Hypotrophy in children – chronic malnutrition, accompanied by insufficient weight gain of the child in relation to his height and age. Hypotrophy in children is expressed by the lag of the child in weight, growth retardation, lag in psychomotor development, underdevelopment of the subcutaneous fat layer, reduction of skin turgor. Diagnosis of malnutrition in children is based on data from the examination and analysis of anthropometric indicators of the child’s physical development. Treatment of hypotrophy in children involves changing the regime, diet and caloric intake of the child and the nursing mother; if necessary, parenteral correction of metabolic disorders.
Hypotrophy in children is a lack of body weight due to a breakdown of absorption or insufficient intake of nutrients in the child’s body. In pediatrics, hypotrophy, parathrophy, and hypostatura are considered as independent types of chronic eating disorders in children — dystrophy. Hypotrophy is the most common and significant variant of dystrophy, to which children of the first 3 years of life are especially susceptible. The prevalence of hypotrophy in children in different countries of the world, depending on their level of socio-economic development, ranges from 2-7 to 30%.
A child’s hypotrophy is indicated when the body weight is more than 10% behind as compared with the age norm. Hypotrophy in children is accompanied by serious metabolic disturbances, decreased immunity, and psychomotor and speech development lag.
Causes of malnutrition in children
Chronic eating disorders can be caused by various factors acting in the prenatal or postnatal period.
Fetal hypotrophy in children is associated with adverse conditions that disrupt the normal development of the fetus. In the prenatal period, pathology of pregnancy (toxicosis, preeclampsia, fetoplacental insufficiency, preterm labor), somatic diseases of the pregnant woman (diabetes, nephropathy, pyelonephritis, heart defects, hypertension, etc.), nervous stress, harmful habits, can lead to malnutrition of the fetus and newborn. insufficient nutrition of women, industrial and environmental hazards, intrauterine infection and hypoxia of the fetus.
Extrauterine hypotrophy in young children may be due to endogenous and exogenous causes. The causes of the endogenous order include chromosomal abnormalities and congenital malformations, fermentopathy (celiac disease, disaccharidase lactase deficiency, malabsorption syndrome, etc.), immunodeficiency states, anomalies of the constitution (diathesis).
Exogenous factors leading to malnutrition in children are divided into alimentary, infectious and social. Alimentary effects are associated with protein-energy deficiency due to insufficient or unbalanced nutrition. Hypotrophy in a child can be the result of constant under-feeding, associated with difficulty sucking when the mother has an irregular nipple shape (flat or inverted nipples), hypogalactia, insufficient milk formula, abundant regurgitation, qualitatively deficient nutrition (micronutrient deficiencies), poor nutrition of the nursing mother, etc. This group of causes should include the diseases of the newborn itself, which do not allow him to actively suck and receive the required amount of food: cleft lip and palate (hare BA, cleft palate), congenital heart defects, birth injuries, perinatal encephalopathy, pyloric stenosis, cerebral palsy, fetal alcohol syndrome, and so forth.
Children with frequent acute respiratory viral infections, intestinal infections, pneumonia, tuberculosis and others are prone to the development of acquired hypotrophy. An important role in the occurrence of hypotrophy in children belongs to unfavorable sanitary and hygienic conditions – poor child care, inadequate staying in fresh air, rare bathing, and inadequate sleep. .
Classification of hypotrophy in children
Thus, intrauterine (prenatal, congenital), postnatal (acquired) and mixed hypotrophy in children are distinguished by the time of occurrence. The basis for the development of congenital malnutrition is a violation of the uteroplacental circulation, fetal hypoxia and, as a result, a violation of trophic processes leading to intrauterine growth retardation. In the pathogenesis of acquired hypotrophy in children, the leading role belongs to the protein-energy deficit due to malnutrition, impaired digestion of food or absorption of nutrients. At the same time, the energy expenditure of a growing organism is not compensated by food coming from outside. In the mixed form of malnutrition in children, alimentary, infectious or social effects join the adverse factors in the prenatal period after birth.
According to the severity of body mass deficiency in children, hypotrophy of I (mild), II (moderate) and III (severe) degree is distinguished. I degree hypotrophy is indicated when a child is 10–20% behind the age norm with normal growth. Hypotrophy of the II degree in children is characterized by a decrease in weight by 20-30% and a lag of growth of 2-3 cm. With hypotrophy of the III degree, the deficit of body weight exceeds 30% from that of the age, there is a significant lag in growth.
During hypotrophy in children, there is an initial period, stages of progression, stabilization and convalescence.
Symptoms of malnutrition in children
In case of hypotrophy of I degree, the condition of children is satisfactory; neuro-psychological development is age appropriate; there may be a moderate decrease in appetite. A careful examination reveals pallor of the skin, reduced tissue turgor, thinning of the thickness of the subcutaneous fat layer on the abdomen.
Hypotrophy of the II degree in children is accompanied by a violation of the child’s activity (agitation or lethargy, lagging in motor development), and poor appetite. Pale skin, scaly, flabby. There is a decrease in muscle tone, elasticity and tissue turgor. The skin easily gathers in the folds, which are then poorly straightened. The subcutaneous fat layer disappears on the abdomen, torso and limbs; on the face – saved. Children often have shortness of breath, hypotension and tachycardia. Children with hypotrophy II degree often suffer from intercurrent diseases – otitis, pneumonia, pyelonephritis.
Hypotrophy of the III degree in children is characterized by dramatic exhaustion: the subcutaneous fat layer atrophies on the whole body and on the face. The child is lethargic, adynamic; practically does not respond to stimuli (sound, light, pain); sharply lagging behind in growth and neuropsychic development. Pale gray skin, mucous membranes dry and pale; the muscle is atrophic, the tissue turgor is completely lost. Exhaustion and dehydration lead to retraction of the eyeballs and fontanel, sharpening of facial features, the formation of cracks in the corners of the mouth, impaired thermoregulation. Children are prone to regurgitation, vomiting, diarrhea, and decreased urination. In children with grade III hypotrophy, conjunctivitis, candidal stomatitis (thrush), glossitis, alopecia, lung atelectasis, congestive pneumonia, rickets, and anemia are often noted. In the terminal stage of malnutrition, hypothermia, bradycardia, and hypoglycemia develop in children.
Diagnosis of malnutrition in children
Intrauterine hypotrophy of the fetus, as a rule, is detected by ultrasound screening of pregnant women. In the process of obstetric ultrasound, the head size, length and estimated mass of the fetus are determined. When intrauterine development of the fetus is delayed, an obstetrician-gynecologist sends the pregnant woman to the hospital to clarify the causes of malnutrition.
In newborns, the presence of malnutrition can be detected by a neonatologist immediately after birth. Acquired hypotrophy is detected by a pediatrician in the process of dynamic observation of the child and control of the main anthropometric indicators. Anthropometry in children includes an assessment of the parameters of physical development: length, mass, head circumference, chest, shoulder, abdomen, hip, thickness of skin-fat folds.
In the detection of hypotrophy, an in-depth examination of children is carried out to clarify the possible causes of its development. For this purpose, consultations are organized for pediatric specialists (pediatric neurologist, pediatric cardiologist, pediatric gastroenterologist, infectious diseases specialist, genetics) and diagnostic studies (abdominal ultrasound, ECG, EchoCG, EEG, coprogram and feces research for dysbacteriosis, biochemical blood tests, etc.).
Treatment of malnutrition in children
Treatment of postnatal hypotrophy of I degree in children is carried out on an outpatient basis; hypotrophy of II and III degrees is performed in a hospital. The main activities include eliminating the causes of malnutrition, diet therapy, organizing proper care, 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 caloric content of food to the physiological age norm. Implementation of diet therapy for malnutrition in children is based on fractional frequent feeding of a child, weekly calculation of the food load, regular monitoring and correction of treatment. Feeding children with weakened sucking or swallowing reflexes is carried out through a probe.
Drug therapy for malnutrition in children includes the appointment of enzymes, vitamins, adaptogens, anabolic hormones. In severe hypotrophy, children are given intravenous administration of protein hydrolysates, glucose, saline solutions, and vitamins. In children with hypotrophy, a massage with elements of exercise therapy and ultraviolet irradiation is useful.
Prognosis and prevention of malnutrition in children
With timely treatment of hypotrophy of I and II degrees, the prognosis for the life of children is favorable; with hypotrophy III degree mortality reaches 30-50%. To prevent the progression of malnutrition and possible complications, children should be examined weekly by a pediatrician with anthropometry and nutritional correction.
Prevention of prenatal malnutrition of the fetus should include adherence to the day regimen and nutrition of the expectant mother, correction of the pathology of pregnancy, elimination of the impact on the fetus of various adverse factors. After childbirth, the quality of nutrition of a nursing mother, the timely introduction of complementary foods, the control of the dynamics of increase in body weight of the child, the organization of rational care for the newborn, the elimination of comorbidities in children become important.