Hypotrophy. Mixed hypotrophy - symptoms and treatment
Hypotrophy - a violation in which the weight of the child is constantly below 3-5 percentiles for his age, there is a progressive decrease in body weight to values below 3-5 percentile or a decrease in the percentile index of the two main parameters of physical development in a short period. The cause may be a diagnosed disease or condition, or the cause may be related to environmental conditions. Both types are associated with inadequate nutrition. The treatment is aimed at restoring proper nutrition.
Hypotrophy - etiology
The physiological basis of the malnutrition of any etiology is inadequate nutrition.
Organic hypotrophy is a violation of physical development due to an acute or chronic disease that affects the intake of nutrients, their absorption, metabolism or excretion or increases energy requirements. The cause may be a disease of any organ system.
Inorganic hypotrophy. Up to 80% of children with impaired physical development do not show obvious signs of slowing the development of the disease; a decrease in physical development occurs due to inadequate care.
Lack of food can be the result of poverty, improper feeding and mixture preparation or inadequate provision of breast milk.
Inorganic hypotrophy is often a complication of the broken relationship between the child and the person caring for him. In some cases, the psychological basis of inorganic hypotrophy turns out to be similar to the causes of “hospitalism”, a syndrome observed in infants who develop depression for the second time due to poor care. A child who is deprived of proper communication becomes depressed, apathetic, and eventually he develops anorek-sia. Inadequate care can also be noted if the person caring for the child is depressed, has poor skills in caring for the child, is experiencing or does not get satisfaction from his role as the person caring for the child, feels dislike towards the child (for example, large babyIf a child does not gain weight despite outpatient testing and treatment, his hospitalization is usually indicated in order to quickly conduct all necessary observations and diagnostic tests. In the absence of anamnestic or physical signs of obvious causes of dysplasia, no single clinical sign or laboratory test alone can reliably distinguish organic from nonorganic hypotrophy. Since inorganic hypotrophy is not a diagnosis of exclusion, the doctor must simultaneously look for both organic problems and personal and family characteristics, as well as characterize the relationship between family and child, which will confirm the psychosocial causes of malnutrition. Optimally, the examination should be carried out by a team of specialists including a doctor, a nurse, a social worker, a nutritionist and an expert on child development, as well as, often, a psychiatrist and a psychologist. Regardless of whether the child is hospitalized or is observant, it is necessary to evaluate the behavior of the child when eating in the presence of a doctor and parents.
It is necessary to encourage parents as active participants in the survey and identify the causes of malnutrition. This helps raise their self-esteem and avoid blaming those parents who may already feel vain and useless or feel guilty because of a perceived inability to care for a child. The family should be encouraged to visit the doctor as many times and as often as possible. The staff should make parents feel welcome, help their efforts to feed the child, and provide toys and ideas to encourage games and other interactions between the parents and the child. Personnel should avoid any comments regarding inadequacy, irresponsibility or other parental errors as causes of malnutrition. If you suspect abandonment, neglect or cruel treatment of a child, you should inform the social services.
Poor care is not responsible for all cases of inorganic malnutrition. The nature of the child, his temperament, capabilities and reactions help to outline the methods of education and care for him. A common scenario is the incompatibility of parents and child,in which the child’s requests, although not pathological, cannot be adequately satisfied by the parents, who nevertheless could cope with the child with other needs or even with the same child under other circumstances.
When mixed hypotrophy can be combined organic and inorganic causes; children with organic causes can also have problems in their surroundings or in interaction with their parents. Similarly, children with severe inorganic hypotrophy may develop organic problems.
Mixed hypotrophy - diagnosis
Manifestations in children with organic hypotrophy can occur at any age, depending on the cause. For most children with inorganic hypotrophy, manifestation occurs as a delay in physical development in the first year of life, and for many as early as 6 months of life. Age should be compared with body weight, height and head circumference. Premature babies up to 2 years of age should correct their age, taking into account the period of gestation.
Body weight is the most sensitive indicator of nutritional status.A decrease in body linear dimensions indicates a more severe, prolonged eating disorder. Since the brain is not affected during protein-energy starvation, a decrease in the growth of the head circumference arises late and indicates a very serious long-term malnutrition.
Usually, when physical developmental delays are detected, anamnesis is collected, nutritional advice is given, but it is recommended that, in many cases, contacting support services aimed at supporting parents' needs for help and education is more appropriate.
During hospitalization, the relationship of the child with the people around him is carefully evaluated, and signs of inappropriate behavior are noted. Some children with inorganic hypotrophy were described as overly cautious and fearful of close contact with people who prefer to play with inanimate objects, if at all they play with something. Although inorganic hypotrophy is more common with insufficient attention than child abuse, the child should be carefully examined for signs of abuse.Screening testing of the child’s developmental level should be carried out and, if indicated, a more thorough examination.
Survey. Extended laboratory tests are usually not informative. If a thorough history does not indicate a specific reason, most experts recommend limiting screening tests with a general blood test with a count of leukocyte formula and ESR, biochemical blood tests with urea or creatinine, urine analysis, urine culture, and pH and reducing substances in the stool, its smell, color, consistency and fat content. Depending on the prevalence of certain diseases in society, testing for HIV, TB or blood lead levels can be justified.
Other tests that are sometimes indicated include electrolyte concentrations if the child has severe vomiting or diarrhea; thyroxin level with more pronounced growth retardation than underweight; sweat test, if the child has a history of recurrent infections of the upper and lower respiratory tract, salty taste of the skin, increased appetite, fetid abundant stools, hepatomegaly, or a family history of cystic fibrosis.A survey for infectious diseases should be left for children with signs of infection. Radiological examination should be left for children with signs of anatomical or functional pathology.
Mixed hypotrophy - prognosis
The prognosis for organic malnutrition depends on the cause. In inorganic malnutrition, 50–75% of children over 1 year old achieve a stable weight above the 3rd percentile. Cognitive function, especially speech development, remains below normal values at about1/3! Children whose malnutrition has developed in the first year of life are at high risk, and those who have been diagnosed with malnutrition at the age of 6 months - when the highest rate of postnatal brain development is noted - are at the highest risk. General behavioral problems detected by teachers or psychologists develop in about 50% of children. Problems associated with food intake or physiological functions tend to develop in the same percentage of children, usually those who also have behavioral and personality disorders.
Mixed hypotrophy - treatment
Treatment aims to provide sufficient medical and environmental resources to ensure satisfactory development. A nutritious diet containing enough calories to make up for proper growth, and individual medical and social support is always needed. The ability to gain weight in the hospital does not always distinguish children with inorganic hypotrophy from children with organic hypotrophy; All children grow up if they are provided with adequate nutrition. Nevertheless, some children with inorganic hypotrophy lose weight in the hospital, which emphasizes the complexity of this condition.
In children with organic or mixed malnutrition, treatment of the underlying disease should be quickly initiated. In children with obvious inorganic hypotrophy or mixed hypotrophy, the tactic includes providing training and emotional support for correcting problems that affect the interaction between the child and the parents. Because long-term social support or psychiatric treatment is often needed, the team that conducts the initial survey can only be able to identify the needs of the family, provide primary instruction and support, and send the family to the relevant public agencies.Parents should understand why they are sent there, and if there are options, they should be involved in choosing a particular agency. If the child is hospitalized in the tertiary care centers, the doctor should consult about local agencies and the level of their competence and experience.
Ideally, before the child is discharged from the hospital, a meeting should be held with the participation of hospital staff, representatives of public agencies who will provide further observation and assistance, and a primary care physician. It is necessary to clearly define the areas of responsibility and reporting lines, preferably in writing, that should be provided to each interested participant. Parents should be invited to a final consultation after this meeting so that they can meet with community workers, ask questions and agree on follow-up visits.
In some cases, the child must be placed in a shelter. If they expect that a child will ever return to biological parents, they should be provided with the opportunity to attend training sessions for parents and counseling by a psychologist.It should be scrupulously monitor the progress of the children of such parents. A return to biological parents should be based on the ability of parents to adequately care for the child.
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