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Anatomical and physiological features of the newborn. Propaedeutic pediatrics Significance of age-related anatomical and physiological features

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1. Respiratory system

3. Nervous system

4. Digestive system

5. Urinary system

7. Endocrine system

Bibliography

1. Respiratory system

The child prepares for independent breathing in advance - as soon as it begins generic activity. The first breath occurs under the influence of a combination of many factors: irritation of the skin during passage through the birth canal and immediately after birth, changing the position of his body, ligation of the umbilical cord. A powerful stimulant of the respiratory center is cold irritation - the temperature difference during birth is 12-16 degrees. The lungs of the fetus are filled with fluid, which is produced by the cells of the respiratory epithelium. As the baby moves through the birth canal, the chest is compressed and fetal fluid is forced out of the airways. A negative pressure is created in the chest, and atmospheric air is sucked into it. The first portions of air fill only those airways that have been freed from fetal fluid during childbirth. But then the air literally rushes into the lungs and straightens them explosively.

Usually, if everything is in order, the first breath the newborn takes 30-90 seconds after birth. The respiratory movements following the cry are not yet uniform, but then the change of inhalation and exhalation becomes regular.

The respiratory rate of full-term newborns in the first week of life ranges from 30 to 50 per minute.

Premature babies breathe more frequently and unevenly. Between inhalation and exhalation, they often have pauses of various durations. The respiratory rate ranges from 36 to 82 per minute. The smaller the body weight of the child, the more often he breathes. Sometimes the baby has convulsive respiratory movements - it can be difficult for him to breathe. If in a full-term baby, after reflex movements, the respiratory rate increases, then in his premature peer, after 5-6 seconds, it can stop or slow down sharply for a while. He will normally respond to muscle load (increased breathing) only 1.5 months after birth. Pneumopathy, pneumonia and malformations are distinguished from lung diseases in the neonatal period. Each of these diseases can lead to the development of the most severe pathological condition of the newborn - respiratory distress syndrome. It can occur immediately after birth or several hours later.

2. Cardiovascular system

From the very beginning of the formation of the placenta, the blood circulation of the mother and fetus is disconnected. The pulmonary vessels (the pulmonary circulation) are in a collapsed state, and only a small amount of blood flows through them. The pressure in these vessels is high - much higher than in the systemic circulation, due to which blood can move through the oval window from the right to the left atrium and arterial (botall) duct, practically bypassing the pulmonary circulation. However, once the baby is born, the pattern of circulation changes. After the first breaths, the oxygen content in the child's blood rises sharply. This leads to a reflex elimination of spasm of the pulmonary vessels. Their pressure drops. At the same time, due to clamping of the umbilical cord, the pressure in the systemic circulation, on the contrary, increases, and blood rushes into the pulmonary vessels. The lungs expand, and the pulmonary capillaries immediately begin to open. Blood from the pulmonary vessels is sent to the left atrium. The pressure in it becomes much higher than in the right. And then the shutter of the oval window slams shut. From this point on, the right and left atria do not communicate with each other. This happens a few hours after birth. Complete closure of the oval window in most children occurs by 5-6 days of life.

thoracic anatomical physiological

The arterial duct in a newborn continues to function for another 24 to 48 hours, or even several days after birth. Gradually, its lumen narrows, and it closes.

The heart of a newborn weighs only 23 g. It beats much more often than in an adult. The highest rates of heart rate and blood pressure are observed in the first 15 minutes of life. Then, during the first day, they decrease and increase again by the 7-10th day.

The heart rate in the first week of life in a full-term baby can range from 100 to 175 beats per minute. When crying, swaddling, sucking, it increases to 180-200, and during defecation, yawning, sleep, on the contrary, it decreases to 100 beats per minute.

A premature baby reacts with an increase in heart rate and an increase in blood pressure to any stimulus. Usually his heart beats at a frequency of 140-160 beats per minute, but during a cry, the frequency of contractions "jumps" up to 200 beats per minute.

Often, with a high degree of prematurity in a child, when he lies on his side, the upper half of the body becomes white, and the lower half becomes pink. This phenomenon occurs due to the immaturity in such children of the parts of the brain that "monitor" the tone of the capillaries of the skin. Later, with the development of the central nervous system, this symptom disappears.

3. Nervous system

Already at the very beginning of the chest period, the child begins to fix his eyes on bright objects, when a feeling of hunger appears, he cries, sucks his fingers, and when the mother’s breast is near, he revives, turns his head, makes sucking and swallowing movements. At this age, the muscles of the neck and back are already becoming stronger, and the child, lying on his stomach, briefly raises his head, and in an upright position holds it straight for several seconds. When you touch the soles of a child lying on his stomach, he pushes off with his feet and tries to crawl, and if you support him under the armpits, he leans with his feet. A two-month-old holds his head for a longer time. He follows moving objects, reacts to the voice by turning his head. In response to an appeal to him, he smiles, “gurgles”. When touching the feet, the child no longer tries to crawl - this reflex disappears. At 3 months, not only freely holds his head, but also easily rolls over from his back to his stomach. More accurately captures the direction of the sound and turns in its direction. With the proximity of the mother's breast, bottle or spoon, the mouth opens, stretches. He shows feelings - he loves when they play with him, and if they stop playing, he screams. At 4 months already sits down with support and support. Begins to react in a certain way to familiar and unfamiliar faces. Not only smiles, but also laughs. A 5-month-old child already knows his mother well, distinguishes the top voice with which he was addressed. His movements become more confident, he stands on his feet, supported under the armpits. 6-month-old independently sits up and sits without support. He tries to crawl on all fours, gets up with support and makes attempts to step over with his feet, rolls over from his stomach to his back. Can eat from a spoon. Begins to pronounce the first syllables: ma, ba, pa, etc. The 7-month-old crawls, rises on all fours, sits independently, kneels with support. Supported under the armpits, steps well with the feet. Repeats syllables: ma-ma, pa-pa, etc. An 8-month-old baby crawls freely, gets up and sits down by himself, clinging to the crib. Repeats the learned movements, claps his hands. He gets up and tries to walk with the support of his hands. Mimicry becomes diverse. The 9-month-old performs rather complex movements - sorts through toys, fulfills simple requests: “give me a pen”, etc. Looks for a hidden object. Tries to stand without leaning. Walks holding hands. Sits down from an upright position. 10-month-old rises and stands without support. Can walk holding hands. Imitates the movements of adults. Starts to pronounce simple words. 11 month old baby gets up, sits down, bends down. Knows the names of some objects and shows them. Understands prohibitions and fulfills requests. At the end of the first year, he takes his first steps without support. Pronounces individual words. Its stock is about 10 words.

4. Digestive system

In terms of its components, the digestive system of a child does not differ from that of an adult. It includes the gastrointestinal tract itself and the oral cavity, pharynx, esophagus, stomach, and digestive organs that form and secrete active substances that digest the nutrients that enter the body.

The wall of the organs of the gastrointestinal tract is formed by three components: the inner one is the mucous membrane, the middle one is the muscular layer and the outer one is the serous membrane. Despite the apparent commonality of the structure, the digestive system of a child is very different from the digestive system of an adult.

After birth, the child feeds only on mother's milk or a mixture during the act of sucking due to the peculiarities of the structure of the oral cavity. The oral cavity of a child is very small compared to that of an adult, and most of it is occupied by the tongue. language is relative large sizes, short, wide and thick.

The muscles of the cheeks and lips are very well developed, in addition, the presence of dense fatty lumps in the cheeks makes them look plump or even thick. On the gums, as well as on the cheeks, there are dense areas that resemble the appearance of rollers. Due to this structure of the oral cavity baby sucking becomes possible.

The inner surface of the oral cavity is covered with a mucous membrane, which also has its own characteristics: it is very delicate, easily injured and richly supplied with blood vessels. Until the age of 3-4 months, the child is still not sufficiently developed, which causes some dryness of the mucous membrane, however, after this age, the secretion of saliva increases significantly, so much so that the child simply does not have time to swallow it, and it flows out.

The structural features of the esophagus in children are as follows: it is short, narrow and highly located.

The esophagus in a newborn begins at the level of III-IV cervical vertebrae, the length and width in an infant is 10-12 cm, and the width is 5 cm. The esophagus is very well supplied with blood, but its muscular layer is poorly developed. The stomach of the child also has its own characteristics. First of all, the position of the stomach itself changes with age. If in newborns it is horizontal, then by the age of 1-1.5 years, when the child begins to walk, it is located more vertically. Of course, with age, the volume of the stomach also increases: from 30-35 ml at birth to 1000 ml by 8 years. Mothers are well aware that infants very often swallow air and spit up, but few people know that these processes are also due to the peculiarities of the structure of the stomach, or rather, the place where the esophagus passes into the stomach: the entrance to the stomach closes the muscle roller, the excessive development of which does not allow food to quickly enter the stomach and make regurgitation possible.

The inner mucous layer of the stomach is well supplied with blood, as it contains a huge number of blood vessels. The development of the muscle layer is inhibited, it remains underdeveloped for a long time. The stomach glands are underdeveloped, and their number is significantly inferior to the number of glands in an adult, which leads to a low content of gastric digestive juice in children of the first month of life and a decrease in its acidity. However, despite the small digestive activity, the gastric juice contains a sufficient amount of a substance that breaks down the components of breast milk well.

The liver, like many other organs of newborns, is functionally immature, even though it is relatively large and protrudes from under the edge of the right costal arch by 1-2 cm. For example, in newborns, the liver is 4 % of body weight, while in adults - only 2%. Like the pancreas, the liver acquires a lobed structure only by 1-2 years.

Another component of the digestive system is the intestines. The intestine consists of the small and large intestines.

The main functions of the small intestine are the digestion of proteins, carbohydrates and fats, as well as the absorption of substances necessary for the body obtained from them, but in children it remains immature for a long time, and therefore does not work well. In addition, the small intestine in children occupies a non-permanent

position, which is determined by the degree of its filling and relatively longer length than that of an adult.

The large intestine also remains immature at birth. During the first 12-24 hours after birth, the child’s intestines remain sterile, however, after 4-5 days, various bacteria, such as bifidum bacteria, enter the intestine through the mouth, upper respiratory tract and rectum , lactobacilli and a small amount of Escherichia coli. The colonization of the intestines with bacteria leads to improved digestion of food and the formation of vitamins.

Common features of the intestines in infants and early age are its increased permeability, underdevelopment of the muscle layer and innervation, rich blood supply and increased vulnerability. Due to the fact that the muscle cells in the child's body are poorly trained, food moves slowly through the gastrointestinal tract.

The frequency of defecation acts in a newborn child is equal to the frequency of feeding and is 6--7 times a day, in an infant - 4--5, in a child of the second half of life - 2--3 times a day. By the age of two, the frequency of bowel movements becomes the same as that of an adult: 1-2 times a day.

5. Urinary system

The relatively large size of the kidneys and the short length of the lumbar spine predetermine the low topographic placement of the kidneys in children of the first years of life. The upper pole of the kidneys is located at the level of the XI-XII thoracic vertebra, and the lower one is at the level of the IV lumbar, i.e. below the iliac crest. In young children, the kidneys are more mobile, which is due to the weak development of the navcolonic fatty tissue. In the first years of life, the kidneys have a lobular structure. The bowls of the kidneys are relatively wide, the ureters extend at a right angle. The ureters are more tortuous, somewhat hypotonic, and have a relatively large diameter. Bladder in infants, it is located above the symphysis, later it descends into the small pelvis. The urethra in girls at all ages is shorter and wider than in boys.

These morphological features of the urinary system in children are prerequisites for the possible development of microbial-inflammatory diseases of the urinary system, and also predetermine the interpretation of a number of instrumental studies and methods for conducting diagnostic studies.

The secretion of urine with its release into the allantoic and amniotic fluid occurs already in the antenatal period. At this stage, urine is hypotonic relative to blood plasma, contains little uric acid, urea, chlorides. After birth, the kidney becomes the main organ that provides the vital constancy of the internal environment of the body. In young children, the concentration function of the kidneys is reduced. Low urine density is associated with a small diameter of the glomeruli, reduced production of antidiuretic hormone, underdevelopment of osmoregulators, functional inferiority of the epithelium of the distal tubules, etc.

Total diuresis in newborns is 2-8 times higher than in older children. It is 80-90 ml per 1 kg of body weight in the first months of life and about 50 ml per 1 kg of body weight in children of 8-10 years of age.

6. Musculoskeletal system

In a newborn, the spinal column is straight, with the exception of a slight sacral curvature. The first bend of the spine, cervical lordosis, appears in a child in infancy when he starts holding his head. Thoracic kyphosis occurs at the age of 6 months, lumbar lordosis and sacral kyphosis appear with the first attempts to stand and walk, i.e. by the end of the first year. At first, the curves of the spine are not strong: the thoracic and cervical curves are finally formed, as a rule, by 6-7 years, the lumbar - by 12 years.

Muscles in a newborn and infant are poorly developed; they make up about 25% of his body weight, while in an adult - at least 40--43%. In children of the first months of life, increased tone muscles, the so-called physiological hypertension, which is associated with the peculiarities of the functioning of the central nervous system. Flexor tone predominates over extensor tone; this explains the fact that infants, when unwadded, usually lie with their arms and legs bent. Gradually, this hypertension disappears.

The strength and tone of the muscles in the child are weak. Motor ability appears first in the muscles of the neck and trunk, and then in the muscles of the limbs.

7. Endocrine system

During childbirth, the adrenal glands carry the greatest load of all glands and some of their cells die, which determines the course of some borderline conditions. The thymus gland, which plays a protective role, is relatively large at birth, subsequently decreasing in size. The thyroid, parathyroid, and pituitary glands continue to develop after birth. The pancreas, which is involved in digestion and takes part in the metabolism of carbohydrates (produces the hormone insulin), functions well by the time of birth.

Bibliography

Anatomy and physiology. Diagnostic reference book: - Moscow, AST, Astrel, 2010 - 272 p.

Anatomy and physiology. Reference book: Tina Parsons - Moscow, AST, Astrel, 2003 - 282 p.

Biology. Part 2. Human anatomy and physiology. General biology. Pocket guide for schoolchildren and applicants: - St. Petersburg, STC "Universitetsky", 2002 - 64 p.

Entertaining physiology: Alexander Nikolsky - St. Petersburg, Book Club Knigovek, North-West, 2010 - 256 p.

normal physiology. In 3 volumes. Volume 1. General Physiology: - St. Petersburg, Academy, 2006 - 240 p.

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Anatomical and physiological features of the development of children

After birth, the height and weight of the baby increase almost exponentially. So, in the second year of life, one centimeter and 200-250 g are added every month. By the third year of life, motor activity increases, which requires most of the energy. At this time, maturation and formation takes place. internal organs. On the part of the musculoskeletal system, the anatomical and physiological features of the development of children consist in a fairly rapid ossification of cartilage tissues. First of all, the periosteum undergoes ossification, therefore, fractures in children are made according to the “twig” type, when the broken bone “hangs” on the whole periosteum. A fracture in a child grows together much faster than in an adult. Human skeletal growth continues until the age of 21.

Anatomical and physiological features of children in adolescence cause conditions that, although not the norm, do not cause serious concerns for the health of the child. IN Lately, due to acceleration, the skeleton grows much faster than a few decades ago. Cases of sudden fainting in adolescents, especially males, are becoming more frequent. Anatomical and physiological features of children of the present time serve as an explanation for such cases. When bone tissue grows - physiological age-related traction - the vessels "do not have time" to germinate in such an amount to provide oxygen and nutrition to muscle tissue. As the consumption of nutrients increases dramatically, the flow of oxygen to the brain is reduced, especially in the upright position of the body. As a result, the child faints. If something similar happens in an adult, this indicates a serious pathology.

An important role in the development of certain conditions in a child is played by the skin, the area of \u200b\u200bwhich in relation to the internal organs is much larger than that of an adult. And here the anatomical and physiological characteristics of children give rise in most cases to unreasonable fears for the health of the child. The fact is that the subcutaneous tissue in a child is not sufficiently developed, since growth processes do not provide for fat deposits. This feature gives rise to the development of diathesis and convulsions in febrile conditions.

In the first years of life, the neuromuscular system of the child is in a state of hypertonicity, therefore tendon reflexes are determined in the baby, which are considered pathological in an adult. These are also anatomical and physiological features of children, which should not be confused with diseases of the nervous system.

The digestive system has been improving over the years. When feeding a child, the ability of the gastrointestinal tract to digest certain foods is taken into account. Only the eruption of all teeth indicates readiness to eat "adult" foods that require a sufficient amount of bile juice and digestive enzymes.

Age anatomical and physiological features of children

The age of children is divided into separate periods of life, and each of them has its own characteristics, both in anatomy and in physiology:

Infancy (from birth to one year of age). Of greatest interest is the development of the nervous system, in particular, the visual analyzer. The age-related anatomical and physiological characteristics of children are such that after birth until the second week of life, the child sees all objects in an inverted state. Therefore, the gaze of a newborn is “floating”, since it is difficult for a child to focus his vision, “compare” the external picture with the visual analyzer of the higher nervous system;
Early childhood (1-3 years). During this period, the anatomical and physiological characteristics of children are to change the internal environment of the body. Indicators of blood and urine tests are brought closer to adult norms. The endocrine glands begin to function. At this age, human character traits and congenital diseases are determined;
Teenage years. The anatomical and physiological characteristics of children at this time are most pronounced in the appearance of secondary sexual characteristics. This age is characterized by the formation of abstract and analytical thinking.

When providing medical care, the anatomical and physiological characteristics of children are always taken into account, completely different approaches, tools and medicines are used.

ANATOMICAL AND PHYSIOLOGICAL FEATURES AND MORBIDITY IN CHILDREN OF DIFFERENT AGE GROUPS. HEALTH GROUPS.

PURPOSE of the lesson: to consolidate students' knowledge about the anatomical and physiological characteristics of the child's body; about health groups. To teach students to determine the group of health.

PATTERNS OF GROWTH AND DEVELOPMENT OF CHILDREN'S ORGANISM.

The human life cycle can be conditionally divided into 3 stages: maturation, mature age, aging. It is possible to draw a chronological boundary for the transition of an organism from one stage to another on the basis of studying the characteristics of its growth, development and interaction with the environment.

under growth is understood as a quantitative increase in the mass of tissues and organs, the formation of new compounds due to substances entering the body.

Development- this is a qualitative change, differentiation of organs and tissues, their functional improvement, the emergence of new functions. Growth and development are in unity, they are interconnected and interdependent, they are two sides of a single process of the organism's vital activity, which is based on the metabolism and energy.

Hygiene of children and adolescents deals with the study of the first stage of human development - the stage of its maturation, and age morphology is the natural basis of the GD&P. At the entire stage of maturation (from the moment of birth to full maturity), the growth and development of the organism proceed in accordance with objectively existing laws. At the same time, the following regularities are determined: 1) uneven rate of growth and development; 2) not simultaneous growth and development of individual organs and systems; 3) conditionality of growth and development by sex; 4) biological reliability of the functional systems of the body as a whole; 5) conditionality of processes by both genetic and environmental factors; 6) acceleration.

The significance of these regularities needs to be known to the sanitary doctor: they explain the activity of individual organs and systems, as well as their relationship, the functioning of the whole organism and its unity with external environment. By monitoring the health and development of the younger generation, the sanitary doctor can correctly interpret the information received only on the basis of knowledge of the age characteristics of the growing organism. This is necessary for the full implementation of state sanitary supervision of children's and adolescent institutions, for the presentation of scientifically based requirements for the daily routine, organization of the educational process, and nutrition. The patterns of growth and development of the organism are the theoretical basis for the hygienic regulation of environmental factors for children.

Uneven rate of growth and development.

The processes of growth and development proceed continuously, but their rate has a non-linear dependence on age. This pattern is clearly manifested in the change in body length. For one year of life, the length increases by 47%, for the second by 13%, for 3 - by 9%, At the age of 4-7 years, the body length increases by 5-7% annually, at the age of 8-10 years - only by 3% . During puberty, there is a growth spurt, at 16-17 years old - a decrease in gains, and at 18-20 - an increase in body length practically stops. The change in mass, OGK, as well as the development of individual organs and the organism as a whole, are subject to the same law of unevenness. This pattern is the basis for the correct grouping of children and adolescents. different ages and development of scientific principles of age periodization. The fact is that when organizing educational work, it becomes necessary to unite children of different ages. In addition, it is necessary to correctly set the age limit for a child to enter a nursery, kindergarten, school. Define start labor activity. Therefore, it is advisable to divide the entire stage of human maturation into age periods. The concept of “age period” includes that period of time within which the process of growth and development, as well as the physiological characteristics of the organism, are identical, and reactions to stimuli are more or less unambiguous. At the same time, the age period is the time required to complete a certain stage of the morphofunctional development of the body and achieve readiness for a particular activity. At the international symposium in Moscow (1965), a scheme of age periodization was proposed, based on the characteristics of the growth and development of the organism. This scheme, called biological, in the individual development of a person (in ontogenesis) distinguishes 7 main periods:

Neonatal period - 1-10 days

Breast age - 10 days-1 year

Early childhood - 1-3 years

First childhood - 4-7 years

Second childhood:

Boys - 8-12 years old

Girls - 8-11 years old

Adolescence:

Boys - 13-16 years old

Girls - 12-15 years old

Youth age:

Boys - 17-21 years old

Girls - 16-20 years old.

As can be seen from this diagram, age periods often change in the first years of life. The neonatal period lasts only 10 days, since the type of physiological reactions characteristic of it is noted for a very short period of time. However, than older child, the longer the segment of the life path can be combined into an age period. Girls and girls enter adolescence and adolescence earlier, and complete it earlier. Such a division is built on a purely biological principle, this period covers the time from the onset of puberty to the ability to reproduce. There is a scheme based on social principles, it is based on the organization of work in educational institutions, the organization of medical care, etc.

Preschool - up to 3 years

Preschool - 3-6-7 years old

School age

Junior - 6-10 years old

Intermediate - 11-14 years old

Teenager - 15-18 years old.

The social scheme basically contradicts the biological one, with the exception of adolescence (taking into account participation in labor from the age of 15), and the benefits available in the country for them: uneven growth and development is a general pattern. However, many children also show some individual characteristics. For some, the rate of development of which is accelerated and in terms of the level of development they are ahead of their own (chronological, calendar) age. But the opposite relationship can also be observed. In this regard, it is necessary to clarify the concept of "age" chronological or biological. The first period lived from birth to the moment "age" is chronological or biological. The first period, lived from birth to the moment of examination, it has a clear time limit. Biological age is a function of time, but it is determined by the totality of the morphological and functional characteristics of the organism and depends on the individual rate of growth and development. In this case, the difference can be very significant (up to 5 years). Children with a slow pace of development are called "lagging behind" or retarded (the number reaches 10-20%), more often they are detected before entering school or during training. Such students are less active in the classroom. They have increased distractibility and an unfavorable type of change in performance; in the course of the educational process, a more pronounced tension of the visual, motor analyzers, sss is revealed. It has been established that the lag of biological age in children is combined with reduced rates of most anthropometric signs and more frequent deviations from the musculoskeletal system, nervous, and cardiovascular systems. The most pronounced changes in working capacity and health status are observed in children with a sharp lag in biological age. The reasons for this lag may be prematurity, birth injuries, diseases at an early age (rickets, chronic pneumonia, frequent illnesses, unfavorable social conditions of the microenvironment (neglect, single-parent family, drunkenness of parents). Such children need dispensary medical supervision, an individual approach to learning, carrying out a complex of health-improving measures that contribute to their harmonious growth and development (there are many of them now - correction classes).

accelerated pace The individual development of the child leads to an advance in biological age compared to chronological. "Ahead" students are less common in the group of students than those who are lagging behind and more often among girls, especially adolescents. Such schoolchildren also have lower working capacity than normal ones. More often they are overweight due to fat deposition; they are more likely to suffer from hypertension, chronic tonsillitis, the incidence is higher, functional deviations are more pronounced. Significant individual changes in the growth rate lead to a discrepancy between paragraphs and b. age. To assess the biological age, certain levels of ossification of the skeleton, eruption and change of teeth, the appearance of secondary sexual characteristics, the onset of menstruation in girls, body length, annual increases, etc. are used. Depending on the age of the children, the information content of these indicators changes. From 6 to 12 years, the number of permanent teeth (dental age) and body length are leading. Between 11 and 15 years - indicators of the annual increase in body length, as well as the severity of secondary sexual characteristics and the age of onset of Me. At the age of 15 and later, the development of secondary sexual characteristics becomes the leading sign, and the length of the body and the development of the teeth lose their information content. The level of "ossification of the skeleton is determined by Ro" - a study only in the presence of special medical indicators: with pronounced developmental disorders in order to diagnose endocrine diseases.

Uneven growth and development of individual organs and systems.

The child's body as a whole, but its organs and systems develop unevenly (heterochronously). This pattern can be explained by the need for selective and accelerated maturation of those structural formations and functions that ensure the survival of the organism. In the first years of life, the mass of the brain mainly increases, in a newborn it is 360-390 g, by the end of 1 year it increases by 2-2.5 times, by the end of the 3rd year - by 3 times. The brain of a seven-year-old child weighs an average of 1250 g and further growth of its mass occurs very slowly. By the age of seven, the size of the cortical areas is 80-90% of the adult. Such an increase in the mass of the brain is not accidental: there is an intensive formation of conditioned reflex activity. Through n.s. communication with the external environment is carried out, mechanisms of adaptation to constantly changing conditions are formed, optimal conditions are provided for receiving information and implementing integral actions. Lymphatic tissue does not develop in the first years of life, its growth and formation occurs at 10-12 years of age. Only after 12 years does puberty occur. Consequently, there is a certain sequence of growth and development of certain structural formations and functions. Such development is a necessary condition for the performance of important biological and social functions at certain stages of human life. It has been established that during the period of intensive growth and development, there is an increased sensitivity to the action of specific factors. For example, during the period of intensive brain growth, there is an increased sensitivity to a lack of protein; during the development of the 2nd sigma system - verbal communication, during the development of motor skills - motor activity. The ability of the child's body to different types of activities, its resistance to various environmental factors by a certain level of maturation of the corresponding functional systems. Thus, the associative sections of the cerebral cortex, which ensure its integral function and readiness for schooling, mature gradually in the course of the individual development of the child by the age of 6-7. In this regard, the forced education of children at an early age adversely affects their subsequent development. The system that transports oxygen from atmospheric air to tissues also develops gradually and reaches maturity by the age of 16-17. Given this, hygienists prescribe the restriction of physical activity for young children. Only in adolescence, upon reaching the morphological and functional maturity of the cardiovascular and respiratory systems, long-term performance of large physical activity and development of endurance. This means that functional readiness for certain types of educational, labor and sports activities is not formed simultaneously, therefore both types of activities and environmental factors affecting various analyzers or functional systems should be differentiated. The hygienic norm throughout the entire stage of maturation of the organism will change in accordance with the change in age-related sensitivity to the action of the factor. Consequently, the heterochrony of the growth and development of individual organs and systems is the scientific basis for the differentiated regulation of environmental factors and children's activities.

Sex differences are manifested in the features of the metabolic process, the rate of growth and development of individual functional systems and the organism as a whole. So boys before the onset of puberty have higher anthropometric indicators. During puberty, the ratio changes: girls in terms of length and body weight, chest circumference surpass their peers. At the age of 15, the intensity of growth in boys increases and, according to their anthropometric data, they are again ahead of girls. At the same time, there is an uneven rate of development of many functional systems, especially muscular, respiratory, and cardiovascular. For example, the strength of the hand or the extensor muscles of the back in boys of all ages and young men is higher than that of their peers. Differences exist not only in physical performance, but also in psychophysiological indicators. This means that, along with general patterns, there are differences in the pace, timing and indicators of growth and development of boys and girls.

Sexual deformism is taken into account in the hygienic regulation of physical activity, the organization of the educational process. These differences are important in career guidance, sports selection, etc.

Ensuring biological reliability. Large stocks of potential possibilities are genetically incorporated into a functional system. Nature provides for the duplication of organs, but despite the large margin of safety of systems designed for life in critical situations, when organizing educational, labor and sports activities of children, optimal loads should be used. Some teachers prove the possibility of teaching children in the second year of life to read and write and write on a typewriter, and at the age of 4 - the possibility of systematic schooling. Such ultra-early and maximally forced learning can lead to a violation of growth and development, an unfavorable change in the state of health of children. /COMPUTER/.

Soviet hygienists believe that training loads should correspond to the functional capabilities of the growing organism and the expediency of its training in order to protect and strengthen health. Based on the age-sex principle, activity standards have been developed, recommendations are given for the reasonable training of a growing organism to increase the reserve abilities of children.

Determination of the process of growth and development by factors of heredity and environment. The genetic program determines the rate of growth and development, the order of maturation of individual organs and systems, their biological reliability, as well as sexual dimorphism. However, under the influence of various factors, various deviations are possible. The problem of the biological and social in the process of growth and development is very complex and has not yet been fully studied. In the study by the twin method, an intermittent dependence of the process of growth and development on biosocial factors was revealed. The increase in body length at the age of 4-6 and 10-15 years is determined mainly by a genetic factor. The body weight of children is more susceptible to environmental factors. This indicator is mainly determined by the quantity and quality of food, diet, physical activity, and the organization of physical education. The type of higher nervous activity, strength and mobility of nervous processes are determined by genetic factors. The development of motor skills /strength, speed, endurance/, the activity of the autonomic nervous system /pulse rate, minute volume of blood circulation/, frequency and depth of breathing, vital capacity of the lungs, reaction to physical activity, temperature exposure, are influenced by environmental factors and therefore to a greater extent are amenable to regulation in the course of a targeted impact on the child's body. Consequently, the processes of growth and development are subject to certain biological laws and at the same time are determined by environmental conditions. In the complex interaction of environmental factors and natural inclinations, the individual development of the child is carried out. An essential pattern must be taken into account when developing preventive measures aimed at the harmonious development, protection and strengthening of children's health.

Acceleration- acceleration of the growth and development of the organism of children in comparison with the rate of past generations. This is manifested in the fact that in the modern generation the stage of biological maturation ends earlier; this acceleration is noted from a very young age. For example, the body weight of a newborn for 30-40 years has increased by 100-300 grams, length by 1.5 cm, weight doubling occurs at 4-5, and not at 5-6 months of life. The change of milk teeth by permanent ones moved for a year. The most pronounced acceleration of growth and development is manifested in adolescence. According to Serdyukovskaya, Moscow schoolchildren are “teenagers” compared to their peers of the 30s by 11 cm “higher”, their body weight increased by 10 kg, chest circumference by 4 cm. In the USA and Europe, the body length of children 13-15 years old in increased by an average of 2.5 cm over 10 years. The timing of puberty has changed, especially in girls. However, in last years there is a slowdown in the rate of acceleration and there is an opinion that by the end of the twentieth century it will stop, but in Africa and Asia an intensive process of acceleration is now observed. Many hypotheses have been put forward, but none of them can explain the epochal shift in the rate of growth and development. Most likely, this is a consequence of the general trend towards a change in the biology of modern man, which is created under the influence of a complex of factors.

Age anatomical and physiological features /up to 3 years/.

The pre-preschool age is characterized by rapid processes of growth and development. Morphological features are intensively growing. Body proportions change. The size of the head decreases relatively, the growth and formation of the musculoskeletal system occurs. There is a restructuring of bone tissue: a coarse-fiber structure gives way to a lamellar one, the growth and ossification of the skeleton is underway. At first, the spine does not have bends, they are formed in connection with the development of movements, by the age of 3-4 they already exist, but are not yet fixed. Peculiarities chemical composition and the structure of the bones make them flexible and pliable, which contributes to the formation of posture disorders. Muscle development does not occur evenly; during the first year, the muscles of the trunk and lower extremities develop intensively, then the arms. By the age of 3, muscle mass increases sharply. The excitability and lability of the neuromuscular apparatus increase, but the strength of the muscles is not very great. There is a rapid increase in the size of the heart and a slow histological differentiation of its tissues, but the work of the heart is ensured by the fact that the arteries and capillaries have a wide lumen. The upper respiratory tract / nasal passages, larynx / are narrow, also narrow tracheas and bronchi, the blood flow in the acini is better than in adults, which provides favorable conditions for gas exchange, but the structural features of the chest, the structure of the diaphragm are such that breathing is shallow, and the necessary pulmonary ventilation provided by private breathing. There is an intensive maturation of the digestive organs. The capacity of the stomach increases 15 times. From 6 months, the eruption of milk teeth begins, and by 2-2.5 years, only 20 milk teeth erupt. When switching to mixed food, the intestines grow intensively. Significant changes take place in the nervous system, many new conditioned reflexes are formed, however, conditioned reflex connections are weak, unstable due to the weakness of inhibitory processes and the predominance of irradiation over concentration processes. Movements in children are inaccurate and poorly coordinated. The formation and development of speech occurs according to the laws of the formation of conditional connections. At the age of 2, there is an intensive development of speech processes, however, children have poor command of speech motor skills. At an early age, refraction is predominantly hyperopic. The main result of the development of the child by the age of 3 is the mastery of the ability to move freely and the formation of speech function.

Preschool age (3-7 years). It is characterized by uniform increases in height (5-8 cm), weight of about 2 kg, JCG -1 - 1 cm, body proportions change (by 6-7 years, the height of the head is 1/6 of the body length). The intensive formation of the musculoskeletal system continues, but the processes of ossification are still ongoing. By the age of 7, ossification nuclei appear in all the bones of the wrist. Muscles that provide erection and walking develop, but the muscles of the anterior abdominal wall are poorly developed (heaviness, prolonged standing is not recommended). The small muscles of the hand are poorly developed, but due to the improvement of the process of innervation, coordination of movements improves, but the flexor tone prevails over the extensor tone, so it is difficult for the child to withstand a static load. Vascular growth continues, but it lags behind the growth of the heart. The depth of breathing increases, but the frequency decreases, VC increases. There is a high excitability of the respiratory center. Short-term physical stress, emotions lead to a rapid disruption of the rhythm of respiratory movements. By the age of 7, secretory and motor functions approach the function of adults; after 6 years, the change of milk teeth begins. The nervous system is characterized by instability of nervous processes, easy exhaustibility of the cells of the cerebral cortex. Conditioned reflexes are formed faster, but are quickly destroyed. The processes of irradiation of excitation predominate, which is manifested in the generalization of the response to the stimulus. Typological features of GNI begin to appear. By the age of 5-6, the child masters the fine coordination of speech movements, but many still have far-sighted refraction. The activity of the goiter and adrenal glands decreases, the thyroid gland increases. The anterior lobe of the pituitary gland is strengthened, which regulates growth and development. By the end of this period, children should be able to perceive systematic knowledge when studying at school (school maturity).

School age (7-18 years) is divided into:

Primary school age (7-11 years) - the development of children is intensive and relatively even. Every year, the body length increases by 4-5 cm, weight - 2-3 kg, JCG - by 1.5-2 cm. The ossification and growth of the skeleton continues. The spine is flexible and pliable, there is a great danger of a violation of posture. Increases muscle strength. The large muscles of the hand develop, but the small ones (for performing coordinated movements) are still underdeveloped. Weak and deep muscles of the back, which, together with the suppleness of the spine, contributes to the development of postural disorders and scoliosis. The VC increases, breathing becomes more rhythmic, but the respiratory center is very excitable, so long-term hard work is not recommended. There is a change of milk teeth, the spread of caries is observed. The development of the nervous system and the inhibition of the excitation process continue, internal inhibition is not sufficiently developed, slight exhaustion of the cells of the cortex, prohibitive inhibition develops rapidly, irradiation processes predominate over concentration processes, therefore, coordination of movements is insufficient and attention is unstable. The second signal system is underdeveloped, which contributes to concreteness, figurative thinking, inability to perceive abstract, abstract concepts. The refraction of the eye becomes emmetropic (commensurate). The endocrine system is driven by the activity of the thyroid and pituitary glands. From the age of 11, the activity of the gonads begins. The resistance of the body increases, the incidence decreases.

Middle school age (12-14 years) is a critical period, characterized by sharp endocrine shifts, changes in the functional state due to puberty. The intensity of growth and differentiation of organs and tissues increases sharply. Annual growth - 4-7.5 cm, weight 3-5 kg.

STATUS OF HEALTH OF CHILDREN AND ADOLESCENTS, METHODS OF ITS STUDY AND INDICATORS.

What is health?

WHO defines it as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". More practically used is such a definition - HEALTH is not a state, but a multidimensional dynamic feature, interconnected with the environment /natural and social/. According to TsAREGORODOTSEV, health is “a state of optimal functioning of the body, allowing it to best perform its species-specific social functions.”

In any case, the health of an individual should be interpreted as a dynamic process and as a social category, and to characterize health, it is necessary to have a wide range of indicators reflecting the development of both biological and social functions of a growing organism.

GROMBACH proposed to use 4 criteria to assess health:

the presence or absence at the time of examination of chronic diseases,

the level of achieved physical, neuropsychic development and the degree of its harmony,

the level of functioning of the main body systems,

the degree of body resistance to adverse factors (1A 61) B),

The unfavorable factors of the geneological and social anamnesis have a great influence on the health of the child. These factors are conditionally divided into 3 types:

features of the antenatal period: toxicosis of pregnancy, threats of miscarriage, extragenital diseases of the mother, occupational hazards in parents, negative Rh-belonging to the mother with an increase in antibody titer, surgical interventions, viral diseases during pregnancy; prolonged or rapid labor, prolonged anhydrous period, caesarean section, etc.

the state of the newborn in the intra- and early postnatal periods, which to a certain extent determines the characteristics of the development and health of the child in the future - birth trauma, asphyxia, prematurity, hemolytic disease, acute infectious and non-infectious diseases in the early period, early transfer of the child to artificial feeding.

Impacts that worsen the developmental opportunities and the state of health of the child in the postnatal period, covering the first 3 years of life, include: repeated acute diseases of any etiology, changes in social conditions. When assessing the state of health, it can be difficult to single out the effect of one leading factor; most often, the total effect of several components from factors of unequal genesis is noted. Criteria characterizing the state of health - physical and mental development, resistance, functional state of the body, chronic diseases. When dividing children into health groups, the following is fundamentally new:

separation of patients with varying degrees of compensation of the pathological process;

selection of group II, i.e. persons who are considered healthy, but have certain functional abnormalities that prevent them to one degree or another from exercising their social functions. In the period of early childhood, a greater differentiation is needed in determining the levels of health status, taking into account anatomorphological features and all risk factors influencing the formation of growth and development of health. At this age, such states as relative immaturity, functional deviations, and borderline states are more pronounced. Therefore, the P group is differentiated taking into account the severity of functional deviations and burdened factors:

Group 1 includes healthy children without deviations in all health criteria selected for assessment, as well as children with minor single morphological abnormalities / anomaly of the nails, mild deformity of the auricle / that do not affect the state of health and require correction.

Group II includes children with a aggravated biological history, some functional and morphological changes, i.e. healthy children at risk of developing chronic pathology. This group includes:

Gr. II-A - healthy with a minimal risk of developing chronic diseases, i.e. with risk factors, only the first type in ontogeny (biological and genealogical history), which include:

1 - extragenital diseases of the mother, prof. harmfulness and alcoholism of parents, acute diseases and surgical interventions during pregnancy, mother's age, toxicosis of the 1st and 2nd half of pregnancy, the threat of miscarriage, an increase or decrease in blood pressure during pregnancy.

2 - fast, protracted labor, a long anhydrous period and other complications.

3 - burdened genealogical history - in the child's pedigree there are diseases with a certain metabolic orientation.

Children of the II-A group are close to the children of the first group in terms of health.

II-B - healthy children with a risk factor of the 2nd type or a simultaneous burden with risk factors of all 3 types, i.e. with those conditions of the fetus and newborn that further affect the growth, development and formation of the child's health, in particular, the appearance of chronic diseases, as well as borderline conditions and functional deviations due to age.

These include children born with a large body weight, immature, with intrauterine infection, who have undergone asphyxia, birth trauma, hemolytic disease, acute severe illness, rickets of the 1st degree, pronounced residual effects of rickets, malnutrition of the 1st degree, allergic predisposition to food products, medicinal and other substances, etc. This entire group (II-B) is divided into 4 categories, which differ in a different combination of deviations that cause them.

First- due to the presence in children or several of the above conditions and abnormalities.

Second- reduced resistance of the child.

Third- deviations in the state of health in combination with reduced resistance.

Fourth- the period of convalescence after the disease.

Group III includes children of patients with chronic diseases or severe pathology in a state of compensation, i.e. rare exacerbations that are not severe in nature without a pronounced violation of the general condition and well-being, behavior, rare intercurrent diseases (1-3 times a year), functional deviations of only one pathologically altered system or organ without clinical manifestations of functional deviations of other organs and systems. Children with a sharply reduced resistance, since in practice they get sick often and are constantly in a state of acute illness or prolonged convalescence.

Group IV - children with chronic diseases, severe malformations in a state of subcompensation, determined by functional deviations not only of a pathologically measured organ, system, but also of other organs and systems, with frequent exacerbations of the underlying disease, disorders of the general condition, well-being, behavior after an exacerbation, sometimes with significant mental retardation.

Group V - children with severe chronic diseases, severe congenital malformations in a state of decompensation, i.e., threatened by disability or disabled. This condition is characterized by severe morphological and functional abnormalities as pathologically altered organs and systems. The degree of compensation is also determined by the ability to adapt to kindergarten and school. The health group is determined by the most severe deviation or diagnosis.

Observing the children, the pediatrician notes the dynamics of the state of health with or without a change in the health group; the so-called intragroup dynamics is more often noted, i.e. without changing the health group, and the positive dynamics is much slower than the negative one, since the chronic form is formed with symptoms of subcompensation immediately after the acute one. For a comprehensive assessment of the state of health, it is necessary not only to characterize the level of health, but also to identify early deviations that have not yet become diseases.

Children assigned to different health groups in need of a differentiated approach in the development of a complex of therapeutic and preventive measures.

For the 1st health group, educational, labor and sports activities are organized without any restrictions in accordance with the existing programs of the educational process. A pediatrician or teenage doctor conducts a preventive examination at the scheduled time, while medical appointments consist of ordinary recreational activities that have a training effect on the body.

Children of the 2nd group (part of it is called the RISK GROUP) require more attention from doctors. This contingent needs a complex of recreational activities, the timely implementation of which is most effective in preventing the development of chronic pathology.

Children assigned to the 3rd, 4th, 5th health groups are under dispensary observation by doctors of various specialties in accordance with the existing guidelines for the medical examination of the child population. Patients receive therapeutic and preventive care depending on the form of pathology and the degree of compensation. In children's and teenage institutions, a sparing day regimen is created for them, the duration of rest and night sleep is lengthened. The volume and intensity of training and physical activity is limited. In the presence of chronic diseases or congenital pathologies, children are sent to special institutions, where, taking into account the characteristics of the pathology, treatment and education are purposefully carried out. At the same time, the doctor should study the organization of clinical examination, the completeness of coverage of children and adolescents with preventive examinations in a timely manner by pediatricians, adolescent doctors and specialists, early detection of morphofunctional deviations and initial forms of pathology; introduction of screening tests into healthcare practice (in accordance with the Order of the Ministry of Health of the Russian Federation dated June 30, 1992) organization of medical and recreational work with children at risk both in a polyclinic and in preschool institutions, schools and other educational institutions.

The health of a population is made up of the health of individuals. One of the indicators of health is the GENERAL INCIDENCE. This refers to the spread of all diseases (acute and chronic) among the population of a certain territory for a specific period of time. This is the leading criterion for characterizing the state of health of children's and adolescent groups. To study the incidence, two sources are usually used: medical care(according to polyclinics) and the results of mass medical examinations conducted in children's institutions. The latter source has great diagnostic value, the ability to detect early forms of pathology.

Diseases detected when seeking medical help are compared with the tip of the iceberg, the main part of which (unrecognized, untreated cases of diseases) remains hidden and unidentified, which means that the role of full-fledged and high-quality medical examinations is very important for studying the health status of children, since they supplement and clarify the data of general morbidity, determined by negotiability.

When studying the incidence of children in Moscow in 1975, E.S. Rysev and L.F. Bereshkov found that 85% of schoolchildren sought medical help on average 2.4 times a year. At the same time, the highest incidence was observed in students of the 1st grade (263 cases per 100). With age, this indicator noticeably decreases and for students in the 8th grade it is (159 lines per 100).

Serenko A.F., Ramensky A.A., Cherkovny G.F. (1978), studying the general morbidity of different population groups, found that the highest morbidity in terms of negotiability in urban children under 3 years old, the lowest 15-19 years old, which means that in preschool children it is higher than in schoolchildren and vocational school students , which probably indicates that the degree of maturity of functional systems, especially immunological ones, affects the incidence.

If we consider the incidence of children in kindergartens, then the fact that it is higher in children 2-3 years old (admission to kindergartens) and at 7 years old (entry to school) attracts attention. This is due (A.G. Sukharev) to an increase in contacts between children in case of non-compliance with dignity. / epidemiological. mode, functional restructuring of the child's body, caused by adaptation to new conditions of the microenvironment. Confirmation is the fact that "home" children get sick (according to the appeal to the clinic) somewhat less often than those attending kindergartens, they do not have a peak incidence of 2-3 years. The process of adaptation to kindergarten and school in a child proceeds individually for different children, but can be very long and be accompanied by complex changes in the body.

In this case, the following phases of adaptation are distinguished: 1-acute adaptation, when shifts in various physiological parameters and behavioral responses are most pronounced; its duration depends on the age, state of health of the child and his readiness for training and education in a team. In healthy children, the first phase of the adaptation period lasts about 10 days, in children with morphological and functional deviations - 20 or more days. 2nd stage- subacute, in which the physiological shift decreases and is recorded only for individual parameters, but the overall resistance remains reduced. It can last several months, this phase is especially prolonged in children with chronic diseases, functional immaturity, lag in physical development or any defects. 3rd phase- is called compensatory, during this period, previously identified deviations disappear and positive changes are observed in the functional state of the body and the behavior of children.

However, some children may develop decompensation, a sharp decrease in the body's resistance, this happens when the strength of the stimulus exceeds the adaptive capabilities of the body. How, then, to facilitate the process of social adaptation and reduce the incidence of children during these critical periods?

It is necessary to prepare the child in advance for admission to preschool and school. Children with chronic diseases, morphofunctional immaturity are taken to the dispensary and carry out the necessary medical and recreational activities, paying attention to the correct neuropsychic development, the formation of their analyzers, especially motor ones. For better adaptation, a stepwise mode of the educational process and a lighter daily routine are introduced.

In the analysis of general morbidity, intensive (frequency of diseases) and extensive (structure of diseases) indicators are used. Analysis of the structure of diseases is necessary for planning sanitary and hygienic and treatment and preventive measures. Respiratory diseases occupy the first place in terms of negotiability. In preschoolers, not only infectious and allergic diseases, but also diseases of the digestive system are common. With age, there is a change in the structure of morbidity: 2nd place after respiratory diseases is occupied by accidents, poisoning, injuries; 3rd - diseases of the digestive and sensory organs. In recent years, the number of cases of intestinal infections, diphtheria (sanitary and hygienic conditions and vaccinations), nosocomial infections has increased. A large percentage of injuries in boys (2.7 times higher than in girls) - road traffic, on the water, accidents. With age, the number of diseases with a chronic course of the pathological process increases. We are talking about diseases of the nervous system and sensory organs, eating disorders and metabolic disorders, etc.

Formed in childhood, these diseases later turn out to be among the leading causes of temporary disability, disability and mortality in the adult population, while the leading etiological factor is the nonspecific impact of environmental conditions. IN school age myopia, chronic tonsillitis, hypertension, neuroses, etc. are formed.

Chronic tonsillitis- (27% of all schoolchildren, especially girls) - rheumatism, nephritis, polyarthritis, heart disease. The reason is often recurring diseases, acute respiratory infections - often ill children, a general weakening of the body's immunological reactivity, not hardening of the body.

Myopia- most often a combined form, in which both the length of the axis of the eye and its refractive power are increased, it is - 1.4-2% - in preschool age, at 7-10 years old - 4.5%, at 11-14 - 10.5%, at 15-18 years old - 21.5%, at 19-25 - 28.7%. The number of patients increases in the process of studying at school and vocational schools. Reason: increased visual work at close range in low light conditions, as well as heredity. The main means of prevention is the creation of favorable conditions for work in kindergartens and schools, the improvement of the educational process and the reduction of visual work.

Nervously-mental disorders- plasticity and increased vulnerability of the psychophysiological functions of a growing organism, the complication of social conditions - create the prerequisites for overloading the nervous system and the development of neuropsychiatric diseases in childhood and adolescence. If (according to WHO data) in the 30s the frequency of neurosis was 22-30 cases per 1000 children, then in 1979 it was already 63 cases per 1000. process, the elimination of overload, streamlining the daily routine and improving the physical education of students, taking into account the neuro-psycho-physiological characteristics in choosing a profession.

Scoliosis- violation of posture (4.1 cases per 100). It is necessary, in the course of preventive and current sanitary supervision, to control the availability of a sparing regime, the necessary conditions for education and upbringing, the organization of preventive treatment of children with scoliosis or impaired posture in special preschool institutions and schools.

MEANS, in modern conditions, in the prevention of chronic diseases, it is necessary to detect diseases early, improve treatment and preventive care and increase the efficiency of environmental control, a rational regime of work and rest, nutrition, and physical education of children and adolescents. Close interaction of hygienists, pediatricians and children's specialists of various profiles is necessary. Of great importance are screening questionnaires, the level of medical care, the combination of preventive and curative work, continuity in medical care, improvement of early diagnosis and timely provision of qualified medical and preventive care. The method of correlation analysis established a conditional classification of factors that have the greatest impact on the development and health of a growing organism.

FAVORABLE HEALTH FACTORS.

Optimal driving mode.

hardening.

Balanced diet.

Rational daily regime.

environmental compliance with hygienic standards.

The presence of hygiene skills and the right way of life.

ADVERSE FACTORS /RISK FACTORS/.

Insufficient or excessive motor activity.

Violations of the regime of the day or the educational process.

Violation of hygienic requirements for the conditions of gaming, educational and labor activities.

Disadvantages in catering.

Lack of hygiene skills, the presence of bad habits.

Unfavorable psychological climate in the family and the team.

According to the table, it is clear that in modern conditions in the health status of children are often due to insufficient motor activity /hypokinesia/, this can explain the healing role of the optimal motor regimen for children.

Hardening and a balanced diet are effective means in the prevention of many diseases. Movement, hardening and nutrition can be called the leading triad that determines the health of the younger generation. In the process of sanitary supervision, the doctor encounters violations of the organization of physical education, daily routine, educational and labor activities, and nutrition. As already mentioned, in addition to factors that indirectly affect health, one must keep in mind the possibility of adverse biological factors. The combination of them can lead to the most severe and progressive form of pathology. Thus, a genetic predisposition to eye refractive error, combined with school workload and household hypokinesia, can contribute to the development of progressive myopia. Or, a complicated pregnancy and an anomaly of the child's psychomotor development, combined with academic overload at school and an unfavorable psychological climate in the family, can cause a severe neuropsychiatric illness in schoolchildren. However, the combined action of biological and socio-hygienic factors can also cause a healing effect and control the health of children. There are FOUR main components in the health management system:

obtaining statistical indicators on the health status of teams according to the annual clinical examination of children and adolescents (health monitoring);

establishing cause-and-effect relationships with the leading factors that shape health;

implementation of sanitary supervision in children's and adolescent institutions on the basis of existing norms and rules;

development of a set of preventive measures and their implementation by influencing the environment and the body.

Analysis of children's health indicators in preschool educational institutions.

In accordance with the proposed scheme, children and adolescents, depending on their state of health, are divided into the following groups:

Healthy, with normal development and a normal level of function.

Healthy, but with functional and some morphological abnormalities, as well as reduced resistance to acute and chronic diseases.

Children with chronic diseases in a state of subcompensation, with preserved functional capabilities of the body.

Children with chronic diseases in a state of subcompensation, with reduced functionality.

Children with chronic diseases in a state of decompensation, with significantly reduced functional capabilities of the body. As a rule, children of this group do not attend general children's institutions and are not covered by mass examinations.

The distinction between I and II health groups usually does not cause difficulties.

Group I includes healthy children with normal physical development, without deformities, injuries and functional abnormalities.

Group II includes children and adolescents who do not have chronic diseases, but have some functional and morphological diseases. This group should include convalescents, especially those who have had infectious diseases, and children with a general delay in physical development without endocrine pathology and with a significant underweight, as well as often (4 or more times a year) sick.

It is desirable that each doctor participating in the examination determines the health group according to their specialty.

Incidence by referral

The number of days the children missed.

The incidence rate for all types.

% of days missed by children due to illness to the number of days spent in groups.

% of children sick per year (health index).

Share of diseases.

Frequently ill children (% of children who fell ill 4 or more times a year).

MORBIDITY ACCORDING TO THE MATERIALS OF MEDICAL EXAMINATIONS

Intensive indicators per 100 children:

Physical development of children (normal, overweight, underweight, obesity, delayed physical development).

forms of pathology.

Extensive indicators (ratios)

Pathological involvement (% of children with chronic diseases and functional abnormalities in the total number of those examined).

Health group.

SCHEME FOR DETERMINING THE HEALTH GROUP DURING MASS MEDICAL EXAMINATIONS, DEPENDING ON THE NATURE AND EXPRESSION OF SOME COMMON DIFFERENCES IN THE STATE

HEALTH.

Name of deviations.	Health groups	clinical criteria.
OF CARDIO-VASCULAR SYSTEM:
Functional heart murmur.
Juvenile hypertrophy of the heart, mitral heart shape; small (hanging) heart.
Tachycardia, bradycardia, sinus arrhythmia, extrasystoles		In the absence of heart disease
Lowering blood pressure		With a decrease in systolic blood pressure in children aged 8-12 years to 80-95 mm Hg; 13-16 years old up to 90-95 mmHg
Vegetovascular dystonia by hypotonic type		Decrease in systolic blood pressure in children aged 8-12 years below 80-85 mm Hg. and 13-16 years old below 90-95 mm Hg. in the presence of increased fatigue, headaches, pulse lability, sweating, etc.
Vegetovascular dystonia of the hypertensive type (hypertension stage I A according to A.L. Myasnikou).		Transient rises in systolic blood pressure up to 135-140 mm Hg. (rarely up to 150 mm) in the presence of autonomic dysfunction - sweating, tachycardia, subfebrile condition and no changes in the fundus vessels and ECG.
Hypertension stage I (stage I B according to A.L. Myasnikov).		Prolonged rises in systolic pressure up to 150-180 mm, the level is labile. Diastolic blood pressure sometimes rises to 85-90 mm.
Myocarditis of non-rheumatic etiology		With complete clinical remission III gr.; With incomplete clinical remission - IV gr.
Rheumatism. Congenital heart defect.		Without heart disease or with a defect without signs of circulatory failure, in the absence of signs of activity of the rheumatic process from 1 to 5 years after the attack - III gr. Without heart disease or with a defect without signs of circulatory failure during the period of subsiding activity of the rheumatic process (from 6 months to 1 year) - IV gr. With heart disease and signs of circulatory failure of the 1st degree in the absence of signs of activity of the rheumatic process (from 1 year or more after the attack) - IV gr. Open ductus arteriosus, ventricular septal defect, without signs of circulatory disorders - III gr; with circulatory failure 1 tbsp. - IV gr.
RESPIRATORY ORGANS
Chronical bronchitis.
chronic pneumonia.		In the absence of clinical and functional changes in the respiratory organs and other systems - III gr., If they are present - IV gr.
Bronchial asthma.		In the inter-attack period, in the absence of functional disorders of various systems, organs and physical development - III group; if available - IV gr.
DIGESTIVE SYSTEM:
Dental caries		Caries of medium activity - group II; high activity – group III.
Anomalies of bite		Initial forms of malocclusion - group II; significantly pronounced bite anomalies - group III
Biliary dyskinesia		In the stage of stable remission - II gr. Short-term, cramping pains in the right hypochondrium or in the umbilical region, arising after eating or not associated with eating, with a slightly disturbed general condition and mild objective data - III gr.
Chronic cholecystitis.		In remission - III gr., In the presence of clinical signs of subcompensation - IV gr.
Chronic gastritis.		In the stage of complete remission - III gr., In the stage of incomplete remission - IV gr.
Chronic gastroduodenitis.		In the stage of complete remission - III gr., In the stage of incomplete remission (slight pain in the epigastric and umbilical region, hungry or 2 hours or more after eating in the presence of painful palpation of the pyloroduodenal region - IV gr.
Peptic ulcer of the stomach and duodenum.		With persistent remission - III gr. Pain in the epigastric region (hungry and nocturnal), acid belching, heartburn, vomiting, with local pain in the epigastric and pyloroduodenal region, muscle tension in the epigastric region - IVgr.
chronic colitis; enterocolitis.		In remission - group III; with vague pains throughout the abdomen, loss of appetite, general weakness, fatigue, weight loss, spastic contraction of the intestine, its swelling and rumbling - IV gr.
Helminthiasis.		Without signs of intoxication - II gr.; if available - III gr.
URINARY SYSTEM:
Benign proteinuria in the absence of kidney disease.
Chronic pyelonephritis		With complete remission and preserved kidney function - III group; with incomplete remission and partially impaired kidney function - IV gr
Chronic pyelonephritis.
Cryptorchidism.
Violation of the menstrual cycle during the formation of the menstrual function
Dysmenorrhea.
ENDOCRINE SYSTEM AND METABOLISM:
Hypertrophy of the thymus.
Enlargement of the thyroid gland I and II degree		Enlargement of the thyroid gland I degree (the isthmus of the thyroid gland is palpable and the lateral lobes are poorly defined), II degree (the gland is visible to the eye, when swallowing, the lateral lobes are easily palpated) before puberty and prepubertal period, without dysfunction.
Enlargement of the thyroid gland I and II degree.		Enlargement of the thyroid gland I, III degree or more, without dysfunction
		With a mild form - III gr., With moderately severe - IV gr.
Diffuse toxic goiter.
Overweight (due to obesity).		Excess body weight by 10-19% due to excess fat deposition.
Obesity (exogenous-constitutional).		Obesity 1 degree (excess body weight by 20-29% due to fat deposition) and 2 degree (excess body weight by 30-49% due to fat deposition) - III gr. Obesity 3 degrees (excess body weight by 50% or more due to fat deposition) - IV gr.
SKIN:
Allergic reactions.		Recurrent skin-allergic reactions to food substances, drugs, etc.
Exudative catarrhal diathesis without eczema
Eczema, dermatitis, neurodermatitis		With limited localization - III gr. With widespread skin changes with symptoms of general intoxication - IV gr.
BLOOD SYSTEMS:
Asthenic manifestations (anemization).

NERVOUS SYSTEM:
Asthenic manifestations.		Light asthenic manifestations (fatigue, headaches, irritability, resentment, superficial sleep, etc.) disappearing after a short rest, normalization of the regimen and rest.
pathological habits.		The habit of biting nails, pens, collars, pulling hair, biting and licking lips, etc. that do not reduce the functional abilities of the body.
Speech disorders (tongue-tied speech).
Vegetative (vegetative-vascular) lability		Somato-vegetative and vegetative-vascular disorders (excessive sweating, acrocyanosis, red dermographism, intolerance to heat and cold, the game of vasomotors), characteristic of the prepubertal and pubertal periods and not disturbing performance.
Vegetative (vegetative-vascular dysfunction).		Neurotic and neurosis-like disorders, expressed as permanent or crisis-like autonomic or somato-vegetative disorders With mild symptoms - III gr.; with severe clinical manifestations and decreased performance - IV gr.
Neuropathy (congenital childhood nervousness).		Sleep disorders (difficulty falling asleep, night terrors, interrupted sleep), appetite; emotional instability, psychomotor disinhibition.
Astheno-neurotic and cerebrasthenic syndrome.		Irritability, headaches, sleep and appetite disturbances. With moderate clinical manifestations - III gr.; with expressed - IV gr.
(asthenic, hysterical neurosis, obsessive-compulsive disorder).		With short-term manifestations - III gr.; with long-term - IV gr.
Logoneurosis, enuresis, tissues, motor obsession.		With moderate manifestations that do not reduce social adaptation - III group; with more pronounced - IV gr.
Pathological personality development, psychopathic syndrome, neurotic personality development.		Wrong forms of behavior qualified by childhood psychoneurosis; health group - depending on the severity of clinical manifestations.
Consequences of an organic disease of the central or peripheral nervous system.		Motor, sensory and coordination disorders, without functional impairment – III group; with their decrease - IV gr
Hypertensive - hydrocephalic syndrome (congenital or acquired).		In the stage of stable compensation and the absence of clinical manifestations - III group; if available - IV gr.
Epilepsy, epileptiform syndrome against the background of residual organic brain lesions
Impaired mental function.
Mental retardation (mild degree).
ORGAN OF VISION:
Mild myopia, astigmatism. Moderate hypermyopia, astigmatism.		Mypic refraction from 0.5 to 3.0 D or hypermeter. refraction from 3.25 to 6.0 D in the merridian of the highest ametropia on best eye, with visual acuity with a correction of at least 1.0 in each eye.
Myopia of medium and high degree, astigmatism.		Myopic refraction from 3.25 to 6.0 D in the meridian of the highest ametropia with visual acuity with a correlation of l 0.5 to 0.9 in the best eye - III gr. Myopic refraction from 6.25 D and above in the best eye in the meridian of the highest ametropia with visual acuity with a correlation in the best eye of at least 0.5 - IV gr.
Hyperopia of a high degree, astigmatism.		Hypermetropic refraction from 6.25 D and above in the meridian of the highest ametropia with visual acuity from 0.5 to 0.9 in the best eye.
Accommodative strabismus.		Without amblyopia with visual acuity with correction for both eyes of at least 1.0 without impaired binocular vision
Non-accommodative strabismus.		Taking into account the degree of refractive error
EAR, THROAT, NOSE:
Adenoid vegetations.		Difficulty in nasal breathing, constant runny nose, mucous discharge along the back of the throat, prolonged subfibrillation, frequent colds. With hypertrophy of the II degree (the tonsils fill two-thirds of the space between the palatine arches and the uvula) - II gr.; with hypertrophy of the III degree (tonsils are in contact with each other) - III gr.
Chronic adenoiditis.
Hypertrophy of the palatine tonsils II-III degree
Deviation of the nasal septum.		In the absence of a violation of nasal breathing - II gr .; in violation of nasal breathing - III gr.
chronic laryngitis.
Otitis chronic.		Otitis externa and otitis media - III gr.; purulent epimesotympanitis - IV gr
Rhinitis chronic
Sinusitis is chronic.
Chronic tonsillitis.		Compensated form (local changes in the palatine tonsils and tonsillitis or frequent respiratory diseases in history without common pathological manifestations without exacerbations) - III group; decompensated or toxic-allergic form (local changes in the tonsils are accompanied by low-grade fever, tonsillocardial syndrome, etc.) - IV group
Chronic pharyngitis.
Hearing loss.		Unilateral and bilateral 1 degree (perception of whispered speech from 1 to 5 m) - group II; unilateral II degree - (perception of whispered speech up to 1 m) and one-sided III degree (whisper speech is not perceived), as well as bilateral II degree - III group; bilateral III - degree - IV group
cochlear neuritis		Health group depending on the degree of hearing impairment (see. Hearing loss).
PHYSICAL DEVELOPMENT:
General delay in physical development		Body length is less than M-2σ lag in the level of age development in terms of the number of permanent teeth, the degree of ossification of the hand skeleton, the severity of secondary sexual characteristics (compared to regional standards) in the absence of endocrine pathology.
Significant underweight.		Body weight is less than M-2σ according to regional standards (regression tables), without chronic pathology.
musculoskeletal system:
Posture disorder		Shoulder asymmetry, lateral curvature of the spine; stooped, lordotic, kyphotic, straightened posture.
		Scoliosis I, II degree (costal bulging or muscle roller, angle of curvature of the main arch of the spine - up to 10 0 - 1 degree; up to 30 0 - 3 degree and more than 50 0 - 4 degree) - 4 gr.
Flattening of the foot.		Violation of the supporting surface; the isthmus of the foot, connecting the area of the calcaneus with the forefoot, is significantly expanded (up to 2/3 of the total diameter of the foot), on its inner side, a compensatory muscle roller is usually determined by palpation; the line of the outer edge of the foot is somewhat convex. The severity of the violation is specified by the plantogram
Flat feet.		Violation of the supporting surface of the foot: the isthmus connecting the area of the calcaneal brush with the forefoot, occupies almost the entire width of the foot.

SITUATIONAL TASKS.

Task 1.Assessed the state of the dynamics of the state of health of children

	SURVEY #1




Alexander




Vladimir









Svetlana



Svetlana

EXTRACT FROM INDIVIDUAL CARDS OF CHILDREN OF THE MIDDLE GROUP of preschool educational institution No. 21

	SURVEY #3




Alexander




Vladimir



		Ex. diathesis





Svetlana



Svetlana

Task number 2.

Assess the health status of children in the network of preschool work for the year.

Group DOW No.

Anatomical and physiological features of the child's body. They are manifested by characteristic features of the nervous system, skin and subcutaneous tissue, bone tissue, muscular system, respiratory organs, cardiovascular system, digestive organs, kidneys and urinary tract. A.-f. O. nervous system. The nervous system carries out coordination fiziol. and metabolic. processes in the body, their relationship with external. environment. The brain of a newborn is characterized by a relatively large mass, richly supplied with blood vessels. After birth, the child undergoes significant quantitative and qualitative morphological changes. changes in brain tissue, its functions. improvement. The most intensive development of the nervous system is noted in young children. They are characterized by a decrease in excitability and easy fatigability of cortical processes, a wide generalization of nervous processes when unconditioned stimuli act on the child's body. With age, the strength and concentration of nervous processes increase, the phenomenon of generalization decreases. In newborns, the most pronounced unconditioned reflexes sucking and swallowing.

Then conditioned reflexes are formed and fixed - vestibular, auditory, visual, tactile, gustatory and olfactory. Each child has individual morphological characteristics. and physiol. features of the nervous system, taking into account to-rykh, the types of higher nervous activity (constitution) are distinguished, which determine the individual characteristics of a healthy child and the variants of the course of their diseases. A.-f. O. skin and subcutaneous tissue. The skin of a newborn and an infant is pale pink, velvety, smooth, and tender. The epidermis consists of a delicate, thin horny and juicy, loose base. layer; the basement membrane is underdeveloped, tender, loose. Sweat glands begin to function at 3-4 months. life, and sebaceous - even in the period embryonic development. The subcutaneous fat layer in young children is well developed (makes up 12% of body weight, while in adults it is normally no more than 8%), protects against heat loss, and contains a supply of nutrients. The protective function of the skin is imperfect, but has a higher regenerative capacity than in adults. The function of thermoregulation (up to 3-4 months) is insufficient, which is associated with the imperfection of the center of its regulation; excretory and respiratory - well developed. In the skin, under the action of ultraviolet rays, the synthesis of vitamin D is actively carried out. A.-f. O. bone tissue. In an infant, bone tissue has a fibrous structure, is abundantly vascularized, contains few minerals, substances, is rich in water and organic matter. substances. Significant differences in bone tissue in children are its low density, porosity and flexibility. Abundant blood supply creates conditions for growth and active metabolic processes. In the bone tissue of children, it is relatively easy to develop inflammatory processes. The skull of a newborn has a much more developed brain part compared to the facial skeleton, the sutures of the skull are wide. A characteristic feature is the presence fontanels, to-rye usually close by the end of the 1st year of life.

The timing of their closure is very variable and depends on constitutional features and the state of phosphorus-calcium metabolism. The spine of newborns is straight and highly flexible. During the first year of life, as static functions develop, cervical (6-7 weeks), thoracic (6-7 months), and lumbar (by one year) curves of the spine appear. The growth of the spinal column is most intense in the first

2 years of life. The chest in newborns has the shape of a cylinder with a slightly expanded lower. department. As it grows, its anteroposterior size decreases somewhat compared to the transverse one. In long bones, epiphyseal cartilages are preserved for a long time, which determines the conditions for their growth. A.-f. O. muscular system. Muscles in a newborn and infant are relatively poorly developed. Muscle fibers are much thinner than adult fibers. In children of the first months of life, increased muscle tone is noted. The flexor tone predominates over the extensor tone. Muscle development is uneven - first, the large muscles of the shoulder, forearm develop, and later - the muscles of the hand. The musculature develops especially intensively during the period puberty. A.-f. O. respiratory organs. The respiratory tract in a child has narrower gaps than in an adult. Their mucous membrane is delicate, thin, dry, rich in blood vessels. Lower the nasal passage is formed by 4 years. Accessory cavities of the nose on radiographs are detected with

3 months life, finally formed by 7-15 years. The pharynx of a newborn is narrow and small, the lymphopharyngeal ring (tonsils) is poorly developed, its hyperplasia is noted after the 1st year of life. The larynx is funnel-shaped with delicate and elastic cartilage, the glottis is narrow. The trachea is weakly fixed, so young children often develop obstructive syndrome with ARVI. Bronchial cartilage is very elastic, soft. The lungs are in constant development throughout childhood. At an early age, they are rich in connective tissue, more dense and full-blooded, less elastic and airy. The respiratory surface of the lungs in children is larger than in adults. The pleura is thin, the pleural cavity is easily extensible, the diaphragm is located high. The respiratory muscles are poorly developed. Breathing in infants is superficial, characterized by a relatively high frequency of respiratory movements, irregularity. A.-f. O. of cardio-vascular system. The mass of the heart in a newborn relative to its mass body more than the same ratio in adults. Until the age of 2, the heart is located horizontally on an elevated diaphragm, then it begins to take an oblique position. The shape of the heart up to 6 years is usually spherical, after 6 years - oval, cone-shaped.

Lumen of arteries and veins in children wide enough, the walls of the arteries are more elastic than the walls of the veins. The pulse is more frequent and blood pressure is lower than in adults. Heart sounds are clear, but with less distinctness between the 1st and 2nd tone. A.-f. O. digestive organs. Oral cavity in children it is relatively small, chewing muscles are well developed. The oral cavity of a newborn and infant has a number of features that provide an act sucking. The salivary glands are not sufficiently differentiated, there is little saliva. The esophagus in young children is shorter than in adults, the anatomical narrowing is weakly expressed. The stomach is located in the left hypochondrium and in a child up to a year old has a horizontal position. The mucous membrane is thicker than in an adult. The muscular layer of the stomach is moderately developed, with the exception of the pylorus, which has well-developed muscles; the sphincter of the inlet part of the stomach is poorly developed, which explains the tendency of children of the first year to regurgitation. The secretory glands of the stomach secrete all digestive enzymes, but their activity is lower than in adults. The liver in children is relatively large, rich in blood vessels, and there are few connective tissue elements in it; its lobules are revealed only by the end of the 1st year of life. The liver in newborns and young children is functionally immature, the secretion of bile acids increases with age, their ratio changes, for example. glycine to taurine. The intestines of an infant are relatively longer than those of an adult. The mucosa is well developed, and the submucosal and muscular layers are poorly developed. Digestive enzymes have sufficient activity. Imperfect in their structure and nerve plexuses. A distinctive feature of the intestines of an infant is the increased permeability of its membranes, which to a certain extent determines the relatively frequent development of toxicosis and exicosis.

The various sections of the digestive tract of a healthy child contain a microflora characteristic of each of them. A.-f. O. kidneys and urinary tract. In children, the kidneys are lobular in nature, their tissue is delicate, up to 2-4 years old it is not sufficiently differentiated. They perform the main, excretory, function from the moment of birth; mechanisms of renal regulation acid-base state imperfect, which leads to the rapid development of acidosis in pathological conditions. The renal pelvis is relatively wide, the diameter of the ureters is larger than in adults. The bladder is located high. Its capacity increases gradually with age. In the first days of life, the amount of urine excreted is insignificant and it is more concentrated. A newborn urinates up to 20-25 times a day, at 2-3 years old - 10 times, at preschool age 6-7 times. The specific gravity of urine after birth is relatively high, in infants it decreases, and rises again with age. Urine in children is acidic, rich in sulfate compounds.

The concept of “age period” includes that period of time within which the process of growth and development, as well as the physiological characteristics of the organism, are identical, and reactions to stimuli are more or less unambiguous. The age period is the time required to complete a certain stage of the morphofunctional development of the body and achieve the child's readiness for a particular activity.
There are 3 periods: preparatory, the period of intrauterine development and postnatal development or "childhood" itself. The most common classification is N.P. Gundobin (1905). Below it is given in a somewhat modified form (A.V. Mazurin, I.M. Vorontsov, 1999).
Preparation period
? The period of formation of heredity.
? Formation of somatic and reproductive health bio
logical parents.

pre-conception period.
intrauterine period.

Phase of embryonic development (up to 3 months).
? Phase of placental development (from 3 months to birth).
extrauterine period.
? Neonatal period™ (up to 4 weeks).
? The period of infancy (from 4 weeks to 12 months).
? Pre-preschool (senior nursery) period (from 1 year to
3 years).
? Preschool period (from 3 to 6 years).
? Junior school period (from 7 to 11 years).
? Senior school period (from 12 to 17-18 lay down).

PREPARATORY STAGE

The preparatory stage includes the entire history of the accumulation of the gene pool, the period of formation of the hereditary set of genes, parental gametes, somatic health in biological parents, and the pre-conception period - the closest to the onset of pregnancy. For primary prevention, this period is extremely important, since the identification and adoption of measures to prevent genetic and infectious risks for the unborn fetus and newborn is a huge opportunity for active management of his health. This period can be 2-4 months before conception, depending on the health of the future parents. At this time, it is possible to correct chronic infectious diseases, primarily the urinary and reproductive systems, normalize the diet of women and men, increase the level of knowledge on medical genetic and psychological support during pregnancy.

INTRAUTERINE PERIOD

The intrauterine period is characterized by organogenesis, intensive and differentiated growth of various body systems. This period lasts from the moment of conception to the birth of a child (an average of 270 days), but in practice, the calculation is based on a period of 280 days, starting from the first day of the woman's last menstrual cycle. Term births are considered births occurring at 37-41 weeks of gestation, premature - before 37 weeks, late - with a period of more than 42 weeks.
There are several periods of intrauterine development.
Terminal or embryonic period. It starts from the moment
and fertilization of the egg before implantation of blastocytes into the mucus
thuyu membrane of the uterus (1 week).
The implantation period lasts about 4 hours. In the embryonic period and in
the period of implantation, the importance of teratogenic factors is high, which
can cause pathology incompatible with life (aplasia, hypoplasia
zia) or the formation of mutant genes.
The embryonic period lasts 5-6 weeks and is characterized by
laying and organogenesis of almost all organs of the unborn child, poet
the impact of teratogenic factors (exogenous and endogenous)
causes embryopathies - the most gross malformations. For odds
the timing of the impact of therapy is important
homogeneous factors on the developing organs and systems of the fetus. Age
fetus from 3 to 7 weeks is considered to be critical period development. IN
Currently, teratogenic factors can be divided into 3 groups.

Exogenous (infectious, viral, toxic, nutritional)
but scarce and their combinations): ionizing radiation, not
which are viral infections (to a lesser extent
, enterovirus infection, viral hepatitis, cytomega-
liya, herpes infection and other viruses), medicinal
drugs (cytostatics, steroids, salicylates in large doses)
zah and others), industrial and agricultural poisons
substances containing mercury, lead, cadmium and other metals
thallus, household poisons (pesticides, herbicides), deficiency
nutrients in the diet of a pregnant woman (lack of
accuracy of folic acid, zinc, copper and other elements),
unbalanced diet.
? Endogenous (genetic): mutant genes that cause
developmental defects with a dominant or recessive type of heredity
cases, for example, familial cases with split upper gu
would, polysyndrome, as well as chromosomal aberrations (the number
vyye and structural).
? A combination of exogenous and endogenous factors. Combined those
ratogenic factors are made up of the above
2 groups.

The neofetal or embryofetal period lasts 2 weeks,
when the placenta is formed, which coincides in time with the end
formation of most internal organs, except for the central nervous system and endocrine
root system. Thus, the embryonic stage of development
should be 9 weeks.
The fetal period lasts from 9 weeks to the birth of the child and his
divided into 2 sub-periods.

The early fetal subperiod (9-28 weeks) is characterized by
intensive growth and tissue differentiation of the organs of the
Yes. The impact of unfavorable factors can lead to
growth retardation and differentiation of organs and tissues. Aggregate
the rate of changes in the organs and tissues of the fetus in this period is called
yut the general term "early fetopathy".
? The late fetal subperiod begins after 28 weeks of gestation.
changes and lasts until the onset of labor, i.e. until departure
amniotic fluid. The impact of teratogenic factors in this
period can cause premature termination of pregnancy
with the birth of a low-weight and functionally immature re
bank.
The late fetal sub-period passes into the intranatal period.
od, lasting from the time of the onset of regular labor

until the ligation of the umbilical cord (from 2 hours to 15-18 hours). During this period, there is a risk of injuries to the central nervous system, peripheral nervous system, disorders of the umbilical circulation, and respiratory disorders. After the umbilical cord is tied, the extrauterine stage or childhood itself begins.

EXTRAUTERINE PERIOD

The postnatal stage, or childhood itself, is characterized by intensive growth, differentiation and improvement of the functions of individual organs and systems of the body as a whole, their integration and interdependence of the functional state in relation to the complicating role of the child in the family and society. The postnatal stage is divided into the following periods.

EARLY NEONATAL PERIOD

The early neonatal period lasts from the moment of ligation of the umbilical cord until the end of 7 days. The most significant physiological changes during the transition from intrauterine life to extrauterine life are considered to be the onset of pulmonary respiration and the functioning of the pulmonary circulation with the blockage of intrauterine hemodynamic pathways (ductus arteriosus and foramen ovale) and an increase in blood flow in the vessels of the lungs and brain, as well as a change in energy metabolism and thermoregulation. From this moment, enteral nutrition of the child begins. Conditions that reflect the child's adaptation to new conditions include physiological catarrh of the skin, physiological jaundice, physiological weight loss, uric acid infarction, sexual crisis, physiological dysbacteriosis, transient intestinal catarrh.
At the birth of a full-term baby, the average body weight for boys is 3500 g, for girls 3350 g. The permissible normal body weight varies from 2700 g to 4000 g. If the body weight at birth exceeds 4000 g, the child is considered large. Body length ranges from 46-56 cm (average 50 cm). The head circumference of a child at birth is 34–36 cm, the chest circumference is 32–34 cm. the jaw is relatively small, the cheeks are thick due to the large fat layer, the chest is rounded, the abdomen is relatively protruding, and the neck, arms and legs are relatively short compared to the length of the whole body. The pelvic bones are poorly developed. The thickness of the fat layer in the shoulder area

averages 4-5 mm. The midpoint along the length of the body of a newborn is located approximately at the level of the navel (in adults, in the area of the pubic joint). The frequency of respiratory movements varies from 40 to 50 per minute, - 120-160 per minute.
In the early neonatal period, various developmental anomalies, fetopathy, hereditary diseases, as well as diseases caused by antigenic incompatibility of the mother and fetus (according to the Rh factor or the ABO system and others), manifestations of birth trauma suffered during childbirth, intrauterine infection or infection in childbirth, aspiration.
In the first days of a child's life, purulent-septic diseases, pyoderma, and some severe bacterial and viral lesions of the intestines and respiratory tract often occur. The ease of infection is caused by the lack of secretory immunoglobulin A in newborns, a low content of class M. The development of the so-called respiratory distress syndrome, due to the immaturity of the lung tissue, is of great importance. In the first days of life, the newborn adapts to lactotrophic nutrition, and the mother intensively develops lactation.
In medical practice, such periods as late fetal, intranatal and early neonatal are usually combined under the general name of the perinatal period (from the 28th week of intrauterine development to the 7th day of life). The number of children dying in the perinatal period is actually equal to the number of deaths during the first 40 years of life.

LATE NEONATAL PERIOD

The late neonatal period covers a period of 21 days (8-28 days of life).
The most important characteristics of this stage are the intensive development of analyzers, primarily visual, the beginning of the development of coordination of movements, the formation of conditioned reflexes, the emergence of emotional, visual and tactile contact with the mother. Around the age of 3 weeks, many babies begin to respond to communication with a smile and facial expressions of joy. This first emotional joyful contact is considered by many to be the beginning of the actual mental life of the child.
During this period, various unfavorable moments can easily cause deviations in development, which, first of all, is manifested by a delay in the increase in body weight. Many diseases and conditions associated with

those associated with pathology of the intrauterine, intranatal and early neonatal periods (sluggish intrauterine and acquired infections, umbilical, injuries of the central and peripheral nervous system and other diseases) are also diagnosed during this period. Most important criterion the well-being of the child is an assessment of the dynamics of body weight, neuropsychic development and sleep status.

BREAST AGE

After the neonatal period, infancy begins, which lasts from the 29th day of life to 1 year. During this period, there is a very intense physical, neuropsychic, motor and intellectual development child.
Height healthy child increases during the first year by 25 cm:
in the I quarter - by 3 cm per month, in the II quarter - by 2.5 cm per month, in
III quarter - by 2 cm per month, in the IV quarter - by 1-1.5 cm per month. IN
the average height of a child at the age of 6 months is 66 cm, at 1 year old - 75 cm.
Most full-term babies weigh 8 kg at 6 months.
age 1 year - 10.5 kg. Monthly in the first half of the body weight
the child increases by 800 g, in the 2nd half of the year - by 400 g.
Head circumference at 6 months is 43 cm, at 1 year - 46 cm.
monthly in the first half of the head circumference increases by
1.5 cm, in the 2nd half of the year - by 0.5 cm monthly. Big fontanel
usually by the age of 6 months decreases and completely closes in
grow at 9-18 months, and the small fontanelle mostly closes at 4 months.
The circumference of the chest in a child at 6 months is 45 cm, at 1 year -
48 cm. In the first half of the year, the circumference of the chest increases
by 2 cm per month, and in the 2nd half of the year - by 0.5 cm per month.
Milk teeth in most children appear by 6 months of age.
The lower central incisors erupt first, then the upper ones.
central and superior lateral. Subsequently erupt
lower lateral incisors, first and second molars. At the age of 1 year
most children have 6-8 teeth.
Motor functions are dramatically improved: from full motion
helplessness of the newborn to independent walking
and manipulation with toys by one year of age.
As a result of constant contact of an infant with adults
in the form of verbal communication, its neuropsychic development occurs
tie.
High growth rates of infants occur due to intensive metabolism with a predominance of anabolic processes.

The energy requirement of children of this age is 3 times higher than that of an adult. To meet this need, the child needs much more food per 1 kg of body weight compared with an adult. At the same time, functionally, the digestive organs are not yet mature enough, which often leads to gastrointestinal diseases in infants.
An infant at the age of 2-3 months loses the passive, transmitted to it transplacentally from the mother, and the formation of its own immune system occurs relatively slowly, as a result of which the incidence of infants is quite high. Anatomical and physiological features of the respiratory organs (narrowness of the airways, immaturity of the acini and other features) in infants predispose to the occurrence of pneumonia, the course of which is particularly severe. In infancy, preventive vaccinations are intensively carried out.

PRESCHOOL PERIOD

The pre-preschool (older nursery) period is characterized by a slight decrease in the rate of physical development of children, a greater degree of maturity of the basic physiological systems. During the 2nd year of life, growth increases by 12-13 cm, during the 3rd year - by 7-8 cm, and then there is some stabilization of growth with an average increase of 5-6 cm per year. Body weight per year, on average, will increase by about 2 kg. In a child of this age, the subcutaneous fat layer is somewhat reduced. Most children begin to lose weight. A child aged 2-3 years is characterized by a slight lordosis and a protruding belly. The circumference of the head increases annually by 1 cm, and the circumference of the chest - by 1.5 cm.
During the 2nd year of life, 8 additional teeth erupt, and their total number reaches 14-16, including the first non-permanent molars and canines. The order of teeth eruption can vary, but canines usually appear after the first molars. By the end of the 2nd year, the eruption of 20 milk teeth is completed.
Muscle mass during this period increases intensively. A typical morphological type (“the type of a small child”) arises with characteristic body proportions, a round cylindrical body and limbs, rounded outlines of the face and its shallow relief.

PRESCHOOL PERIOD

Preschool age (age from 3 to 7 years) - the period when the majority of children attend kindergarten. This stage is characterized by the first physiological acceleration of growth, the increase in body weight slows down somewhat, the length of the limbs clearly increases, and the relief of the face deepens. Milk teeth gradually fall out, and permanent teeth begin to grow.
The first acceleration of growth is observed in boys from 4 to 5.5 years, and in
girls after 6 years. Body length increases due to relative
lower limb enlargement. At the age of 3-5 years, body weight is
gradually increases by about 2 kg per year.
The annual increase in head circumference up to 5 years is 1 cm
(at 5 years, the head circumference is 50 cm), and after 5 years - 0.6 cm.
The circumference of the chest increases by 1.5 cm annually (at 10 years old, this
the indicator is 63 cm).
Since the muscles are not yet sufficiently developed, incorrect body position, long standing, sitting, furniture that impedes growth can adversely affect the formation of the skeleton and lead to poor posture. in the preschool period reaches a certain maturity.

JUNIOR SCHOOL AGE

At primary school age (age 7-11 years), milk teeth are replaced by permanent ones, there is a clear difference in physical development by sex.
During this period, the growth rate in children gradually decreases, reaching a minimum in boys at 9.5 years, and in girls at 8.5 years. After that, the boys observe a period of moderate uniform growth until the age of 13. In girls, the period of growth stabilization is very short: from the age of 9, growth begins to accelerate, reaching a maximum at the age of 10-11.5 years.
The average increase in body weight at this time is about 3-3.5 kg per year. Head circumference increases slowly: 0.6 cm per year (from 51 to 54 cm over the period from 5 to 12 years). The annual increase in chest circumference up to 10 years is 1.5 cm (at 10 years the chest circumference is 63 cm), and after 10 years - 3 cm. Skeletal muscles develop, the skeletal system continues to improve, the child's diet becomes like in adults. The formation of the bones of the facial skull continues actively, the paranasal sinuses are especially enlarged. The first permanent teeth (first molars) often erupt at the age of 7 years in place of the milk molars, from which

baby teeth begin to fall out in the order in which they appeared. The change of teeth occurs with an intensity of about 4 teeth per year for 5 years.
There are differences between boys and girls both in terms of growth and maturation, and in the formation of a sex-specific physique. Complex coordination movements of small muscles develop rapidly, so that the child can learn to write. Education at school disciplines children, stimulates their independence and strong-willed qualities, expands the range of interests. At the same time, the child now spends much less time in the air, the diet is often disturbed, the load on nervous system and psyche. At this age, changes in vision, posture disorders, and dental caries occur. The frequency of infectious diseases, as well as gastrointestinal, cardiac and allergic diseases in children remains high. The number of children with overnutrition (obesity and obesity) is significantly increasing. Injuries are the main cause of death in children during this period.