Child's health: factors of support and optimal development

In this article, let us dwell on factors related to positive conditions, without which there can be no optimal development of the fetus and the health of the child. A number of such conditions have been known for a long time, since the birth of childhood medicine. At the same time, the deepening of these ideas, their detailed 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 with their incomplete provision, it is unlikely or impossible to achieve optimum development and health for the child. Accordingly, the lack or insufficient provision of these determinants become guarantors of incompleteness of development and health.

[1], [2], [3], [4], [5], [6]

Love and psychological support

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

Only under such conditions there is complete and deep relaxation, at which the anabolic, growth processes and differentiation processes are maximally activated. Absence of mother; the disappearance of signals of her proximity - smell, voice, her special face, eyes and smiles - are signs of disaster, a risk to very existence. A child who has been weaned from his mother or has lost her attention and affection, immediately loses the potential for normal growth. His neuro-endocrine mechanisms are "switched" to fear, anxiety or seeking refuge. Even if this "dark strip" in his life will not last long, its consequences for development can remain irreversible. All these provisions are broad and almost out-of-age, but nevertheless, for a newborn and an infant, links to the mother are much more naturally and tensely 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 "kangaroo" technology, in which the time of constant skin contact between the newborn and the mother is practiced. It turned out that this method of managing low birth weight provides significant additional opportunities to reduce morbidity and mortality.

Later, the spectrum of stress states will expand. Its causes can be pain, sudden cooling, the appearance of a stranger and much more. Now we have received evidence that the stresses of the mother during pregnancy are captured and amplified by the endocrine system of the fetus, leading to an intrauterine growth and developmental delay. Obviously, the smaller the age and degree of maturity of the child, the more significant can be the negative consequences of stress. Describing the mechanisms for the formation of a stress response in a newborn child, K. F. Arnand and F. M. Scalzo (2000) emphasize the significance of the resulting excitotoxic damage to growing neurons, expressed by the intensification of apoptosis of brain cells. The outcome is the emergence of a characteristic symptom complex, which includes:

• anxiety;
• changes in thresholds of pain sensitivity (lower or higher);
• low ability to concentrate;
• decreased learning and memory;
• motor hyperactivity;
• asocial and autodestructive behavior.

In children of school age and adolescents, the unfavorable situation in the family, conflicts in the school or children's company can also cause 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 of attention. Such symptoms are included in the complex of "psychosocial deprivation" and often require observation from a psychologist.

Creation and maintenance of optimal operating conditions. Determining for many very high-quality properties of children's development, even with the best conditions for mother-child contact and with the most nutritious nutrition are the two components of the regime. This is the organization of sleep and the physical activity of the child.

Sleep, development and health of the child

A deep full and sufficient sleep (in the amount of night and daytime sleep) is a necessary condition for maintaining the brain cells. During sleep hours, the whole complex of regenerative processes and the assimilation of energy and trophic substances are carried out. The tendency to accumulation of trophic and energy nutrients (for example, adenosine and some amino acids) in brain tissues during periods of wakefulness and their rapid utilization with decreasing concentrations during sleep is revealed. An analogy in our life is the need for regular charging of batteries in technical devices, for example, in mobile phones. Sleep in life and in the development of a child is no less important than eating food or water. This was well understood by the teachers of the past. John Locke, a British educator and philosopher of the 17th century, wrote: "Every student needs physical exercise, play, and a complete restoring sleep - a great source of vitality in nature."

At the same time, the attention of adults to childhood sleep is usually extremely inadequate. A significant proportion of children suffer from a lack of duration or quality of sleep. According to the data of American researchers, up to 13% of older schoolchildren suffer from sleep insufficiency with the formation of clinical signs of the syndrome of "chronic sleep deprivation", very similar to the syndrome of chronic fatigue.

Even a small but regular lack of sleep can cause a delay in the development of brain functions. The main result of a shortened, incomplete (superficial) or interrupted sleep is a violation of the quality of the subsequent wakefulness and everything associated with it - moods, behavior, contact with others, loss of attention and memory. Similar phenomena are very widely represented in the life of adults. There are studies that have shown enormous losses of human lives and economic resources associated only with a lack of sleep, realized in the form of the so-called "human factor" in the event of transport accidents, accidents at industrial and military facilities, accompanied by a decline in labor productivity, the quality of research or teaching work . The sample of children with the highest K? Shows a greater duration of sleep in this group relative to the control group with lower levels of 10. Conversely, any improvement in sleep in children with an already developed attention deficit hyperactivity disorder leads to a positive effect, often exceeding the effectiveness of drug therapy. Systematic violations of the integrity of sleep or the reduction of hours spent on sleep, are reflected in somatic diseases. First of all, the immune system responds to the lack of sleep (after memory, intellect and mood) - the child begins to often get sick, the course of the diseases becomes more protracted and difficult. Experimental animals, artificially deprived of sleep, die from generalized infections. That's why it is very important to monitor the adequacy of sleep time. It must be remembered that girls and girls need a longer sleep time than boys and boys. In addition, at the beginning of puberty and before it is completed, adolescents tend to later on the time of day the inclusion of physiological sleep mechanisms (delayed sleep syndrome of a teenager). Of particular importance is the usefulness of sleep for newborns and young children, as well as in periods of intensive growth.

Entire sections of pediatric neurology and otorhinolaryngology are devoted to violations of breathing in sleep. Irregularity of night breathing, snoring or a combination of snoring with respiratory pauses create very significant hypoxic episodes and are the reasons for the formation of stable states of attention deficit, memory loss and learning.

In recent years, biological associations of night sleep and light regime have been revealed. The light regime directly determines the daily rhythms of the endocrine system, primarily the pineal gland and its subordinate departments, so synchronization of illumination with periods of sleep and wakefulness takes on special significance. Sleeping a child in a brightly lit room can be a powerful factor that disrupts optimal development.

Physical activity of the child

Physical activity is a universal general stimulator of development and health in any period of childhood.

The volume and functionality of muscle tissue largely characterize the quality and degree of optimality of the entire process of physical and physical development. On the other hand, active processes of growth and differentiation of the muscular apparatus play a certain coordinating and determinative role in relation to the development of all life support systems-the cardiovascular, respiratory, autonomic nervous system, metabolic and energy supply systems. The formation of coordination of movements and fine motor skills is determined through the formation of the musculoskeletal and musculoskeletal system, and on the other hand, it is an incentive to improve the cortical parts of the motor analysor and the development of the functions of the brain 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 activities are one of the most real keys to active management of health formation both in childhood itself and for subsequent periods of life.

Physical load is an essential external component of providing osteogenesis in any age periods of life, as well as any arbitrary or involuntary immobilization or simply hypokinesia are the factors of bone resorption and the occurrence of osteopenia. Sufficiency of physical activity for children and adolescents is important for osteogenesis processes with the role of calcium supply and is one of the conditions for long-term protection against osteoporosis in an adult. The main conductors of the influence of the load on the growth of bones are mechanosensors of bone tissue. As Charles Turner (2004) writes: "The mechanical load that activates the mechanosensors must first of all be vertical, pulsed and short-term." The most effective jogging and jumping (but not swimming and biking).

In recent years, the role of physical activity as a means of preventing obesity, diabetes mellitus, arterial hypertension and arteriosclerosis of blood vessels has attracted special attention. Understanding the mechanisms of this connection has long been simplistic, and their interpretation was reduced to a balance of energy costs and energy inflow, i.e., the energy value of the daily ration. Today, this is not questioned, and the regulation of energy balance through exercise and body weight control remain the main recommendation for the prevention of obesity. At the same time, the connections between exercise and health proved to be much more complicated, and the preventive role of this load was quite high and very significant even for people who have normal and reduced body weight. Therefore, a simple calculation of caloric intake of consumed food obviously does not exhaust the complexity of the problem. It can not be ruled out that the very fact of muscle movement and the impulse that plays a part at the level of the integral metabolom plays an important role.

Measures to create an enriched development environment or stimulate development. Inadequately stimulated systems, receptors or organs may be disadvantaged in trophic provision. Over time, their growth can be transformed into processes of atrophy and involution.

Stimulation is subject to hearing, vision, vestibular apparatus, skin receptors, muscle proprioceptors, gastrointestinal tract, etc. However, the greatest connection between stimulation and development is peculiar to the brain. The inflow of information gives a direct morphogenetic effect on the structure of the brain. In this case, there is a pronounced "targeting" of the effect of stimuli on the processes of growth and differentiation of brain structures. Learning poems or learning foreign languages will stimulate morphogenetic rearrangements in some zones, and driving instruction is quite different. If the total stimulation is not enough, then instead of growth and differentiation of neurons, reverse processes will begin to take place - cell resorption with the formation of atrophy and cyst zones in the brain substance. A child deprived of affectionate communication can not timely and fully master articulate speech and forms of non-verbal communication with other children and adults (the phenomenon of true "Mowgli", not the hero R. Kipling). Further this mechanism of stimulation 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 almost indefatigable and unsaturated. Hence the huge needs for communication, knowledge, new experiences and new experiences. Hence the emergence of modern schools of early and intensive training, and an increasing understanding of the role of the family and mother in the organization of new knowledge and impressions.

Creation of habits and stereotypes of behavior, focused on maintaining health. All of the above in the process of life and development must be transformed from dictated or imposed on the child rules of nutrition, the regime, behavior in the formed needs. As the child is freed from the continuous care of adults, it is these stereotypes that should become decisive for the formation and maintenance of health. Among them, the skills of safe behavior, adherence to hygiene rules, the skills of choosing the right foods and food in the school canteen, the store, the cafe, the need for motor activity, the desire for reading are of particular importance. But, perhaps, the most critical importance for modern children is their willingness to say "no" to smoking, alcohol, drugs, unsafe sex, destructive predilections in nutrition.

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

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

• Pre-concept and intrauterine periods - 0%;
• early age - 10%;
• preschool and primary school age - 35%;
• prepubertate and puberty - 55%.

Nutrition and health of the child

The leading mechanisms of nutritional health care include the following:

• maintenance of normal or optimal tissue trophism and regeneration with an adequate level of deposition; this leads to:
• adequacy of food support for maintaining 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 reduction in the risk of autoimmune and tumor diseases.

The nutrition of the child performs the same functions as the adult, but additionally it is a "material" support for the processes of growth and development. The child "builds" himself from food, and the body's design can become perfect only by providing the widest and complete set of "materials" or "details" supplied with food. This is called an adequate, multicomponent balanced diet. Such nutrition should be provided by a woman in preparation for pregnancy, and then during the entire period of pregnancy and breast-feeding. After the end of breastfeeding, there are problems of optimality of the child's own nutrition, until the end of its growth and development.

Nutrition issues are one of the most crucial, but also the most difficult to solve in preventive pediatrics. It can be argued that, from among the reasons for medicine-driven, suboptimal nutrition is one of the main causes of ill-health in the development and health of both the children themselves and the adults growing up from them. Many severe and even disabling diseases of children, adults, including elderly people, are rooted not in heredity, not in environmental disasters, but only in the malnourished mothers who carried them out or in other periods of the previous life, but more often in childhood or adolescence . It's time to gather facts and formulate the concepts of a special direction in nutritional science - dietetics development.

Dietology of a growing organism is fundamentally different from the diet of an adult. This difference is emphasized by the term "developmental dietology". Its most specific features refer to periods of the highest dynamics of growth processes - intrauterine, then to early age and subsequent childhood periods, in which there is an intensive build-up of body length or an increase in the rate of differentiation of certain organs or cells. And since these processes take place during the entire childhood, up to the completion of growth and puberty, the criticality of food supply is also characteristic of the whole childhood.

Dietology of development - the doctrine of balanced, adequate and functionally complete nutrition of the fetus, child and adolescent, focused not only on maintaining health and active life, but also on the optimal implementation of the development program and the achievement in the process of development of critical parameters of the mass of tissues and organs, completeness and maturity their differentiation, the formation of the maximum adaptive capacity and functional perfection of the organism for the immediate and distant periods of the forthcoming life.

The main biological meaning of dietetics of development is that the characteristics of infant nutrition have significant effects on the formation of "distant" health, phenotypic individual features of the structure and functions of various systems and organs, including intelligence, psyche, the ability to socialize, the risk of acute and chronic diseases, and Also the terms of debuts of diseases of adult age. A radical change in the structure of nutritional thinking occurred in connection with the accumulation of three very different databases. The first is materials on the comparative quality of life, frequency and severity of diseases of 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 the relationship between the magnitude of the risk of these diseases and the timing of their occurrence with the body weight at birth, i.e., the value derived from the state of nutrition of a woman before pregnancy and in during pregnancy. The third database tells about the essential role of various food deficits in pregnancy in the occurrence of congenital malformations. These observations were reliably confirmed both in the experiment and in clinical epidemiology.

The effect of long-term effects on human health factors acting in utero or at an early age, received different terminology, but the most adequate was "programming".

"Programming development - according to A. Lucas (1991) - a physiologically significant event or effect, leading to long-term changes in functional properties and capabilities. Programming arises from the increase or inadequacy of growth stimulation or the development of some somatic structures. "

Following the term "intrauterine programming", which has already been established in the literature, one can talk about programming health and phenotypic properties throughout childhood, with primary participation in this nutrition programming. More recently, the principal mechanisms of the main nutrition effects, focused on long-term changes in development and health phenotypes, have been elucidated.

The main theoretical basis for understanding these mechanisms were:

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

Nutrigenetics has a long history of existence. Clinicians know groups of diseases with sharply altered sensitivity to particular macro- or micronutrients. In the last two decades, the addition of nutrientics to representations associated with nutrigenomics has become important.

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

1. the expression of genes, like the structure of DNA, can change under the influence of nutrients or bioactive substances of food;
2. nutrition can 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 of the essential nutrients directly through changes in DNA or gene expression can lead to lifelong changes in the properties of growth or quality of differentiation, and then to impaired functionality of tissues or organs regulated by this gene or DNA. At the present time, specific genes have been identified that react with certain vitamins, vitamin-like substances, as well as with microelements, and outlines the consequences for development and health properties.

Mechanisms of health programming through nutrition can be more simple. For example, the inadequacy of any of the essential nutrients can be "compensated" by replacing it with a relatively similar in chemical properties, but, nevertheless, a less adequate nutrient. Such substitution will necessarily affect the properties of the tissue, organ and viability of the child and adult. An example is the intensive absorption and accumulation of lead in place of iron deficiency, the inclusion of strontium in bone tissue with calcium deficiency, the inclusion of omega-9 fatty acids in the membranes of the child's brain cells when the pregnant woman does not have polyunsaturated fatty acids in the omega-3 diet. The physiological inadequacy of such compensatory substitutions again underscores the uniqueness of the complete balance of the diet. The adaptation of physiological systems and hormonal-receptor relationships that are formed in the prenatal period to nutritional features have long-term health consequences. These physiological "impressions" of the intrauterine period and early childhood can become very important programmers for subsequent periods of life.

The most direct relationship to long-term health properties and quality of life is the tempo characteristics of growth and development both in the intrauterine period, and in childhood. The key factors of accelerated or delayed growth and development are the levels of protein and energy nutrition (the energy value of the diet in relation to energy costs). Significant and long-lasting processes of bradygenesis form not just a slowed growth rate, but also the risk of unrealization of the full extent of growth and differentiation with a decline in all functional capabilities for subsequent age periods. A certain risk is also the accelerated growth with nutritional excess, as well as a pronounced uneven growth and maturation rate (altered growth path).

The low level of reserves of nutrients in multiple-birth women with short intervals between births significantly reduces the viability of the next newborn.