General principles or laws of the physiological nutrition of children

The principle of physiological adequacy of nutrition is the maximum degree of conformity of a food product to the possibilities of biting, chewing, swallowing, digestion, absorption and metabolism, which the child of this age has. It is very important to rely on the well-studied natural patterns of occurrence of various possibilities of fermentation, immunological tolerance or inclusion in plastic processes. The concept of "adequacy" should include the immunological, mechanical properties of the product, its osmotic and taste characteristics. In practice, one has to deal with "pseudo-adequacy" - a seemingly good tolerance of a food product.

It is necessary to emphasize this because children have great adaptive plasticity and are able to adapt quickly and effectively to "transfer" the variety of food products. One can also say that such adaptive plasticity is used in the age physiology itself. The swallowing movements of the fetus arising with the ingestion of amniotic fluid arising in the medium term are a new step in the adaptation of the gastrointestinal tract with all enzymatic systems of parietal digestion to future enteric milk nutrition. The same very smooth system of re-adaptation measures is used by the family and the pediatrician, regulating the gradual accustoming of the child to dense food when introducing lures. But it is often necessary to state that the relatively crude dietary "experiments" children suffer without gross clinical failures. There are observations of quite calm reaction of children of several days or weeks of life on supplementing with simple milk mixtures, including whole milk or kefir, or for the early introduction of lures based on gluten-containing cereals. Children are forced to obey and trust adults. However, such adaptation is always a "zigzag" in the path of normal development. Such phenomena can be represented as particular manifestations of the general phenomenon of "adaptive development".

Premature appearance or enhancement of the function due to forced adaptation, on the one hand, leads to a relative lag in other directions of growth and differentiation, creating heterochronies of development, and on the other hand to the final incompleteness of the formation of that function that was induced prematurely. This is one of the general laws of the nature of development. Artificial feeding is asymphysiological for the child, it inevitably generates significant biological characteristics and changes in the incidence spectrum in the later life of older children, adolescents and adults. They include such as hyperlipidemia, hyperinsulinemia, obesity and obesity, early atherosclerosis, impaired behavior and the ability to form relationships, reduced ability to learn.

At present, there is no doubt that natural feeding can not be regarded as exclusively nutrient and energy supply. As an equivalent and continuation of the umbilical connection of the intrauterine period, breast milk carries the widest range of regulatory and information carriers - hormones, biologically active substances and stimulators of differentiation of individual systems and organs, factors of immunological regulation and tolerance. Very important in natural feeding is a unique system of psychological and social imprinting in the process of breastfeeding, as well as a specific mechanism of sucking effort and tension. At the same time, being only a component of the complex effect of breastfeeding, the phenomenon of nutrition through mother's milk is in itself the "gold standard" of dietetics. In the "lessons" of breastfeeding, you can disclose many of the basic principles of dietetics development.

[1], [2], [3], [4]

Principle of sufficiency of power supply

It may seem somewhat artificial, because it repeats the formula of the main purpose of nutrition for a child of any age.

The food or its energy characteristics should be sufficient to cover all energy expenditures and ensure growth. In any situation, the basic functions of the child - weight gain, growth and differentiation - must be carried out. Children (like pregnant women) should never lose weight or stop in the accumulation of body weight. The emphasis on energy supply to the baby is needed because it requires special attention or support from the physician. In the overall structure of energy expenditure, which includes the main exchange, the specific dynamic effect of food, the costs of physical activity, stress, losses associated with excretion, the costs of growth and development are always the last in order. Moreover, one can also say that their coverage is carried out "on a residual basis", even after compensation for all other energy debts. The more "other" costs increase, the higher the risk of under-delivery of growth and development.

It is easy to imagine that in those childhood periods when the energy consumption of growth becomes relatively small (5-8% of the total energy balance), even a less pronounced decrease in appetite or an increase in competing energy costs can cause the child to lag behind in growth and development.

Examples can be found in any situation with increasing physical activity. For example, forcing the training mode in the sports section is accompanied by a decrease in the growth rate or even its stop.

An illustration of this is the whole clinical picture of childhood diseases, where a decrease in growth and weight gain can be observed against a background of feverish conditions and stress, even if the appetite is preserved and the child's diet is normal. Any, including the most objectively forced, energy malnutrition, which creates a restriction on the rate of growth, is a significant alteration of development and creates irreversible changes in its qualitative characteristics. The pediatrician should imagine the "systemic" growth processes. It should hardly be considered a dramatic event "shortage" of 1-2 cm of growth in some age period. But this insignificant backlog in the growth of the skeleton may reflect a much more significant "shortage" in the mass of the brain, lymphoid and hematopoietic tissue, parenchymal organs, reproductive organs in adolescents, etc. From the position of "systemic growth", any risk of a decrease in the normal rate of development , and even more so, its actual reduction in the child is an extremely important pathological condition. It requires immediate intervention both in the content of the diet and in the methods of its "feeding" to a sick child. All these deviations are even more significant in those periods of growth, when the intensity, speed, and systemic nature of the growth-differentiation processes are maximal, i.e. In the intrauterine period or postnatally, with children born with a small body weight.

The principle of "multicomponent nutrition balance"

It is a continuation and confirmation of the concept of balanced nutrition introduced into dietetics by AA Pokrovsky. To create the whole variety of organic molecules or structures, one-stage use of a wide range of starting materials is necessary. Simplified treatment of diets with limited control of its nutritional value (energy and B: F: Y) means our simplified and negligent attitude towards the development of children. Not including in the control of the diet calculations of the provision of iodine or iron, we do not consider it necessary to care for the development of intelligence and memory, neglecting the analysis of zinc availability in boys, we doom them to problems of growth, puberty and fertility, not counting the calcium "ration", we form youth osteochondropathies and osteochondrosis of adults.

In implementing the principle of multicomponent provision, there are many problems associated with proving the essentiality of a particular nutrient for children. First of all, this refers to the so-called conditioned-essential substances of food, the circle of which is often much larger for newborns or sick children than for adults. These can include such nutrients as long chain polyunsaturated fatty acids (arachidonic, eicosapentaenoic and docosahexaenoic), carnitine, choline, inositol, cysteine, tyrosine, arginine, glycine, and nucleotides. In this case, the conditional nature of the essence is determined in relation to the state of children's overall health. However, in any unfavorable situation in the life of the child, especially in infections, it is the supply of conditional-essential nutritional factors that can be decisive in reducing the severity or risk of chronic illness. Adequate selection of nutrients for multicomponent provision is, as a rule, taking into account the "gold standard", ie, women's milk.

A significant problem is the transition from a list of the set of normalized nutrients to specific diets, taking into account the possibility of a fractional or periodic supply of nutrient with food, its short-term or long-term deposition, the level preceding the deposition of the nutrient.

It was the lessons of natural feeding that were the basis of numerous "recommended consumption norms" development, numbering up to 40 normalized nutrients. They also form the basis for the development of new baby food products and relevant international requirements or "codes" for the composition of these products.

At present, it is not possible to evaluate the food ration on the whole gamut of nutrients by hand. The only possibility and perspective is automated analysis systems based on modern computers.

The principle of "nutritional support"

Any event in the development, especially cell division, cytoplasmic growth, differentiation of cellular structures, can occur adequately only in the presence of all chemical substances, both involved in tissue "new buildings" and involved in the regulation of plastic processes. Thus, the provision must necessarily precede and outstrip all the processes of growth and development. It is obvious that with a border or relatively insufficient supply of nutrients, children will always have a contradiction between their direction to plastic processes and the necessary provision of active life or stress. In growth physiology, there is a system of insurance for such emergencies through the use of various tissue depots. In the absence of a sufficient depot of the nutrient, this competition often leads to a deficit in the provision of development, to its alterations. Thus, the pre-requisite task emphasizes the importance of the processes of depositing nutrients, their vital importance for the quality of development. The principle of preemption can be illustrated especially vividly and convincingly by examples related to the nutritional habits of pregnant women. The most studied is the inadequacy of iodine in the diet of a pregnant woman.

The spectrum of consequences of iodine deficiency in pregnancy

• Stillbirth.
• Congenital malformations.

Neurological cretinism:

• mental retardation;
• deaf-mute;
• strabismus.

Myxedema cretinism (hypothyroidism, dwarfism):

• mental retardation;
• short stature, hypothyroidism;
• psychomotor disorders.

The table shows the effect of iodine supplementation by administering it intramuscularly (in oily or aqueous solution) before conception or in the first weeks after it.

Preventive administration of iodine before conception or during pregnancy and the number of children with cretinism

Index	Introduction of iodine
	Before conception	After conception
Births total	593	95
Newborns with cretinism	1	5
Frequency per 1000 newborns	1.7	52.6

Iodine-based data can be supplemented with numerous other examples of the importance of pre-maintenance in development dietetics. Convincing disabilities of development and health can be and at many, more rarely observed deficiencies of a delivery of the pregnant woman, for example copper.

Prenatal Copper Deficiency

Influence on the fetus and newborn

• Stillbirth or early neonatal death.
• Neurological disorders:
  • defective synthesis of myelin;
  • hypoplasia of the brain or cerebellum.
  • Changes in the cardiovascular system:
  • aneurysms and varicose veins;
  • fragility and fragility of blood vessels.
• Changes in the skeletal matrix:
  • abnormal structure of collagen;
  • anomaly of elastin.
• Disturbances in the exchange of energy.
• Disorders of metabolism of phospholipids.
• Slowing growth.

This principle to a certain extent falls out of the stereotypes of thinking and the activities of doctors aimed at ascertaining the pathological state and the subsequent decision-making. Pre-provision, like all prevention through the maintenance of the development environment, must be carried out permanently with respect to each child, both the patient and the healthy.

The principle of providing for infants needs to be interpreted also in terms of a systematic understanding and absolute continuity of the problems of feeding a baby, feeding a nursing mother in the period of breastfeeding, feeding a pregnant woman, feeding a woman (and a man to some extent) in the period of preparation for conception, nutrition of women of childbearing age and adolescent girls.