Diathesis in children of different ages, symptoms, treatment, diet

Medical Editor: D. Mills, a pediatrician.
July 2019.

ICD-10 code: L20-L30.

Diathesis in infants usually manifests symptoms on the skin - on her cheeks and scalp.
Children 3-6 years of age can increase the lymph nodes.
From 7 to 12 years may be pain in the joints, gastrointestinal tract disorders.
The disease occurs as a result of the structural features of the immune system and gastrointestinal tract. Development diathesis due to the presence of hereditary predisposition in combination with errors in diet.
Treatment comprises administering antihistamines, local therapy and hypoallergenic diet.

Diathesis is not a specific disease, it is a set of symptoms and changes associated with anomalies of the constitution - genetically determined characteristics of the organism. These features are expressed in the tendency to certain diseases. At its core, the diathesis - a "preillness", which is characterized by a predisposition to adverse reactions to stimuli (Food components, chemicals and so forth.) And the ability to be converted to a disease under the influence of negative reactions.

Allocate 3 forms of diathesis:

• Up to 3 years: exudative-catarrhal: appears on the skin and mucous membranes;
• 3-6 years: limfatiko-hypoplastic: increased lymph nodes;
• 7-12 years: neuro-arthritic: gastrointestinal disorder, enuresis, pain in the joints.

Causes

Diathesis may provoke the use of child or nursing mother the following products:

• cow's milk, or rather, cow's milk protein or milk sugar (lactose);
• egg white;
• puree and juice from orange or red fruit (especially strawberries, citrus fruit, strawberries, bananas);
• chocolate;
• foods with preservatives and food dyes;
• seafood;
• pickles, sauces and spices.

Cause diathesis in babies who are breastfed are errors in the diet of the mother.

When the flushing (redness) of the skin, rash, parents should remember, what's new in the diet in the nearest days and eliminate these products.

As a precipitating factor in the development of diathesis serves hygiene compliance is the wrong skin care of the child, the use of inappropriate care products. You need to use hypoallergenic creams and tools for swimming, permitted for use from birth.

Who is at risk:

Among the children at risk, isolated group with anomalies proceeding pregnancy in the mother - toxemia, infections, smoking, alcohol. Also here should also include violations of flow genera - asphyxia, hypoxia.

Diathesis often affects children:

• with hereditary predisposition,
• congenital disorders of the nervous system,
• LBW or vice versa with a large birth weight,
• with dysbiosis,
• fed infant formula.

Manifesto of the disease may be caused by SARS, carrying out vaccinations, especially at an early age. Increased risk of development is often associated with improper care, poor diet, poor living conditions, intense emotional atmosphere in the family.

Virtually any sudden change - climate change, beriberi, household chemicals and even poor environmental conditions can give impetus to the development of atopy. Child organism more sensitive to histamine (main regulator of allergic reactions), however its release It may be associated not only with foreign agents (e.g., food or detergent powder), but with natural conditions.

Symptoms of age

Signs diathesis vary depending on the form of its manifestation. It can take the form of:

• a negative reaction from the mucosa and skin (dermatitis, geografichny language, cradle cap)
• Hypoplastic changes of lymph nodes (their increase throughout the body), and endocrine glands.
• often suffer from metabolic processes, this is usually increased secretion of uric acid, phosphates and oxalates.

Photo: gneiss - seborrheic dermatitis

Photo: geografichny language

Photo: cradle cap. taken on Online Department of Dermatovenereology Tomsk Military Medical Institute

Diathesis in infants: exudative-catarrhal form

Synonyms: allergic, atopic diathesis

For the diagnosis is not used by other diagnostic methods. You can determine the presence of a diathesis of skin manifestations and data about the products that used the child.

When you are a baby being breastfed diathesis symptoms can occur after the use of these products mother.

Manifestations can start from the first month of life in the form of a persistent diaper rash (do not pass even with careful care), abundant prickly heat (Even in mild hyperthermia), and finally, as a gray-yellow greasy crusts on the scalp and eyebrows. A baby's skin is pale and dry.

From the age of 3 months, for a child may appear limited cheeks bright red spots, which are then covered with a thin crust. In these places, felt itching and soreness. This so-called milk crust or scab milk - one of the characteristic manifestations improper metabolism - exudative diathesis. It is also called allergic or atopic.

Manifestations in infants:

• and frequent loose stools with foam or greenish hue,
• pain in the tummy,
• rash,
• redness on cheeks (milk crust).

Diathesis sick child cranky, restless, can refuse to eat and sleep poorly. Rash accompanied by constant severe itching, so the children older than one year can comb the affected area, which leads to the attachment of a secondary infection, the appearance of purulent wounds. Grudnichki itching react crying, increased motor activity.

Untreated, it affected the entire body. At the initial stage of acute forms of the disease marked redness of the skin, then there are small vesicles, filled with clear content. Over time, the bubbles burst, in their place formed a crust.

Diathesis manifests itself not only rash but also digestive disorders (diarrhea) due to skin manifestations protracted inflammatory eye diseases (blepharitis, conjunctivitis), obstructive bronchitis. Later this form of diathesis may be complicated by asthma.

When diathesis child develops hypersensitivity to certain food and drug substances. Therefore, the usual care and feeding of such a child is insufficient, it is necessary to make them appropriate adjustments.

usually active symptoms are significantly reduced by the end of two years, and only a small percentage of children (About 10%) can be shown in a later age as bronchial asthma, eczema, allergic reactions.

Diathesis in 3-6 years: limfatiko-hypoplastic

For lymphatic form characterized by rapid fatigue of the child, it is usually pale slack has excess weight (or obesity prone to occurrence).

A distinctive feature of children with a constitutional anomaly is an increase in the thymus cancer (primary iron for the preparation of T-lymphocytes exposed to atrophy with age) and lymph nodes. The main symptoms of this form include:

• frequent respiratory infections,
• hoarseness, noisy breathing, shortness of breath, with increased thymus (thymus)

The midst of the process between the ages of 3 to 6 years of age, then the negative manifestations almost entirely disappear. Perhaps a slight delay in sexual development in adolescents.

Diathesis in 7-12 years: neuro-arthritic form

For arthritic forms a peak school age (7-12 years). In appearance, the children are often thin, but it is possible a sharp weight gain in adolescents. This type of constitution is noticeable even from infancy - the baby does not sleep well, excitable, restless, does not eat. Then, as the maturing can be added tics, nightmares, enuresis (urinary incontinence), emesis nervosa.
Children often complain of dyspepsia - vomiting, diarrhea, the smell of acetone breath and pain in the joints volatiles.

Also for this form it is characterized by the manifestation of spastic syndrome (increased muscle tone):

• bronchospasm,
• colic, constipation,
• an increased likelihood of developing hypertension, heart disease.

In his book Childhood diseases: the textbook, ed. A.A.Baranova provides the following comparative table¹:

sign	Exudative-catarrhal diathesis	Limfatiko-hypoplastic form	Neuro-arthritic form
The frequency in the population	60-70%	10-12%	2-3%
dates manifestations	the first 3 months of life	second year	6-7 years later
Dates disappearance manifestations	for 3-4 years at 20-25% of children in the transformation of allergic diseases	at puberty (most children)	It persists for life
Causes	transient or genetically caused by overproduction of IgE, adrenal insufficiency, allergic	dysfunction of the system "pituitary-adrenal", hyperplasia of the thymus gland, adrenal insufficiency	genetic defect exchange of uric acid and purine bases, dysfunction of liver enzymes
The reaction of the nervous system	excitability, irritability	apathy, lethargy, intolerance to stress, low blood pressure	accelerated development and excitability, neuropathic reaction
The weight and length of the body	age appropriate	more than the age norm (paratrofiya)	decrease body weight during normal length dystrophy
Body type	proportional, often asthenic	disproportionate, often giperstenicheskom	without features
The nature of skin changes	seborrhea, infiltration, redness, crusting, erythematous nodules, exudative erythematous rash	70% of children are absent in 30% of cases are identical to those of exudative-catarrhal diathesis; characterized by Moisture in the skin folds, skin mottling	hives, angioedema, neurodermatitis, Dry skin
Location cutaneous changes	predominantly on the exposed parts of the body	on the lower half of the body, in the skin folds, behind the ears	without the favorite localization
mucous membranes	language as a "geographical map", reinforced by exudation	propensity to edema, enhanced exudation	without clear changes
subcutaneous fat	moderately developed: how can an excess and a lack of	overly developed, distributed unevenly	usually is not sufficiently developed, adolescent obesity can
Trugor tissue	reduced	reduced	reduced
muscle tone	normal	reduced	normal
The reaction of the lymphoid tissue	increase in regional lymph nodes	generalized hyperplasia of the lymphoid tissue, 70% of children with an increase in the thymus	moderate inflammation of the large number of lymph nodes
Immunity	reduced	reduced	satisfactory
Metabolic disorders	unstable water-salt metabolism, metabolic acidosis	the same as in the exudative form of bluetongue, and also increase the concentration of cholesterol and phospholipids, decreased glucose, thymus factors	increased concentration of uric acid in the blood and urine, acidosis
The reaction of peripheral blood	eosinophilia	absolute and relative lymphocytosis, neutropenia and monotsitopeniya	sometimes eosinophilia
Characteristic clinical syndromes develop in the future in adults	asthma in the second year of life, cholecystitis, duodenitis	bronchial asthma, severe from the first year of life, cardiovascular and kidney disease	hypertension, kidney stones and gallstones, gout, peptic ulcer, irritable bowel syndrome, asthma
State of internal organs	frequent SARS, bronchitis with obstructive syndrome, urinary and intestinal infections, biliary tract dysfunction and gastrointestinal	multiple stigma dizembriogeneza (small defects, for example, protruding ears), congenital hypoplasia (reduced size) of the endocrine glands, heart, kidneys	colic: renal, hepatic, intestinal; neurasthenia, arthralgia, urination disorders, Salur (presence of salts in the urine), vomiting atsetonemicheskaya

treatment of diathesis

Treatment comprises administering antihistamines, local therapy and hypoallergenic diet.

The basis of the treatment of the anomalies of the constitution should be the establishment of modes and menus. It is important to write a good diet not only eliminating potential allergens, but also by adjusting the content of proteins, fats, carbohydrates and calories. For treatment of skin lesions should be approached comprehensively, not limited to topical treatment.

For relief of symptoms using antihistamines 1-2 generations in age dosage (loratadine, cetirizine, clemastine, dimetiden). They eliminate the itching, reduce swelling of the skin, reduces redness, have a sedative effect, prevent the further spread of dermatitis. Better to choose the drugs that are available in the form of drops. The syrups may contain dyes and fragrances, provoking the development of allergic reactions.

When expressed cutaneous manifestations topically used ointments with antihistamines and corticosteroids. In the presence of signs of inflammation, topical application shown antiseptics: solution of potassium permanganate, boric acid, methylene blue.

Drug treatment of diathesis

Strictly! on prescription²

Exudative-catarrhal diathesis	Limfatiko-hypoplastic diathesis	Neuro-arthritic diathesis
All products are selected strictly individually!
Enzymes (rennet, pancreatin). Antihistamines with the change in 7-10 days. Vitamins A, B6, B15, ascorbic acid, rutin. Calcium. When the persistent current dermatitis - ketotifen dosage in the age of 3-6 months.	Regular (2-3 times per year) application adaptogenov: bendazol, licorice root extract, pentoxy, potassium, etc. ororat. for 10 days. Compulsory course adaptogens with lifestyle changes (entering school, kindergarten, moving to another climate zone). In marked allergic lesions of the skin and mucous membranes - the same as in exudative-catarrhal diathesis.	In compliance with the regime and diet treatment practically required. When atsetonemicheskoy vomiting hunger for 12 hours in small portions (1-2 teaspoons) 5% glucose solution, saline solutions. If it is impossible to drink - intravenous glucose-saline solutions. While improving the state - mashed potato, banana. In severe cases, intravenous drip glucose solution, saline solutions.
Locally: bath with chamomile, bran, succession. Indiffirentnye ointment without hormones, for example, Naftalan.	Local treatment is indicated.
In the absence of effect - a dermatologist consultation and revision of treatment.

local treatment

Before removing the crusts that occur in children with diathesis, it is necessary to soak them with vaseline oil, naphthalan ointment, cream Unna (zinc-based). A thick layer of pre-heated oil or cream is applied to the affected area of ​​the skin is covered with a soft clean gauze, and top - paper (in any case not plastic film!). Above the tie or scarf worn thin cap. After several hours crusts easily removed during bathing, the skin is not damaged, in case of a new abundant the appearance of crusts procedure is repeated - the so-called occlusive dressing, the official recommended medicine¹.

Diaper rash skin in areas treated with a 1% aqueous solution or zelenki fukortsinom. For the prevention of diaper rash skin folds must be processed after each cleaning the cream under a diaper or a special oil. When inflammation can apply baby cream with panthenol. Bathe children suffering from diathesis should be without soap and potassium permanganate, add broth succession, a decoction of oak bark, bran.

The rapid spread of the rash, the appearance of purulent discharge is cause for immediate treatment for medical assistance. In the presence of infection to treatment connected with antibiotics.

Diet

Usually, the first signs of allergy manifested in the child within 4-6 hours after eating. Therefore, to accurately identify the allergen mix products!

If sensitivity to any product it for some time excluded from the child's diet. Then you can try again. Scientists have shown that allergies can be cured only with the allergen. After all, even to the poison in small doses, the body gets used.

Important: if there was a reaction to the lure of a rash, it is necessary to appoint antihistamines and sorbents, which help to quickly bring the allergen.

If a woman is breastfeeding, it is necessary to carefully monitor their diet and give up some "tasty" things. From the diet should exclude vysokoallergennye products such as chocolate, coffee, pickles, smoked meats.

Babies who suffer from allergies, particularly first lure administered cautiously. It is usually recommended to start with vegetables (zucchini, cauliflower). Doctors recommend the use of ready meals manufacturing, as it is made of proven quality products and contains the required amount of vitamins.

Intolerance to cow's milk - one of the reasons diathesis. In infants usually occurs when the child is transferred to artificial feeding. In this case, doctors recommend refuse dairy mixes and go to mixtures based on soybean protein (also called lactose-free), allergenic or using goat milk. If your child has long been observed allergic symptoms in the form of frequent, liquid and foamy stool, it is recommended to introduce in his diet dairy products containing bifidobacteria.

In any case it is impossible to choose baby food for children with diathesis. It has to do a doctor, based on the characteristics of the child.

Organism year-old child is still very weak and influenced. Diathesis in these children may cause and familiar food. Even an extra spoon favorite porridge eaten "for the pope" can become a cause of concern. Try not to overfeed the baby. It is advisable to feed him more often, but small portions.

When the child reaches three years of age, parents often cease to pay due attention to his diet and put the child at the common table. This is a huge burden, even for completely healthy baby, not to mention the allergies. It is necessary to minimize the intake of salt and sugar, and hot spices and spices.

Recommendations on the treatment and nutrition for the various forms of diathesis³

destination	Exudative-catarrhal diathesis	Limfatiko-hypoplastic diathesis	Neuro-arthritic diathesis
Diet, including the mother during breastfeeding	Hypoallergenic, with the exception of the obligate allergens, red- and yellow-colored vegetables and fruits. Limitation of broths, whole cow's milk. Meat and fish boiled. Dairy products, vegetables, fruit. In severe cases - elimination diet, detection and elimination of the cause and significant agent	The age restriction table with flour products and cereals. The predominance in the diet of vegetables, fruits, milk products. When allergic reactions - the same as in exudative-catarrhal diathesis.	The age restriction or table except broths, roasted, stewed and canned meat, sausages, smoked meat, hot dishes, coffee, cocoa, citrus fruits and some vegetables (spinach, radishes, radish, cauliflower, green pea). Table lacto-vegetarian, meat and fish boiled.
watching	Keeping a food diary, an individual vaccination schedule. Monitoring the regularity and quality of the chair. If necessary, treatment of dysbacteriosis.
meticulous care	Constantly	Constantly	Constantly
home education	Up to 3 years	5-6 years	Up to 3 years

Recommendations on the regime

Be sure to maintain a hypoallergenic atmosphere in the house - air regularly, wet cleaning at least 2 times a day. It is recommended to remove all carpets, furnishings that accumulate dust. Books, toys should be stored in closed cabinets. Undesirable presence in the house animals (allergic reaction is not itself wool and animal skin scales). Even harmless fish can cause acute diathesis, potted plants is also better to remove.

Children suffering from diathesis, vaccinations are administered after the preliminary course antihistamines.

prevention

An important factor in preventing the occurrence of a diathesis is adherence before birth. Pregnant should carefully monitor their diet, eliminate bad habits. Children with risk of diathesis shows breastfeeding is recommended to keep as long as possible.