of growth. The skin practically does not change its color or may turn slightly pale, the state of health is not disturbed. Appetite in children with 1 degree of hypertrophy worsens slightly, but the stool is normal. Outwardly, the disease is almost invisible, only an experienced doctor can put correct diagnosis, and before that, he will conduct a series of diagnostics in order to understand whether the lack of mass is related to the structural features of the body.

Hypotrophy 2 degrees in one-year-old children, it is caused by a deficit in body weight, which reaches up to 20-30% of the norm. In this case, a lag in growth of 2-4 cm from the norm is possible. The patient's skin is dry and pale, the subcutaneous fat layer becomes thinner, which is why it wrinkles, and the muscles become flabby. Appetite noticeably worsens, and after eating food, the child spits it up. The kid becomes capricious, his mood is changeable, his sleep is restless, general physical state violated. Breathing quickens, pressure decreases, and heart rate accelerates. There is also a deterioration in thermoregulation, which is characterized by constantly cold hands and feet. Infectious diseases are frequent and protracted, rickets develops, the child becomes irritable and quickly weakens.

For malnutrition 3 degrees in young children, a decrease in body weight by more than 30% is characteristic, a lag of up to 10 cm in growth. The dermis is devoid of subcutaneous fat, wrinkled and pale, earthy in color, the face becomes like an old man's, with a pointed chin. The extremities are always cold, the temperature is low, the stool is either liquid, and urination is infrequent. The muscle tone is extremely high, while they are thinned, the stomach sinks. The pressure is reduced, breathing is superficial, the baby is lethargic in reaction to irritants, asthenic emotions dominate, immunity is critically reduced, protracted infections take place, and are pronounced. Anemia can be diagnosed, in which the blood becomes thicker, hemoglobin and the number of red blood cells increase. There may be a delay in the development of various static and mobile skills, speech that is devoid of intonation.

Diagnosis for the detection of malnutrition in children under one year old

Diagnosis of malnutrition in young children is necessary when the first symptoms of the disease are detected. She is very milestone to ensure proper treatment and get well soon child.

If you think your child is underweight, you should contact your local pediatrician.

During a medical examination in a children's clinic, a pediatrician conducts a detailed medical history, examines the child, checks weighing, makes sure that breast milk is sufficient or insufficient, prescribes additional methods examinations - a general blood test, a general urinalysis, a coprogram, feces for dysbacteriosis and an immunogram (if indicated), as well as consultations of specialist doctors - a neurologist, orthopedist, ophthalmologist, endocrinologist and immunologist (if indicated).

Treatment, nutrition and care of children with different degrees of malnutrition

Treatment of malnutrition in young children should be comprehensive and take into account the individual characteristics of the patient. Doctor prescribes it.

Sick children should eat regularly. It is preferable to use mother's milk, but if it is not available, then it is permissible to feed with the intended mixtures, which are necessary for children with low weight.

The nutrition of children in the presence of malnutrition is divided into 2 phases. The first involves the fact that the body is accustomed to a gradual increase in nutrients and nutrients. After successfully passing this stage, they proceed to the second, when the baby eats regular baby food in those doses that correspond to the age norm.

It is important to know that malnutrition found in newborns has a lower rate of recovery, especially if the degree of the disease is severe. A prolonged illness can cause deterioration mental development. Therefore, stage 1 of the disease is treated on an outpatient basis, and stages 2 and 3 are treated in a hospital.

The pediatrician diagnoses malnutrition, eliminates feeding defects, calculates nutrition for the main food ingredients (proteins, fats, carbohydrates, calories per kilogram of the child’s weight), prescribes balanced diet(increasing the calorie content of the diet by 10-15%) until the proper weight is reached. Optimal nutrition for children with malnutrition is breast milk. In case of insufficiency of breast milk, measures are prescribed to combat hypogalactia, and in its absence, adapted physiological, better fermented milk mixtures intended for feeding healthy children in the first year of life.

Treatment of malnutrition different stages in young children may be accompanied by prescriptions of vitamins and enzymes:

1. Gastric juice - ½ tsp. 5 times a day or 1% HCl solution with pepsin before feeding.
2. Pancreatin - 0.2 g 2 times a day an hour after a meal.

Therapy is carried out for 1-1.5 weeks. Perhaps the use of anabolics.

As for caring for a small child with malnutrition, it is important to provide the most favorable conditions for life due to reduced immunity. In the room where the baby lives, you need temperature regime not less than +24°С. He should choose clothes for walking, according to weather conditions, do not overcool a weakened body. When the air temperature outside is less than + 5 ° C, walks are not recommended. In addition, you need:

1. Bathing the child before bed.
2. Washing the baby in the morning and evening.
3. Treatment of skin folds.
4. Exception long stay on wet diapers.
5. Washing after urination or defecation.

Despite all Taken measures, malnutrition can continue to develop if it is due to a congenital defect.

Prevention of the development of malnutrition and paratrophy in young children

Prevention of malnutrition in children should begin at the stage of gestation.

Very important:

1. Proper nutrition, smoking and alcohol cessation by a pregnant woman.
2. In case of influence of harmful production factors removal from such work, transition to lighter work.
3. Rational consumption of food by a nursing woman.
4. Feeding a newborn only with breast milk or special dry mixtures.
5. Monthly baby weight check.
6. Compliance with the rules of child care.

Prevention of the development of malnutrition and paratrophy in children also implies sufficient exposure of the baby to the fresh air and the sun, the provision of massage and children's gymnastics. Up to 1.5 years, as prescribed by the doctor, vitamin D should be given to the child.

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Parents are not always to blame for the occurrence of malnutrition in children. It happens that the mother has enough milk, and the child sucks the breast reluctantly. Or, a woman’s nipple is strongly drawn in, and the baby does not have the opportunity to get enough of it. It is possible to develop malnutrition in young children and due to birth defects oral cavity baby or lack of a sucking reflex.

Causes and symptoms of malnutrition in children

Hypotrophy refers to reduced nutrition; is one of the chronic eating disorders in children.

The most common cause of malnutrition in children is a violation of the feeding of the child; Proper feeding is especially important in the first few months of life. If the mother has hypogalactia, the child constantly does not have enough milk. Also, the child may be malnourished for a long time if the mother flat nipple, inverted nipple. Other children do not actively suckle their breasts (they are also called sluggish, or lazy, suckers), in others, physical defects (cleft lip, for example) prevent normal sucking, and in premature and immature children, as a rule, they are underdeveloped (maybe completely absent). ) sucking reflex. There is congenital malnutrition, which has developed as a result of certain diseases of the mother or as a result of some violations. Often, malnutrition occurs due to frequent and serious illnesses child (viral infections, diseases of the stomach and intestines, scarlet fever, as well as chronic infections, etc.). Contribute to the development of malnutrition can be constant violations of the daily routine, improper care of the child, hypovitaminosis (insufficient intake of vitamins in the body). Hypotrophy is also observed in a child who, for some reason, is transferred too early to mixed or artificial feeding, and the ratio of nutrients in the food offered to him is not balanced.

The main symptom of the manifestation of malnutrition in children is a decrease in nutrition; significant thinning or complete disappearance of the subcutaneous fat layer.

The photo of malnutrition in children shows how malnourished babies are who do not receive enough nutrition:

Hypotrophy in children I, II and III degree

When classifying malnutrition in children, there are three degrees of the disease.

The manifestations of malnutrition of the first degree are as follows: the subcutaneous fat layer is preserved everywhere, however, it becomes somewhat thinner on the abdomen and on the extremities (normally, the skin fold at the level of the navel is 1.5 cm thick); the elasticity of the skin and muscles is somewhat reduced; when weighing, a lag in weight from the norm by 10-20% is detected; growth corresponds to age; the general condition does not suffer, the state of health is not disturbed, however, the child may be capricious; integuments - normal color or slightly pale.

For malnutrition of the II degree in children, the following manifestations are characteristic: the subcutaneous fat layer on the abdomen and on the limbs disappears; on the chest, neck and face, it becomes noticeably thinner; there is a decrease in weight by 20-30%, in addition, growth suffers; the child is pale, the skin is flabby and folds easily; the fold straightens out slowly; the child is lagging behind in, his general condition and well-being are disturbed; the child is sometimes restless and excited, sometimes sluggish and whiny, he has a bad dream.

With malnutrition III degree, which is characterized by a lag in weight from the norm by more than 30%, a different picture is observed: the subcutaneous fat layer is absent everywhere, growth stops; facial features are sharpened, and the child's face takes on an senile look, the eyes seem to fall into the sockets; a large fontanel sinks; the skin is pale, the skin is dry, flaky; the mucous membrane of the lips against this background is bright red; the muscles become thinner, the ribs show through, the stomach retracts; dyspepsia is often observed; feeling unwell; the child is lethargic and weak, inactive; his cry is weak; breathing is slow and uneven, the pulse is poorly palpable; no appetite, but expressed thirst; the child has a reduced reactivity of the body, so it is susceptible to infection, complications such as otitis media, pyelitis, pneumonia, etc. may occur.

Treatment and prevention of malnutrition in young children

Treatment of malnutrition in young children is prescribed complex, and it begins with the elimination of the causes of malnutrition. The child needs good care and proper hygiene. The most important place is occupied by diet therapy. Even with malnutrition of the first degree, the child's nutrition is controlled by a doctor. All appointments are also made by a doctor. In the treatment of malnutrition in children, the child is given daily general massage, therapeutic gymnastics classes are held. Closer to recovery - active games, long walks.

As preventive measures, the following can be considered: a good level of child care; daily monitoring of weight gain (it is recommended for mom to draw a weight curve); strict adherence to the diet (the child's nutrition is periodically monitored by the district pediatrician); control over the sufficient intake of vitamins in the body; observance of the sanitary and hygienic regime aimed at preventing infectious diseases; in case of illness - timely seeking medical help and timely treatment; hardening of the child. Especially careful attention in the prevention of malnutrition in children is required by babies who, for some reason, were transferred to mixed or artificial feeding.

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It is extremely common to observe malnutrition in children, accompanied by a slight increase in body weight in relation to height and age. When this gap exceeds 10%, hypotrophy is diagnosed.

Hypotrophy (protein-energy malnutrition (PEM)) is a spectrum of conditions caused by various levels of protein and calorie deficiency and is characterized by insufficient body weight in relation to height.

Hypostatura is described as one of the variants of PEI, in which an interconnected deficit is established, both in body weight and in height.

The causes of malnutrition can be divided into two groups:

• exogenous (associated with external factors);
• endogenous (internal causes).

The mechanism of the onset of the disease and the development of its manifestations (pathogenesis)

In pathogenesis, the following pathophysiological phases are distinguished:

1. 1st phase - hungry excitement. The consumption of reserve reserves of carbohydrates provides the body's energy needs, the metabolism of amino acids weakens, and the excretion of nitrogen decreases.
2. 2nd phase - the phase in which the metabolism switches to the breakdown of fat, the main metabolism decreases, the synthesis of vital proteins is still preserved due to the breakdown of other body proteins.
3. The 3rd phase is irreversible: the splitting of the “internal” protein is carried out to cover energy goals, changes occur in the structure of mitochondria (organelles that are the energy base of cells) with a violation of their regulatory mechanisms.

Symptoms

Clinical manifestations of malnutrition are grouped into several syndromes.

Trophic disorder syndrome

Lack of tissue nutrition that caused structural changes tissue and cell death

• flat or negative curve of body weight in dynamics;
• deficiency of body weight, to a lesser extent - body length;
• the proportionality of the physique is violated;
• trophic disorders of the skin and skin appendages: decreased elasticity, sagging, dryness, with cachexia (extreme exhaustion of the body) - a symptom of a "pouch" (a narrow mouth opening with deep wrinkles around it), dull nails and hair, alopecia (baldness);
• the subcutaneous fat layer is consistently thinning - on the body, abdomen, limbs, face;
• muscle hypotorphy and increasing muscle hypotension;
• decrease in tissue elasticity.

Syndrome of digestive disorders and impaired food tolerance

• appetite decreases up to anorexia;
• increasing dyspeptic disorders - regurgitation, unstable stools, irregular defecation, followed by constipation;
• enzymatic and secretory gastrointestinal tract are weakened.

CNS dysfunction syndrome

• disturbed emotional tone (scream, cry) and neuro-reflex excitability;
• involuntary muscle contraction;
• hyporeflexia (decreased reflexes);
• lag of psycho-emotional development;
• thermoregulation and sleep are disturbed.

Syndrome of impaired hematopoiesis and immunobiological reactivity

• deficiency of iron and other micro and macro elements, vitamins (iron deficiency anemia, rickets, etc.);
• frequent infectious and inflammatory diseases, their course is erased and atypical;
• develop toxic-septic conditions, dysbiocenosis of natural microbiological niches;
• signs of secondary immunodeficiency.

Weakened nonspecific resistance.

Depending on the lack of body weight, three degrees of malnutrition are distinguished: at degree 1, the insufficiency is 11–20% of the due value, at degree 2 - 21–30%, at degree 3 – a deficiency of more than 30% of the due body weight. IN clinical practice hypotrophy of the 1st degree prevails, mainly associated with temporary alimentary disorders, the second degree is less often observed, the development of which is associated with a complex etiological factors predominantly endogenous. III degree or cachexia with irreversible organ system consequences and subsequent death is a rare condition.

Fetal hypotraphy

Fetal hypotrophy is a delay in intrauterine development of the child.

There are three options for the development of pathology:

1. Hypotrophic. There is a malnutrition of all systems and organs, characterized by slow development of the fetus, which does not correspond to the gestational age.
2. Hypoplastic. It is characterized by a delay in the maturation of all organs, combined with a lag general development fetus. This means that at birth, tissues and organs are not sufficiently formed and their functions are not fully performed.
3. Dysplastic. There is uneven development of some organs. For example, the liver, heart develop in accordance with the gestational age, and other organs have a lag in maturation.

Diagnosis of malnutrition in children

Diagnosis is based on anthropometry data (a method of measuring the human body and its parts): a lack of body weight and a slowdown in growth relative to proper values.

In the blood test, anemia is detected, with malnutrition of the 3rd degree - absolute lymphopenia (decrease in lymphocytes), slowing down the ESR.

At biochemical research reveal:

• hypoalbuminemia (decrease in albumin, a substance that is an integral part of blood plasma);
• dysproteinemia (imbalance between blood protein fractions);
• hypoglycemia (decrease in glucose concentration);
• hypocholesterolemia (decreased cholesterol);
• dyslipilemia (impaired lipid balance).

In the analysis of urine - leukocyturia, ketone bodies, an excess amount of ammonia. In the coprogram - signs of impaired intestinal digestion.

How is the treatment carried out?

Children with grade 1 malnutrition are treated on an outpatient basis when the social environment is favorable. At the 2nd - 3rd degree, therapy is carried out only in a hospital (first in the intensive care unit, then in the general somatic unit).

All children need a therapeutic and protective regimen: sufficient sleep in calm conditions, regular ventilation of the room, access sun rays, twice a day wet cleaning. The temperature in the room is maintained at 25 - 26 ° C. Walks, physiotherapy, massage, bathing - daily; skin and visible mucous membranes are carefully cared for (moisturizing creams, emulsions, vitamin masks).

Diet therapy is the basis of treatment, and is carried out in 3 stages. The basis is the rejuvenation of the diet (“step back”), that is, they use foods that are typical for an earlier age group.

When a child is breastfed, it is unacceptable to exclude a single drop of mother's milk from the diet of a patient with malnutrition.

Organization of diet therapy

In the complex treatment of children, enzyme replacement therapy is used, taking into account the coprogram, as well as vitamin D3, iron preparations, vitamins of groups B, C, PP, A and E. Probiotic preparations based on bifido- and lactobacilli are prescribed to correct microbiocenosis disorders. At the 3rd degree of malnutrition, antimycotic agents are used to prevent candidal lesions of the intestine.

The use of anabolic medicines carried out with caution, since, under the condition of a deficiency of nutrients, their use can lead to profound violations of protein and other types of metabolism.

Conclusion

The prognosis is favorable for PEU of the 1st and 2nd degree. With the 3rd degree of malnutrition, despite the ongoing treatment, mortality is 20 - 50% of cases.

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

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

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

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

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

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

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

Children with Down syndrome are at risk for malnutrition How is the disease diagnosed?

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

Degree 1. At first glance, the baby feels satisfactory. If you examine it more closely, you can find a decrease in skin elasticity, a low subcutaneous fat layer on the abdomen. According to the parents, the child's appetite is reduced, weight is growing slowly. Objectively, the doctor notes that body weight is 10-20% lower than normal. A decrease in the level can be seen digestive enzymes, while the body temperature is normal and the development of motor functions is within the normal range.

Degree 2. The child is depressed, his activity is reduced, his appetite is disturbed. The skin is pale, dry, inelastic, weak muscle tone. The subcutaneous fat layer is noticeably reduced on the abdomen, arms and legs, but on the face it is normal. The temperature fluctuates during the day within one degree, which indicates a disorder of thermoregulation. The baby almost does not grow weight (it is 20-30% less than the norm), tachycardia, muffled heart tones may be noted. These symptoms are not the only ones: the child begins to lag behind in development - he lacks the strength to catch up with his peers.

Degree 3. This is the most severe degree of malnutrition, it is diagnosed when the child's general condition is significantly impaired. The baby does not have a subcutaneous fat layer - on the stomach, arms and legs, on the face. The child resembles a skeleton covered with skin. His weight does not increase and may even decrease. The mood of the baby changes - from lethargy and apathy, he goes into the stage of irritability and tearfulness. The body temperature drops, hands and feet are cold. Breathing is shallow, heart sounds are muffled, arrhythmia is manifested. The child is constantly spitting up, he has frequent liquid stool, urination in small portions. Weight below normal by more than 30%.

The third degree of malnutrition is the complete exhaustion of the body. Chair with malnutrition

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

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

Complications

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

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

Hypotrophy can lead to the development of rickets

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

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

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

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

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

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

Child care during recovery

Newborns with a diagnosis of "hypotrophy" should be in cuveuses, in which the temperature is constantly maintained at about 30 ° C. So that the skin does not dry out, after the bath they wipe the body with oil, to which vitamin A is added. Older children also need to provide appropriate conditions: the air temperature in the room should be about 24 ° C, humidity - 60-70%.

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

The simplest massage techniques:

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

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

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

Adaptation period

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

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

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

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

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

The total amount of food eaten should reach one-fifth of the child's weight 2 and 3 stages of therapeutic nutrition

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

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

Medical therapy

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

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

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

Bath with soothing herbs is very beneficial for the nervous system

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

Prevention

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

Nutrition should be balanced: from six months, vegetable food is introduced into the baby's menu, closer to a year - meat, fish, eggs. It is important to observe drinking regimen and make sure that the child drinks not only formula or breast milk, but also water, various teas, compotes. infant you need to show the pediatrician monthly and carry out control weighings and measurements of physical indicators. At the first sign of a lag in weight or height, the cause of such deviations should be found and eliminated. Subject to all these recommendations, the likelihood of developing malnutrition will be minimized.

It is very common in children pathological disorder nutrition, which is accompanied by a small increase in body weight compared to the norms in relation to age and height. If this gap is more than 10%, malnutrition is diagnosed, which most often manifests itself before 3 years.

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

Causes of the disease

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

Intrauterine malnutrition:

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

Extrauterine malnutrition:

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

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

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

Classification

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

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

The above three degrees of malnutrition suggest different symptoms and methods of treatment.

Symptoms of childhood malnutrition

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

I degree

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

II degree

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

III degree

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

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

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

Treatment of the disease

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

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

At timely treatment diseases of I and II degrees, the prognosis is favorable, but with malnutrition of the III degree in 50% of cases, a fatal outcome is noted.

Prevention methods

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

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

After the baby is born important role are playing:

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

Having heard such a diagnosis as malnutrition, parents should not give up. If you provide the child with normal conditions for the regimen, care and nutrition, quick and effective treatment possible infections, severe forms can be avoided.

Often, young children have insufficient weight gain for their age and height. Chronic weight gain of 10% or more that is missing in a baby is called malnutrition.

This pathologically disturbed nutrition is an independent disease - a kind of dystrophy. More often it is observed in babies of the first 3 years of life, causes serious changes in the body, so it is so important to identify and treat it in time.

Hypotrophy is also accompanied by a slowdown in growth, psychomotor development. A lack of body weight is due to insufficient intake of food or problems with the absorption of nutrients in the baby's body.

Classification

Depending on the period of development of malnutrition, there are:

1. Congenital, or arising in utero (prenatal), malnutrition, which develops as a result of oxygen starvation fetus, with a delay in its development.
2. Acquired malnutrition (postnatal), which occurs as a result of a protein-energy deficiency in the body that is not compensated by the calorie content and composition of food. Deficiency may be due to an unbalanced composition of food, a violation of its digestion or absorption of nutrients.
3. Mixed malnutrition, during the development of which additional postnatal causes (alimentary or social order) are added to the factors of the prenatal stage.

According to the severity, malnutrition is distinguished:

• 1 (mild) degree: the weight deficit is 10-20% of the norm by age, and the growth of the baby is normal;
• 2 (medium) degree: weight is reduced by 20-30%, and height - by 2-3 cm from the average age norm;
• 3 (severe) degree: the weight deficit exceeds 30% of the due against the background of a pronounced lag in growth.

During malnutrition in children, periods are distinguished:

• elementary;
• progression;
• stabilization;
• recovery or convalescence.

Causes of malnutrition

Preeclampsia and placental dysfunction can lead to intrauterine hypotrophy of the fetus.

Hypotrophy of a child can be caused by many factors of the prenatal and postnatal stages of its development.

Intrauterine malnutrition may be associated with:

1. Pathology of pregnancy:

• toxicosis;
• preeclampsia;
• fetoplacental insufficiency;
• premature birth;
• fetal hypoxia;
• intrauterine infection.

1. Factors unfavorable for the development of the fetus:

• bad habits in a pregnant woman;
• stressful situations or frequent depression;
• malnutrition of a woman when carrying a child;
• non-compliance with the daily routine during pregnancy;
• unfavorable environment;
• industrial hazards.

1. The presence of a serious pathology in the expectant mother:

• heart defects;
• diabetes;
• chronic pyelonephritis;
• hypertension;
• nephropathy.

Acquired malnutrition in a child can be caused by endogenous or exogenous causes.

Endogenous causes include:

• congenital anomalies of development (including chromosomal);
• enzymatic deficiency, including malabsorption syndrome, lactase deficiency, celiac disease, etc.;
• constitutional anomalies (diathesis);
• immunodeficiency state.

Among the exogenous factors that cause malnutrition, there are alimentary, infectious and social factors.

1. Alimentary factors are unbalanced or insufficient food, the consumption of which causes a protein and energy deficiency. Alimentary factors include:

• regular malnutrition associated with impaired sucking (due to inverted or flat nipples of the mother's breast);
• lack of nutrition with a decrease in lactation or a decrease in the volume of milk mixtures;
• profuse regurgitation in the baby;
• poor-quality composition of milk with insufficient nutrition of the mother;
• infant diseases that impede the process of sucking and proper nutrition: pyloric stenosis, cleft lip, cleft palate, cerebral palsy, birth defects hearts, etc.

1. Infectious factors that can lead to malnutrition:

• intestinal group of infections;
• severe pneumonia;
• frequently occurring respiratory diseases;
• tuberculosis, etc.

1. Social factors play an important role in the appearance of malnutrition. These include:

• insufficient financial support for the family;
• unsanitary conditions and errors in caring for the baby (lack of walks in the air, non-compliance with the daily routine, insufficient sleep, etc.).

If there are several reasons for hypotrophy, then the disease progresses at an accelerated pace, since they complement each other. Malnutrition reduces immunity, contributes to the occurrence of infectious pathology, which provokes weight loss and increases malnutrition. A vicious circle is formed, and malnutrition is rapidly increasing.

Symptoms

Manifestations of malnutrition depend on the severity of the process. congenital form Doctors determine diseases already at the first examination of the baby. Postnatal malnutrition is diagnosed in the process of monitoring the development of the baby according to characteristic features.

With a mild degree of the disease, the general condition of the crumbs does not suffer. In neuropsychic development, the child does not lag behind. There may be some loss of appetite. From objective data, the following manifestations can be detected:

• pale skin;
• tissue elasticity is reduced;
• the subcutaneous fat layer in the abdomen is thinned.

Children with moderate malnutrition are characterized by reduced activity. Lethargy can be replaced by excitement. Characterized by a lag in the development of motor skills. Appetite is greatly reduced. Flaky, flabby, pale skin. Muscle tone reduced. Due to the deterioration of elasticity, skin folds are easily formed, cracking down with difficulty.

The subcutaneous fat layer is preserved only on the face, and is completely absent in other parts of the body. Respiration and heart rate are quickened, blood pressure is reduced. Children often develop somatic diseases - pyelonephritis, pneumonia, otitis, etc.

With severe malnutrition, the subcutaneous fat layer in children disappears not only on the trunk and limbs, but also on the face. The child lags far behind both in physical and neuropsychic development. Growth is significantly reduced, muscles are atrophic, tissue density and elasticity are completely lost.

The baby is lethargic, almost motionless. There is no reaction to external stimuli - not only to light, sound, but even to pain. It is obvious that the child is emaciated. Babies have a sunken large fontanel. The skin is pale, has a grayish tint.

Pallor and dryness of the mucous membranes, cracked lips, sharpened facial features, sunken eyes are expressed. Thermoregulation is broken. Babies spit up (or vomit), are prone to diarrhea, and urinate infrequently.

For children with severe malnutrition, the following diseases are characteristic:

• fungal infection of the oral mucosa (thrush);
• conjunctivitis;
• anemia;
• pneumonia (inflammation of the lungs);
• rickets;
• alopecia (hair loss), etc.

In the terminal stage, the temperature drops sharply, slows down heartbeat drops in blood sugar levels.

Diagnostics

The doctor will detect fetal hypotrophy during the next ultrasound examination conducted by the pregnant woman.

Intrauterine malnutrition can be detected during an ultrasound screening examination of pregnant women. The measured dimensions of the fetal head, body length and the calculation of the estimated weight of the fetus make it possible to assess its development in accordance with the gestational age, to identify intrauterine maturation delay.

A pregnant woman is hospitalized in order to identify the cause that caused fetal hypotrophy. Congenital malnutrition is diagnosed by a neonatologist (pediatrician of the maternity ward, specialist in newborns) at the first examination of a born baby.

Acquired malnutrition is detected by a pediatrician when observing a child on the basis of controlled anthropometric data: height, weight, chest circumference, head, abdomen, hips and shoulders. The thickness of the skin-fat fold in different parts of the body is also determined.

If malnutrition is detected, a deeper examination is prescribed to identify its cause:

• consultations of pediatric specialists (cardiologist, neuropathologist, geneticist, gastroenterologist, endocrinologist);
• laboratory methods: blood test (clinical and biochemical method), urinalysis, feces for dysbacteriosis, coprogram;
• hardware research: ECG, ultrasound, echocardiography, electroencephalography, etc.

Treatment

Treatment of children with mild (1st) degree malnutrition can be carried out at home in the absence of concomitant pathology and a minimized risk of complications. When diagnosing moderate and severe malnutrition (2nd or 3rd degree), the child is hospitalized.

Appointed complex therapy, the purpose of which is:

• elimination of the cause of the disease;
• ensuring a balanced diet in accordance with age norms;
• treatment of complications caused by malnutrition.

For each child, an individual set of measures is selected depending on the severity of malnutrition.

Comprehensive treatment should include:

• identifying the cause of malnutrition and, if possible, eliminating it;
• diet therapy, which is the basis for the treatment of malnutrition;
• treatment of existing foci of infection in a child;
• symptomatic therapy;
• proper care of the baby;
• Exercise therapy and massage, physiotherapy.

When choosing a diet, it is important to take into account the degree of dysfunction of the digestive organs and the degree of malnutrition.

diet therapy

Nutrition correction is carried out in several stages:

1. At the first stage in the process medical supervision the possibility of full digestion and assimilation of food in the body is determined. The duration of observation varies from several days with 1 degree of malnutrition to 2 weeks with 3 degrees. The digestibility of food and the presence of bloating, diarrhea or other signs of indigestion are determined.

From the first days of treatment, a reduced amount of food per day is prescribed: with 1 degree of malnutrition, it is equal to 2/3 of the volume due to age, with 2 - ½ volume, with 3 degrees - 1/3 of the age norm of daily volume.

The intervals between feedings are reduced, but the frequency of meals increases: with 1 degree of malnutrition up to 7 times a day, with 2 - up to 8 times, with 3 - up to 10 times.

1. The second stage is called transitional. The purpose of the diet during this period of treatment is to gradually compensate for the deficiency of nutrients, minerals and vitamins necessary to restore health.

Tactics are used to increase the volume of a portion of food and its calorie content, but the number of feedings per day is reduced. With small daily additions of the amount of food, the volume is gradually brought to a full age.

1. The third stage of diet therapy is characterized by enhanced nutrition. It is possible to increase the food load only if the functional ability of the digestive organs is fully restored.

An important condition for diet therapy is the use of easily digestible food. The optimal nutrition is mother's milk. In its absence, milk mixtures are prescribed, the choice of which is made by the doctor.

With severe malnutrition, when the child is unable to eat on his own, or the affected organs of the digestive tract are not able to digest it, the baby is prescribed parenteral nutrition.

At the same time, not only nutrient solutions are administered intravenously ( glucose solution, protein hydrolysates), as well as electrolyte solutions (Trisol, Disol), vitamins to replenish the body's need for fluids and maintain metabolism.

During treatment (in order to facilitate nutrition control), a special diary records the quantity and quality of the food received, including nutrient mixtures administered intravenously. The nature of the stool and the number of bowel movements per day, the number of urination and the volume of urine excreted are monitored and reflected in the diary.

Repeatedly in a week, the coprogram is examined (the presence of undigested fibers, fatty inclusions is determined in the feces). The child's body weight is monitored weekly, on the basis of which the doctor recalculates the need for nutrients.

The criteria for the effectiveness of diet therapy are:

• improved condition of the baby;
• restoration of skin elasticity;
• normal emotional state of the child;
• the appearance of appetite;
• daily increase in body weight by 25-30 g.

The child must be hospitalized with his mother. It will provide care not only at home, but also in the hospital.

Care

One of the components of the complex treatment of malnutrition is a general strengthening massage.

Care for a child with malnutrition should provide:

• comfortable conditions for the baby at home and in the hospital;
• airing the room at least 2 times a day;
• air temperature should be 24-25 C;
• daily exposure to air;
• conducting special exercises to restore muscle tone;
• massage courses for a beneficial effect on the baby's body.

Medical therapy

Drug therapy for malnutrition may include:

• the appointment of probiotics to correct the imbalance of microflora in the intestine (Bifiliz, Atsilakt, Linex, Probifor, Bifiform, Florin Forte, yogurts, etc.);
• enzyme therapy with a decrease in the ability of the gastrointestinal tract to digest food - the prescribed drugs will compensate for the lack of digestive juices of the stomach, pancreas (gastric juice, Creon, Panzinorm, Festal);
• vitamin therapy - at first, drugs are injected (vitamins B1, B6, C), and after normalization of the condition, vitamin-mineral complexes are prescribed orally;
• stimulating therapy that improves metabolic processes: Dibazol, ginseng, Pentoxifylline improve blood flow and provide delivery of oxygen and nutrients to tissues.

If any complications are detected in a child, symptomatic therapy is carried out.

With anemia, iron preparations are prescribed (Totem, Sorbifer, etc.). In the case of a hemoglobin index below 70 g / l, red blood cells can be transfused.

The appointment of immunoglobulin will increase the protective capabilities of the body and protect the baby from infection.

If signs of rickets are detected, a course of treatment with vitamin D plus UVR is carried out in a physical room.

Forecast

Timely treatment of mild to moderate malnutrition will provide a favorable prognosis for the life of the baby. With a severe degree of malnutrition, a lethal outcome is possible in 30-50% of cases.

Prevention

To prevent intrauterine malnutrition, measures should be taken during the period of bearing a child:

• elimination of factors of adverse effect on the fetus;
• regular observation of a woman by a gynecologist and timely screening studies;
• proper nutrition of a pregnant woman;
• timely correction of the pathology of pregnancy;
• strict observance of the pregnant regimen of the day.

For the prevention of postnatal malnutrition, it is necessary:

• regular observation of the child by a pediatrician and anthropometry;
• breastfeeding a baby;
• balanced nutrition of a woman during lactation;
• correct and timely introduction of complementary foods;
• ensuring competent care of the newborn;
• treatment of any disease of the baby as prescribed by the pediatrician.

Summary for parents

Hypotrophy in a baby at an early age is not just a lag in body weight of 10% or more. This disease leads to a lag in mental development, speech. Progressive malnutrition leads to exhaustion and poses a threat to the life of the baby.

The birth of a child is an event of extreme importance. It is necessary to prepare for it and observe all medical recommendations during the period of gestation. These measures will help to avoid the development of malnutrition in the womb.

After the birth of a baby, breastfeeding, proper care of the newborn, regular monitoring of the baby's developmental indicators (physical and mental) will make it possible to prevent the development of acquired malnutrition.

In the event of the occurrence of this serious disease in a child, only timely full-fledged treatment will help restore the health of the crumbs.

Hypotrophy in children is starvation, quantitative or qualitative, as a result of which significant changes occur in the body. Quality fasting is possible with the wrong artificial feeding, lack of essential nutrients and vitamins, quantitative - with incorrect calculation of caloric content or lack of food resources.

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

What does a normally developing baby look like?

Signs of normotrophic:

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

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

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

According to scientific research, such a deficient 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 - anemia. Half of the children with this pathology are born in the cold season.

Causes and development

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

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

Causes of acquired malnutrition

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

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

In Group endogenous factors worth highlighting separately food allergy and three hereditary diseases that occur with malabsorption syndrome - one of common causes malnutrition in children:

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

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

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

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

Symptoms

Signs and symptoms of intrauterine malnutrition in a child:

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

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

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

Degrees of malnutrition in children

Hypotrophy of the 1st degree is sometimes practically not noticeable. Only an attentive doctor on examination can identify it, and even then he will first differential diagnosis and find out if a body weight deficit of 11-20% is not a feature of the child's physique. Thin and tall children are usually so due to hereditary characteristics. Therefore, a new mother should not be afraid if her active, cheerful, well-nourished child is not as plump as other children.

Hypotrophy of the 1st degree in children is characterized by a slight decrease in appetite, anxiety, sleep disturbance. The surface of the skin is practically not changed, but its elasticity is reduced, the appearance may be pale. The child looks thin only in the abdomen. Muscle tone is normal or slightly reduced. Sometimes they show signs of rickets, anemia. Children get sick more often than their well-fed peers. Stool changes are insignificant: a tendency to constipation or vice versa.

Hypotrophy of the 2nd degree in children is manifested by a mass deficit of 20-30% and growth retardation (about 2-4 cm). Mom can find cold hands and feet in a child, he can often spit up, refuse to eat, be lethargic, inactive, sad. Such children lag behind in mental and motor development, sleep poorly. Their skin is dry, pale, flaky, easily folded, inelastic. The child looks thin in the abdomen and limbs, and the contours of the ribs are visible. The stool fluctuates greatly from constipation to diarrhea. These kids get sick every quarter.

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

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

Diagnostics

Differential Diagnosis

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

Treatment

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

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

Treatment of congenital malnutrition is to maintain the child constant temperature body and forging breastfeeding.

Nutrition for children with malnutrition

Diet therapy for malnutrition is divided into three stages.

The main directions of drug therapy

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

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

Study of the causes and symptoms of malnutrition in children

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

Prevention of malnutrition in children

Prevention of both intrauterine and acquired malnutrition begins with the struggle for the health of the woman and for the preservation of long-term breastfeeding.

The following areas of prevention are tracking the main anthropometric indicators (height, weight), monitoring the nutrition of children.

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

It should be remembered:

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

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

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

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

Very often in children there is a pathological malnutrition, which is accompanied by a small increase in body weight compared to the norm in relation to age and height. If this gap is more than 10%, malnutrition is diagnosed, which most often manifests itself before 3 years.

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

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

Intrauterine malnutrition:

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

Extrauterine malnutrition:

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

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

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

Classification

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

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

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

Symptoms of childhood malnutrition

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

I degree

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

II degree

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

III degree

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

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

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

Treatment of the disease

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

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

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

Prevention methods

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

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

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

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

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