medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-306medsovet-8446Research ArticleШКОЛА ПЕДИАТРАPEDIATRICIAN SCHOOLАнорексия младенца: как не ошибиться в диагнозе?Infantile anorexia: how to avoid diagnostic errors?https://orcid.org/0000-0002-2847-6268БережнаяИ. В.BerezhnayaI. V.

Бережная Ирина Владимировна, к.м.н., доцент кафедры педиатрии имени академика Г.Н. Сперанского; врач-педиатр, гастроэнтеролог

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1

125373, Москва, ул. Героев Панфиловцев, д. 28

Irina V. Berezhnaya, Cand. Sci. (Med.), Associate Professor of the Department of Pediatrics, Academician G.N. Speransky

2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993

28, Geroev Panfilovtsev St., Moskow, 125373

berezhnaya-irina26@yandex.ruhttps://orcid.org/0000-0002-6482-010XГончароваЛ. В.GoncharovaL. V.

Гончарова Людмила Викторовна, врач-педиатр 1-го педиатрического отделения

125373, Москва, ул. Героев Панфиловцев, д. 28

Liudmila V. Goncharova, Pediatrician Paediatrics Department No 1

28, Geroev Panfilovtsev St., Moskow, 125373

doct-goncharova@mail.ruhttps://orcid.org/0000-0003-4200-4598ЗахароваИ. Н.ZakharovaI. N.

Захарова Ирина Николаевна, д.м.н., профессор, заведующая кафедрой педиатрии имени академика Г.Н. Сперанского

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1

Irina N. Zakharova, Dr. Sci. (Med.), Honored Physician of Russia, Head of the Department of Pediatrics named after Academician G.N. Speransky

2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993

zakharova-rmapo@yandex.ruРоссийская медицинская академия непрерывного профессионального образования; Детская городская клиническая больница имени З.А. БашляевойРоссияRussian Medical Academy of Continuous Professional Education; Bashlyaeva Children’s City Clinical HospitalRussian FederationДетская городская клиническая больница имени З.А. БашляевойРоссияBashlyaeva Children’s City Clinical HospitalRussian FederationРоссийская медицинская академия непрерывного профессионального образованияРоссияRussian Medical Academy of Continuous Professional EducationRussian Federation202409082024011210–218Copyright © Бережная И.В., Гончарова Л.В., Захарова И.Н., 20242024Бережная И.В., Гончарова Л.В., Захарова И.Н.Berezhnaya I.V., Goncharova L.V., Zakharova I.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/8446

Капризы в еде, отказ от некоторых продуктов, избирательность в еде ребенка – проблемы, с которыми часто обращаются к педиатру родители. За несколько минут на приеме трудно разобраться в причинах проблемы. Но наибольшие трудности в диагностике возникают, когда родители жалуются, что не могут накормить ребенка первых месяцев жизни как на грудном, так и на искусственном вскармливании. Анорексия у детей раннего возраста может иметь психологический и/или органический генез. Наиболее сложные и ранние формы часто имеют смешанную этиологию. При сборе анамнеза часто отмечаются случаи насильственного кормления, частая смена смесей, эмоциональная неустойчивость мамы. В статье приводится несколько клинических случаев с разными причинами отказа от еды детей, с которыми обращались родители к врачу. Первый клинический случай: мальчик Н., 11 лет, с жалобами на отсутствие прибавки массы тела – вес не превышал 6,8 кг, крайне низкие темпы роста. У ребенка выявлена умеренная эозинофильная инфильтрация пищевода эозинофилами до 10–12 в поле зрения. Второй клинический пример: девочка М., 7 мес., с жалобами на снижение аппетита, отказ от еды, отсутствие пищевого интереса и жажды, срыгивания на фоне кормления. Эозинофильная инфильтрация в двенадцатиперстной кишке до 50 эозинофилов в поле зрения. В желудке до 5 эозинофилов в поле зрения. Третий пример: мальчик Я. с жалобами на беспокойство, больше в вечернее и ночное время, часто просыпается ночью, появились срыгивания, икота, периоды вздутия живота. В зависимости от причины анорексии в статье приведены современные возможности использования специализированных продуктов питания для этой категории детей.

Food whims, some food refusals, food selectivity are issues for which parents often seek advice from a paediatrician. It is difficult to identify the reasons of the issues for just a few minutes of a visit. But the greatest challenges in the diagnosis arise when parents complain that they fail to feed both breastfed and non-breastfed young infants. Anorexia in young infants may be of a psychological and/or organic origin. The most complex and early forms often have a mixed etiology. A detailed history taking reveals cases of forced feeding, frequent changes of formula, and mother’s emotional instability. The article presents several clinical cases with different reasons for food refusals in children for which parents sought advice from a doctor. The first clinical case: a 11-year-old boy with complaints about lack of weight gain, as his weight did not exceed 6.8 kg, extremely slow growth rates. The child was diagnosed with moderate eosinophilic infiltration of the esophagus with eosinophils up to 10–12 per high-power field (hpf). Second clinical case: a 7-month-old girl M. with complaints about decreased appetite, food refusal, lack of interest in food and thirst, regurgitation during feeding. The examination showed eosinophilic infiltration of the duodenum up to 50 eosinophils per hpf. In the stomach there were up to 5 eosinophils per hpf. Third case: a boy Ya. with complaints about restlessness, more in the evening and at night, waking up frequently at night, regurgitation, hiccups, and periods of bloating. The article presents modern options for using specialized food products for this category of children according to the cause of anorexia.

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The authors declare that there are no conflicts of interest present.