Dystrophy in children (malnutrition) is a chronic eating disorder, one of the main manifestations of which is the gradually developing depletion of a child. There are mild and severe forms of dystrophy. The distinction between these forms is often difficult to determine. Far advanced form of dystrophy is called atrophy.
Etiology and pathogenesis. The causes of the development of dystrophy in children are very diverse. It may be due to external and internal factors. The most common cause (external factor) is malnutrition in both quantitative and qualitative terms. A quantitative lack of food is often associated with malnutrition and can be from the first days of a child’s life (mother’s lack of milk, the presence of tight breast or flat and inverted nipples, sluggish suction ). Lack of active sucking is more common in premature babies , as well as those born with asphyxia and intracranial birth injury . All sorts of congenital malformations can interfere with getting enough food (cleft of the upper lip and hard palate , pyloric stenosis , etc.). Hypotrophy develops as a result of the lack or absence of one of the important components of food (for example, protein, vitamins, salts), in violation of their correct ratio. High-quality errors in nutrition are more often with mixed and artificial feeding. Adverse environmental conditions (non-observance of the sanitary and hygienic regime, lack of air, light, etc.) and improper care are of great importance. There are children in whom dystrophy has developed mainly as a result of lack of appetite under the influence of improper introduction of complementary foods, drugs, with force-feeding. Infections and chronic diseases contribute to the development of dystrophy due to metabolic disorders and the activity of regulatory mechanisms. In all these circumstances, food entering the body does not cover its needs; as a result, the child’s own reserves are spent, which leads to exhaustion. When fasting, the activity of all body systems is distorted, a violation of all types of metabolism develops. These children have reduced body resistance and they have a tendency to all sorts of diseases, which are difficult for them and often cause death.
Clinic. The main manifestation of dystrophy (hypotrophy) is the reduction of the subcutaneous fat layer primarily on the abdomen, then on the chest, back, limbs and later on the face. Going on. slowing down and even stopping weight gain, it becomes less than normal.Go
There are three degrees of malnutrition. Hypotrophy 1 degree is characterized by a lag in weight by 10 - 15%, but the child has a normal growth . There is a decrease in the subcutaneous fatty layer on the abdomen and partly on the limbs. Skin color remains normal or somewhat pale, the general condition is not disturbed.
With hypotrophy 2 degrees, the weight of the child lags behind the norm by 20–30%, there is also a slight lag in growth (by 1-3 cm). The subcutaneous fat layer is reduced everywhere. The child is pale, the tissue turgor is lowered, the skin is gathered into folds, the muscles are flabby. The general condition, sleep , appetite decreases, the mood becomes unstable, the development of static and motor functions worsens or is delayed.
Grade 3 hypotrophy is characterized by a decrease in weight by more than 30%, marked exhaustion and stunting. The subcutaneous fat layer is absent, the eyes are sunken, wrinkles appear on the forehead, the chin is pointed, and the face is senile. The muscles are flabby, the stomach is retracted, the large spring falls, the conjunctiva and the cornea of the eyes are prone to drying and ulceration, Breathing is shallow, slow, the pulse is weak, heart sounds are muffled. Appetite is reduced, but there is a thirst , a tendency to diarrhea. Urination is restricted. Hypochromic anemia develops, with a sharp thickening of the blood, hemoglobin and the number of red blood cells increase. Children are depressed, their voice is aphonic, the development of static and motor skills and speech is delayed.
The diagnosis of dystrophy in children (hypotrophy) is established on the basis of anamnesis, the appearance of the child, clinical examination data, weight, height.
Treatment of malnutrition is complex, taking into account the individual characteristics of the child, the conditions under which the disease has developed. In severe forms, symptomatic, pathogenetic and stimulating therapy. It is especially important to properly assign food. Thus, in case of hypotrophy of the first degree, it is necessary first of all to prescribe the child nutrition on the basis of the weight that he should have according to his age. With a shortage of breast milk, the mother is prescribed supplementation with donor milk or mixtures. When artificial feeding temporarily prescribed breast milk and mixtures.
In case of hypotrophy 2 degrees, breast milk or sour mixtures are prescribed at the rate of 2/3 or% of the amount required for a given age of the child (see Feeding children ). If the child’s weight is reduced by 20%, then the total amount of food is calculated on the actual weight. If more than 20%, then the calculation is carried out on the average weight, i.e., on the actual plus 20% of it. Lack of food volume is replenished with fruit and vegetable decoctions, 5% glucose solution, juices . The number of feedings increases to 7-8 times per day.
After 5-7 days while improving the condition of the child, the amount of food increases, but the calorie should not exceed 130-150 calories per 1 kg of body weight. If necessary, carry out the correction of proteins, carbohydrates and (carefully) fats.
Especially carefully prescribed food for malnutrition 3 degrees. Daily calculation of power produced by the average weight between the obligatory and actual. In the first days of treatment, regardless of age, only half of the required amount is prescribed, and only breast milk. When it is impossible to provide the baby with sufficient milk, give acidic mixtures. The lack of volume of food is replenished by fluid. The increase in the daily amount of food spend very carefully, even with a clear tendency to improvement. Kalorazh on the actual weight should not exceed 180 cal per 1 kg of body weight. All children with hypotrophy need vitamins and enzymes . To improve the appetite, gastric juice is prescribed 1 / 2-1 teaspoon 5 times a day or 1% solution of diluted hydrochloric acid with pepsin before feeding, pancreatin 0.2 g 2 times a day one hour after eating for 7-10 days . The appointment of anabolic hormones is shown (see. Anabolic steroids ). Activities to combat dehydration are carried out as in toxic dyspepsia (see Dyspepsia in children). In severe cases, plasma and blood transfusions are recommended.
Prevention . Proper organization of the general regime and feeding.
The prognosis depends on the degree of the disease, reactivity and timeliness of treatment.