Dystrophy (protein - power insufficiency) - chronic frustration of a food and trofic the fabrics, breaking correct harmonious development of the child. Children of the first 3 years of a life are subject to it. Disease is accompanied by considerable infringement of exchange processes, immunity decrease, a delay physical, psychomotor, and further and intellectual development.
Dystrophy (protein - power insufficiency) - chronic frustration of a food and trofic the fabrics, breaking correct harmonious development of the child. Children of the first 3 years of a life are subject to it. Disease is accompanied by considerable infringement of exchange processes, immunity decrease, a delay physical, psychomotor, and further and intellectual development.
Allocate three kinds of a dystrophy:
Allocate three kinds of a dystrophy:
Hypotrophya (deficiency of weight of a body in relation to growth).
Paratrophya (one of variants paratrophy - adiposity
With prevalence of weight of a body over growth.
With superfluous in weight of a body and growth.
With normal in weight of a body and growth.
Hypo stature (uniform backlog of weight of a body and growth from age norms).
On time of occurrence it divide into three forms:
On time of occurrence it divide into three forms:
prenatal, developed till a birth of the child;
postnatal, arisen after a birth;
Mixed, generated under the influence of the reasons operating on an organism of the child intra-and oututeric.
Pre-natal the dystrophy is caused by adverse conditions and the various factors breaking correct development of a fruit.
Pre-natal the dystrophy is caused by adverse conditions and the various factors breaking correct development of a fruit.
Young (till 20 years) or elderly (after 40 years) age of the pregnant woman.
Infectious and somatic diseases of the pregnant woman.
Gestosis in any trimester of pregnancy.
Adverse social conditions, nervous stresses, an irrational food and bad habits.
Professional harm at both parents.
Placenta pathology (reveal in most cases if all factors set forth above are excluded, and the dystrophy is diagnosed for the child prenatal).
Postnatal the dystrophy can be connected both with exogenous influences, and with endogens the factors causing a secondary dystrophy.
Postnatal the dystrophy can be connected both with exogenous influences, and with endogens the factors causing a secondary dystrophy.
The basic exogenous factors postnatal dystrophies:
The alimentary: the protein-power insufficiency caused quantitatively or qualitatively unbalanced food, deficiency of microcells (zinc, copper, selenium, etc.);
The infectious: intestinal infections, repeated ARID, especially complicated resedive an otitis;
The social.
To endogenous ethological to factors postnatal dystrophies carry:
To endogenous ethological to factors postnatal dystrophies carry:
Developmental anomalies and chromosomal diseases;
enzimophathy and malabsorstion (both primary, and secondary);
Anomalies of the constitution;
immunodeficiency conditions.
In development prenatal dystrophies a leading role play infringement of matochno-placentary blood circulation and pre-natal hypoxia a fruit, leading to frustration of trophic functions SNS.
In development prenatal dystrophies a leading role play infringement of matochno-placentary blood circulation and pre-natal hypoxia a fruit, leading to frustration of trophic functions SNS.
Pathogenesis postnatal hypotrophy irrespective of its origin and the form can be presented as uniform phathophisiological process in which basis infringement of digestion and decrease in excitability of a bark of a brain lay.
The Nevropatic form: the weight of a body at a birth is normal or moderately lowered, growth without features. Psychomotor development corresponds to age. Attract attention excitation and negativism of the child, dream infringement, a distortion and appetite decrease.
The Nevropatic form: the weight of a body at a birth is normal or moderately lowered, growth without features. Psychomotor development corresponds to age. Attract attention excitation and negativism of the child, dream infringement, a distortion and appetite decrease.
The Nejrodistrofic form: are characteristic decrease as weights, and bodies are (to a lesser degree long at a birth, prevalence of processes of braking in SNS, moderate backlog in psychomotor development, a persistent anorexia
Neuroendocrine the form: mark considerable (usually proportional) decrease in weight and length of a body since a birth (nanisme), the expressed backlog in physical and psychomotor development; often observe congenital stigma dysembriogenesis.
Neuroendocrine the form: mark considerable (usually proportional) decrease in weight and length of a body since a birth (nanisme), the expressed backlog in physical and psychomotor development; often observe congenital stigma dysembriogenesis.
The Entsefalopatichesky form is accompanied by deep backlog of the child in physical and psychomotor development, microcephaly, signs local brain defeats, hypoplasia bone system, an anorexia and development poligypovitaminosis.
Deficiency of weight of a body makes 10-20 % on comparison with average indexes. A condition satisfactory, appetite is lowered moderately, a skin smooth, elastic, pale, internal bodies and physiological departures without visible deviations. Тургор fabrics it is lowered, the thickness hypodermic fatty cells on a stomach is much less than norm, but on the person and finitenesses is kept. At inspection mark dysproteinemia and decrease in activity of digestive enzymes.
Deficiency of weight of a body makes 10-20 % on comparison with average indexes. A condition satisfactory, appetite is lowered moderately, a skin smooth, elastic, pale, internal bodies and physiological departures without visible deviations. Тургор fabrics it is lowered, the thickness hypodermic fatty cells on a stomach is much less than norm, but on the person and finitenesses is kept. At inspection mark dysproteinemia and decrease in activity of digestive enzymes.
Deficiency of weight of a body in relation to growth makes 20-30 % against backlog in growth on 2-4 the Curve of increase of weight of a body explanted see. Decrease in an emotional tone and activity of the child, apathy, slackness, adynamia, an arrest of development of psychomotor functions and speech, bad appetite is observed. A skin pale, dry. Elasticity and turgor fabrics are lowered, as well as a muscular tone. Hypodermic fatty cells it is kept on the person, but it is considerably reduced or is absent on a stomach and finitenesses. Fluctuations of a body temperature within days (to 1°С) and constantly cold finitenesses testify to thermoregulation frustration. Often mark taxipnoe, arrhythmic rigid breath, deadness warm tones, propensity to a tachycardia and an arterial hypotension. At violent feeding there is a vomiting quite often there are locks. Often join intercurrent diseases. At laboratory researches find out hypoxrome an anaemia, hypo-and dysproteinemia
Deficiency of weight of a body in relation to growth makes 20-30 % against backlog in growth on 2-4 the Curve of increase of weight of a body explanted see. Decrease in an emotional tone and activity of the child, apathy, slackness, adynamia, an arrest of development of psychomotor functions and speech, bad appetite is observed. A skin pale, dry. Elasticity and turgor fabrics are lowered, as well as a muscular tone. Hypodermic fatty cells it is kept on the person, but it is considerably reduced or is absent on a stomach and finitenesses. Fluctuations of a body temperature within days (to 1°С) and constantly cold finitenesses testify to thermoregulation frustration. Often mark taxipnoe, arrhythmic rigid breath, deadness warm tones, propensity to a tachycardia and an arterial hypotension. At violent feeding there is a vomiting quite often there are locks. Often join intercurrent diseases. At laboratory researches find out hypoxrome an anaemia, hypo-and dysproteinemia
Deficiency of weight of a body is made more than 30 %, by a curve of its increase absolutely flat or decreasing. Growth less than age norm see on 7-10 Causes considerable infringements of the general condition of the child: drowsiness, indifference, irritability, the negativism, the expressed delay in development, loss of already got skills and abilities, an anorexia. Outwardly the child reminds a skeleton fitted by a dry skin of is pale-grey colour, hanging down folds on buttocks and hips. The person senile, wrinkle нистое, the triangular form. Hypodermic fatty клетчатка is absent everywhere. Laboratory data testify to a blood condensation
Deficiency of weight of a body is made more than 30 %, by a curve of its increase absolutely flat or decreasing. Growth less than age norm see on 7-10 Causes considerable infringements of the general condition of the child: drowsiness, indifference, irritability, the negativism, the expressed delay in development, loss of already got skills and abilities, an anorexia. Outwardly the child reminds a skeleton fitted by a dry skin of is pale-grey colour, hanging down folds on buttocks and hips. The person senile, wrinkle нистое, the triangular form. Hypodermic fatty клетчатка is absent everywhere. Laboratory data testify to a blood condensation
It is an arrest of development caused by belkovo-power insufficiency, a variant of a dystrophy with more or мене uniform backlog of the child in growth and weight of a body at satisfactory fatness.
It is an arrest of development caused by belkovo-power insufficiency, a variant of a dystrophy with more or мене uniform backlog of the child in growth and weight of a body at satisfactory fatness.
The child more or less proportionally lags behind in growth, weight, psychomotor development, intelligence, teething terms. The biological age of the child lags behind from calendar and corresponds to its growth and weight of a body. The patient on all parametres of development makes impression of the child of smaller age.
Paratrophya develops at a reforage of the child chest milk, dry dairy mixes, sweet juice is more often, and also at an unbalanced food it is a lot of carbohydrates and deficiency of fiber (for example, at excessive feeding by porridges), especially at inactive children with ECD or a limfatiko-hypoplastic diathesis. The long reforage or a constant hypodinamia can lead to adiposity development.
Paratrophya develops at a reforage of the child chest milk, dry dairy mixes, sweet juice is more often, and also at an unbalanced food it is a lot of carbohydrates and deficiency of fiber (for example, at excessive feeding by porridges), especially at inactive children with ECD or a limfatiko-hypoplastic diathesis. The long reforage or a constant hypodinamia can lead to adiposity development.
Instability of an emotional tone, anxiety or slackness, adynamia are characteristic. Senior children complain of a short wind, fatigue, headaches. Appetite selective, often lowered. Integuments pale, quite often pastose, their elasticity can be lowered. Turgor fabrics and a muscular tone are insufficient. Cells it is often distributed non-uniformly and more expressed on hips and a stomach. Infringements albuminous, water-salt, vitamin and other kinds of an exchange are expressed. It is possible asidosis. Functional and morphological changes of internal bodies, decrease immunologic protection are frequent
Instability of an emotional tone, anxiety or slackness, adynamia are characteristic. Senior children complain of a short wind, fatigue, headaches. Appetite selective, often lowered. Integuments pale, quite often pastose, their elasticity can be lowered. Turgor fabrics and a muscular tone are insufficient. Cells it is often distributed non-uniformly and more expressed on hips and a stomach. Infringements albuminous, water-salt, vitamin and other kinds of an exchange are expressed. It is possible asidosis. Functional and morphological changes of internal bodies, decrease immunologic protection are frequent
The dystrophy diagnosis is based on the characteristic clinical symptoms including decrease turgors of fabrics, consecutive disappearance or reduction of a thickness hypodermic fatty клетчатки on a stomach, finitenesses and the person (or superfluous and its non-uniform adjournment), backlog of weight of a body from growth, resistibility decrease to infectious diseases' and to various influences of an environment. In the diagnosis specify a kind of a dystrophy and time of its occurrence in relation to the birth moment (prenatal, postnatal). At gipotrophy specify its degree, an aetiology and the development period (initial, progressing, reconvalessent).
The dystrophy diagnosis is based on the characteristic clinical symptoms including decrease turgors of fabrics, consecutive disappearance or reduction of a thickness hypodermic fatty клетчатки on a stomach, finitenesses and the person (or superfluous and its non-uniform adjournment), backlog of weight of a body from growth, resistibility decrease to infectious diseases' and to various influences of an environment. In the diagnosis specify a kind of a dystrophy and time of its occurrence in relation to the birth moment (prenatal, postnatal). At gipotrophy specify its degree, an aetiology and the development period (initial, progressing, reconvalessent).
The primary dystrophy should be differentiated from secondary, caused by developmental anomalies GIT and other bodies, a hereditary pathology, organic defeat SNS, endocrines diseases.
The primary dystrophy should be differentiated from secondary, caused by developmental anomalies GIT and other bodies, a hereditary pathology, organic defeat SNS, endocrines diseases.
Hypostature differentiate from the diseases accompanied by sharp backlog in physical development, first of all from nanisme, and also constitutional small.
Disproportionate nanisme, caused chondrodystrophya, congenital fragility of bones or tubulophatya, differs from hypostature a rough pathology of a skeleton which it is impossible to explain a rickets quite often accompanying dystrophies. Roentgenograms of bones and indicators fosfor-kaltsie an exchange allow to exclude these diseases.
Disproportionate nanisme, caused chondrodystrophya, congenital fragility of bones or tubulophatya, differs from hypostature a rough pathology of a skeleton which it is impossible to explain a rickets quite often accompanying dystrophies. Roentgenograms of bones and indicators fosfor-kaltsie an exchange allow to exclude these diseases.
Proportional nanisme it is caused by defeat of a hypophysis or a heavy c ongenital pathology of cardiovascular and respiratory systems. It is seldom shown at a birth, usually develops later. Difficulties arise at differential diagnostics from nanisme, caused by tolerance of fabrics of an organism to СТГ. At this disease children at a birth have low indicators of weight and length of a body, and further the increase in growth and weight of a body is extremely insignificant. However clinical and laboratory signs of a dystrophy are absent.
Elimination etiologic factors
Elimination etiologic factors
The organisation of a mode and optimum for the child of conditions of environment
Diet treatment.
Sanitation of the centres of a chronic infection
Treatment of accompanying diseases, the prevention of secondary infections
Struggle with hypodinamia
Diet treatment it is possible to divide into two stages:
Diet treatment it is possible to divide into two stages:
Finding-out of shipping of various food;
Gradual increase in volume of food and correction of its quality before achievement of physiological age norm.
The first stage proceeds from 3-4 till 10-12 days, the second - before recover.
Diet "rejuvenation" - application of the foodstuff intended for children of more younger age (chest milk, the sour-milk adapted mixes on a basis hydrolysats the squirrel);
Diet "rejuvenation" - application of the foodstuff intended for children of more younger age (chest milk, the sour-milk adapted mixes on a basis hydrolysats the squirrel);
A fractional food - frequent feeding (for example, to 10 times a day at hypotrophya III degrees) with reduction of quantity of food by one reception;
Weekly calculation of food loading by quantity of fibers, fats and carbohydrates with correction according to increase in weight of a body;
The regular control of a correctness of treatment (conducting a food diary with instructions of quantity of the food, the drunk liquid, diuresis and chair characteristics; drawing up of "a weight curve»).
At hypotrophya I degrees carry out on forced (corresponding to age) weight of a body of the child with full satisfaction of its requirements for the basic components of food, microcells and vitamins.
At hypotrophya I degrees carry out on forced (corresponding to age) weight of a body of the child with full satisfaction of its requirements for the basic components of food, microcells and vitamins.
At hypotrophya II and III degrees in the first 2-3 days food volume limit to 1/3-1/2 for forced weight of a body. In the subsequent it gradually increase to 2/3-3/5 daily diets of the healthy child. Missing volume of a food fill with a liquid - vegetable and fruit juice, 5 % a glucose solution. On reaching the volume of food put on age the quantity of fibers and carbohydrates count on forced weight of a body, and fats - on actual.
If at the child in the course of increase in quantity of food is not present диспепсии, and the weight of a body increases (usually it occurs through 1 - 12 days from the treatment beginning), gradually spend qualitative correction of the food, all components count on forced weight of a body (fibers and fats - 4-4,5 g/kg, carbohydrates - 13-16 g/kg).
Enzimotherapy spend it is long, replacing preparations: enzymes (abomine), pancreatine+ festal, at a considerable quantity of neutral fat and fat acids in fecaly-pankreatin, pansinorm.
Enzimotherapy spend it is long, replacing preparations: enzymes (abomine), pancreatine+ festal, at a considerable quantity of neutral fat and fat acids in fecaly-pankreatin, pansinorm.
Pathogenetic application of vitamins, first of all ascorbic acid, pyridoxine and thiamine is proved also.
Stimulating therapy includes alternating courses uterine a milk (apilac), pentoxil, a ginseng and other means.
At infectious disease development enter Ig.
Antenatal preventive maintenance includes family planning, sanitary education of parents, struggle against abortions, treatment of diseases of future mother, especially illnesses of sexual sphere, health protection of the pregnant woman [a balanced diet, observance of a mode of day, walk on fresh air, transfer into easy work (at adverse working conditions), an exception of smoking and other bad habits].
Antenatal preventive maintenance includes family planning, sanitary education of parents, struggle against abortions, treatment of diseases of future mother, especially illnesses of sexual sphere, health protection of the pregnant woman [a balanced diet, observance of a mode of day, walk on fresh air, transfer into easy work (at adverse working conditions), an exception of smoking and other bad habits].
Postnatal preventive maintenance includes natural feeding with its timely correction, observance of a mode and rules of care of the child, correct education, the prevention and treatment infectious and intercurrents diseases, dispensers supervision with monthly (till 1 year) weighing and measurement of length of a body.
The forecast depends first of all on possibility of elimination of the reason which have led to development of a dystrophy, and also from presence of accompanying diseases. At a primary alimentary and alimentarno-infectious dystrophy the forecast quite favorable.
The forecast depends first of all on possibility of elimination of the reason which have led to development of a dystrophy, and also from presence of accompanying diseases. At a primary alimentary and alimentarno-infectious dystrophy the forecast quite favorable.
