Anatomy of the digestive system in children. Age features of the digestive system in children and adolescents

Importance of digestion.

Metabolism is a complex complex of various interdependent and interdependent processes that occur in the body from the moment these substances enter it and until the moment they are released. Metabolism is a necessary condition for life. It is one of its mandatory manifestations. For the normal functioning of the body, it is necessary to supply organic food material, mineral salts, water and oxygen from the external environment. For a period equal to the average life expectancy of a person, he consumes 1.3 tons of fat, 2.5 tons of proteins, 12.5 tons of carbohydrates and 75 tons of water. Metabolism consists of the processes of substances entering the body, their changes in the digestive tract, absorption, transformations inside cells and excretion of their decay products. The processes associated with the transformation of substances inside cells are called intracellular or intermediate metabolism. As a result of intracellular metabolism, hormones, enzymes and a wide variety of compounds are synthesized, which are used as a structural material for building cells and intercellular substance, which ensures the renewal and growth of a developing organism. The processes that result in the formation of living matter are called anabolism or assimilation. The other side of the metabolism is that the substances that form the living structure undergo splitting. This process of destruction of living matter is called catabolism or dissimilation. The processes of assimilation and dissimilation are very closely related, although they are opposite in their final results. Thus, it is known that the breakdown products of various substances contribute to their enhanced synthesis. Oxidation of cleavage products serves as a source of energy that the body constantly spends even in a state of complete rest. In this case, the same substances that are used for the synthesis of larger molecules can undergo oxidation. For example, in the liver, glycogen is synthesized from a part of the breakdown products of carbohydrates, and the energy for this synthesis is provided by another part of them, which is included in metabolic or metabolic processes. The processes of assimilation and dissimilation occur with the obligatory participation of enzymes.

The role of vitamins in nutrition

Vitamins were discovered at the turn of the 19th and 20th centuries as a result of studies of the role of various nutrients in the life of the body. The founder of vitaminology can be considered the Russian scientist N.I. Lunin, who in 1880 was the first to prove that in addition to proteins, fats, carbohydrates, water and minerals, some other substances are needed, without which the body cannot exist. These substances were called vitamins (vita + amin - "amines of life" from Latin), since the first vitamins isolated in their pure form contained an amino group in their composition. And although later it turned out that not all vitamin substances contain an amino group and nitrogen in general, the term "vitamin" has taken root in science.

According to the classical definition, vitamins are low molecular weight organic substances necessary for normal life that are not synthesized by an organism of a given species or are synthesized in an amount insufficient to ensure the life of the organism.

Vitamins are necessary for the normal course of almost all biochemical processes in our body. They provide the functions of the endocrine glands, that is, the production of hormones, increase mental and physical performance, support the body's resistance to the effects of adverse environmental factors (heat, cold, infections, and many others).

All vitamin substances are conditionally divided into vitamins proper and vitamin-like compounds, which are similar in their biological properties to vitamins, but are usually required in larger quantities. In addition, deficiency of vitamin-like substances is extremely rare, since their content in everyday food is such that even in the case of a very unbalanced diet, a person receives almost all of them in sufficient quantities.

According to their physical and chemical properties, vitamins are divided into two groups: fat-soluble and water-soluble. Each of the vitamins has a letter designation and a chemical name. In total, 12 true vitamins and 11 vitamin-like compounds are currently known.

At present, vitamins can be characterized as low-molecular organic compounds, which, being a necessary component of food, are present in it in extremely small quantities compared to its main components.

Vitamins are a necessary element of food for humans and a number of living organisms because they are not synthesized or some of them are synthesized in insufficient quantities by this organism. Vitamins are substances that ensure the normal course of biochemical and physiological processes in the body. They can be attributed to the group of biologically active compounds that have an effect on the metabolism in negligible concentrations.

Diseases of the gastrointestinal tract in children

Recently, there has been a significant increase in the number of diseases of the digestive system in children. Many factors contribute to this:

1. bad ecology,

2. unbalanced diet,

3. heredity.

Sweets and confectionery products with a high content of preservatives and artificial colors, fast food, carbonated drinks, so beloved by many, cause great harm to the child's body. The role of allergic reactions, neuropsychic factors, and neuroses is growing. Doctors note that intestinal diseases in children have two age peaks: at 5-6 years and at 9-11 years. The main pathological conditions are:

Constipation, diarrhea

Chronic and acute gastritis and gastroenteritis

Chronic duodenitis

Chronic enterocolitis

Peptic ulcer of the stomach and duodenum

· Chronic cholecystitis

· Chronic pancreatitis

Diseases of the biliary tract

Chronic and acute hepatitis

Of great importance in the occurrence and development of gastrointestinal diseases is the insufficient ability of the child's body to resist infections, since the child's immunity is still weak. The formation of immunity is greatly influenced by proper feeding in the first months of life.

The best option is breast milk, with which protective bodies are passed from mother to child, increasing the ability to resist various infections. Formula-fed babies are more susceptible to various diseases and have a weakened immune system. The cause of violations in the digestive system can be irregular feeding or overfeeding of the child, early introduction of complementary foods, non-compliance with hygiene standards.

A separate group consists of acute intestinal diseases in children (dysentery, salmonellosis). Their main clinical manifestations are dyspeptic disorders, dehydration (dehydration) of the body and symptoms of intoxication. Such manifestations are very dangerous and require immediate hospitalization of a sick child.

Intestinal infections are especially often diagnosed in childhood, this is due to the imperfection of protective mechanisms, the physiological characteristics of the digestive organs and the lack of sanitary and hygienic skills in children. Especially negative acute intestinal infections affect young children and can lead to a significant decrease in immunity, delayed physical development, and complications.

Their onset is accompanied by characteristic signs: a sharp increase in temperature, abdominal pain, diarrhea, vomiting, loss of appetite. The child becomes restless, or, on the contrary, lethargic and inhibited. The clinical picture largely depends on which parts of the intestine are affected. In any case, the child needs emergency medical care and antibiotic therapy.

The treatment of diseases of the digestive system in babies is handled by a pediatric gastroenterologist, it is he who should be contacted when unfavorable symptoms appear.

Age features of the digestive system in children and adolescents.

The most significant morphological and functional differences between the digestive organs of an adult and a child are observed only in the first years of postnatal development. The functional activity of the salivary glands is manifested with the appearance of milk teeth (from 5-6 months). A particularly significant increase in salivation occurs at the end of the first year of life. During the first two years, the formation of milk teeth is intensively going on. At the age of 2-2.5 years, the child already has 20 teeth and can eat relatively coarse food that requires chewing. In subsequent years, starting from the age of 5-6, milk teeth are gradually replaced by permanent ones. In the first years of postnatal development, the formation of other digestive organs is intensively going on: the esophagus, stomach, small and large intestines, liver and pancreas. Their size, shape and functional activity change. Thus, the volume of the stomach from birth to 1 year increases 10 times. The shape of the stomach in a newborn is round, after 1.5 years the stomach becomes pear-shaped, and from 6-7 years old its shape is no different from the stomach of adults. The structure of the muscular layer and the mucous membrane of the stomach changes significantly. In young children, there is a weak development of muscles and elastic elements of the stomach. The gastric glands in the first years of a child's life are still underdeveloped and few in number, although they are able to secrete gastric juice, in which the content of hydrochloric acid, the number and functional activity of enzymes are much lower than in an adult. So, the number of enzymes that break down proteins increases from 1.5 to 3 years, then at 5-6 years and at school age up to 12-14 years. The content of hydrochloric acid increases up to 15-16 years. A low concentration of hydrochloric acid causes weak bactericidal properties of gastric juice in children under 6-7 years of age, which contributes to an easier susceptibility of children of this age to gastrointestinal infections. In the process of development of children and adolescents, the activity of the enzymes contained in it also changes significantly. The activity of the enzyme chymosin, which acts on milk proteins, changes especially significantly in the first year of life. In a child of 1-2 months, its activity in conventional units is 16-32, and in 1 year it can reach 500 units, in adults this enzyme completely loses its significance in digestion. With age, the activity of other enzymes of gastric juice also increases, and at senior school age it reaches the level of an adult organism. It should be noted that in children under 10 years of age, absorption processes are actively going on in the stomach, while in adults these processes are carried out mainly only in the small intestine. The pancreas develops most intensively up to 1 year and at 5-6 years. According to its morphological and functional parameters, it reaches the level of an adult organism by the end of adolescence (at the age of 11-13, its morphological development is completed, and at 15-16 years - functional). Similar rates of morphofunctional development are observed in the liver and all parts of the intestine. Thus, the development of the digestive organs goes in parallel with the general physical development of children and adolescents. The most intensive growth and functional development of the digestive organs is observed in the 1st year of postnatal life, in preschool age and in adolescence, when the digestive organs in their morphological and functional properties approach the level of an adult organism. In addition, in the course of life, children and adolescents easily develop conditioned food reflexes, in particular, reflexes at the time of eating. In this regard, it is important to accustom children to strict adherence to the diet. Important for normal digestion is the observance of "food aesthetics".

43. Age features of the structure of the digestive organs in children.

The development of the digestive organs in children occurs in parallel with the development of the whole organism. And this development is divided into periods of the first year of life, preschool age and adolescence. At this time, the work of the digestive organs is controlled by the nervous system and depends on the state of the cerebral cortex. In the process of the formation of the digestive system in children, reflexes are easily developed for the time of eating, its composition and quantity. The esophagus in young children has the shape of a spindle. It is short and narrow. In children in the year of life, its length is 12 cm. There are no glands on the mucosa of the esophagus. Its walls are thin, but it is well supplied with blood. The stomach in young children is located horizontally. And as the child develops, he takes a vertical position. By the age of 7-10, the stomach is already positioned as in adults. The gastric mucosa is thick, and the barrier activity of gastric juice is low compared to adults. The main enzyme of gastric juice is rennet. It provides curdling of milk. The pancreas of a young child is small. In a newborn, it is 5-6 centimeters. In 10 years, it will triple in size. This organ is well supplied with blood vessels. The pancreas produces pancreatic juice. The largest organ of the digestive system of a young child, occupying a third of the abdominal cavity, is the liver. At 11 months, its mass doubles, by 2-3 years it triples. The capabilities of the liver of a child at this age are low. The gallbladder at an early age reaches a size of 3 centimeters. It acquires a pear-shaped form by 7 months. Already at 2 years old, the child's gallbladder reaches the edge of the liver. For children up to a year, substances that come with mother's milk are of great importance. With the introduction of complementary foods to the child, the mechanisms of the child's enzyme systems are activated.

Importance of digestion.

The body needs a regular supply of food. Food contains nutrients: proteins, carbohydrates and fats. In addition, the composition of food includes water, mineral salts and vitamins. Nutrients are necessary for building the living matter of body tissues and serve as a source of energy, due to which all vital processes are performed (muscle contractions, heart function, nervous activity, etc.). In short, nutrients are plastic and energy material for the body. Water, mineral salts and vitamins are not nutrients and a source of energy, but are part of cells and tissues and participate in various life processes. Proteins, carbohydrates and fats in food are complex organic substances and are not absorbed by the body in this form. In the digestive canal, food is subjected to mechanical and chemical influences, as a result of which nutrients are broken down into simpler and more water-soluble substances that are absorbed into the blood or lymph and absorbed by the body. This process of processing food in the alimentary canal is called digestion. Mechanical processing of food consists in its crushing and grinding, which contributes to mixing with digestive juices (food liquefaction) and subsequent chemical processing. Chemical processing - the breakdown of complex substances into simpler ones - occurs under the influence of special substances contained in digestive juices - digestive enzymes. Water, mineral salts and vitamins are not subjected to special treatment in the digestive canal and are absorbed in the form in which they arrive.

44. Neurohumoral regulation of the digestive system.

45. Importance of metabolism and energy.

In the embryonic period, the main thing is the histiotrophic nutrition of the embryo (the secret of the mucous membrane of the uterus, the material of the yolk sac).

From the 2-3rd month of intrauterine development, hemotrophic nutrition begins due to the transplacental transport of nutrients. From the 16-20th week they begin to function, which is the beginning of amniotrophic nutrition.

Depending on the formation of individual enzyme nutrition systems, the fetus begins to enterally receive protein, glucose, water, mineral salts, etc. The rate of differentiation and maturation of the digestive organs increases rapidly, but the relative immaturity of this system still remains until the time of birth. Lactotrophic nutrition is the most important stage in the adaptation of a newborn child; it allows to resolve the contradiction between the very large needs of a rapidly growing organism and the low degree of functional development of the apparatus of distant digestion.

All parts of the digestive system in newborns are adapted to natural feeding with mother's milk. The oral cavity of a child in the 1st year of life is relatively small, the palate is flattened. Fat bodies of the cheeks are well expressed, roller-like thickening on the gums, transverse folds on the mucous membrane of the lips, which are also of great importance for the act of sucking. The mucous membrane of the oral cavity is dryish, rich in blood vessels, and very vulnerable. The secretion of saliva is provided by the submandibular, sublingual, parotid and numerous small glands. In the first 3 months of life, the secretion of saliva is insignificant, however, under its influence, digestion of carbohydrates and coagulation of milk casein already begin in the oral cavity. The esophagus is funnel-shaped, its length is equal to half the length (10 cm); in adolescents it reaches 25 cm. in a newborn child it is round, its capacity is 30-35 ml, at the age of 7-11 years the stomach is similar in shape to the stomach of an adult, its capacity grows to 1020 ml. The motor function of the stomach consists of peristaltic movements and periodic zmikan and openings of the goalkeeper. The acidity and enzymatic activity of the gastric glands is low, but 1/3 of the fat (emulsified by lactic lipase) is hydrolyzed in the stomach under the action of gastric lipase. In the stomach, the protein is partially hydrolyzed mainly due to such proteolytic enzymes as chymosin (renin, labenzyme, rennet), gastrixin; a small amount of salt, water, glucose is absorbed. Histological differentiation of the stomach continues until the end of the 2nd year of life.

The pancreas is the main gland of the digestive tract, its secretion increases especially rapidly after the introduction of complementary foods (complementary foods) and reaches the level of an adult at the age of 5 years. Main pancreatic enzymes: trypsin, chymotrypsin, diastase, amylase, lipase, phospholipase, endocrine insulin.

The liver of a newborn is relatively large, makes up 4-4.4% of body weight, is well vascularized, has insufficiently developed connective tissue and poorly demarcated lobules, functionally immature. The function of glycogen digestion is well manifested and not enough - detoxification. The liver is involved in the processes of digestion, hematopoiesis, blood circulation and metabolism. Bile in the first months of a child's life is formed in a small amount, contains some bile acids (which sometimes leads to steatorrhea in newborns), a lot of water, mucin, pigments; newborns also have a lot of urea. It also contains more taurocholic acid than glycocholic acid, which enhances its bactericidal properties, stimulates pancreatic secretion, and enhances colon peristalsis.

The intestines of an infant are relatively longer, than an adult, they are 6 times the length of her body. The intestinal mucosa is delicate, rich in villi, blood vessels, and cellular elements. Lymph nodes are well developed. The caecum and appendix are movable, the descending colon is longer than the ascending one. The rectum is relatively long, with weakly fixed mucosa and submucosa. The intestines of the child perform digestive, motor and suction functions. Intestinal juice is less active compared to the juice of an adult, it must be slightly acidic or neutral, then alkaline. Contains the enzymes enterokinase, alkaline phosphatase, amylase, lactase, maltase, invertase, and subsequently lipase. hydrolysis products, formed as a result of cavity (distant) and membrane (parietal) digestion, are absorbed by all parts of the small intestine, unlike adults. Of great importance in childhood is intracellular digestion with an easy transition of milk lactoglobulin unchanged into the blood. Water is absorbed in the large intestine, feces are formed, and mucus is secreted. A feature of the intestines in children is a relatively weak but long mesentery, which creates favorable conditions for the development of intussusception.

afo of the gastrointestinal tract in children

The laying of the organization of digestion occurs at an early stage of embryonic development. Already by the 7-8th day from the endoderm → the primary intestine, from which 2 parts are formed on the 12th day: intraembryonic(future digestive tract), extraembryonic(yolk sac).

From the 4th week of embryogenesis, the formation of various departments begins:

from the foregut the pharynx, esophagus, stomach and part of the duodenum with the rudiments of the pancreas and liver develop;

from the midgut a part of the duodenum, jejunum and ileum is formed;

from the back- all parts of the colon develop.

afo

Oral cavity has features that provide the act of sucking:

relatively small volume of the oral cavity;

big tongue;

good development of the muscles of the mouth and cheeks;

roller-like duplicatures of the mucous membrane of the gums;

fat bodies (Besh lumps);

The salivary glands are underdeveloped.

Esophagus formed at birth. The entrance to the esophagus in a newborn is at the level between the III and IV cervical vertebrae, at the age of 12 - at the level of the VI-VII vertebrae. Funnel-shaped. The length of the esophagus increases with age. Anatomical narrowings are weakly expressed.

The transition of the esophagus to the stomach in all periods of childhood at the level of the X-XI thoracic vertebrae.

Stomach in infants is located horizontally. As the child begins to walk, the axis of the stomach becomes vertical.

in newborns, poor development of the fundus and cardiac region

the cardiac sphincter is very poorly developed, and the pyloric one functions satisfactorily  tendency to regurgitation;

there are few glands in the mucosa  the secretory apparatus is underdeveloped and its functional abilities are low;

the composition of gastric juice is the same, but the acid and enzymatic activity is lower;

the main enzyme of gastric juice is chymosin (rennet), which provides curdling of milk;

there is little lipase and its low activity;

the timing of the evacuation of food from the stomach depends on the type of feeding;

motility of the gastrointestinal tract is slowed down, peristalsis is sluggish;

the physiological volume is less than the anatomical capacity and at birth is 7 ml. On the 4th day - 40-50 ml, by the 10th day - up to 80 ml. By the end of 1 year - 250 ml, by 3 years - 400-600 ml. At the age of 4-7 years, the capacity of the stomach increases slowly, by the age of 10-12 it is 1300-1500 ml.

With the onset of enteral nutrition, the number of gastric glands begins to increase rapidly. If a fetus has 150-200 thousand glands per 1 kg of body weight, a 15-year-old has 18 million.

Pancreas pancreas is not completely formed by birth;

at birth, weight  3 g, in an adult 30 times more. Iron grows most intensively in the first 3 years and in the pubertal period.

at an early age, the surface of the gland is smooth, and by the age of 10-12, tuberosity appears, which is due to the isolation of the boundaries of the lobules. In newborns, the head of the pancreas is most developed;

trypsin, chymotrypsin begins to be secreted in utero; from 12 weeks - lipase, phospholipase A; amylase only after birth;

secretive activity of the gland reaches the level of adult secretion by the age of 5;

Liver parenchyma is little differentiated;

dollatity is detected only by 1 year;

by the age of 8, the morphological and histological structure of the liver is the same as in adults;

the enzymatic system is untenable;

by birth, the liver is one of the largest organs (1/3 - 1/2 of the volume of the abdominal cavity, and mass = 4.38% of the total mass); the left lobe is very massive, which is explained by the peculiarities of the blood supply;

the fibrous capsule is thin, there are delicate collagen and elastic fibers;

in children 5-7 years old, the lower edge extends from under the edge of the right costal arch by 2-3 cm;

in the composition of the liver, the newborn has more water, at the same time less protein, fat, glycogen;

there are age-related changes in the microstructure of liver cells:

in children, 1.5% of hepatocytes have 2 nuclei (in adults - 8.3%);

the granular reticulum of the hepatocyte is less developed;

many free-lying ribosomes in the endoplasmic reticulum of the hepatocyte;

glycogen is found in the hepatocyte, the amount of which increases with age.

gallbladder in a newborn, it is hidden by the liver, has a spindle shape  3 cm. Bile differs in composition: poor in cholesterol; bile acids, the content of bile acids in hepatic bile in children aged 4-10 years is less than in children of the first year of life. At the age of 20, their content again reaches the previous level; salts; rich in water, mucin, pigments. With age, the ratio of glycocholic and taurocholic acids changes: an increase in the concentration of taurocholic acid increases the bactericidal activity of bile. Bile acids in the hepatocyte are synthesized from cholesterol.

Intestines relatively longer in relation to body length (newborn 8.3:1; adult 5.4:1). In young children, in addition, intestinal loops lie more compactly, because. the pelvis is not developed.

in young children, there is a relative weakness of the ileocecal valve, and therefore the contents of the caecum, the richest in bacterial flora, can be thrown into the ileum;

due to weak fixation of the rectal mucosa in children, its prolapse can often occur;

mesentery longer and more easily distensible easy = torsion, intussusception;

omentum short  diffuse peritonitis;

structural features of the intestinal wall and its large area determine a higher absorption capacity and, at the same time, an insufficient barrier function due to the high permeability of the mucosa for toxins and microbes;

In children of all ages, the maltase activity of the small intestine mucosa is high, while its sucrase activity is much lower. The lactase activity of the mucosa, noted in the first year of life, gradually decreases with age, remaining at a minimum level in an adult. Disaccharidase activity in older children is most pronounced in the proximal small intestine, where monosaccharides are mainly absorbed.

In children older than 1 year, as in adults, protein hydrolysis products are absorbed mainly in the jejunum. Fats begin to be absorbed in the proximal ileum.

Vitamins and minerals are absorbed in the small intestine. Its proximal sections are the main site of nutrient absorption. The ileum is the reserve zone of absorption.

The length of the large intestine in children of different ages is equal to the length of the body of the child. By the age of 3-4, the structure of the sections of the large intestine of a child becomes similar to the anatomy of the corresponding sections of the adult intestine.

Juice secretion by the glands of the large intestine in children is weakly expressed, but it increases sharply with mechanical irritation of the mucosa.

motor activity is very energetic (increase in the act of defecation).

By birth all enzymes membrane digestion, have high activity, the topography of enzymatic activity throughout the small intestine or distal shift, which reduces the reserve capacity of membrane digestion. In the same time intracellular digestion, carried out by pinocytosis in children of the 1st year of life, is much better expressed.

Transient dysbacteriosis passes on its own from the 4th day

in 60-70% - pathogenetic staphylococcus aureus

30-50% - enterobacterial, Candida

10-15% - proteus

Excreta:

Meconium (intestinal contents, I. Aseptic phase (sterile).

accumulated before childbirth and up to II. The phase of colonization by flora (dysbacteria-

first application to the breast; oz coincides with toxic erytherma).

consists of intestinal III cells. The phase of displacement of the bifidobacter flora

epithelium, amniotic fluid). terium.

Transitional stool (after 3rd day)

Newborn stool (from the 5th day

birth).

Features of digestion in children

By birth, the salivary glands are formed, but the secretory function is low for 2-3 months. -amylase of saliva is low. By 4-5 months there is profuse salivation.

By the end of the 1st year, hydrochloric acid appears in the gastric juice. Among the proteolytic enzymes, the action of renin (chymosin) and gastrixin predominates. Relatively high activity of gastric lipase.

At birth, the endocrine function of the pancreas is immature. Pancreatic secretion increases rapidly after the introduction of complementary foods (with artificial feeding, the functional maturation of the gland is ahead of that with natural feeding). Particularly low amylolytic activity.

Liver relatively large at birth, but functionally immature. The excretion of bile acids is small, at the same time, the liver of a child of the first months of life has a greater “glycogenic capacity”.

Intestines in newborns, as it were, it compensates for the insufficiency of those organs that provide distant digestion. Of particular importance is membrane digestion, whose enzymes are highly active, the topography of enzymatic activity throughout the small intestine in newborns has a distal shift, which reduces the reserve capacity of membrane digestion. In the same time intracellular digestion, carried out by pinocytosis, in children of the 1st year is expressed much better than at an older age.

During the 1st year of life there is a rapid development distant digestion which is increasing in importance every year.

Disaccharides (sucrose, maltose, isomaltose) are subjected, like lactose, to hydrolysis in the small intestine by the corresponding disaccharidases.

FUNCTIONAL DISORDERS

GASTROINTESTINAL TRACT IN CHILDREN

OMSK - 2010

The textbook "Functional disorders of the gastrointestinal tract in children", intended for students of the pediatric faculty, is published by decision of the Central Medical Committee of the Omsk State Medical Academy and the educational and methodological association for medical and pharmaceutical education of Russian universities.

Reviewers: Doctor of Medical Sciences, Professor Yu.G. MUKHINA

MD M.A. LIVZAN

Potrokhova E.A., Sobotyuk N.V. Functional disorders of the gastrointestinal tract in children: a textbook / E.A. Potrokhova, N.V. Sobotyuk // Omsk, 2009 - 105 p.

The manual outlines modern ideas about functional disorders of the gastrointestinal tract in children. Classifications are given, clinical and diagnostic issues are highlighted, the main groups of drugs used in the treatment of this pathology are presented.

1. INTRODUCTION…………………………………………………………………….4

2. ANATOMICAL AND PHYSIOLOGICAL FEATURES OF THE GASTROINTESTINAL TRACT IN CHILDREN…………………5

3. FUNCTIONAL DISORDERS OF THE GASTROINTESTINAL TRACT IN CHILDREN…………………………………….. 11

3.1 Background……………………………………………….…11

3.2 Epidemiology…………………………………………………...12

3.3 Etiology and pathogenesis……………………………………….….13

3.4 Classification……………………………………….………….19

3.5 Diagnosis…………………………………………………………21

3.6 Treatment………………………………………………………………28

3.6.1 Correction of neuropsychiatric disorders………………………………………………………28

3.6.2 Diet therapy………………………………..…………32

3.6.3 Drug therapy…………………………...37

4. PRIVATE PATHOLOGY…………………………………………………………………………65

4.1. Infantile regurgitation………………………………..…65

4.2 Rumination syndrome……………………………………….66

4.3 Syndrome of cyclic vomiting………………………………..…67

4.4 Infant colic…………………………………………...70

4.5 Functional diarrhea………………………………………..72

4.6 Infantile difficulty defecation (dyschezia)…………75

4.7 Functional constipation……………………………………………75

4.8 Aerophagia……………………………………………………………78

4.9 Functional dyspepsia……………………………………79

4.10 Irritable bowel syndrome………………………...83

4.11 Abdominal migraine…………………………………………87

4.12 Functional abdominal pain……………………...88

4.13 Functional fecal incontinence…………………………..91

5. DISPENSARY SUPERVISION FOR CHILDREN WITH FUNCTIONAL DISORDERS OF THE GASTROINTESTINAL TRACT……………………………………………….………………………………………………………………………………………………………………….…95

6. TESTS…………………………………………………...97

7. SITUATIONAL TASKS……………………………….…………98

8. REFERENCES……………………………………………….103

INTRODUCTION

In recent years, in general, there has been an increase in the number of diseases of the gastrointestinal tract: in 1999, diseases of the digestive system in children amounted to 450 cases per 10,000 children, and in 2003 - 525, in adolescents, respectively - 402 and 412. the most common diseases of childhood, ranking second in frequency. When studying the structure of morbidity, it is noted that the first place is occupied by functional disorders of the gastrointestinal tract.

The problem of functional diseases of the gastrointestinal tract is becoming increasingly important, due to the widespread prevalence of this pathology and the numerous problems associated with it. Every second inhabitant of our planet has such disorders as functional dyspepsia, biliary tract dysfunction, irritable bowel syndrome, which significantly worsen the quality of life, limit social and labor activity. Worldwide, hundreds of millions of dollars are annually spent on the diagnosis and treatment of functional disorders of the gastrointestinal tract. At the same time, many doctors still treat this pathology as insignificant and not requiring treatment.

Diagnosis of functional disorders often causes significant difficulties for practitioners, leading to a large number of unnecessary examinations, and most importantly, to irrational therapy. In this case, one often has to deal not so much with ignorance of the problem as with its misunderstanding. In terms of terminology, it is necessary to differentiate between functional disorders and dysfunctions, two consonant, but somewhat different concepts that are closely related to each other. Violation of the function of one or another organ can be associated with any reason, including its organic damage. Functional disorders, in this light, can be considered as a special case of an organ dysfunction that is not associated with its organic damage.

Deepening the doctor's knowledge on the problem of functional pathology of the gastrointestinal tract in childhood and adolescence, timely and high-quality preventive and dispensary observation, treatment using modern schemes, shifting the focus of helping gastroenterological patients to outpatient services is one of the conditions for the prevention of organic diseases of the gastrointestinal tract. -intestinal tract in subsequent age periods.

ANATOMICAL AND PHYSIOLOGICAL FEATURES OF THE GASTROINTESTINAL TRACT IN CHILDREN

The formation of the digestive organs begins from the 3-4th week of the embryonic period, when the primary intestine is formed from the endodermal plate. At the front end of it, a mouth opening appears on the 4th week, and a little later, an anus appears at the opposite end. The intestine quickly lengthens, and from the 5th week of the embryonic period, the intestinal tube is delimited into two sections, which are the basis for the formation of the small and large intestines. During this period, the stomach begins to stand out - as an extension of the primary intestine. At the same time, the mucous, muscular and serous membranes of the gastrointestinal tract are being formed, in which blood and lymphatic vessels, nerve plexuses, and endocrine cells are formed.

The embryo before implantation in the uterine wall is fed by reserves in the cytoplasm of the egg. The embryo feeds on the secrets of the uterine mucosa and the material of the yolk sac (histotrophic type of nutrition). Since the formation of the placenta, hemotrophic (transplacental) nutrition, provided by the transport of nutrients from the mother's blood to the fetus through the placenta, is of primary importance. It plays a leading role until the birth of a child.

In the first weeks of pregnancy, the endocrine apparatus of the gastrointestinal tract is laid in the fetus and the production of regulatory peptides begins. In the process of intrauterine development, the number of endocrine cells increases, the content of regulatory peptides in them increases (gastrin, secretin, motilin, gastric inhibitory peptide, vasoactive intestinal peptide, enteroglucagon, somatostatin, neurotensin, etc.). At the same time, the reactivity of target organs with respect to regulatory peptides increases. In the prenatal period, peripheral and central mechanisms of nervous regulation of the activity of the gastrointestinal tract are laid.

In the fetus, the gastrointestinal tract begins to function already at the 16-20th week of intrauterine life. By this time, the swallowing reflex is expressed, amylase is found in the salivary glands, pepsinogen in the stomach, and secretin in the small intestine. A normal fetus swallows a large amount of amniotic fluid, the individual components of which are hydrolyzed in the intestine and absorbed. The undigested part of the contents of the stomach and intestines goes to the formation of meconium. From 4-5 months of intrauterine development, the activity of the digestive organs begins and, together with hemotrophic, amniotrophic nutrition occurs. The daily amount of liquid absorbed by the fetus in the last months of pregnancy can reach more than 1 liter. The fetus absorbs amniotic fluid containing nutrients (proteins, amino acids, glucose, vitamins, hormones, salts, etc.) and hydrolyzing enzymes. Some enzymes enter the amniotic fluid from the fetus with saliva and urine, the second source is the placenta, the third source is the mother's body (enzymes through the placenta and, bypassing it, can enter the amniotic fluid from the blood of a pregnant woman).

Part of the nutrients are absorbed from the gastrointestinal tract without prior hydrolysis (glucose, amino acids, some dimers, oligomers and even polymers), since the intestinal tube of the fetus has a high permeability, fetal enterocytes are capable of pinocytosis. This is important to consider when organizing the nutrition of a pregnant woman in order to prevent allergic diseases. Some of the nutrients of the amniotic fluid are digested by its own enzymes, that is, the autolytic type of digestion plays an important role in the amniotic nutrition of the fetus. Amniotrophic nutrition of the type of own abdominal digestion can be carried out from the 2nd half of pregnancy, when pepsinogen and lipase are secreted by the cells of the stomach and pancreas of the fetus, although their level is low. Amniotrophic nutrition and the corresponding digestion are important not only for the supply of nutrients to the blood of the fetus, but also as a preparation of the digestive organs for lactotrophic nutrition.

In newborns and children in the first months of life, the oral cavity is relatively small, the tongue is large, the muscles of the mouth and cheeks are well developed, in the thickness of the cheeks there are fatty bodies (Bish's lumps), which are distinguished by considerable elasticity due to the predominance of solid (saturated) fatty acids in them. These features provide full breast sucking. The mucous membrane of the oral cavity is tender, dryish, rich in blood vessels (easily vulnerable). The salivary glands are poorly developed, produce little saliva (submandibular, sublingual glands function to a greater extent in infants, in children after a year and adults - parotid). The salivary glands begin to function actively by the 3-4th month of life, but even at the age of 1 year, the volume of saliva (150 ml) is 1/10 of the amount in an adult. The enzymatic activity of saliva at an early age is 1/3-1/2 of its activity in adults, but it reaches the level of adults within 1-2 years. Although the enzymatic activity of saliva at an early age is low, its action on milk contributes to its curdling in the stomach with the formation of small flakes, which facilitates the hydrolysis of casein. Hypersalivation at 3-4 months of age is due to teething, saliva may flow from the mouth due to the inability of children to swallow it. The reaction of saliva in children of the first year of life is neutral or slightly acidic - this can contribute to the development of thrush of the oral mucosa if it is not properly cared for. At an early age, saliva contains a low content of lysozyme, secretory immunoglobulin A, which determines its low bactericidal activity and the need for proper oral care.

The esophagus in young children has a funnel-shaped form. Its length in newborns is 10 cm, with age it increases, while the diameter of the esophagus becomes larger. The relatively short esophagus contributes to the fact that part of the stomach is located in the chest cavity, and part - in the abdominal cavity. There are 3 physiological constrictions in the esophagus: in the area of ​​​​contact of the esophagus with the posterior wall of the left ventricle (during esophagoscopy, when the endoscope passes through this section, various heart rhythm disturbances can be observed); when passing through the diaphragm; at the level of the tracheal bifurcation. The transition of the esophagus to the stomach in all periods of childhood is located at the level of the X and XI thoracic vertebrae.

The stomach in infants is located horizontally, its fundus and cardia are poorly developed, there is no tight coverage of the esophagus by the legs of the diaphragm, all these features, combined with increased intragastric pressure, explain the tendency of children of the first year of life to regurgitation and vomiting. As the child begins to walk, the axis of the stomach becomes more vertical, and by 7-11 years it is located in the same way as in an adult. The capacity of the stomach in a newborn is 30-35 ml, by the year it increases to 250-300 ml, by the age of 8 it reaches 1000 ml. The secretory apparatus of the stomach in children of the 1st year of life is not sufficiently developed, in the gastric mucosa they have 2.5 times fewer glands per 1 kilogram of body weight compared to adults. Although the composition of gastric juice in children is the same as in adults (hydrochloric acid, lactic acid, pepsin, rennet, lipase), but the acidity and enzymatic activity are lower, which determines the low barrier function of the stomach and pH of gastric juice (pH of gastric juice in the first 6-12 hours - 1.0-2.0 due to lactic acid, then very quickly within a few days rises to 6.0; by the end of the first week - pH 4.0-6.0; by the end of 1 year - pH 3.0-4.0; in adults, pH 1.5-2.2). The high pH of the stomach, on the one hand, preserves the integrity of anti-infective factors, including immunoglobulins, supplied with breast milk, on the other hand, leads to insufficient breakdown of proteins in the stomach by pepsin (the required pH for pepsin activity is 1-1.5), so proteins they are cleaved mainly by cathepsins and gastrixin produced by the gastric mucosa, their optimum action is at pH 4-5. Lipase of the stomach (produced by the pyloric part of the stomach, the optimum activity at pH - 4.0-8.0) breaks down in an acidic environment, together with lipase of human milk, up to half of the fats of human milk. These features must be taken into account when prescribing various types of nutrition to a child. With age, the secretory activity of the stomach increases. Motility of the stomach in children of the first months of life is slowed down, peristalsis is sluggish. The timing of the evacuation of food from the stomach depends on the nature of feeding. Women's milk lingers in the stomach for 2-3 hours, cow's - 3-4 hours, which indicates the difficulties of digesting the latter.

The intestines in children are relatively longer than in adults. Newborns do not have omental processes, the bands of the colon are barely visible, haustra are absent up to 6 months. The caecum is mobile due to the long mesentery, the appendix, therefore, can be located in the right iliac region, shift to the small pelvis and to the left half of the abdomen, which creates difficulties in diagnosing appendicitis in young children. The appendix is ​​shorter (4-5 cm in newborns , in adults 9-12 cm), has a large inlet diameter, is easily drained, so appendicitis rarely develops in young children. The mesentery of the small intestine is longer and more easily distensible, which can lead to torsion, intussusception, and other pathological processes. The weakness of the ileocecal valve also contributes to the occurrence of intussusception in young children. A feature of the intestines in children is the better development of the circular muscles than the longitudinal ones, which predisposes to intestinal spasms and intestinal colic. Weak development of small and large omentums leads to the fact that the infectious process in the abdominal cavity (appendicitis, etc.) is often complicated by the development of diffuse peritonitis. The ascending part of the colon in newborns is short, the descending part is slightly mobile. The sigmoid colon is relatively long, which predisposes to constipation in children, especially if the mother's milk contains an increased amount of fat. The rectum in children in the first months of life is also relatively long, with weak fixation of the mucous and submucosal layers, and therefore, with tenesmus and persistent constipation, the mucous membrane may prolapse through the anus. The ampulla of the rectum is poorly differentiated, fatty tissue is not developed, as a result of which the ampulla is poorly fixed. The anus in children is located more dorsally than in adults at a distance of 20 mm from the coccyx.

Digestion processes are intensively occurring in the intestine, represented by 3 types: extracellular (cavity), membrane (parietal) and intracellular. Extracellular (cavity) digestion is carried out in the intestinal cavity, where enzymes are secreted from large and small food glands; membrane (parietal) digestion is carried out in space by enterocyte enzymes themselves, as well as enzymes of pancreatic origin, absorbed by various layers of the glycocalyx; intracellular digestion is carried out in special vacuoles of the cytoplasm of the epithelium with the help of pinocytosis. In children of the first year of life, there is a low activity of the cavity and a high activity of the membrane and intracellular processes of digestion.

The secretory apparatus of the intestine by the time of the birth of the child is generally formed, the intestinal juice contains the same enzymes as in adults (enterokinase, alkaline phosphatase, lipase, erypsin, amylase, maltase, lactase, nuclease, etc.), but their activity is low. Under the influence of intestinal enzymes, mainly the pancreas, there is a breakdown of proteins, fats and carbohydrates. However, the pH of duodenal juice in young children is slightly acidic or neutral, so the breakdown of protein by trypsin is limited (for trypsin, the optimal pH is alkaline). Especially intense is the process of digestion of fats due to the low activity of lipolytic enzymes. In children who are breastfed, lipids emulsified by bile are cleaved by 50% under the influence of maternal milk lipase. Digestion of carbohydrates occurs in the small intestine under the influence of pancreatic amylase and intestinal juice disaccharidases. The processes of putrefaction in the intestines do not occur in healthy infants. The structural features of the intestinal wall and its large area determine in young children a higher absorption capacity than in adults and, at the same time, an insufficient barrier function due to the high permeability of the mucous membrane for toxins and microbes.

The motor function of the gastrointestinal tract in young children also has a number of features. The peristaltic wave of the esophagus and the mechanical irritation of its lower section with a food lump cause a reflex opening of the entrance to the stomach. Motility of the stomach consists of peristalsis (rhythmic waves of contraction from the cardiac section to the pylorus), peristoles (resistance exerted by the walls of the stomach to the tensile action of food) and fluctuations in the tone of the stomach wall, which appears 2-3 hours after eating. The motility of the small intestine includes pendulum movement (rhythmic oscillations that mix intestinal contents with intestinal secretions and create favorable conditions for absorption), fluctuations in the tone of the intestinal wall and peristalsis (worm-like movements along the intestine that promote the promotion of food). Pendulum and peristaltic movements are also noted in the large intestine, and antiperistalsis in the proximal sections, which contributes to the formation of fecal masses. The time of passage of food gruel through the intestines in children is shorter than in adults: in newborns - from 4 to 18 hours, in older ones - about a day. It should be noted that with artificial feeding, this period is extended. The act of defecation in infants occurs reflexively without the participation of a volitional moment, and only by the end of the first year of life does defecation become arbitrary.

For a newborn in the first 7 days after birth, physiological dyspepsia (physiological intestinal catarrh) is characteristic. The first act of defecation is characterized by the release of original feces, or meconium, in the form of a thick mass of dark olive color and odorless. In the future, as the intestines are populated with a variety of microflora, stools increase up to 5 times, the stools become watery, frothy with abundant wetting of diapers (transitional stools). By the 7th day, a normal microbial landscape is established and milk stools appear - mustard-like, doughy consistency with a sour smell from 1 to 4-5 times a day. At an older age, the chair becomes decorated, 1 time per day.

The intestines of a child in the first hours of life are free from bacteria. In the future, the gastrointestinal tract is populated by microflora, while 3 stages are distinguished: 1 - (aseptic) - lasts 10-20 hours from the moment of birth; 2 - (settlement) - 2-4 days; 3 - (stabilization) - 1-1.5 months. In the oral cavity of an infant, staphylococci, streptococci, pneumococci, Escherichia coli and some other bacteria can be found. E. coli, bifidobacteria, lactic acid bacilli, etc. appear in the feces. With artificial and mixed feeding, the phase of bacterial infection occurs faster.

Functions of microflora

Protective - a barrier against microbial contamination, reducing the permeability of the intestinal mucosa for macromolecules

Immune - stimulation of the maturation of the lymphoid apparatus of the intestine, maturation of phagocytes.

Metabolic

Synthesis of vitamins of group B, K

Metabolism of iron, bile acids, participation in lipid and carbohydrate metabolism

Digestive breakdown of carbohydrates, enzyme synthesis, parietal digestion, absorption regulation, stimulation of gastrointestinal motility.

Gut bacteria contribute to the processes of enzymatic digestion of food. With natural feeding, bifidobacteria, lactic acid bacilli predominate, and in a smaller amount - Escherichia coli. With artificial and mixed feeding, due to the predominance of decay processes in the feces, there are a lot of Escherichia coli, fermentative flora (bifidoflora, lactic acid bacilli) is present in a smaller amount.

The liver in children is relatively large, in newborns it is about 4% of body weight (in adults - 2% of body weight). In young children, bile formation is less intense than in older children. The bile of children is poor in bile acids, cholesterol, lecithin, salts and alkali, but rich in water, mucin, pigments and urea, and also contains more taurocholic than glycocholic acid. It is important to note that taurocholic acid is an antiseptic. Bile neutralizes the acidic food slurry, which makes possible the activity of pancreatic and intestinal secretions. In addition, bile activates pancreatic lipase, emulsifies fats, dissolves fatty acids, turning them into soaps, and enhances peristalsis of the large intestine.

Thus, the system of the digestive organs in children is distinguished by a number of anatomical and physiological features that affect the functional ability of these organs. In a child in the first year of life, the need for food is relatively greater than in older children. Although the child has all the necessary digestive enzymes, the functional capacity of the digestive organs is limited and can only be sufficient if the child receives physiological food, namely human milk. Even small deviations in the quantity and quality of food can cause digestive disorders in an infant (they are especially frequent in the 1st year of life) and ultimately lead to a lag in physical development.

Some of the many benefits of breastfeeding are ease of feeding. Each part of the digestive tract has specific functions that work to transport and digest foods that are important for your baby's growth. The digestion of breast milk plays important roles, from absorbing protective antibodies that fight bacteria and viruses to creating healthy gut bacteria.

Anatomy and physiology of the children's digestive tract

Let's start by learning the anatomy of baby digestion from the moment food enters the mouth until it passes into your baby's diaper, and the functions that occur along the way. The accessory organs are extremely important for proper digestion and will be discussed below.

• Mouth. The mouth of children plays the role of food intake, as well as the place where the digestion of certain nutrients begins. Some newborns may have difficulty fixating or problems associated with conditions such as cleft lip or cleft palate.
• Esophagus. It is a tube that connects the mouth to the stomach and has two main tasks - to push food or liquid from the mouth into the stomach and to stop the backflow of stomach contents.
• Stomach. It is responsible for storing ingested food, combining and breaking down food, and regulating the release of stomach contents into the duodenum, the first part of the small intestine. Digestion occurs in three phases - cephalic (initiated by the vagus nerve when something sees and smells of any food), gastric (caused by food intake and controlled by gastrin) and intestinal (regulated by hormones released in the small intestine).
• Small intestine. It is a tubular organ divided into three parts - the duodenum, small intestine and ileum. It does a great job as it is responsible for the digestion and absorption of nutrients, vitamins, trace elements, fluids and electrolytes. Essentially, the acidic, partially digested food from the stomach is combined with the basic secretions from the pancreas, liver, and intestinal glands. Digestive enzymes from these secretions are responsible for much of the digestion process in the small intestine - they break down breast milk proteins into amino acids; breast milk carbohydrates into glucose and other monosaccharides; and fats in breast milk into glycerol and fatty acids. The intestinal wall must be very strong to do the job it does. Its strength comes from the fact that it has four distinct layers - serous, muscular, submucosal and muscular. The intestinal surface is greatly enlarged by the presence of villi and microvilli, through which the end products of digestion are absorbed.
• Colon. It curves upward from the end of the small intestine, through the abdomen, and up to the rectum. Mainly responsible for the absorption of water and electrolytes.
• Straight. The "O'Beirne Sphincter" regulates the flow of waste from the sigmoid colon to the rectum, which is the storage area for digestive waste. The internal and external anal sphincters regulate the flow of fecal matter from the rectum.

Auxiliary organs of the children's digestive tract

In addition to the digestive tract itself, there are several accessory organs that are important in the digestion of food. These include:

• Salivary glands. The salivary glands in the mouth produce salivary enzymes. The submandibular, sublingual, and parotid glands produce saliva that contains amylase, the enzyme responsible for initiating carbohydrate digestion.
• Liver. The liver is actually the largest organ in the body. It is responsible for protein and carbohydrate metabolism and storage of glycogen and vitamins. It also aids in the formation, storage, and elimination of bile and plays a role in fat metabolism. The liver is where toxins are captured and sometimes stored to protect the rest of the body.
• Gallbladder. The gallbladder is a tiny sac that rests on the lower region of the liver. This is where bile (which consists of salts needed for digestion and absorption of fats) is collected from the liver. The Sphincter of Oddi regulates the flow of bile into the duodenum. Like the liver, the gallbladder helps in the composition, storage, and removal of bile and plays a role in the digestion of fat.
• Pancreas. The pancreas produces alkaline (or neutral) secretions that take part in the removal of acidic, partially digested food (also called chyme) from the stomach. These secretions contain enzymes that are essential for the absorption of fats, proteins and carbohydrates. Although these digestive enzymes are produced in the "exocrine" pancreas, many people are more familiar with the hormone insulin, which is produced in the "endocrine" parts of the pancreas.

Breast milk also contains enzymes that aid in digestion such as amylase, lipase, and protease. This is important for infants because digestive enzymes are not present at the adult level until infants are six months of age.

In general, the parts of the digestive system work together to take in food, transport it further into the digestive tract, break it down mechanically and chemically and absorb nutrients, and then dispose of excess material as waste.

Differences between the gastrointestinal system of infants and adults

There are several anatomical as well as functional differences between the digestive tract of infants and adults.

• Differences in the head and neck. The infant's tongue is larger in relation to the mouth, and there are extra fat pads on the sides of the tongue to aid in suckling. In addition, the larynx or voice box is higher in infants than in adults, and the epiglottis lies above the soft palate to provide additional airway protection.
• Differences in the esophagus. In a newborn baby, the esophagus is about 11.5 cm long (versus 24 cm in adults) and the lower esophageal sphincter is about 1 cm in diameter. Quite often at birth, a thin suction tube is passed through the esophagus to ensure that this sphincter is open. Esophageal defects that are not uncommon include atresia (a condition in which the esophagus is completely closed) and fistulas (a condition in which there is a connection between the esophagus and another organ such as the trachea).
• Differences in the stomach. A newborn stomach can only hold 1/4 and 1/2 cups of liquid (versus 14 cups in adults!). The digestive activity of the stomach is the same in infants and adults. The gastric glands of the stomach include parietal cells that produce hydrochloric acid and intrinsic factor. The chief cells in these glands secrete pepsinogen, which is converted to pepsin, breaking down proteins in the gastric juices. Surprisingly, bowel sounds already exist an hour after birth, and parietal cells begin to work immediately after birth. The stomach pH is less than 4 during the first 7-10 days of life.
• Small intestine. There are also anatomical differences in the small intestine. In an infant, it is from 255 to 305 cm in length, and in an adult, from 610 to 800 cm.
• Colon. At first, the baby's intestines are sterile. However, E. Coli, Clostridium and Streptococcus are established within a few hours. The collection of bacteria in the tract is necessary for digestion and the formation of vitamin K, a vitamin that is important for blood clotting. Since it takes some time for this to be produced after birth, babies are usually given a shot of vitamin K at birth.
• Emptying. The first stool passed is called meconium. Meconium is thick, sticky and tarry. It is black or dark green in color and is made up of mucus, a white cheesy substance present on baby's skin, lanugo (fine hair present on baby's skin), hormones, and carbohydrates. It is imperative that the newborn has a stool within 24 hours of birth.

Healthy gut bacteria

In recent years, we've been learning more about gut bacteria and their importance in everything from physical health to emotional well-being. Breastfeeding usually results in colonization of the colon with the right balance of healthy bacteria. Instead of only working on enzymes in the digestive tract, healthy gut bacteria are very important for the proper digestion of foods and the resulting absorption of nutrients needed for growth and development. As we learn more about how the infant gut microbiome is linked to breastfeeding, it is likely that current breastfeeding recommendations will become even stronger.

A child's digestive tract differs from adults in several ways and is a process involving many different organs and several steps. From providing digestive enzymes to creating healthy gut bacteria, breast milk can get your baby off to a healthy start.