Diathesis in children

Diathesis is associated with anomalies of the constitution – genetically determined features of the body. These features are expressed in a tendency to certain diseases. In other words, diathesis is a “predisease”, due to which a full-fledged disease can develop in a child or already an adult (1).

What is diathesis

The concept of diathesis, later renamed as anomalies of the constitution, was introduced into the practice of pediatricians at the end of the XNUMXth century. Today, this term is practically not used. Basically, he remained in the everyday life of young parents and some old-school pediatricians.

Often the term is used incorrectly, equating the concept of “diathesis” with another diagnosis – atopic dermatitis with rashes on the face and body. It is important to emphasize the difference: a rash on the cheeks is not diathesis! An anomaly of the constitution is a set of hereditary traits: physique, fat distribution, the functioning of organs and systems. It forms the characteristics of reactions of adaptation to the environment and predisposition to certain groups of diseases (2).

Diathesis is not a disease, but an individual feature that affects the life of a child both in the first years of life and in the future. The presence of a certain diathesis in a child (there are several types) is a kind of warning for parents and pediatricians. In the presence of adverse conditions, diathesis can become one of the predisposing factors for diseases. According to some scientists, up to 90% of adult diseases “grew” from constitutional anomalies, under the influence of additional factors.

Causes of diathesis in children

Anomalies of the constitution most often arise due to shifts in the neuroendocrine regulation of metabolic processes and immune responses. This leads to the fact that the child’s body does not always adequately and correctly respond to stimuli.

More often, diathesis occurs in children who were born as a result of a difficult pregnancy (toxicosis, infections, medication, nutritional problems, bad habits in the mother). A certain influence is exerted by difficult childbirth, accompanied by hypoxia, asphyxia, a long anhydrous period, and so on.

Also, anomalies of the constitution can occur in children with unfavorable heredity, pathologies of the nervous system that occurred during childbirth (3). Diathesis is possible if the baby is born with too high or low weight, suffers from disorders of the intestinal microflora. Anomalies of the constitution can manifest themselves with acute respiratory viral infections, non-compliance with regimen measures, with defects in care, after vaccinations, emotional stress and other factors.

Types of diathesis

There are 3 main forms of diathesis.

1. Exudative catarrhal diathesis

It has the alternative names “atopic” or “allergic” diathesis, and suggests that the baby is prone to allergies. In a child in early childhood, various transient allergic reactions are possible, which in the future, if you do not pay attention to them in time, can develop into infectious and inflammatory skin processes or chronic allergic reactions.

2. Lymphatic-hypoplastic diathesis

With lymphatic-hypoplastic diathesis, primary immunodeficiency states of varying degrees are detected. Such an anomaly of the constitution is accompanied by an increase in lymph nodes and tonsils.

3. Nervous-arthritic diathesis

This type of diathesis means initial defects in the process of metabolism of uric acid, purine bases. They can create conditions for the development of metabolic problems and disorders of the nervous system (4).

Symptoms of diathesis in children

Each type of diathesis in childhood has its own characteristics in the clinical picture, which must be considered separately (5).

Symptoms of exudative-catarrhal diathesis

In the first year of life, this form of diathesis is recorded in 40-70% of all cases of diathesis in children. But with proper correction, all its manifestations can disappear by the age of three. Sometimes an allergic anomaly of the constitution is isolated separately, since it may be associated with excessive synthesis of IgE in families where allergic diseases are inherited.

In the first weeks of life with this form of diathesis, gneiss appears on the head (it is also seborrheic dermatitis) with the formation of greasy scales covering the hair growth area with a dense “cap”, especially plentiful on the crown and crown. Usually the crusts go away on their own, but with aggressive care and an attempt to forcibly rip them off, they can turn into eczema with weeping, redness and swelling, the appearance of crusts on the ears, cheeks and forehead. In the first year of life in children, a milk scab may appear – this is peeling, redness, slight swelling and itching of the skin on the cheeks. Typical persistent diaper rash in the area of ​​the folds of the skin and buttocks, if the children are well-fed, weeping and pustular rashes appear in the area of ​​​​the folds. The most serious symptom is childhood eczema, which can develop into atopic dermatitis with age.

Therapeutic methods

Children with this type of anomaly of the constitution usually have paratrophy (excessive weight gain), but the weight fluctuates, can quickly decrease. Outwardly, babies appear pale, with slight swelling, and frequent digestive problems with spasms and flatulence (6).

Babies diagnosed with exudative-catarrhal diathesis are prone to prolonged pneumonia, pharyngitis and sinusitis, chronic rhinitis, bronchitis. In addition, we often develop atopic dermatitis.

Symptoms of lymphatic-hypoplastic diathesis

On average, this variant of constitutional anomalies is recorded in approximately 10% of children. The main features of diathesis are formed closer to 2-3 years, and with a favorable course, they are completely eliminated by the period of puberty. In some children, some manifestations may persist into adulthood.

In children, disproportions in physique are noted – the body is short relative to the limbs, the skin is pale, with a marble pattern, the muscles are poorly developed, the tone of the tissues is somewhat reduced. These are children with a tendency to fatigue, sedentary, lethargic, often suffer from colds, which usually occur with a high temperature. They often have enlarged lymph nodes (usually cervical, submandibular, behind the ear), but others may be enlarged. Also typical is the growth of adenoids (which often recur when removed) and tonsils, an increase in the thymus, spleen and liver. There may be minor anomalies in the development of the heart (false chords, valve prolapse), changes in the size of the kidneys and adrenal glands, genital organs (7).

Symptoms of neuro-arthritic diathesis

This form of diathesis accounts for up to 3-5% of all cases of constitutional anomalies. The process is based on inherited metabolic features – the metabolism of uric acid, as well as the deterioration of the liver. Among the manifestations may be neurasthenic syndromes, spastic, skin and metabolic. In adulthood, nephritis (kidney damage), obesity, diabetes mellitus, gout, cholelithiasis, atherosclerosis, and kidney failure occur.

Among the manifestations, the neurasthenic syndrome is in the lead – it is noted in 80% of all manifestations. In the first year of life, children have excessive excitability, are shy and restless, and suffer from sleep disorders. At preschool age, they begin to speak and read early, are inquisitive and interested in others, have a good memory. But emotional instability, headache, hyperactivity syndrome, loss of appetite, enuresis or stuttering are possible (8).

Exchange syndrome is manifested by pain in the joints, impaired urination, the appearance of salts in the urine. Infections often cause vomiting with dehydration and fever.

Spastic syndrome against the background of diathesis is manifested by bronchospasm, pain in the heart, migraine-like headaches, increased pressure, colic, constipation or spastic colitis. Children are prone to asthmatic bronchitis, which threatens to turn into bronchial asthma.

Manifestations of the skin syndrome include the frequent development of urticaria, itching of the skin, Quincke’s edema, eczema, or neurodermatitis. Often children give a false positive Mantoux test. By adulthood, they can suffer from neurosis and rheumatism.

Treatment of diathesis in children

Since diathesis refers to borderline conditions and is not a disease, children need dynamic observation of specialists and the correction of certain deviations due to changes in the regimen, lifestyle and preventive measures. As such, courses of serious treatment are not prescribed to them.

Diagnostics

Due to the fact that diathesis is a tendency to certain pathologies, children need the supervision of a pediatrician, as well as consultations of specialized specialists – a dermatologist, nephrologist, endocrinologist, allergist, ENT doctor, neurologist (9).

It is necessary to undergo regular medical examinations with blood and urine tests, biochemical studies, determination of plasma glucose, lipids, proteins, uric acid, cholesterol, hormonal tests, immunogram.

It is also important to timely perform an ultrasound of the thymus, lymph nodes, liver and spleen, as well as a chest x-ray.

Modern methods

Correction of deviations in the work of the body, so that they do not turn into diseases, is carried out in a complex manner. The basis of treatment is regimen measures, nutritional correction, and full-fledged care for the child (10).

Children with exudative-catarrhal anomaly of the constitution long-term breastfeeding, full and phased introduction of complementary foods, keeping a food diary with the identification of irritants that need to be excluded from food are recommended.

Medical support for this form of diathesis includes the use of antihistamines.

Topical treatment for the appearance of peeling, rashes or other elements on the skin includes the use of emollients, the use of non-hormonal ointments with anti-inflammatory effects, protective moisturizers, preparations with panthenol, local calcineurin inhibitors.

No need to rush into the introduction of complementary foods – it is important to minimize the number of experiments.

Do not overheat the child, give preference to natural materials in clothes.

Lymphatic-hypoplastic anomaly of the constitution implies courses of taking adaptogens, taking multivitamin complexes, gymnastics, hardening, sufficient exposure to fresh air.

Nervous-arthritic diathesis should be accompanied by a diet with restriction of purine products – cocoa and chocolate, liver, spinach, peas, fatty foods. Shown are sedatives, choleretic agents, a course of B vitamins, exercise therapy. Children with this diagnosis need to drink plenty of water – at least 8 glasses a day.

Prevention of diathesis in children at home

The basis for the prevention of diathesis in children is the planning and rational management of pregnancy, the full nutrition of the expectant mother, the prevention of complications during pregnancy and childbirth.

After the birth of children, it is important to fully feed and care, observe the daily routine, physical activity and stay in the fresh air.

Popular questions and answers

Sources of

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7. Yarovaya YA, Lozovskaya ME, Vasilyeva EB, et al. Anomalies of the constitution and tuberculosis infection in children // Pediatrician. – 2017. – T. 8. – No. 3. – C. 62-68. doi: 10.17816 / PED8362-68

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