這是國際健康厚生園區的網頁中所列的，參考囉！推薦訂閱電子報，可以獲得不少新知呢！
http://www.24drs.com/professional/list/content.asp?x_idno=3822&x_classno=8&x_chkdelpoint=Y
5個”S”可能使哭鬧的嬰兒安靜下來
作者：Linda Little
出處：WebMD醫學新聞
審閱：Gary D. Vogin, MD
Oct. 11, 2005（華盛頓訊）－一位加州小兒科醫師於美國小兒科國際會議與展覽中向聽眾表示，嬰兒令人頭痛的絞痛可能是一哭鬧反射而不是腸胃道不適。
加州大學洛杉磯醫學院小兒科副教授Harvey Karp醫師表示，嬰兒的哭鬧可以持續幾分鐘，甚至到幾小時，事實上，可能是他們想要持續的噪音，或是想要刺激子宮；這可能是3000年來造成絞痛醫學秘密的答案。
Karp醫師表示，一項以5個「S」為代表的系統，包括包覆、以父母懷中改變胃的姿勢、發出「噓」的聲音、搖晃、與吸吮，這些動作可以使哭鬧的嬰兒安靜下來；透過模擬在子宮內的情境，可以激發足月至4個月時的嬰兒的體內冷靜反射。
他表示，大部分嬰兒的哭鬧不是因為醫療緊急事件，而是應嬰兒需要更多的關注。 Karp醫師表示，在他的理論中，在懷孕第4期前，嬰兒在完全發育前離開了子宮；在許多方面，嬰兒在出生時還沒有準備好，而且需要溫柔撫摸、懷抱、與發出「噓」的第4期。
他表示，過去的試驗已經證實6週的嬰兒平均每天哭鬧3.5個小時，這造成許多照顧小孩上的問題、父母之間的問題、產後憂鬱、不必要的就診、以及搖晃嬰兒症候群。
許多年來，嬰兒腹痛的原因一直被認為是腸胃道問題造成的，但事實上可能不是這樣；早產兒的腹痛可能在出生3個月後停止，而且在這個時間點前的2週才會消失。
Karp醫師指出，僅有10%至15%的腹痛案例是乳製品過敏引起的；當嬰兒胃酸逆流被認為是絞痛的主要原因，一項丹佛試驗結果顯示，每50位哭鬧的嬰兒到急診室就診僅有1位是因為胃酸逆流引起的，而另外一項澳洲試驗結果顯示，每24位3個月以下的嬰兒中僅有1位有胃酸逆流的問題。
Karp醫師表示，緊緊地手臂抱住嬰兒可能會使哭鬧更加嚴重，但是面對面抱嬰兒、以手部支撐嬰兒的頭部與頸部溫柔地搖晃他具有立即安撫嬰兒的作用；如果需要的話，應該加入「噓」聲，而且要與嬰兒的哭聲一樣的大。
在子宮中，胎兒聽到很大的快速移動的聲音，就像吸塵器一樣大聲；但是在出生後，環境變得相對寧靜；Karp醫師表示，過度刺激不像刺激不夠是項大問題；嬰兒想念規律的、可以助眠的聲音與運動。
嬰兒經常在看護或是喝牛奶的時候入睡，但是父母們應該在嬰兒躺著睡覺時將嬰兒的頭抬高一點。
如果依照5個「S」的原則，不但可以使哭鬧的嬰兒安靜下來，也可以使嬰兒多睡1至2個小時。
如果5個「S」的原則在嬰兒精力發洩完後進行，則可以開啟冷靜反射，而且嬰兒會因此停止哭泣；Karp醫師表示，如果父母們可以使嬰兒停止哭泣，會比得到一大筆錢還要高興，但是如果他們不行，則這將是項災難；父母們必須被教導如何使他們的小孩安靜下來。
麻州波士頓Tufts大學小兒科副教授Karen Miller醫師表示，教導這些原則對付父母們來說是有用的，但是需要更多的研究證實這些技巧是安全且有效的。
Miller醫師表示，許多個人技巧已經被證實是有意義的，但是在為這些技巧背書之前需要更多的研究。
Five S's May Calm the Crying Infant
By Linda LittleMedscape Medical News
Oct. 11, 2005 (Washington) — The age-old problem of colic in infants may be more a result of a crying reflex than gastrointestinal upset, a California pediatrician told attendees here at the American Academy of Pediatrics National Conference and Exhibition.
An infant's crying, which can last from minutes to hours, may actually be the result of missing the constant noise and stimulation of the womb, said Harvey Karp, MD, an associate professor of pediatrics at the University of California at Los Angeles Medical School. "This may be the solution to a 3,000-year-old medical mystery of what causes colic."
A new system that involves the five S's — swaddling, side/stomach positioning in the parents' arms, shushing, swinging, and sucking — can calm most crying infants, Dr. Karp said. This activates the baby's calming reflex during the first three to four months of life by mimicking experiences in the uterus.
Most infant crying is not due to an emergency, but the baby's need for attention, he said.
In his theory, infants are evicted from the womb before their "fourth trimester," before they are fully developed, Dr. Karp said. "In many ways, newborns aren't ready for the world at birth and need that fourth trimester for gentle stroking, holding, and shushing."
Past studies have shown that the average infant at six weeks of age cries about 3.5 hours a day, he said. "This results in nursing problems, marital stress, postpartum depression, unnecessary emergency room visits, and shaken baby syndrome.
It has been thought for years that the main cause of colic in infants was due to gastrointestinal problems, but this may not be true, Dr. Karp said. Colic appears to stop after three months and in preterm infants it usually does not begin until two weeks after the due date.
Only about 10% to 15% of cases of colic are caused by milk allergies, Dr. Karp pointed out. While infant acid reflux has been a prime reason cited for colic, a Denver study shows that just one in 50 crying infants in an emergency department had reflux and an Australian study showed only one in 24 crying infants younger than three months had reflux, Dr. Karp cited.
Tightly swaddling a crying infant with its arms down by its side initially may make the crying worse, Dr. Karp warned, but holding the baby on its side and gently jiggling it while supporting the head and neck has an immediate calming influence. Shushing sounds should be added, if necessary, and should be as loud as the infant's crying.
In the womb, fetuses hear a loud whooshing sound — louder than a vacuum cleaner. But after birth, there is silence. "Overstimulation is not nearly as big of a problem as understimulation," Dr. Karp said. "Babies miss the rhythmic, hypnotic sounds and movement."
Infants often fall asleep when nursing or taking a bottle, but parents should wake the infant up a tiny bit when laying the baby down to sleep, Dr. Karp said.If the five S's are followed, not only will the crying infant stop, but the baby will sleep an extra one to two hours a night, he said.
"If the five S's are done exactly right with just enough vigor, the calming reflex will be turned on and the baby will stop crying," Dr. Karp said. "If a parent can get the baby to stop crying they feel like a million bucks, but if they can't, they feel miserable. Parents need to be taught how to quiet their babies.
"Teaching this to parents may be useful, said Karen Miller, MD, an associate professor of pediatrics at Tufts University in Boston, Massachusetts. "But more research needs to be done to show the techniques are safe and effective."
Many of the individual techniques have been found to be valid, Dr. Miller said. "It's the whole package that needs further research before it is endorsed."
AAP 2005 National Conference and Exhibition: Selected Short Subjects F 131. Presented Oct. 8, 2005.Reviewed by Gary D. Vogin, MD
0 comments:
Post a Comment