Hypotrophy in children: causes and treatment forlack of weight in a child

Update: December 2018


  • And what does a baby look like that develops normally?
  • Causes and development malnutrition
  • Symptoms
  • The degree of malnutrition in children
  • Diagnostics
  • Treatment
  • Исследование причин и симптомов malnutrition детей
  • Профилактика malnutrition у детей
  • Table of dependence of weight on height in children up to 4 years

Hypotrophy in children is fasting, quantitative or
quality, which resulted in the body occur
significant changes. High-quality fasting is possible with
improper artificial feeding, lack of basic
nutrients and vitamins, quantitative – with the wrong
calorie calculation or lack of food resources.

Hypotrophy may be due to acute illness
or the result of a chronic inflammatory process. Wrong
parental actions – lack of treatment, poor care, poor sanitation,
lack of fresh air – also lead to this condition.

And what does a baby look like that develops normally?

Signs of normotrophy:

  • Healthy appearance
  • Skin is pink, velvety, elastic
  • Lively look, activity, with interest exploring the surrounding
  • Regular increase in weight and height
  • Timely mental development
  • The proper functioning of organs and systems
  • High resilience to adverse external factors
    environment, including infectious
  • Rarely cries

In medicine, this concept is used only in children under 2 years. By
According to the WHO, hypotrophy is not common:

  • in developed countries, its percentage is less than 10,
  • and in developing countries, over 20.

By данным научных исследований, такое дефицитное состояние
occurs about the same in boys and girls. Heavy
случаи malnutrition наблюдаются в 10-12 процентах случаев, причем у
she has rickets in a fifth of children, and anemia in a tenth.
Byловина детей с этой патология рождается именно в холодное время
of the year.

Causes and development

Причины malnutrition у детей многообразны. The main factor
causing intrauterine hypotrophy, is toxicosis first and
second half of pregnancy. The remaining causes of congenital
malnutrition таковы:

  • pregnancy before the age of 20 or after 40 years
  • bad habits of the future mother, poor nutrition
  • chronic maternal diseases (endocrine pathologies, defects)
    hearts and so on)
  • chronic stress
  • mother’s work during pregnancy in hazardous work
    (noise, vibration, chemistry)
  • pathology of the placenta (improper attachment, early aging,
    one umbilical artery instead of two and other placental disorders
    blood circulation)
  • multiple pregnancy
  • metabolic disorders of the hereditary fetus
  • genetic mutations and fetal abnormalities

Причины приобретенной malnutrition

Внутренние — обусловленные патологиями
organism, violating food intake and its digestion, absorption
nutritional elements and metabolism: Гипотрофия

  • congenital malformations
  • CNS lesions
  • immunodeficiency
  • endocrine diseases
  • metabolic disorders

In the group of endogenous factors, it is worth to separate food
allergies and three hereditary diseases that occur with
синдромом мальабсорбции – одной из частых причин malnutrition у

  • cystic fibrosis – a violation of the external secretion glands,
    affected gastrointestinal tract, respiratory system
  • celiac disease – gluten intolerance, changes in work
    intestines in a child begin with the introduction of the diet
    gluten-containing products – barley, semolina, wheat
    porridge, rye groats, oatmeal
  • lactase deficiency – milk digestibility is disturbed
    (lack of lactase).

By данным научных исследований, синдром мальабсорбции
provokes hypotrophy twice as often as nutritional deficiency. This
the syndrome is primarily characterized by impaired stool: he
becomes plentiful, watery, frequent, frothy.

Внешние — обусловленные неправильными
actions of parents and adverse environment:

Food factor Insufficient intake of breast milk; wrong
selected formula for artificial feeding; Byздно введен
lure, a small amount of calories in the lure, imbalance
on proteins, fats and carbohydrates
Infectious factor Intestinal infections; Chronic infections, frequent ARVI and other
Toxic factor Unfavorable environmental conditions, medication,
poisoning, excessive intake of vitamins, especially A and D
Social factor Inattentive attitude of parents to the child, lack
walks in the fresh air, caress, care, communication with mom,
lack of gymnastics and massage

Все экзогенные факторы развития malnutrition вызывают у ребенка
stress. Proved that mild stress increases energy demand.
by 20%, and in protein – by 50-80%, moderate – by 20-40% and 100-150%,
strong – by 40-70 and 150-200%, respectively.


Признаки и симптомы внутриутробной malnutrition у ребенка:

  • body weight below normal from 15% or more (see table below
    depending on the weight of the child’s height)
  • height less than 2-4 cm
  • child is lethargic, muscle tone is reduced
  • congenital reflexes are weak
  • thermoregulation is disturbed – the child is cold or overheated
    faster and stronger than normal
  • further, the initial weight is slowly restored
  • umbilical wound does not heal well

Acquired hypotrophy is characterized by similarities in the form
clinical syndromes.

  • Insufficient fatness: the child is thin, but the proportions of the body are not
  • Trophic disorders (malnutrition of body tissues):
    the subcutaneous fat layer is thinned (first on the abdomen, then on
    limbs, with severe and on the face), the mass is insufficient,
    body proportions are disturbed, skin is dry, elasticity is reduced.
  • Changes in the nervous system: depressed mood,
    decrease in muscle tone, weakening of reflexes, psychomotor development
    delayed, and in severe course, even acquired ones disappear.
  • Decreased food perception: appetite decreases to full
    his absence, there are frequent regurgitations, vomiting, violations
    stool secretion of digestive enzymes is inhibited.
  • Immunity reduction: the child begins to get sick often, develop
    chronic infectious and inflammatory diseases, perhaps
    toxic and bacterial damage to the blood, the body suffers from
    total dysbiosis.

The degree of malnutrition in children

The hypotrophy of the I degree sometimes is almost not noticeable. Only
an attentive doctor on examination can reveal it, and even then at the beginning
will conduct a differential diagnosis and find out if
Underweight body weight 11-20% of the child’s body. Skinny
and tall children are usually so due to hereditary
features. Therefore, a young mother should not be afraid if her
active, cheerful, well-fed child is not so
plump like other children.


Hypotrophy 1 degree in children is characterized by a slight decrease.
appetite, restlessness, sleep disturbance. Skin surface
practically unchanged, but its elasticity is reduced, the view can
be pale The baby looks thin only in the abdomen. Tone
muscle normal or slightly reduced. Sometimes there are signs
rickets, anemia. Children are sick more often than their well-fed peers.
The changes in the stool are minor: a tendency to constipation or
vice versa.

Hypotrophy 2 degrees in children manifested by a mass deficit of 20-30%
and lag in growth (about 2-4 cm). Mom can detect u
the child’s cold hands and feet, he can often regurgitate,
refuse to eat, be lethargic, sedentary, sad. Such
children lag behind in mental and motor development, sleep poorly. Skin y
they are dry, pale, flaky, easy to fold,
inelastic. The baby looks thin in the abdomen and limbs,
he has outlines of ribs. The chair varies greatly from constipation to
diarrhea Such дети болеют каждый квартал.

Sometimes doctors see hypotrophy even in a healthy child who
looks too thin. But if height is age, he
active, mobile and happy, it means a lack of subcutaneous fat
fiber is due to the individual characteristics and large
baby mobility.

When hypotrophy 3 degrees of growth in the growth of 7-10 cm, deficiency
weight ≥ 30%. The child is sleepy, indifferent, tearful, acquired
skills lost. Subcutaneous fatty tissue is thinned everywhere,
pale gray, dry skin clings to the bones of the baby. Observed
muscle atrophy, cold limbs. Eyes and lips are dry, around the mouth
cracks. The child is often detected chronic infection in
form of pneumonia, pyelonephritis.


Clinical methods: Laboratory methods:
  • History: parents are interviewed on the subject of child nutrition
    and care for him, find out congenital diseases, whether he accepts
    medication where he lives, spits up or not after eating and so on
  • Examination: determine the condition of the skin, hair, nails, mouth,
    muscle tone, assess child behavior
  • Determination of the thickness of the subcutaneous fat and mass index
  • General tests (urine, blood)
  • Blood chemistry
  • Immunological examination
  • The analysis of feces on the amount of undigested fat,
  • Breathing tests, ECG
  • Abdominal ultrasound
Differential diagnostics

As mentioned above, the doctor first of all needs
find out whether hypotrophy is an individual feature
organism. In this case, no changes in the body
will not be observed. In other cases, you need to hold
differential diagnosis of the pathology that led to
malnutrition: congenital malformations, diseases of the gastrointestinal tract or endocrine
system, CNS damage, infection.


The main directions of treatment of malnutrition in children are as follows:

  • Identifying the cause of malnutrition, its elimination
  • Proper care: daily routine, walks (3 hours daily, if on
    street ≥5˚), gymnastics and professional massage, swimming in warm
    baths (38 degrees) in the evening
  • The organization of proper nutrition, protein-balanced,
    fats and carbohydrates, as well as vitamins and trace elements
    (diet therapy)
  • Drug treatment

Treatment врожденной malnutrition заключается в поддержании у
child constant body temperature and the establishment of a breast

Food for children malnutrition

Диетотерапию при malnutrition разделяют на три этапа.

Stage 1 – the so-called “rejuvenation” of the diet that is, use food intended for children
younger Feed the child often (up to 10 times a day),
calculation of the diet is carried out on the actual body weight, keep a diary
control over the absorption of food. The stage lasts 2-14 days (depends on
степени malnutrition).
Stage 2 – Transitional The mixture is added to the diet, they optimize nutrition to
approximate norm (by weight, which should be
Stage 3 – the period of enhanced nutrition Caloric intake increases to 200 calories per day
(at a rate of 110-115). Use special high-protein mixture.
When celiac disease exclude gluten-containing products, limit
fats, nutrition recommended buckwheat, rice, corn. With lactase
deficiencies are removed from the products of milk and dishes prepared
on milk. Instead, they use dairy products, soy
mixes. With cystic fibrosis – a diet with high calorie, food
should be salted.
The main directions of drug therapy
  • Pancreatic enzyme replacement therapy;
    drugs that increase the secretion of gastric enzymes
  • Use of immunomodulators
  • Treatment dysbacteriosisа кишечника
  • Vitamin therapy
  • Symptomatic therapy: correction of individual disorders
    (iron deficiency, irritability, stimulating
  • При тяжелых формах malnutrition – анаболические препараты –
    drugs that promote the formation of building protein in
    body for muscles, internal organs.

Treatment malnutrition требует индивидуального подхода. Correct
to say that children are nursed, not treated. Прививки при malnutrition
1 степени проводят по общему графику, при malnutrition 2 и 3 степени
– individually.

Исследование причин и симптомов malnutrition детей

In one of the somatic hospitals 40 stories were analyzed.
diseases of children diagnosed with hypertrophy (19 boys and 21 girls
1-3 years). Conclusions were obtained as a result of the analysis specifically
developed questionnaires: most often children with hypotrophy were born from
pregnancy, proceeding with pathologies, with heredity
pathologies of the gastrointestinal tract and allergic diseases, with delay
intrauterine development.

Частые причины malnutrition у children:
  •  37% – malabsorption syndrome – cystic fibrosis, lactase
    deficiency, celiac disease, food allergies
  • 22% – chronic diseases of the digestive tract
  • 12% – lack of nutrition
By severity:
  • 1 degree – 43%
  • 2 degree – 45%
  • 3 degree – 12%
Concomitant pathology:
  • 20% – rickets in 8 children
  • 10% – anemia in 5 children
  • 20% – delayed psychomotor development
Основные симптомы malnutrition:
  • dystrophic changes of teeth, tongue, mucous membranes,
    skin, nails
  • 40% unstable stools, impurities of undigested food
Laboratory data:
  • 50% of children – absolute lymphocytopenia
  • total protein in 100% of the examined children is normal
  • results of scatological examination:
    • 52% – creatorrhea – disorders of digestion processes in
    • 30% – amilorrhea – in the intestine
    • 42% – violation of bile secretion (fatty acids)
    • in children with cystic fibrosis – neutral fat

Профилактика malnutrition у детей

Профилактика как внутриутробной, так и приобретенной malnutrition
begins with the struggle for the health of women and for the preservation of long
грудного feeding.

The next areas of prevention are tracking the main
anthropometric indicators (height, weight), power control

An important point is the timely detection and treatment
childhood diseases, congenital and hereditary
pathologies, proper child care, prevention of influence
внешних факторов развития malnutrition.

It should be remembered:

  • Mother’s milk is the best and irreplaceable food for
    baby up to a year.
  • In 6 months you should expand the menu at the expense of plant foods
    (see how to properly feed the baby). Also not worth it early
    translate a child to adult food. Weaning
    feeding up to 6 months of a child is a crime against a baby,
    if you have problems with lactation, the baby lacks milk,
    you must first apply it to your chest and only then
    to feed
  • Diversity in food is not different types of cereals and pasta in
    throughout the day. Nutrition is balanced
    combination of proteins (animal, vegetable), carbohydrates (complex and
    simple), fats (animal and vegetable), that is, necessarily in
    the diet should include vegetables, fruits, meat, dairy
  • As for meat – after a year it must necessarily
    being present in the child’s diet is an indispensable product
    what vegetarianism speech can not be, only the meat contains
    compounds necessary for growth, they are not produced in
    the body in the quantities in which you need to complete
    development and health.
  • Important!!! There are no safe medicines.
    “just” to reduce or increase the appetite of the child.

Table of dependence of weight on height in children up to 4 years

Very strong deviations in mass of the child are not due
reduced appetite or some specific features
the body – usually an unrecognized disease or
lack of nutrition in the child. Monotonous diet
food that does not meet age needs – leads to
болезненному недостатку массы body. Child’s weight should
control not so much by age, but by the height of the baby.
Below is a table of dependence of height and weight of the baby (girls and
boys) from birth to 4 years:

  • Норма –  это промежуток между
    ЗЕЛЕНОЙ и СИНЕЙ цифрой величины
    weights (25-75 centiles).
  • Снижение массы тела – между
    ЖЕЛТОЙ и ЗЕЛЕНОЙ цифрой (10-25
    centiles), but may be a variant of the norm or a small
    weight loss trends in relation to growth.
  • Увеличение массы тела –  между
    СИНЕЙ и ЖЕЛТОЙ цифрой (75-90
    centiles), as normal, and indicates a tendency to
    weight gain.
  • Byвышенная или сниженная масса тела – 
    между КРАСНОЙ и ЖЕЛТОЙ цифрой
    indicates both low body weight (3-10 centile), and
    increased (90-97 centile). This may indicate the presence of
    diseases, and on features of the child. Such показатели требуют
    thorough diagnosis of the child.
  • Painful decrease or increase in body weight
    – за КРАСНОЙ границей ( >97  или <3
    centile). A child with such weight needs to establish the cause
    malnutrition или ожирения и корректировки питания и назначения
    treatment, massage, etc., as this is a manifestation
    any disease and dangerously inharmonious development of organs,
    body systems, reducing resistance to infections and
    negative environmental factors.

Зависимость веса от роста ребенка

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