malnutrition in children
Introduction
Introduction to pediatric malnutrition Malnutrition is a chronic nutritional deficiency caused by insufficient calories and/or protein. More common in infants and young children. With the continuous improvement of people's lives, the incidence of malnutrition has dropped significantly. Most of the malnutrition seen at present is caused by improper feeding methods or disease factors in infancy and to a lesser extent. Long-term feeding is not the main cause of malnutrition. If prolific, twin and premature infants do not pay attention to scientific feeding, they often cause malnutrition. Congenital malformations such as cleft lip and chronic wasting diseases such as tuberculosis can also cause malnutrition. The performance is that the body weight does not increase or decrease, and the subcutaneous fat gradually disappears. The general order is the abdomen, chest and back, waist, double upper and lower limbs, and cheeks. In severe cases, muscle atrophy, motor function development is slow, mental retardation, poor immunity, susceptible to indigestion and various infections. basic knowledge The proportion of illness: 0.003% Susceptible people: children Mode of infection: non-infectious Complications: upper respiratory tract infection, thrush, enteritis
Cause
Causes of malnutrition in children
Improper feeding (35%):
Insufficient long-term food intake, such as insufficient breast milk, can not add food supplements early; artificial feeding, the quality and quantity of food failed to meet the needs, such as excessive dilution of milk, or simply fed with starchy food; sudden weaning, the baby can not adapt to the new Food, etc.
Poor eating habits (30%):
Untimely diet, partial eclipse, ruminating habits or nerve vomiting.
Disease factors (35%):
Disease affects appetite, hinders digestion, absorption and utilization of food, and increases body consumption. Common diseases that cause malnutrition are: prolonged infantile diarrhea, chronic enteritis or dysentery, malabsorption syndrome caused by various enzyme deficiency, Intestinal parasitic diseases, tuberculosis, measles, repeated respiratory infections, chronic urinary tract infections, etc., some congenital malformations of the digestive tract (such as cleft lip, cleft palate, congenital hypertrophic pyloric stenosis or stenosis of the cardia) and severe congenital heart disease Difficulties in feeding: Certain hereditary metabolic disorders and immunodeficiency disorders can also affect the digestion, absorption and utilization of food.
Premature birth and twins are prone to malnutrition, intrauterine infection, maternal disease or low nutrition, and abnormal structure and function of placenta and umbilical cord can lead to fetal undernutrition and intrauterine growth retardation, which is a prerequisite for malnutrition in infants.
Severe malnutrition is mostly due to a variety of factors.
Pathology and pathophysiology
The pathological changes of mild malnutrition are only the reduction of subcutaneous fat, mild atrophy of the muscles, the pathological changes of other tissues and organs of the body are not obvious, and the severe malnutrition often has thinning of the intestinal wall, disappearance of mucosal folds, and turbidity of myocardial fibers. Liver fat infiltration, lymphatic and thymus atrophy, all organs are reduced, resulting in a series of physiological changes from the surface.
Due to insufficient or excessive consumption of glycogen, hypoglycemia is often caused, body fat is consumed in a large amount, serum cholesterol is decreased, protein intake is insufficient and consumption is increased to form a negative nitrogen balance, extracellular fluid is often hypotonic, blood potassium, blood calcium Low, often lack of zinc and other trace elements, digestive juice and enzyme secretion decreased, reduced activity, affecting the digestion and absorption of various nutrients, myocardial contractility, blood flow, blood pressure is low, pulse is weak, kidney is concentrated Reduced ability, decreased urine specific gravity, abnormal nervous system regulation, slow exercise and language development, low cellular and humoral immune function, easy to be complicated by various infections, tuberculin test can be negative.
Prevention
Pediatric malnutrition prevention
1. Strengthen nutrition guidance, encourage breastfeeding, breast milk deficiency or no breast milk, should be supplemented with high-quality protein substitute milk (bovine, goat's milk, soy milk, fish, etc.) to prevent simple starchy food, condensed milk or malt extract Feeding, older children should pay attention to the correct mix of food ingredients, appropriate supply of meat, eggs, soy products, and add enough vegetables.
2, active prevention and treatment of diseases: prevention of infectious diseases, elimination of lesions, correction of congenital malformations.
3, pay attention to physical exercise: correct bad hygiene and eating habits, diet timing, to ensure adequate sleep.
Complication
Pediatric malnutrition complications Complications Upper respiratory tract infection Thrush enteritis
1, infection: upper respiratory tract infection, thrush, otitis media, pneumonia, enteritis, pyelonephritis and so on.
2, multivitamin deficiency: angular keratitis, bleeding gums, rickets, corneal dryness, softening or ulcers.
3, zinc deficiency: growth retardation, refractory appetite deficiency, skeletal development disorders, severe pygmy state, and liver, anemia, rough skin and pigmentation and sexual development disorders.
4, spontaneous hypoglycemia: severely malnourished children, sometimes sudden sweating, palpitation, slow pulse, apnea and other spontaneous hypoglycemia, mostly at night, if not rescued in time can die from respiratory failure .
Symptom
Symptoms of malnutrition in children Common symptoms Loss of appetite, pale children, partial eclipse, dry skin, constipation, weight loss, subcutaneous fat, disappearance, simple upper body, thin, irritability
Clinical manifestations:
Weight loss is the first symptom to appear, followed by weight loss, subcutaneous fat reduction, gradually thinning out, long-term dry skin, pale, irritability, muscle relaxation, height is lower than normal, according to the weight Third degree: I degree is light, II, III degree is heavy.
I degree malnutrition: normal mental state, weight less than normal 15%-25%, abdominal wall subcutaneous fat thickness of 0.8 cm -0.4 cm, dry skin, height does not affect.
II degree malnutrition: lack of energy, irritability, muscle tension is weakened, muscle relaxation, weight is lower than normal 25%-40%, abdominal wall subcutaneous fat thickness is less than 0.4 cm, skin is pale, dry, hair is dull, height is normal reduce.
III degree malnutrition: listlessness, lethargy and irritability alternate, mental retardation, muscle atrophy, low muscle tone, body weight below normal 40%, abdominal wall subcutaneous fat disappears, wrinkles on the forehead, showing the face of the elderly, The skin is pale, dry, inelastic, dry hair, height is significantly lower than normal, often low body temperature, slow pulse, loss of appetite, constipation, severe cases of dystrophic edema due to decreased serum protein.
Examine
Pediatric malnutrition examination
Mainly for routine examination in pediatrics, gastroenterology or nutrition. Blood glucose and cholesterol levels decreased, albumin and total protein decreased, transferrin was more sensitive than albumin reduction, thyroxine combined pre-albumin, plasma ceruloplasmin decreased; alkaline phosphatase decreased, blood amylase <50IU/ L, blood zinc reduction is more common.
Diagnosis
Diagnosis and diagnosis of pediatric malnutrition
diagnosis
Diagnosis can be based on the cause, symptoms and related tests.
Differential diagnosis
1. Progressive spinal muscular atrophy: is an autosomal recessive spinal cord anterior horn cell degeneration, clinical manifestations of muscle atrophy and weakness, the course of disease is gradually progressing, but common muscle bundles vibrate, distal limb muscle atrophy is more Obviously, there were no abnormalities in serum enzymology, and electromyography was characterized by neurogenic damage.
2, polymyositis: onset more urgent, rapid progress, often accompanied by myalgia or fever, no positive family history, laboratory tests can have increased ESR, muscle biopsy can be seen inflammatory changes.
3, myasthenia gravis: muscle atrophy in the late stage, but muscle weakness is volatility, frequent morning light weight, anti-cholesterol esterase drug test positive, serum muscle enzymes are not elevated, anti-acetylcholine receptor antibody mostly Positive, EMG stimulation of the nerves at a repetition rate, showing that the amplitude of the action potential is decreasing, and the treatment of adrenocortical hormone or anticholesteryl esterase is effective.
4, amyotrophic lateral sclerosis: children are less common, muscle atrophy and weakness, the course of disease gradually progress, but often accompanied by fasciculation, and increased muscle tone, hyperreflexia and pathological signs and other upper motor neurons The performance of the damage.
