Hypotrophy in children: what kind of disease and how to deal with it

Classification

There are three degrees of malnutrition in children, each of which is characterized by its own characteristics:

I degree - 20% of the required body weight is missing, while growth and neuropsychic development are maintained within normal limits;
II degree - the deficiency is 25–30% of the required indicators, the first signs of growth retardation and neuropsychic disorders appear;
III degree - weight loss is more than 30% of normal, stunted growth and pathological changes in the neuropsychic sphere become clearly visible.

Read also: Food poisoning in a child

Hypotrophy

Hypotrophy is a chronic nutritional disorder caused by insufficient intake of nutrients or impaired absorption of nutrients into the body and is characterized by a decrease in body weight. Hypotrophy in children is expressed by the child's weight retardation, growth retardation, psychomotor development lag, underdevelopment of the subcutaneous fat layer, and decreased skin turgor. Diagnosis of malnutrition in children is based on examination data and analysis of anthropometric indicators of the child’s physical development. Treatment of malnutrition in children involves changing the regime, diet and caloric intake of the child and the nursing mother; if necessary, parenteral correction of metabolic disorders. Based on the time of occurrence, they are divided into congenital and acquired. Congenital malnutrition can be caused by a pathological course of pregnancy, accompanied by impaired blood circulation in the placenta, intrauterine infection of the fetus; diseases of the pregnant woman herself, her poor diet, smoking and drinking alcohol, age (under 18 or over 30 years), exposure to occupational hazards.

Acquired malnutrition can be caused by underfeeding, difficulty sucking associated with irregularly shaped nipples or a tight mammary gland; insufficient amount of formula during artificial feeding, qualitatively inadequate nutrition; frequent illnesses of the child, prematurity, birth trauma, malformations, impaired intestinal absorption in many metabolic diseases, pathology of the endocrine system (diabetes mellitus, etc.).

Symptoms and course:

I degree: the thickness of the subcutaneous tissue decreases in all parts of the body except the face. First of all, it thins on the stomach. The mass deficit is 11 - 20%. Weight gain slows down, growth and neuropsychic development correspond to age. The state of health is usually satisfactory, sometimes there is a disorder of appetite and sleep. The skin is pale, muscle tone and tissue elasticity are slightly below normal, bowel movements and urination are normal.

II degree: subcutaneous tissue on the chest and abdomen almost disappears, on the face it becomes noticeably thinner. The child is delayed in growth and neuropsychic development. Weakness and irritability increase, appetite deteriorates significantly, and mobility decreases. The skin is pale with a grayish tint, muscle tone and tissue elasticity are sharply reduced. There are often signs of vitamin deficiency, rickets, and children easily overheat or become hypothermic. The liver enlarges, the stool is unstable (constipation is replaced by diarrhea), its character (color, smell, consistency) changes depending on the cause of malnutrition.

III degree: observed mainly in children in the first 6 months of life and is characterized by severe exhaustion. Subcutaneous tissue disappears in all parts of the body, sometimes a very thin layer remains on the cheeks. The mass deficit exceeds 30%. Body weight does not increase, sometimes it decreases progressively. Growth and neuropsychic development are suppressed, lethargy increases, reactions to various stimuli (light, sound, pain) are slowed down. The face is wrinkled, “senile”. The eyeballs and large fontanelle are sunken. The skin is pale gray in color, dry, the skin fold does not straighten out. The mucous membranes are dry, bright red; the elasticity of the tissues is almost lost. Breathing is weakened, and sometimes disturbances occur. The heart rate is slowed down, blood pressure is reduced; the abdomen is retracted or bloated, constipation and changes in stool character are noted. Urination is rare, there is little urine. Body temperature is below normal, hypothermia easily occurs. Often an infection occurs that occurs without significant symptoms. If left untreated, the child may die.

Treatment:

It is carried out taking into account the cause of malnutrition, as well as its degree. In case of I degree - outpatient, in case of II and III degrees - in hospital. The basic principles are elimination of the cause of malnutrition, proper nutrition and child care, treatment of resulting diseases, metabolic disorders, and infectious complications. If the mother does not have enough milk, the baby is fed with donor milk or formula.

If the content of components in breast milk is lower than normal, they are prescribed additionally (if there is a deficiency of proteins - kefir, cottage cheese, protein milk, if there is a deficiency of carbohydrates - sugar syrup is added to drinking water, if there is a deficiency of fats, 10-20% cream is given). In severe cases, nutrients are administered intravenously. In case of malnutrition caused by metabolic disorders, special therapeutic nutrition is carried out.

Regardless of the cause of the disease, all children are prescribed vitamins, enzymes (Abomin, Pepsin, Festal, Panzinorm, Pancreatin, etc.), stimulants (Apilak, Dibazol, in severe cases - hormonal therapy), massage, physical therapy, and ultraviolet irradiation. Proper care of the child is of great importance (regular walks in the fresh air, preventing congestion in the lungs - pick the child up more often, turn him over; when cooling, put a heating pad at the feet, careful oral care).

The prognosis for grade I malnutrition is favorable; for grade III malnutrition, the mortality rate is 30-50%. Treatment of postnatal malnutrition of the first degree in children is carried out on an outpatient basis, malnutrition of the second and third degrees - in a hospital setting. The main measures include eliminating the causes of malnutrition, diet therapy, organizing proper care, and correcting metabolic disorders. Diet therapy for malnutrition in children is implemented in 2 stages: clarification of food tolerance (from 3-4 to 10-12 days) and a gradual increase in the volume and calorie content of food to the physiological age norm. The implementation of diet therapy for malnutrition in children is based on fractional frequent feeding of the child, weekly calculation of the food load, regular monitoring and correction of treatment. Children with weakened sucking or swallowing reflexes are fed through a tube. Drug therapy for malnutrition in children includes the administration of enzymes, vitamins, adaptogens, and anabolic hormones. In case of severe malnutrition, children are given intravenous administration of protein hydrolysates, glucose, saline solutions, and vitamins. For malnutrition in children, massage with elements of exercise therapy and ultraviolet irradiation is useful.

Prevention:

Compliance with a woman’s daily routine and diet during pregnancy, avoiding smoking and alcohol, and occupational hazards. If fetal malnutrition is detected, the pregnant woman’s diet is adjusted, vitamins and substances that improve blood circulation in the placenta are prescribed. After birth, careful monitoring of the baby’s development (weigh it as often as possible!) and proper nutrition of the nursing mother is important.

Factors leading to development

The causes accompanying the disease can be external and internal. The first group, characterized by disorders in the body, includes:

encephalopathy, due to which not only the functioning of the nervous system is disrupted, but also secondary changes occur in the functioning of other organs;
pathological development of lung tissue, due to which the body does not receive the required amount of oxygen, slowing down its internal processes;
congenital pathological changes in the functioning of the gastrointestinal tract, leading to insufficient absorption of food;
surgical operations on the intestines, leading to its shortening;
diseases of the immune system, leading to the inability to fight infections;
endocrine changes (most often hypothyroidism or pituitary dwarfism);
hereditary diseases that disrupt the absorption of certain nutrients (galactosemia, fructosemia, etc.).

The second category includes:

insufficient nutritional value of breast milk;
underfeeding;
the impact of toxic factors on the body;
frequent infectious infections.

Causes of malnutrition in the fetus and newborn

Chronic eating disorders occur due to the impact of various factors on the fetus/child's body. Thus, intrauterine fetal hypotrophy during pregnancy may be associated with:

gestosis, toxicosis, premature birth, placental insufficiency and some other pathologies;
somatic diseases (pyelonephritis, diabetes mellitus, heart defects, nephropathies, hypertension, etc.);
smoking, alcohol abuse;
nervous experiences, stress;
poor quality and insufficient nutrition of a pregnant woman;
environmental and industrial hazards;
intrauterine infection and fetal hypoxia.

Acquired malnutrition in young children is usually caused by:

Exogenous factors, which in turn are divided into: - nutritional (due to insufficient/unbalanced nutrition, protein-energy deficiency develops); - social (constant underfeeding of the baby, poor nutrition of the nursing mother); - infectious (intestinal infections, ARVI, tuberculosis, pneumonia). Also included in the group of exogenous factors are conditions due to which the child cannot suck normally: abnormal nipple shape, hypolactia, cleft lip and cleft palate, birth injuries, cerebral palsy, pyloric stenosis, perinatal encephalopathy, fetal alcohol syndrome, etc.
Endogenous factors (chromosomal abnormalities, enzymopathies, congenital malformations, immunodeficiency states).

Symptoms

Symptoms of malnutrition in a child depend on the stage of the disease.

At stage I , the doctor can determine the signs by carefully examining the small patient. Pay attention to insufficiently intense staining and decreased skin turgor, lack of fat in the abdominal area.

At stage II, disturbances in motor activity and appetite are evident. The patient's skin becomes flabby, peels, and does not straighten on its own with mild deformities. The layer of subcutaneous fat remains only on the face. Frequent deviations in the functioning of other systems, attacks of tachycardia or too low blood pressure are recorded.

At stage II , a poor reaction to external stimuli is revealed, the face also loses a layer of subcutaneous fat, and muscle atrophy is noted. Characteristic signs are retraction of the eyeballs and the fontanel area. Disturbances in stool and urination appear, and vomiting is common.

Treatment options

Treatment of malnutrition in children begins with the selection of adequate diet therapy. The diet is selected in two stages:

find out if there is any food intolerance;
Calculate nutrition for a child with malnutrition.

The calculation is carried out based on the baby’s body weight, his height and the severity of the disease. Meals should be fractional, if necessary, portions are adjusted up or down, so doctor’s supervision over the progress of treatment is necessary.

Diet therapy is accompanied by drug treatment based on the selection of enzymes, vitamins, and hormonal anabolic drugs, if necessary.