This condition is observed in children at an early age. The most common cause of malnutrition is lack of protein in the diet, as well as low nutritional and energy value of products.

Hypotrophy is the most common type of dystrophy, to which children in the first 2–3 years of life are especially susceptible. High mortality among children of this age has in the past been associated with malnutrition. Now, thanks to rising social standards of living and the emergence of effective medicines cases of malnutrition have become rare.

If we consider the problem of hunger globally, then it still remains relevant in many countries of the world, where it is a mass disease. The prevalence of this phenomenon varies in different countries from 2 to 30% and directly depends on the social and economic condition of the population.

From the moment of birth, children rapidly gain body weight, along with it all internal organs and bone tissue skeleton. In the early years decisive role in proper development baby playing food. If the diet is poor or the nutrition is insufficient, the child will show signs of changes in work internal organs and systems. Lack of weight affects the functioning of the digestive organs, which leads to problems with the absorption of vitamins and nutrients. A lack of weight of more than 10% in comparison with the norm is a reason to talk about malnutrition.

REASONS

The development of malnutrition is influenced by many reasons, and this condition can accompany other diseases.

If there is insufficient intake of nutrients into the body, they speak of the exogenous origin of the syndrome. In the event that the body is not able to absorb a sufficient amount of food, this indicates the endogenous nature of malnutrition.

Exogenous causes of malnutrition:

• underfeeding or overfeeding;
• unbalanced diet (nutritional factors);
• acute infectious processes;
• low social status families;
• wrong mode.

Endogenous causes of malnutrition:

• malformations of the digestive organs and other systems;
• endocrine pathologies;
• diseases of a neuroendocrine nature;
• metabolic diseases;
• congenital enzymopathies;
• malabsorption in the intestine;
• chromosomal abnormalities.

CLASSIFICATION

Hypotrophy is systematized in several directions.

Classification of malnutrition depending on the period of occurrence:

• Congenital(prenatal, or intrauterine). Its development is based on pathological changes in uteroplacental metabolism. Intrauterine malnutrition causes oxygen starvation fruit, metabolic disorders and entails a delay in the child’s development.
• Acquired(postnatal). Of primary importance is protein and energy deficiency caused by poor nutrition and pathological disorders in the process of digestion and absorption. The child does not compensate for the energy costs for growth and development, which should come with nutrients.
• Mixed the form indicates accession to congenital factors, infectious, social and nutritional reasons after the birth of the child.

Classification of malnutrition according to the severity of lack of body weight:

• I degree - mild;
• II degree - average;
• III degree - severe.

Dividing malnutrition into degrees of severity is necessary for correct assessment of the child’s condition and for planning treatment measures.

SYMPTOMS

Symptoms depend on the severity of the syndrome:

• I degree. Signs of a lag from optimal body weight are at the level of 10–20%. There is a slight loss of subcutaneous fat in the abdominal area. The general condition of the child is satisfactory. Noted loss of appetite, pallor, decreased muscle tone and sleep disturbance.
• II degree. Has a pronounced symptomatic picture. The height deficiency is 2–4 cm, and the weight deficiency is in the range of 20–30%. The child has weakness and apathy, dry skin, peeling and some swelling. Microcirculation is impaired, and thin layer subcutaneous tissue is concentrated only in the facial area. These symptoms are accompanied by nausea, vomiting and stool instability. When listening to the heart, muffled tones and . Respiratory function is impaired and blood pressure decreases.
• III degree. Weight deficiency of more than 30% is fraught with developmental delays and serious conditions. Arises high risk anorexia. In addition, the child loses previously acquired skills. His skin the integument is pale, dry, subcutaneous tissue is absent. Muscle atrophy occurs, symptoms of dehydration occur, cardiac activity decreases, and body temperature drops below normal.

DIAGNOSTICS

When diagnosing malnutrition, several factors must be taken into account: important points. One of the indicators of probable deviations is changes in the functioning of organs and systems.

Clinical signs to detect malnutrition:

• trophic changes;
• thinning of the fat layer under the skin;
• indigestion;
• changes in metabolism;
• disturbances in the functioning of the central nervous system.

One of the main criteria is the thickness of the subcutaneous fat layer: the smaller it is, the more pronounced the hypotrophy.

The syndrome is differentiated from diseases whose symptoms are manifested by weight loss, short stature and retardation. physical development child. These include dwarfism, or growth hormone deficiency. With this disease, there are no trophic changes, the subcutaneous tissue is not thinned, and the size of the organs corresponds to the size of the body.

Character feces is one of the signs of the severity of the pathological condition. Insufficient content Protein in a child’s diet leads to the fact that to compensate for its deficiency, the body uses internal reserves in the form of its own muscle tissue and fat layer. One of the metabolic products in this case is ammonia, which gives urine a characteristic odor. With the help laboratory research blood, it is possible to detect a decrease in the number of red blood cells and hemoglobin, a lack of vitamins, microelements and disturbances in the liver.

In case of complications from internal organs, instrumental diagnostic methods such as an electrocardiogram of the heart and an electroencephalogram of the brain are used.

Ultrasound examination is used to examine internal organs and to detect intrauterine malnutrition during pregnancy based on anthropometric indicators.

When making a diagnosis, the doctor evaluates living conditions, social and financial condition families, and also conducts surveys of parents on the subject of genetic pathologies. As a rule, diagnosing malnutrition is not difficult; problems may arise when identifying the causes of this condition.

TREATMENT

Treatment of malnutrition is the whole complex measures aimed at eliminating its root cause and restoring normal functioning of the body. Mild malnutrition is treated in an outpatient setting; moderate and severe malnutrition requires hospitalization.

Therapeutic measures for malnutrition:

• elimination or regulation of the etiological factor;
• diet therapy;
• elimination of chronic foci of infection;
• organization of a rational regime;
• compliance with child care rules;
• prescription of medications;
• vitamin therapy, use of enzymes (symptomatic treatment);
• massage, physical therapy.

Diet therapy deserves special attention. It is carried out in two stages: at the first, the tolerance of the products is determined, and then the volume of food and its calorie content are increased to the required standards. Meals are frequent and fractional - 7-10 meals per day in small portions.

In severe cases of malnutrition, when the child is not able to eat on his own, nutrition is provided through a tube. If the gastrointestinal tract is unable to accept food due to any internal damage, parenteral nutrition is used, which consists of intravenous administration of nutritional solutions, electrolytes and minerals. When cases of intrauterine fetal malnutrition are detected, the nutrition of the expectant mother is adjusted.

In children drug treatment malnutrition is aimed at maintaining normal functioning body in children and depends on the complications that arise.

A decrease in the functional activity of the digestive organs requires the prescription of enzymatic drugs to replace the deficiency of gastric juice and pancreatic enzymes. It is possible to prescribe immunomodulators, probiotics and antibiotics. Symptomatic therapy is aimed at treating anemia, reducing excitability and prescribing stimulant drugs.

A mandatory component of treatment is vitamin therapy. First, B vitamins and vitamin C are administered intramuscularly, and then proceed to their enteral use. Later, a course of multivitamin preparations is prescribed.

COMPLICATIONS

Considering possible negative consequences malnutrition, it is necessary to take into account the stage of development of the disease. Thus, mild malnutrition does not affect the child’s health. Insufficient body weight can provoke tendency to hypothermia, but with proper care and proper nutrition, these factors are easily neutralized.

Serious complications are often associated with a predisposition to infectious processes and the development of concomitant pathologies.

Complications of malnutrition:

• persistent colds and viral diseases;
• chronic fetal hypoxia;
• newborns;
• hemorrhagic disease of newborns;
• inflammation of the colon and fine sections intestines (enterocolitis);
• blood poisoning ();
• vitamin D deficiency ();
• anemia;
• pneumonia;
• inflammation of the middle ear;
• mental retardation.

PREVENTION

Preventive measures are relevant from the moment of pregnancy. They include proper nutritious nutrition for the woman, adherence to the regimen, as well as the exclusion of any negative effects on the fetus.

After the child is born, special attention should be given quality of nutrition for a nursing mother. It is necessary to monitor the child’s weight monthly and introduce complementary foods in a timely manner. Natural feeding mother's breast milk is a priority, as it contains all the necessary substances for normal development baby. In case of shortage mother's milk the child is fed with specially selected artificial mixtures.

Constant monitoring of the child’s health for the development of infectious diseases and diseases of the gastrointestinal tract will help prevent the development of malnutrition. Walking on fresh air, exposure to the sun and hardening are also effective measures prevention of malnutrition.

PROGNOSIS FOR RECOVERY

The prognosis for malnutrition depends on the factors that caused the child’s exhaustion, as well as on the nature of feeding, concomitant diseases and age.

For mild to moderate malnutrition the prognosis is favorable. In severe cases mortality reaches 30%. The outcome of the disease depends on how effectively secondary infection is avoided. Long-term malnutrition is dangerous for the future development of mental retardation in infants.

A child's chances of recovery in severe cases depend on his age. Associated developmental defects significantly worsen the prognosis; a prosperous environment and full-fledged home care after a hospital stay.

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Hypotrophy in newborns is one of the types chronic disorder nutrition.

From the moment they are born, babies begin to actively gain weight. All their organs grow, all body systems continue to develop. If the child is not fed enough and the child is not properly cared for, then the first signs of a disorder will appear quite quickly.

The described pathology is the most common and most significant variant of dystrophy. Children in the first 3 years of life are especially susceptible to this disease. The prevalence of this condition among child population depends on the level of socio-economic development of countries and ranges from 2-7 to 30%.

As a rule, about malnutrition we're talking about in the case when there is a lag in body weight from age norm by more than 10%. The disease in question is accompanied by profound disturbances in the process, suppressed immunity, and delayed psychomotor and speech development.

Causes of malnutrition in newborns

The reasons as a result of which malnutrition may develop in newborns can be divided into internal factors and external.

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

The second include insufficient and improper feeding, late introduction of complementary foods, exposure to toxic substances, including medications, and the incidence of various infections. All these negative external factors leading to malnutrition in newborns, the photo of which is located below, are quite rare. However, they should not be underestimated.

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

Manifestations of the described disease may be mild, moderate severity or severe, which corresponds to three degrees of the pathology in question.

Intrauterine malnutrition of the 1st degree in newborns

Newborn hypotrophy of the 1st degree is manifested by a slight change in appetite, which is usually accompanied by sleep disturbances and frequent occurrences anxiety. This degree considered the easiest. The lag in body weight is no more than 20%; no deviations in growth are noted. The baby's skin, as a rule, does not undergo any changes, with the exception of the appearance of some pallor and decreased elasticity. Thinness is noted only in the abdomen area. Muscle tone is usually preserved, sometimes slightly reduced.

In some cases, grade 1 intrauterine malnutrition in newborns occurs with anemia or rickets. The activity of the immune system as a whole decreases. As a result, children get sick more often and outwardly seem not as well-fed as their peers. Some babies may experience digestive disorders such as diarrhea or constipation.

Often, grade 1 malnutrition in newborns is not noticed at all by parents. The disease can only be detected by an experienced specialist during a thorough examination and diagnostics.

In this case, the doctor must find out whether the child’s thinness is due to his physiological characteristics. The fact is that tall height and thinness could be inherited by the baby. And it is quite possible that you should not worry at all about the fact that the child does not look so well-fed, if at the same time the baby remains active, he is quite cheerful and eats quite well.

2nd degree of malnutrition in a newborn child

The second degree of the described pathology is moderate in severity. It includes a lag from the norm in both weight and body length. At the same time, weight is reduced by an average of 20-30%, height by 30-40 mm, which, unlike the first degree of the disease, no longer goes unnoticed by parents.

This degree of malnutrition in newborns can be accompanied by frequent regurgitation, the baby is lethargic, he is reluctant to eat or refuses it altogether, he moves little, he is sad, his arms and legs are cold.

With the described option pathological changes In infants, developmental delay occurs not only physically, but also mentally. There is deterioration in sleep. The skin becomes dry and pale, often peels, it loses its elasticity and easily wrinkles.

Thinness is more pronounced and affects not only the stomach, but also the limbs. With second degree malnutrition, the contours of the ribs are clearly visible in the baby. Children with this form of disorder are very often exposed to various kinds of diseases. The stool of such children is characterized by instability.

Hypotrophy of the 3rd degree in newborns

Neonatal hypotrophy of the 3rd degree is the most severe of the described options. Deviations in body weight reach more than 30%. The growth deficiency is significant, on average about 10 cm. The child is weak, drowsy and whiny, indifferent to almost everything. Many acquired skills are lost in the baby.

The thinning of the subcutaneous fat layer is significantly expressed throughout the body. Severe atrophy is observed on the muscle side. The baby's arms and legs are cold. The skin is dry, the color is pale with a grayish tint. The baby's eyes and lips are dry, and cracks form around the mouth.

Often, children with a similar pathology develop various infectious lesions of various organs, in particular the kidneys (pyelonephritis), lungs (), etc.

Treatment of malnutrition in newborns

The diagnosis of the described pathology is established not only according to a medical examination.

In order to objectively assess the severity of malnutrition in a newborn, the baby’s body weight is determined and the baby’s body length is measured. In addition, the thickness of the skin fold is determined, and the circumference of the shoulders and hips is determined.

Therapy for the pathological condition in question always depends on the cause that led to its development, on the severity of the disease, as well as on the nature and type of dysfunction of the internal organs formed as a result of the disease.

To save your baby from malnutrition, you need not only to take vitamins medications or start intensive feeding. Treatment of this disease usually involves a whole range of measures aimed at eliminating the cause of the disease, maintaining optimal age-appropriate nutrition, and also aimed at combating complications.

In case of stage 1 pathology, the baby can undergo treatment at home. Hypotrophy of the 2nd degree in newborns, and even more so the 3rd degree of the disease in mandatory is treated in a hospital setting.

Fundamental therapeutic method at this disease is a diet. Its first stage is stability testing. At the same time, the doctor observes how the child digests food, whether there is diarrhea, bloating, etc.

The second stage includes gradual compensation of missing nutrients, including microelements and. The number of meals is reduced, the volume and calorie content increases.

At the third stage of diet therapy, the food load increases. This is done only after complete restoration of the function of the stomach and intestines. At the same time, protein intake is limited. The criteria for the effectiveness of treatment are daily weight gain of 25-30 grams, restoration of appetite and general condition of the baby, normalization of skin condition.

With grade 3 malnutrition in newborns, independent eating often becomes impossible. Plus, the baby’s digestive tract is severely damaged and is unable to process food. Based on this, such children are transferred to intravenous nutrition, which is used as various solutions, replenishing fluid volume and regulating metabolism.

A mandatory component of therapy for the described pathology is intramuscular or intravenous administration vitamins The most important ones in this case are vitamins C, B1 and B6. Subsequently, multivitamin complexes are prescribed.

The lack of gastric juice is replaced with enzyme preparations, of which Festal or Panzinorm are most often prescribed. To improve metabolic processes resort to stimulant therapy. Pentoxifylline or ginseng preparations are prescribed. In severe cases, they resort to immunoglobulin.

When rickets develops, physiotherapy and vitamin D are used. In case of anemia, iron supplements are prescribed.

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Ecology and lifestyle modern women lead to the fact that the development of the baby in the womb lags behind the norm. Fetal hypotrophy is a serious diagnosis that some expectant mothers face. The disease can affect the physical and mental state child in the future.

If detected in a timely manner, such a deviation does not pose a danger to the baby and mother. This is why it is necessary to regularly visit your doctor. If the disease is detected in the early stages, there will be no consequences for the child.

Women often hear this diagnosis at the beginning of pregnancy or in the 3rd trimester. Hypotrophy is a developmental delay of the fetus and deviation of fetometric indicators from the norm.

At each routine visit, the doctor measures the woman's abdominal circumference. But this is not enough to determine malnutrition. By using ultrasound examination you can find out the length of the limbs, the circumference of the head, abdomen of the fetus, the volume of amniotic fluid. All these indicators are called fetometric. And any deviation from them requires close attention behind the child's body in the womb.

Intrauterine growth retardation can be caused by various factors.

Causes of malnutrition:

• poisoning of the body with nicotine, alcohol and drugs;
• sexual infections: , and others;
• (late toxicosis);
• hypertension and serious diseases of the cardiovascular system;
• diabetes mellitus;
• taking certain medications that do not allow beneficial nutrients and trace elements to reach the fetus;
• early placental maturation;
• pregnancy with two or more fetuses (multiple pregnancy);
• chromosomal abnormality;
• risk age of a woman (less than 17 years and more than 30);
• tight;
• heavy physical labor or working with pesticides;
• violations endocrine system and hormonal levels;
• constant exposure to stress.

Very often the causes of the disease are hidden in the placenta. Hypotrophy can be caused by its detachment, premature aging, inflammation or presentation.

Measurements do not always provide reliable information, since the thickness of the fat layer, the volume of amniotic fluid and the body type of each woman are different. Sometimes malnutrition is determined erroneously when there is no way to know exact date pregnancy. A woman may not remember the date of her last menstruation or may not contact the gynecologist immediately. These factors do not allow us to determine exact week pregnancy.

Forms of the disease

There are several types of disease. Intrauterine hypotrophy can be:

1. Symmetrical– all organs lag behind in development proportionally. The week of pregnancy does not correspond to the actual measurements of the fetus. The diagnosis is often made on early stages pregnancy.
2. Asymmetrical– development of organs is uneven. For example, the length of the limbs is normal, but the kidneys or stomach are smaller required sizes. This form of the disease occurs most often after 28 weeks.

Like any disease, malnutrition has its stages, which are characterized by the severity of the disease and different principles treatment.

Degrees of intrauterine hypotrophy:

• 1st degree– the fetus lags behind in development by a maximum of 2 weeks. Often after childbirth the diagnosis is not confirmed. Genetics plays a big role. If everyone in the family is born with low weight, then malnutrition does not threaten the future life of the baby. Also, doctors may make mistakes about the pregnancy period if the woman does not know exact date menstruation or conception. This happens when a pregnant woman applies too late to register.
• 2nd degree– the fetus lags behind in development from 2 to 4 weeks. The woman requires hospital treatment. Pathology can also be caused by metabolic disorders in the placenta. The child does not receive nutrition and sufficient oxygen from the mother.
• 3rd degree– the fetus lags behind in development by more than a month. This stage is very advanced and requires close attention to the child and woman. 3rd degree occurs when initial stages no diseases were noticed. The baby in the womb is exhausted and its life is at risk.

The doctor can determine the degree of development and symmetry of the disease only with the help of ultrasound, Doppler, and cardiotocography. It is impossible to establish an accurate diagnosis by measuring abdominal circumference.

What is the danger of fetal hypotrophy syndrome?

Fetal hypotrophy of the 1st degree is not dangerous. A woman just needs to get rid of the factors causing disease. Enhanced and proper nutrition, consumption of vitamins, minerals, vegetables and fruits, meat, fish and other healthy foods help the fetus receive all the necessary nutrients.

Other degrees are harmful to the child and may affect future psychological and physical development.

Hypotrophy can weaken the fetus so much that it cannot pass on its own. birth canal. In such cases, women are prescribed. After birth, a child may lag behind his peers in weight and development, but timely treatment and following the doctor’s recommendations, all indicators return to normal after a few years. In terms of physical parameters, the baby will not differ from children of the same age.

Consequences of malnutrition

The consequences of malnutrition for a child depend on the cause that caused it. For example, if the fetus was exposed to alcohol or drugs during pregnancy, the likelihood of having a baby with acquired dementia increases.

Such children have reduced immunity from birth, their body will have poor resistance infectious diseases. In childhood, it is necessary to pay special attention to any cold. The child's weakness and weight discrepancy are corrected proper nutrition and special exercise. At good feeding the weight returns to normal on its own.

Diagnosis of fetal malnutrition

The disease cannot be detected without modern medical devices. The size of a pregnant woman's abdomen can only determine her predisposition to malnutrition. But sometimes this indicator is erroneous. Women with a small belly can give birth to absolutely healthy children, but with a large one, the opposite is true. Due to the increased amount of amniotic fluid, the doctor may not see the disease.

The following methods are used to diagnose malnutrition:

1. Ultrasound. Makes it possible to obtain fetometric indicators and assess the condition of the placenta.
2. Doppler. Allows you to analyze blood flow in the uterine vessels, evaluate the umbilical cord, cerebral arteries.
3. Ultrasound cardiotocography. Used after 30 weeks of pregnancy. The method allows you to assess the functioning of the fetal cardiovascular system.

Treatment of fetal malnutrition

Intrauterine malnutrition, detected at the initial stage, should push the woman to give up bad habits and switch to healthy food. Nutrition should include all the vitamins and microelements necessary for mother and baby. The diet should include vegetables, fruits, meat, fish, and dairy products.

2 and 3 degrees of malnutrition, in addition to these actions, provide for the use:

• vasodilators to improve uteroplacental circulation;
• medical products that dilate the uterus;
• drugs that normalize blood rheology;
• antihypoxic medications that increase the supply of oxygen to the fetus;
• drugs that improve metabolism (enzymes);
• complexes of vitamins and minerals.

With timely treatment, as well as constant monitoring by a doctor, malnutrition does not cause harm to the child’s body. The main thing is not to trigger the condition when detected.

Prevention of fetal malnutrition

Most best way prevent disease - plan pregnancy. At least 3 months in advance, a woman is recommended to give up all bad habits. Alcohol, smoking, and drug use will negatively affect the development of the child. Also, future parents need to be examined for sexually transmitted infections, which can affect the course of pregnancy.

If the body has chronic infections, then it is necessary to carry out prevention so that the disease does not worsen during the period of bearing a child.

At the first signs of pregnancy, you need to contact a gynecologist and register with the antenatal clinic.

• limit the influence of stress factors;
• reduce the amount of physical work and spend more time in the fresh air;
• choose a safe place to live during pregnancy (no radiation, clean environment).

Fetal hypotrophy during pregnancy is a serious diagnosis. Only initial stage the disease does not pose a threat. 2nd and 3rd degrees of malnutrition are dangerous for further physical and mental development child.

In order for the baby to be born absolutely healthy, you need to follow the doctor’s recommendations and eat well. Bad habits have never graced a woman. And during pregnancy, the expectant mother who drinks alcohol or nicotine puts the child at risk of developing malnutrition, which is extremely dangerous.

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Hypotrophy- child eating disorder early age, which is characterized by a stop or slowdown in the increase in body weight, progressive thinning of the subcutaneous tissue, disturbances in body proportions, disorders of the digestive and metabolic functions, a decrease in specific and nonspecific protective forces body, a tendency to develop other diseases, delayed physical and neuropsychic development.

Cause and pathogenesis of malnutrition

The cause of malnutrition should be considered a lack of one, several or multiple nutrients necessary for normal functioning child's body, its growth and development.

Clinical manifestations of malnutrition

Hypotrophy of the first degree is rarely diagnosed

Hypotrophy of the first degree is rarely diagnosed because general condition the child remains satisfactory. Clinical symptoms: fasting (anxiety, interrupted sleep, manifestation of “greed” for food, loose stool during feeding in the first half of life), slight pallor skin, thinning of the subcutaneous tissue on the abdomen and torso. The thickness of the skin fold at the navel level reaches 0.8-1 cm. The elasticity of the skin and tissue turgor are moderately reduced. Body weight decreases by 10-20%, the weight gain curve is flattened; growth does not lag behind the norm. The weight-height coefficient is 56-60 (normally, it exceeds 60), the proportionality index is distorted, and the fatness index is reduced to 10-15 (normally, 20-25). The child’s interest in the environment remains, psychomotor development corresponds to age. Immunological reactivity and tolerance to food, as a rule, do not change. Of the biochemical parameters, changes in the protein spectrum of blood serum are significant (hypoalbuminemia, dysproteinemia, decrease in albumin globulin coefficient to 0.8). Other indicators are normal or slightly changed. In 40% of children with malnutrition, signs of degrees I and II are noted, and in 39%, of course, there is a mild form.

Hypotrophy II degree

Second degree hypotrophy is characterized by distinct changes in all organs and systems. Such children have a poor appetite, and when force-fed, vomiting occurs, they are lethargic or restless, indifferent to their surroundings, toys, and sleep is disturbed. A noticeable delay in motor development: the child does not hold his head up, does not sit, does not stand on his legs, does not walk or stops walking. Due to deep disturbances in metabolic and regulatory processes, monometricity is disrupted (fluctuations in body temperature during the day exceed 1 ° C). Marked weight loss, the subcutaneous tissue is absent or insignificant in the torso, limbs. The thickness of the skin fold at the turnip navel is 0.4-0.5 cm, the Chulitskaya index decreases to 10-0, the proportionality index is changed, the mass-rosiovy coefficient is below 56; the child lags behind in weight by 20-30 in igti - by 2 - 4 cm. The weight curve is of the wrong type, the skin is pale or pale gray in color, there is dryness, peeling (manifestations of polyhypovitaminosis), a significant decrease in elasticity (easily folds and slowly straightens out). Tissue turgor is sluggish, muscle tone is reduced, and the muscles themselves are hypotonic in the absence of dehydration. Hair is dull and sparse. Tolerance to food is reduced, the activity of enzymes, and especially those involved in hydrolysis and absorption, is sharply reduced. Due to polyenzymeopathy, stool changes. At first they can be so-called cold - scanty, discolored, lumps, with putrefactive foul odor further turn into frequent, rare green coloring and a large number mucus, the presence of extracellular starch, undigested fiber, fatty acids, neutral fat, and at the end of the first year - with the inclusion muscle fibers. Show dysbacteriosis to varying degrees. Urine smells like ammonia. With a predominantly carbohydrate diet (porridge), the stool is liquid, foamy, yellow with a green tint, has a pronounced acidic reaction (fermentation), containing mucus, extracellular starch, fatty acids, neutral fat. Putrid feces are inherent in the so-called milk mania, when the menu is limited mainly to milk and its products (cottage cheese). They are dense, crispy, livid in color, alkaline, and have a fetid odor.

With II degree malnutrition, changes occur in cardiovascular system, respiratory organs, liver. Polyglandular insufficiency develops. Most children with this form of eating disorder suffer from rickets, every second child suffers from anemia. Observed various disorders protein, fat, carbohydrate, water-electrolyte and vitamin metabolism. Immunological reactivity decreases sharply. Such children often get sick. Moreover, these diseases, against the background of malnutrition, are asymptomatic and atypical; their end is often unfavorable.

III degree hypotrophy (atrophy, marasmus)

III degree hypotrophy (atrophy, marasmus) is characterized by an extreme degree of exhaustion in young children. Every third child with such malnutrition was born prematurely, with prenatal malnutrition. There is no appetite, most babies refuse food, and some of them refuse liquids. They are lethargic, apathetic, not interested in others; active movements are sharply limited or absent. The face expresses suffering, and in the preterminal period - indifference. The monometric nature of body temperature is sharply disrupted, and the child easily cools down with a drop in temperature to 34-32 ° C, the limbs are always cold. The subcutaneous tissue is absent throughout the body; the patient resembles a skeleton covered with skin.

The face is triangular, wrinkled; the nasolabial fold is deep, the jaws and cheekbones protrude, the chin is pointed, the cheeks are sunken. It looks like the face of an old man (“Voltaire’s face”). The thickness of the skin fold at the level of the navel is reduced to 0.2 cm (the skin is thinned), the Chulitskaya fatness index is negative, and proportionality is sharply distorted. The skin is pale gray in color, sometimes purplish-blue, hangs in folds on the neck and limbs, is dry, peeling, in places there are areas of pigmentation, its elasticity is lost, skin fold does not straighten out, tissue turgor is sluggish, muscle tone is reduced, although hypertension is possible, the conjunctiva and oral mucosa are dry. The mouth is large, the lips are scarlet (blood thickening), cracks form in the corners of the mouth (“sparrow’s mouth”). The child loses more than 30% of body weight, is sharply delayed in growth (more than 4 cm), and psychomotor development.

Breathing is shallow, apnea appears periodically. Heart sounds are weakened or muffled, there is a tendency to bradycardia, blood pressure reduced. The abdomen is enlarged due to flatulence, anterior abdominal wall thinned, loops of intestines are visible. Constipation alternates with soapy-calcareous stools. The processes of hydrolysis and absorption are sharply weakened due to hypofermentopathy, which develops as a result of atrophy of the mucous membrane of the small intestine, liver, pancreas and other organs. Most patients have rickets, anemia, bacterial infection (pneumonia, sepsis, otitis media, pyelonephritis, etc.). All types of metabolism are severely impaired; immunological deficiency, loss of function and atrophy of organs of regulatory systems (nervous, endocrine), dysbacteriosis are observed II-III degrees. The terminal period is characterized by hypothermia (33-32 ° C), bradycardia (60-40 per 1 min), hypoglycemia; completely indifferent to her surroundings, the child slowly dies.

Prenatal malnutrition

Prenatal malnutrition (intrauterine growth retardation) is one of the types of malnutrition that manifests itself immediately after birth. In case of fetal developmental delay from the second trimester of pregnancy, children are born with much reduced body weight, height and head circumference. Symptoms low nutrition expressed moderately, and appearance these babies resemble premature babies. If unfavorable factors, which retard fetal development, began to act in last trimester, then children are born with severe underweight and normal height and head circumference. They experience dryness, flaking of the skin, and wrinkles. Its turgor is reduced, the subcutaneous base is thinned.

In children with intrauterine growth retardation, hypotension, decreased physiological reflexes, decreased appetite, impaired thermoregulation, a tendency to hypoglycemia, late fall of the umbilical remnant, sluggish healing of the umbilical cord wound, prolonged transient jaundice, regurgitation, unstable stool are observed. diagnostic criterion prenatal hypotrophy in full-term newborns should be considered a decrease in the weight-height coefficient below 60. This index is not suitable for assessing this condition in premature infants. In this case, use the following formula: the trophic index (IT) is equal to the difference between the length and circumference of the thigh (cm). In premature infants with a gestational age of 36-37 weeks in the absence clinical signs malnutrition IT = 0, with I degree hypotrophy IT is 1 cm, II degree - 2 cm, III degree - C cm or more. A convenient method for calculating the body weight deficiency of premature infants according to gestational age: weight deficiency at birth of 10-20% - I degree, 20-30% - II degree, 30% or more - III degree of malnutrition.

Hypostature

Hypostatura should be considered as a variant of malnutrition, which occurs when congenital defects heart, brain, encephalopathy, endocrine pathology. It is characterized by a uniform lag behind the norm of height and body weight with satisfactory condition nutrition and skin turgor. Hypostature should be differentiated from a type of dwarfism, characterized by a disproportionate physique (chondrodystrophy, vitamin D-resistant rickets, etc.).

Treatment of children with malnutrition - complex problem. Every day it is necessary to take into account the dynamics of body weight, the amount of liquid and food consumed, regurgitation, vomiting, and bowel movements.

With grade I malnutrition, the period for determining food tolerance is 1-3 days. It is carried out according to the following scheme. First, the deficiencies of feeding are eliminated, food appropriate for age is prescribed (on the 1st day - 1/2-2/3 of the daily volume, on the 2nd - 2/3-4/5 and on the 3rd day - the full daily volume) . The amount of food that is missing is compensated with liquid (vegetable, fruit, rice and other decoctions, infusions medicinal plants, digested water). The amount of food is calculated in accordance with a certain body weight, the lack of one or another component in food is corrected by adding protein (cottage cheese, yolk, acidophilus paste, protein enpit), fat (fat enpit, butter, cream), carbohydrates (vegetables, fruits, cereals, refined carbohydrates).

In some cases, in order to improve digestion processes, it is prescribed replacement therapy(enzymes). Give by mouth ascorbic acid, ergocalciferol, B vitamins. In the absence of other diseases, children with grade I malnutrition are treated at home.

Treatment of patients with degree II and III malnutrition is carried out in a hospital. For grade II malnutrition, 1/2 of the required daily volume of food is prescribed during the 1st week, 2/3 on the 2nd week, and the full volume on the 3rd week. For grade III malnutrition - In the 1st week - 1/3, 2nd - 1/2, 3rd - 2/3 and 4th - full volume. The frequency of its administration is increased by 1-2 and 2-3 times, respectively. The rest of the daily volume is provided with liquid (vegetable and fruit decoctions, electrolyte solutions, parenteral feeding).

For parenteral nutrition, amino acid mixtures are used (polyamine, Vamin, Alvesin “New”, Amikin, Levamin, etc.), 10% glucose solution with insulin (5-8 days, daily or every other day, 5-6 times). For 2-3 weeks, in doses exceeding physiological ones by 3-5 times, children are given vitamins (group B, ascorbic acid, vitamin P preparations, ergocalciferol). In order to improve the processes of hydrolysis and absorption into digestive tract prescribed for a period of 2-3 weeks enzyme preparations (gastric juice, pancreatin, Pepsidil, festal, panzinorm, abomin, etc.).

In the first days, courses of treatment are carried out with drugs that stimulate metabolism (apilak, pentoxyl, tincture of ginseng, pantocrine), and during the recovery period they use potent anabolic hormones (methandrostenediol, nerobol, retabolil, etc.).

Prevention of antenatal malnutrition consists of treating toxicosis in pregnant women, observing hygienic conditions labor, life, nutrition, elimination of bad habits and the like. Natural feeding in combination with correct mode and education, periodic determination of the chemical composition of food and the dynamics of body weight is a prerequisite for eliminating the development of postnatal malnutrition.

Prevention of any acute and chronic, acquired, hereditary and congenital disease and early diagnosis is the most important stage prevention of the development of malnutrition.

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

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, delayed speech and psychomotor development), it is important to promptly identify the disease and begin treatment.

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

Intrauterine hypotrophy:

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

Extrauterine hypotrophy:

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

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

For example, due to poor nutrition, malnutrition begins to develop, while frequent infectious diseases contribute to its intensification, 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. Typically, grade 1 malnutrition is detected in newborns (in 20% of all infants), which is diagnosed if the child’s weight loss is 10–20% less than the age norm, but growth indicators are absolutely normal. Parents should not worry about this diagnosis: with timely care and treatment, the baby gains weight, especially when breastfeeding.
2. Hypotrophy of the 2nd degree (moderate) is a decrease in weight by 20–30%, as well as a noticeable growth retardation (by about 2–3 cm).
3. Hypotrophy of the 3rd degree (severe) is characterized by a mass deficiency exceeding 30% of the age norm and significant stunting.

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

Symptoms of childhood malnutrition

Usually, symptoms of malnutrition in newborns are determined already in the maternity hospital. If the disease is acquired and not congenital, attentive parents, even at home, will be able to understand by some signs 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;
• decreased tissue turgor;
• thinning of the subcutaneous fat layer (begins this process from the stomach).

II degree

• impaired activity of the child (excitement, lethargy, delayed motor development);
• poor appetite;
• pallor, peeling, sagging 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 throughout the child’s body;
• lethargy;
• lack of reaction to banal stimuli in the form of sound, light and even pain;
• severe growth retardation;
• neuropsychic underdevelopment;
• pale gray skin;
• dryness and pallor of the mucous membranes;
• muscles atrophy;
• loss of tissue turgor;
• retraction of the fontanelle, 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 purpose, consultations with pediatric specialists are prescribed - a neurologist, cardiologist, gastroenterologist, geneticist, infectious disease specialist.

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

Treatment of the disease

Outpatient treatment of malnutrition of the 1st degree in young children is carried out, inpatient treatment of the 2nd and 3rd 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 daily routine;
• organization proper care for the child;
• correction of metabolic disorders;
• drug therapy (enzymes, vitamins, adaptogens, anabolic hormones);
• if available severe form diseases are prescribed intravenous administration of glucose, protein hydrolysates, vitamins, saline solutions;
• massage with elements of exercise therapy.

With timely treatment of grade I and II disease, the prognosis is favorable, but with grade III malnutrition, death is observed 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 preventing such a terrible disease even while carrying a baby:

• maintain a daily routine;
• eat in a timely manner;
• correct pathologies;
• eliminate all unfavorable factors.

After the baby is born important role play:

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

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