Child health: factors to support and ensure optimal development

In this article we will focus on factors related to positive conditions, without which there can be no optimal development of the fetus and health of the child. A number of such conditions have been known for a long time, since the emergence of childhood medicine. At the same time, the deepening of these ideas, their detailing and fundamental scientific interpretation appeared relatively recently.

These conditions are designated as essential and positive determinants of a child's health. This means that without these factors or if they are not fully provided, achieving optimal development and health for a child is unlikely or impossible. Accordingly, the absence or insufficient provision of these determinants become guarantors of incomplete development and health.

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Love and psychological support

The most important and essential need of a child, the most necessary condition for his well-being is the presence of a mother and her love. The mother is the second microcosm in his life. The first was the uterine cavity, where his formation and growth took place. The mother gives the child everything necessary for development - food, warmth, and the joy of communication. Only at the mother's breast, communicating with her with a look and a smile, the child is happy, active and inquisitive.

Only in such conditions is there complete and deep relaxation, in which anabolic, growth and differentiation processes are maximally activated. The absence of the mother; the disappearance of signals of her closeness - smell, voice, her special face, eyes and smile - these are signs of a catastrophe, a risk to existence itself. A child separated from the mother or deprived of her attention and affection immediately loses the potential for normal growth. His neuroendocrine mechanisms are "switched" to fear, anxiety or the search for shelter. Even if this "dark streak" in his life does not last long, its consequences for development may remain irreversible. All these provisions are of a broad and almost age-neutral nature, but, nevertheless, for a newborn and an infant, the connection with the mother is much more naturally and intensely associated with issues of health and survival. This is very clearly confirmed by the strengthening of the child's connection with the mother with the help of perinatal technologies such as the "kangaroo" technology, which practices increasing the time of constant skin contact between the newborn and the mother. It turned out that this method of managing low birth weight infants provides significant additional opportunities to reduce morbidity and mortality.

Later, the spectrum of stress conditions will expand. Its causes may be pain, sudden cooling, the appearance of a stranger, and much more. Evidence has now been obtained that the mother's stress during pregnancy is captured and amplified by the fetus's own endocrine system, leading to intrauterine growth retardation and development. It is obvious that the younger the child's age and maturity, the more significant the negative consequences of stress can be. Describing the mechanisms of stress reaction formation in a newborn child, K. FS Arnand and F. M. Scalzо (2000) emphasize the importance of the resulting excitotoxic damage to growing neurons, expressed by increased apoptosis of brain cells. The outcome is the emergence of a characteristic symptom complex, which includes:

• anxiety;
• changes in pain thresholds (lower or higher);
• poor ability to concentrate;
• decreased learning ability and memory;
• motor hyperactivity;
• antisocial and self-destructive behavior.

In school-age children and adolescents, an unfavorable family environment, conflicts at school or in a children's group can also be the cause of both acute and chronic stress conditions. Their characteristic manifestations can be a combination of increased appetite with slower growth and weight gain, weakening of memory and concentration. Such symptoms are part of the "psychosocial deprivation" complex and often require observation by a psychologist.

Creating and maintaining optimal regime conditions. Two components of the regime are decisive for many qualitative properties of children's development, even with the best conditions for contact between mother and child and the most complete nutrition. These are the organization of sleep and the child's physical activity.

Sleep, development and health of the child

Deep, full and sufficient sleep (night and daytime in total) is a necessary condition for maintaining the performance of brain cells. During sleep, the entire complex of recovery processes and the absorption of energy and trophic substances occurs. A tendency has been identified for the accumulation of trophic and energy nutrients (for example, adenosine and some amino acids) in brain tissue during periods of wakefulness and their rapid utilization with a decrease in concentration during sleep. An analogy in our lives is the need to regularly charge batteries in technical devices, such as mobile phones. Sleep in the life and development of a child is no less important than eating or drinking. This was well understood by educators of the past. Thus, John Locke, a British educator and philosopher of the 17th century, wrote: "Every student needs physical exercise, play, and a full restorative sleep - a great source of vitality in nature."

At the same time, adults' attention to children's sleep is usually extremely insufficient. A significant portion of children suffer from insufficient duration or quality of sleep. According to American researchers, up to 13% of high school students suffer from insufficient sleep with the formation of clinical signs of "chronic sleep deprivation" syndrome, which is very similar to chronic fatigue syndrome.

Even a small but regular sleep deficit can cause a delay in the development of brain functions. The main result of shortened, inadequate (superficial) or interrupted sleep is a disruption in the quality of subsequent wakefulness and everything connected with it - mood, behavior, contact with others, decreased attention and memory. Similar phenomena are very common in the lives of adults. There are studies that have shown colossal losses of human lives and economic resources associated only with sleep deficit, realized in the form of the so-called "human factor" in the event of transport disasters, accidents at industrial and military facilities, accompanied by a decrease in labor productivity, the quality of research or pedagogical work. A sample of children with the highest K? Indicators shows a longer duration of sleep in this group relative to the control group with lower levels 10. And on the contrary, any improvement in sleep in children with an already established attention deficit hyperactivity disorder leads to a positive effect, often exceeding the effectiveness of drug therapy. Systematic disruptions of sleep integrity or reduction of hours allocated for sleep are also reflected in somatic diseases. First of all, the immune system reacts to sleep deficiency (after memory, intelligence and mood) - the child begins to get sick often, the course of diseases becomes more protracted and severe. Experimental animals artificially deprived of sleep die from generalized infections. That is why it is very important to control the adequacy of sleep time. It is important to remember that girls and young women need more sleep than boys and young men. In addition, at the beginning of puberty and until its completion, teenagers tend to turn on the physiological mechanisms of sleep later in the day (retarded sleep syndrome of adolescence). Adequate sleep is of particular importance for newborns and young children, as well as during periods of intensive growth.

Entire sections of pediatric neurology and otolaryngology have been created devoted to sleep breathing disorders. Irregularity of night breathing, snoring or a combination of snoring with breathing pauses create very significant hypoxic episodes and are the causes of the formation of stable states of attention deficit, memory loss and learning disabilities.

In recent years, biological associations between night sleep and light regime have been revealed. Light regime directly determines the daily rhythms of the endocrine system, primarily the pineal gland and its subordinate departments, so synchronizing illumination with periods of sleep and wakefulness is of particular importance. A child's sleep in a brightly lit room can become a powerful factor disrupting optimal development.

Physical activity of the child

Physical activity is a universal general stimulant for development and health at any period of childhood.

The volume and functionality of muscle tissue largely characterize the quality and degree of optimality of the entire process of somatic and physical development. On the other hand, active processes of growth and differentiation of the muscular apparatus play a certain coordinating and determining role in relation to the development of all life support systems - the cardiovascular, respiratory, autonomic nervous system, metabolic and energy supply systems. The development of coordination of movements and fine motor skills is determined through the formation of the muscular and musculoskeletal system, and on the other hand, is a stimulus for the improvement of the cortical sections of the motor analyzer and the development of brain functions as a whole. Based on these connections, there are opportunities to manage the development of the central nervous system and the functions of many organs through the activation of the motor sphere. Muscles and their normally organized activity are one of the most real keys to active management of health formation both in childhood and in subsequent periods of life.

Physical activity is an essential external component of osteogenesis at any age, just as any voluntary or forced immobilization or simply hypokinesia are factors of bone resorption and the development of osteopenia. The adequacy of physical activity for children and adolescents in its significance for osteogenesis processes is comparable to the role of calcium supply in food and is one of the conditions for long-term protection against osteoporosis in adults. The main conductors of the influence of the load on bone growth are the mechanosensors of bone tissue. As Charles Turner (2004) writes: "The mechanical load that activates the mechanosensors should be primarily vertical, pulsed and short-term." The most effective are running and jumping (but not swimming and cycling).

In recent years, special attention has been paid to the role of physical activity as a means of preventing obesity, diabetes, arterial hypertension and vascular atherosclerosis. For a long time, the understanding of the mechanisms of this connection was simplified, and their interpretation was reduced to the balance of energy expenditure and energy inflow, i.e. the energy value of the daily diet. Today, this is beyond doubt, and regulation of the energy balance through physical activity and body weight control remain the main recommendation for preventing obesity. At the same time, the connections between physical activity and health turned out to be much more complex, and the preventive role of this activity turned out to be quite large and very significant even for people with normal and reduced body weight. Therefore, a simple calculation of the caloric content of consumed food, obviously, does not exhaust the complexity of the problem. It cannot be ruled out that the very fact of muscle movement and the impulses that are triggered at the level of the integral metabolome play a significant role.

Measures to create an enriched development environment or stimulation of development. Insufficiently stimulated systems, receptors or organs may find themselves in an unfavorable position in terms of trophic provision. Over time, their growth may transform into processes of atrophy and involution.

The hearing, vision, vestibular apparatus, skin receptors, muscle proprioceptors, gastrointestinal tract, etc. are subject to stimulation. However, the greatest connection between stimulation and development is inherent in the brain. The influx of information gives a direct morphogenetic effect on the structures of the brain. At the same time, there is a pronounced "targeting" of the action of stimuli on the processes of growth and differentiation of brain structures. Memorizing poems or learning foreign languages will stimulate morphogenetic restructuring in some areas, and learning to drive a car - in completely different ones. If the total stimulation is insufficient, then instead of growth and differentiation of neurons, the opposite processes will begin to occur - resorption of cells with the formation of atrophy zones and cysts in the brain matter. A child deprived of affectionate communication cannot master articulate speech and forms of non-verbal communication with other children and adults in a timely and complete manner (the phenomenon of the true "Mowgli", and not the hero of R. Kipling). Further, this stimulation mechanism should be supported by means of education, training, creativity, socialization lessons, etc. With good health, adequate nutrition, adequate sleep and good motor activity, the child's brain is practically tireless and insatiable. Hence the enormous needs for communication, knowledge, new impressions and new experience. Hence the emergence of modern schools of early and intensive education, and the growing understanding of the role of the family and mother in organizing new knowledge and impressions.

Creating skills and stereotypes of behavior aimed at maintaining health. All of the above should be transformed in the process of life and development from the dictated or imposed rules of nutrition, regime, behavior to the formed needs. As the child is freed from the constant care of adults, these stereotypes should become the determining factors for the formation and maintenance of health. Among them, the skills of safe behavior, compliance with hygiene rules, the skills of choosing the right dishes and food products in the school cafeteria, store, cafe, the need for physical activity, the desire to read are of particular importance. But, perhaps, the most critical significance for modern children is their readiness to say “no” to smoking, alcohol, drugs, unsafe sex, and harmful addictions in nutrition.

The creation of such behavioral stereotypes is no less important for maintaining population health than providing adequate nutrition and other essential conditions for normal development. As for the age periods most sensitive to the implementation of educational measures, they will not coincide with the critical periods for the formation of biological health. Their distribution clearly demonstrates the special importance of valeological education in preschool, school and adolescence.

The contribution of different age periods to the formation of “behavioral” health:

• preconception and intrauterine periods - 0%;
• early age - 10%;
• preschool and primary school age - 35%;
• prepuberty and puberty - 55%.

Nutrition and health of the child

The leading mechanisms of nutritional health support include the following:

• maintenance of normal or optimal tissue trophism and regeneration with an adequate level of deposition; this results in:
• sufficiency of nutritional supply to maintain the functions of internal organs, physical, intellectual and social activity;
• sufficiency of immunological protection;
• sufficiency of detoxification functions;
• antioxidant effect - suppression of acute and chronic inflammation, including infectious, allergic, immune, neurogenic and inflammation of the vascular wall in atherosclerosis;
• antimutagenic action - stabilization of DNA structure - protection against breaks, methylation and oxidation of chains with a reduced risk of autoimmune and tumor diseases.

A child's nutrition performs the same functions as an adult's, but additionally serves as "material" support for the growth and development processes. A child "builds" itself from food, and the body's structure can become perfect only if it is provided with the widest and most complete set of "materials" or "parts" supplied with food. This is called adequate, multi-component balanced nutrition. A woman should be provided with such nutrition when preparing for pregnancy, and then throughout the entire period of pregnancy and breastfeeding. After the end of breastfeeding, problems arise with the optimality of the child's own nutrition, right up until the end of its growth and development.

Nutrition issues are among the most important, but also the most difficult to solve in preventive pediatrics. It can be argued that among the causes relatively controlled by medicine, suboptimal nutrition is one of the main causes of poor development and health of both the children themselves and the adults they grow up to be. Many severe and even disabling diseases of children, adults, including the elderly, have their roots not in heredity, not in environmental disasters, but only in poor nutrition of the mothers who bore them or in other periods of their previous life, but most often in childhood or adolescence. It is time to collect facts and formulate concepts of a special direction in nutrition - developmental dietetics.

The dietetics of a growing organism is fundamentally different from the dietetics of an adult. We emphasize this difference with the term "developmental dietetics". Its most specific features relate to the periods of the highest dynamics of growth processes - intrauterine, then to early age and subsequent periods of childhood, in which there is an intensive increase in body length or an increase in the rate of differentiation of certain organs or cells. And since these processes take place throughout childhood, right up to the end of growth and puberty, the criticality of nutritional provision is also characteristic of childhood.

Developmental dietetics is the study of balanced, adequate and functionally complete nutrition of the fetus, child and adolescent, aimed not only at maintaining health and active life, but also at the optimal implementation of the development program and the achievement in the process of development of critical parameters of tissue and organ mass, the completeness and maturity of their differentiation, the formation of maximum adaptive capabilities and functional perfection of the body for the immediate and distant periods of the future life.

The main biological meaning of developmental dietetics is that the characteristics of children's nutrition have a significant impact on the formation of "long-term" health, phenotypic individual features of the structure and functions of various systems and organs, including intelligence, psyche, ability to socialize, risk of acute and chronic diseases, as well as the timing of the onset of diseases in adulthood. A radical change in the structure of nutritional thinking occurred due to the accumulation of three very different databases. The first is materials on the comparative follow-up of the quality of life, frequency and severity of diseases in children and adults raised exclusively on breastfeeding or artificial feeding. The second is a database containing information on the epidemiology of chronic cardiovascular diseases, on the basis of which a relationship was confirmed between the risk of these diseases and the timing of their onset with birth weight, i.e. a value derived from the state of nutrition of a woman before pregnancy and during pregnancy. The third database tells about the significant role of various nutritional deficiencies of pregnancy in the occurrence of congenital malformations. These observations have been reliably confirmed both experimentally and in clinical epidemiology.

The influence of remote effects on human health of factors that acted in utero or at an early age received different terminological designations, but the most adequate turned out to be “programming”.

"Developmental programming - according to A. Lucas (1991) - is a physiologically significant event or impact that leads to long-term changes in functional properties and capabilities. Programming occurs as a result of increased or insufficient stimulation of growth or when the development of some somatic structures is disrupted."

Following the term “intrauterine programming” that has already become established in the literature, we can talk about programming health properties and phenotype throughout childhood with primary participation of nutrition in this programming. Comparatively recently, the fundamental mechanisms of the main effects of nutrition, oriented towards long-term changes in development and health phenotypes, have been clarified.

The main theoretical foundation for understanding these mechanisms was:

1. the study of significant genotypic variation in reactions to various properties and components of food (nutrients), pronounced individual differences in the physiological needs of food components and the risk of toxic effects from the intake of certain nutrients; this study is called nutrigenetics;
2. the concept of constantly ongoing interactions between nutrients and genes (nutrigenomics, or nutritional epigenetics), the specific orientation of most nutrients towards the expression or suppression of certain genes with subsequent changes in the structures of functional proteins, enzymes, hormones or receptors;
3. the discovery of the role of vitamins as stabilizers of DNA structure and, accordingly, vitamin deficiencies as destabilizers of DNA structure and genetic regulatory mechanisms, which can lead to an increased risk of various diseases, primarily of a neoplastic and autoimmune nature (Bruce N., 2001).

Nutrigenetics has a long history of existence. Clinicians know groups of diseases with sharply changed sensitivity to certain macro- or micronutrients. The achievement of the last two decades is the addition of nutrigenetics with ideas associated with nutrigenomics.

Basic concepts of nutrigenomics (Kaput J., Rodrigues R., 2004):

1. Gene expression, like DNA structure, can be altered by nutrients or bioactive substances in food;
2. Nutrition may be a risk factor for certain diseases and developmental disorders in certain individuals;
3. The occurrence of chronic diseases and developmental disorders, their severity and progression can be determined by the presence of nutrient-regulated genes or their mononucleotide polymorphisms.

Thus, the absence of any essential nutrient directly through DNA changes or gene expression can lead to lifelong changes in growth properties or differentiation quality, and then to disruptions in the functional capabilities of tissues or organs regulated by this gene or DNA. Specific genes that react with certain vitamins, vitamin-like substances, and microelements have now been identified, and the resulting consequences for development and health properties have been outlined.

Mechanisms of health programming through nutrition may be simpler. For example, deficiency of any essential nutrient may be “compensated” by replacing it with a nutrient that is relatively close in chemical properties, but, nevertheless, less adequate. Such a substitution will certainly affect the properties of tissue, organ, and viability of the child and adult. Examples include intensive absorption and accumulation of lead instead of iron that is absent in the diet, inclusion of strontium in bone tissue with calcium deficiency, inclusion of omega-9 fatty acids in the membranes of brain cells of a child with the absence of polyunsaturated fatty acids of the omega-3 class in the diet of a pregnant woman. The physiological inadequacy of such compensatory substitutions once again emphasizes the uniqueness of a fully balanced diet. Adaptations of physiological systems and hormonal-receptor ratios to nutritional characteristics that form during the prenatal period have long-term consequences for health. These physiological “imprints” of the intrauterine period and early childhood can become very significant programmers for subsequent periods of life.

The most direct relation to long-term health properties and quality of life are the tempo characteristics of growth and development both in the prenatal period and in childhood. The key factors of accelerated or slow growth and development are the levels of protein and energy nutrition (energy value of the diet in relation to energy expenditure). Significant and long-term processes of bradygenesis form not just a slow growth rate, but also the risk of failure to realize the full potential of growth and differentiation with a decrease in all functional capabilities in subsequent age periods. A certain risk is also represented by accelerated growth with excess nutrition, as well as pronounced unevenness in the rate of growth and maturation (altered growth trajectory).

Low levels of nutrient reserves in women who have given birth many times, with short intervals between births, significantly reduce the viability of the next newborn.