Anorexia in children
Introduction
Introduction to anorexia in children Anorexia in children is very common in children. The main symptoms are vomiting, loss of appetite, diarrhea, constipation, bloating, abdominal pain and blood in the stool. These symptoms not only reflect the functional or organic diseases of the digestive tract, but also often appear in other systems. When the disease is particularly common in central nervous system diseases or mental disorders and a variety of infectious diseases, it is necessary to inquire about the medical history in detail, closely observe the changes in the condition, and correctly diagnose and treat the primary disease. Normal children every 3 to 4 hours of gastric emptying, blood sugar drops, there will be appetite, improper feeding or bad eating habits, such as eating irregular, eating snacks or candy before meals, there is always something in the stomach, blood sugar does not fall, There will be no appetite. Western medicine treatment methods in addition to maintaining a reasonable diet, develop good habits, if necessary, can give zinc sulphate 10mg, put syrup or 100g of salt into the 1g zinc sulphate, so that the zinc intake reaches the standard dosage of about daily 10mg, can promote the increase of appetite. basic knowledge Sickness ratio: 5% Susceptible people: young children Mode of infection: non-infectious Complications: pediatric malnutrition
Cause
Causes of anorexia in children
The causes of anorexia are diverse and can be summarized as follows:
Effects of systemic diseases (20%):
Many acute and chronic infectious diseases have anorexia manifestations, especially digestive tract diseases, such as peptic ulcer, acute and chronic hepatitis, acute and chronic enteritis, long-term constipation, etc. can cause anorexia.
Drug impact (20%):
Many drugs, especially antibiotics, can cause nausea, vomiting, such as erythromycin, chloramphenicol, sulfonamides, etc. can also cause anorexia, vitamin A or vitamin D poisoning also shows anorexia, some anticancer drugs are more likely to cause anorexia.
Lack of trace elements and some endocrine deficiency (15%):
Zinc deficiency often shows anorexia, some endocrine hormones such as hypothyroidism, and relatively insufficient adrenal cortex hormones can also show anorexia.
Climate impact (10%):
If the summer is hot, it is also the cause of anorexia.
Improper feeding (10%):
This is the most prominent reason at present. The city is particularly obvious. The reason is that the family economy is improving, the market for children's food supply is increasing, the only child is spoiled, the parents lack scientific feeding knowledge, eating snacks, eating cold drinks, and giving nutritious food. High protein, high sugar foods (such as chocolate), in turn, reduce appetite.
Anorexia nervosa (10%):
It refers only to a type of anorexia caused by mental factors. The incidence factors and clinical manifestations are as follows:
1. Acute mental stimulation: If the child is strongly scared, the spirit is wilting, the activity is inhibited, and the appetite is reduced. This kind of anorexia is often not too long, and the appetite will be restored in the past.
2, subacute or chronic mental stimulation: leaving a loved one and a familiar environment into the nursery or other new environment, the new environment is not suitable, low mood, loss of appetite, sometimes vomiting after meals, family misfortune or divorced parents.
3. The impact of wrong education:
1 Parents are too demanding on children, restrict freedom, prevent playing with other children, or limit where they want to go, affect their mood and reduce appetite.
2 Parents pay too much attention to children's eating, repeated induction or aversion to threats and anorexia.
4, refractory anorexia nervosa: individual girls anorexia can be very serious, patients are extremely thin, weak, and similar to severe malnutrition, such as low body temperature, cold, slow heart rate, low blood pressure, limbs Bun, older girls have amenorrhea, anemia, and are characterized by vitamins and protein deficiency.
Pathogenesis
1. Disease effects: Acute and chronic diseases can cause anorexia caused by gastrointestinal motility (functional dyspepsia), which has been paid attention to today. Almost all long-term application of antibiotics can cause intestinal flora disorder, micro-ecological imbalance, bloating, nausea With anorexia.
2, climate: high temperature, high humidity, can affect gastrointestinal function, reduce the secretion of digestive juice, digestive enzyme activity, gastric acid reduction, etc., resulting in decreased digestive function caused by anorexia.
3, improper feeding: normal children every 3 ~ 4h stomach contents emptying, blood sugar drops, there will be appetite, improper feeding or eating habits, such as eating irregular, eating snacks or candy before meals, there is always something in the stomach If blood sugar does not drop, there will be no appetite.
4, emotional factors: forced feeding, causing children's resentment, a variety of factors affecting children's emotions, can lead to anorexia.
5, refractory anorexia: endocrine examination of children, urinary 17-hydroxysteroid discharge is lower than normal, plasma cortisol content is normal or high, the hypothalamic-pituitary-adrenal system response to dexamethasone is inhibited, these Changes can also be seen in severe malnutrition. It has been suggested that such patients may have inter-brain-neuroendocrine dysfunction, which is the basis of pathology. In addition, when anorexia nervosa, plasma growth hormone is weakened by hypoglycemia, while other malnutrition is normal or Strengthening, the anorexia children's response to levodopa is also impaired. These two reactions are closely related to the function of the hypothalamic system of the limbic system. Some authors suspect that it is related to the central nervous system disorder of appetite regulation in the hypothalamus.
Prevention
Pediatric anorexia prevention
1. Reasonable feeding, develop good eating habits, and start from a young age.
Infants within 4 months are best breast-fed. Because related research shows that children who are exclusively breastfed rarely have anorexia. Add food supplements in order, don't worry too much. Children's diet is mainly based on staple food, and no additional "nutritional food" is added. Do not use tonics and supplements to make up for your child's nutritional deficiencies, but to patiently explain the taste and nutritional value of various foods.
2. Develop good eating habits.
Regular, press to eat, do not eat snacks (including drinks) before meals, because the rise in blood sugar affects appetite, eat fruit after meals. Parents should pay attention to the variety of foods that are often changed, and try not to be the same. Animal foods contain more zinc and must maintain a certain proportion in the diet.
3, to maintain a relaxed and happy eating mood.
Create a good eating atmosphere. Let the child eat in a happy mood. Even if there are several times when the children are not eating well, don't worry, don't threaten to intimidate the children to eat, and don't beg the children to eat. Don't eat a meal, don't worry, don't replenish it with snacks, and eat naturally when you are hungry. When children are unwilling to eat certain foods, adults should consciously and step-by-step guide them to taste this kind of food, neither without principle, nor too much.
4. Parents are good examples for children.
If the parents are picky eaters or partial eclipses, the child will also be affected, and most of them are also anorexia. Therefore, parents must lead by example, not picky eaters and not partial eclipse, giving children a positive impact.
5. Actively treat the root cause of anorexia.
If anorexia caused by a disease, the appetite will naturally increase after the primary disease is cured.
Complication
Pediatric anorexia complications Complications, malnutrition in children
The disease can not be relieved for a long time, can be complicated by diseases, malnutrition in children, and even cause developmental disorders. Children are in constant growth and development, and more nutrients are needed than adults. If the supply of various nutrients is insufficient, it will not only affect Normal growth and development of children, when the growth and development are stagnant in severe cases, the body organs shrink, which will inevitably affect the normal immune system of children, such as severe protein due to anorexia - heat energy is insufficient, malnourished children, cellular immune function may occur Disorders and decreased serum antibodies, which are prone to infections of various bacteria, viruses and fungi, and infections often persist, prolonged unhealed, and even life-threatening, manifested as repeated colds, fever, or repeated coughs, not eating, not moving, The weight does not increase, it is not long.
Symptom
Pediatric anorexia symptoms Common symptoms Anorexia Emotional anorexia Antifeeding Physiological anorexia Appetite loss Skin rough Thyroid function Low appetite loss Summer anorexia Anorexia
1. Age: Infants under 1 year old, especially those with obvious appetite, are mostly caused by diseases. Pay special attention to sepsis, tuberculosis, rickets and various nutritional deficiencies. Children and older children should pay special attention. The effects of various neurological factors such as poor eating habits and mood.
2, family environment: children with better family conditions, due to excessive love, excessive concern about children's health and nutrition, deception, snoring, more snacks and other methods, in an attempt to let children eat more, the results are often counterproductive, some parents to children Not enough care, affecting children's mood and appetite.
3, the degree of loss of appetite: mild appetite may be caused by abnormal differences in normal individuals or excessive snacks, severe appetite loss or refusal often indicates the existence of underlying disease.
4, with or without symptoms: Although there is mild appetite, but children are lively, happy, full of mental and asymptomatic, mostly normal, accompanied by fatigue, lack of energy, low fever, multiple tuberculosis or other infections, accompanied by abdomen Pain and blood in the stool should pay attention to the stomach, duodenal ulcer, parasites, etc., with slow response, rough skin, less sweat and dysplasia, should pay attention to hypothyroidism, accompanied by sweating, rib beading, square, skull softening And other bone changes are rickets.
In the case of anorexia children, first of all, carefully ask about the medical history, do a physical examination and necessary tests to distinguish whether it is caused by systemic or digestive diseases, whether the drug is affected, whether there are trace elements or endocrine deficiency, and to investigate the family of the child. , nursery school and school environment, whether there is no bad mental stimulation and bad food hygiene habits, and then determine the cause.
Clinically, parents often complain that their appetite is not good. Is it getting anorexia? In fact, it is not diagnosed as anorexia by loss of appetite. The so-called anorexia must first rule out whether the baby is suffering from it. Cold or medical chronic diseases (eg long-term diarrhea, chronic hepatitis, tuberculosis), if it is because of the above reasons, the anorexia at this time is natural, and the anorexia should be improved after the disease is cured; the real anorexia refers to the children for a long time. Loss of appetite, do not want to eat food, or even refuse to eat, this situation generally lasts for more than two months, so that it is in line with the so-called "anorexia."
Examine
Pediatric anorexia check
1. When the gastrointestinal tract is bleeding, the coffee-like substance and the fecal occult blood test are positive, and the hemoglobin level is lowered.
2, serum electrolytes, blood sugar, blood gas, plasma osmotic pressure to reflect whether the body environment is balanced.
3, abdominal and inflated liver and kidney function, serum myocardial enzymes and other monitoring to observe the degree of systemic damage of various organs.
4, fiber gastroscopy is the main method for early diagnosis of stress ulcers. Selective angiography shows that contrast agent spills into a mass and accumulates in the blood vessels for a long time without dissipating. X-ray plain film shows free perforation when there is free gas in the abdominal cavity. Ultrasound images may have thickening of the stomach wall, hypertrophy of the mucosa, and the like.
Diagnosis
Diagnosis and diagnosis of anorexia in children
diagnosis
Can be diagnosed based on clinical symptoms and laboratory tests.
Differential diagnosis
Many conditions and diseases can reduce appetite, among which habits are poor, iron deficiency anemia, rickets, parasitic diseases, tuberculosis and infectious hepatitis are more common.
1, bad habits
In addition to poor dietary habits in the family environment and medical history, it is necessary to rule out the relevant disease factors in order to diagnose, and pay attention to correct bad habits, step by step, correct induction and encouragement.
2, iron deficiency anemia
Iron deficiency anemia is a frequent disease in children. Iron deficiency not only leads to anemia, metabolic disorders, decreased cellular immune function and abnormal behavior, but also causes gastric acid reduction, stomach, duodenitis, intestinal mucosal atrophy and absorption dysfunction and other stomachs. Intestinal digestive dysfunction, affecting children's appetite, and even growth and development, should promote iron fortified foods, group prevention, hemoglobin, serum iron, total iron binding capacity, red blood cell protoporphyrin and serum ferritin, etc. Iron treatment.
3, hookworm disease
For children with hookworms in the epidemic area, anemia, eclipse and poor appetite should be checked for stool routinely, and the eggs should be dewormed and ironed.
