Paratrophy

Paratrophy (paratrophia; para- + trophe - nutrition) is a pathological condition that is characterized by chronic malnutrition in children at an early age and is accompanied by a disorder of the body's functions responsible for metabolism, characterized by the presence of excess or normal weight, as well as tissue hydrolability.

Causes of paratrophy

The main reason for the development of paratrophy is excessive, one-sided (usually carbohydrate) nutrition with a protein deficiency. This can happen with the correct organization of feeding (predominance of cereals and flour dishes in the diet; violation of the technique of preparing adapted mixtures recommended for artificial feeding, with an excess of dry matter concentration), especially in sedentary children.

Clinical and biochemical data allow us to distinguish two forms of paratrophy:

1. lipomatous - alimentary overfeeding in combination with hereditary hyperliposynthetic metabolic orientation, accelerated absorption and increased assimilation of fats;
2. pastous (lipomatous-pastous) - metabolic disorders in the organs of the nervous, immune and endocrine systems.

Symptoms of paratrophy

The lipomatous form of paratrophy is characterized by excessive fat deposition in the subcutaneous fat tissue. At the same time, the pink color of the skin and visible mucous membranes and satisfactory tissue turgor are preserved for a long time.

The pasty form of paratrophy is often observed in children with a specific phenotype (soft rounded body shapes, round face, wide-oval, widely spaced eyes, short neck, relatively broad shoulders, presence of multiple stigmas of dysembryogenesis) and is characterized by pastosity and decreased tissue turgor, pale skin, hypotension, instability of emotional tone, restless behavior, sleep disturbances, delayed motor development).

Children with pastous paratrophy are prone to immediate allergic reactions, acute rickets, frequent viral and bacterial diseases, and intestinal dysbacteriosis. Thymomegaly is often registered in children with pastous paratrophy.

The ratio of body weight and height in children with paratrophy is normal, however, when comparing these indicators with average age indicators, children with paratrophy show a tendency to increase (body weight exceeds average age indicators by up to 10%, height - by 1-2 cm). The curve of body weight increase is steep.

Diagnostic criteria for paratrophy

Anamnestic diagnostic criteria allow us to detect etiological and predisposing factors, a heredity burdened with obesity and metabolic diseases: intrauterine "overfeeding", abuse of high-calorie foods, high-protein diet, electrolyte overload, intake of high-calorie foods in the afternoon, low mobility of the child, neuroendocrine disorders.

Clinical diagnostic criteria: the severity of clinical and laboratory signs depends on the severity and clinical form of paratrophy.

Metabolic disorder syndrome:

• excess body weight;
• violation of body proportionality;
• excess deposition of adipose tissue;
• signs of polyhypovitaminosis;
• pallor;
• pastosity of the skin;
• decreased tissue turgor;
• lethargy, sleep disturbances and thermoregulation.
• selective decrease (children eat vegetable types of complementary foods poorly, sometimes meat) or increase (they prefer dairy products, cereals) of appetite;
• high uneven weight gain (weight curve lability);
• bowel disorder (constipation or loose stools);
• signs of functional disorders of gastrointestinal digestion (according to coprogram data).

Syndrome of decreased immunological responsiveness:

• a tendency to frequent infectious diseases with a protracted course;
• Respiratory diseases often recur, occurring with obstructive syndrome and severe respiratory failure.

Laboratory diagnostic criteria:

• Blood test - anemia.
• Biochemical blood test - dysproteinemia, decreased globulin content and relative increase in albumin, hyperlipidemia, hypercholesterolemia, distorted type of sugar curve.
• Coprogram:
  • in case of milk eating disorder - the stool is putrid, dense, shiny (fatty-soapy), the stool reaction is alkaline, neutral fat, soap, putrefactive microflora are often determined:
  • in case of flour disorder - stool is yellow or brown, dense, abundant (in case of dysfunction - foamy, green), the reaction of feces is acidic, extra- and intracellular starch, iodophilic microflora are often determined.
• Immunogram - disimmunoglobulinemia, decreased non-specific resistance indicators.

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Example of diagnosis formulation

Paratrophy of the second degree, constitutional-alimentary, lipomatous-pasty form, period of progression.

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Treatment of paratrophy

• Clarification and elimination of the possible cause of paratrophy.
• Organization of rational dietary nutrition and daily routine.
• Organization of the motor regime.
• Rehabilitation activities.
• Timely diagnosis and treatment of concomitant pathology.

Principles of diet therapy

• Organization of rational, balanced nutrition.
• Feeding according to the schedule.
• Optimization of water regime.

Conducting staged dietary treatment:

• Stage I (unloading) involves the abolition of high-calorie foods and all types of complementary feeding. The total volume of food corresponds to age norms. The best product is breast milk. After 6 months, a combination of breast milk and fermented milk mixtures is advisable. The duration of the stage is 7-10 days.
• Stage II (transitional) lasts 3-4 weeks. Children over 4 months are introduced to age-appropriate complementary foods, starting with vegetable puree.
• Stage III (minimum-optimal diet) - the child receives all types of complementary foods appropriate to age. The required amount of protein is calculated based on the actual body weight. The need for fats, carbohydrates, calories - based on the expected body weight.

Organization of the motor regime

Daily massage and gymnastics, regular (at least 3-4 hours a day) stay in the fresh air, aero- and hydro-procedures. Children's age-related daily routine is changed 2-4 weeks earlier.

Scheme of dispensary observation and rehabilitation of young children with chronic nutritional disorders such as hypotrophy

The observation period was 1 year.

The period of clinical manifestations is 1 month. A general blood test is performed 1-2 times, urine analysis is performed once, coprogram is performed once, examination by a pediatrician is weekly. According to indications, a biochemical blood test is performed (protein and its fractions, urea, creatinine, alkaline phosphatase, calcium, phosphorus, iron, potassium, glucose), feces for dysbacteriosis are examined, a pilocarpine test, ECG, ultrasound of the gastrointestinal tract are performed. Consultations are performed with a neurologist, endocrinologist, gastroenterologist.

The recovery period is up to 1 year. A general blood test is performed once every 3 months, a urine test once every 6 months, a coprogram once every 3 months, a monthly examination by a pediatrician with anthropometry (height, body weight, chest and head circumference, Chulitskaya fatness index). According to indications, a biochemical blood test is examined (protein and its fractions, urea, creatinine, alkaline phosphatase, calcium, phosphorus, iron, potassium, glucose), feces for dysbacteriosis, a pilocarpine test is performed, an ECG and an ultrasound of the gastrointestinal tract are performed. Consultations with a neurologist, endocrinologist, gastroenterologist.

Criteria for removal from dispensary register

Gradual normalization of physical, psycho-emotional and static-motor development indicators. Satisfactory tissue turgor. Increased resistance to infections. Normalization of clinical and biochemical blood indicators.

Preventive vaccinations

According to the calendar of preventive vaccinations. According to indications at individual times.