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2023年5月5日 星期五

Mental illness in children: Know the signs

來自梅約診所的資訊

https://www.mayoclinic.org/healthy-lifestyle/childrens-health/in-depth/mental-illness-in-children/art-20046577

Children can develop the same mental health conditions as adults, but their symptoms may be different. Know what to watch for and how you can help.

By Mayo Clinic Staff

Mental illness in children can be hard for parents to identify. As a result, many children who could benefit from treatment don't get the help they need. Understand how to recognize warning signs of mental illness in children and how you can help your child.

# What is a mental illness?

Mental health is the overall wellness of how you think, regulate your feelings and behave. A mental illness, or mental health disorder, is defined as patterns or changes in thinking, feeling or behaving that cause distress or disrupt a person's ability to function.

Mental health disorders in children are generally defined as delays or disruptions in developing age-appropriate thinking, behaviors, social skills or regulation of emotions. These problems are distressing to children and disrupt their ability to function well at home, in school or in other social situations.

# Barriers to treating childhood mental health disorders

It can be difficult to understand mental health disorders in children because normal childhood development is a process that involves change. Additionally, the symptoms of a disorder may differ depending on a child's age, and children may not be able to explain how they feel or why they are behaving a certain way.

Other factors might also prevent parents from seeking care for a child who has a suspected mental illness. For example, parents might be concerned about the stigma associated with mental illness, the use of medications, and the cost or logistical challenges of treatment.

# Common disorders among children

Mental health disorders in children — or developmental disorders that are addressed by mental health professionals — may include the following:

·         Anxiety disorders. Anxiety disorders in children are persistent fears, worries or anxiety that disrupt their ability to participate in play, school or typical age-appropriate social situations. Diagnoses include social anxiety, generalized anxiety and obsessive-compulsive disorders.

·         Attention-deficit/hyperactivity disorder (ADHD). Compared with most children of the same age, children with ADHD have difficulty with attention, impulsive behaviors, hyperactivity or some combination of these problems.

·         Autism spectrum disorder (ASD). Autism spectrum disorder is a neurological condition that appears in early childhood — usually before age 3. Although the severity of ASD varies, a child with this disorder has difficulty communicating and interacting with others.

·         Eating disorders. Eating disorders are defined as a preoccupation with an ideal body type, disordered thinking about weight and weight loss, and unsafe eating and dieting habits. Eating disorders — such as anorexia nervosa, bulimia nervosa and binge-eating disorder — can result in emotional and social dysfunction and life-threatening physical complications.

·         Depression and other mood disorders. Depression is persistent feelings of sadness and loss of interest that disrupt a child's ability to function in school and interact with others. Bipolar disorder results in extreme mood swings between depression and extreme emotional or behavioral highs that may be unguarded, risky or unsafe.

·         Post-traumatic stress disorder (PTSD). PTSD is prolonged emotional distress, anxiety, distressing memories, nightmares and disruptive behaviors in response to violence, abuse, injury or other traumatic events.

·         Schizophrenia. Schizophrenia is a disorder in perceptions and thoughts that cause a person to lose touch with reality (psychosis). Most often appearing in the late teens through the 20s, schizophrenia results in hallucinations, delusions, and disordered thinking and behaviors.

 

# What are the warning signs of mental illness in children?

Warning signs that your child may have a mental health disorder include:

·         Persistent sadness that lasts two weeks or more

·         Withdrawing from or avoiding social interactions

·         Hurting oneself or talking about hurting oneself

·         Talking about death or suicide

·         Outbursts or extreme irritability

·         Out-of-control behavior that can be harmful

·         Drastic changes in mood, behavior or personality

·         Changes in eating habits

·         Loss of weight

·         Difficulty sleeping

·         Frequent headaches or stomachaches

·         Difficulty concentrating

·         Changes in academic performance

·         Avoiding or missing school

# What should I do if I suspect my child has a mental health condition?

If you're concerned about your child's mental health, consult your child's health care provider. Describe the behaviors that concern you. Talk to your child's teacher, close friends, relatives or other caregivers to see if they've noticed changes in your child's behavior. Share this information with your child's health care provider.

# How do health care professionals diagnose mental illness in children?

Mental health conditions in children are diagnosed and treated based on signs and symptoms and how the condition affects a child's daily life. To make a diagnosis, your child's health care provider might recommend that your child be evaluated by a specialist, such as a psychiatrist, psychologist, clinical social worker, psychiatric nurse or other mental health care professional. The evaluation might include:

·         Complete medical exam

·         Medical history

·         History of physical or emotional trauma

·         Family history of physical and mental health

·         Review of symptoms and general concerns with parents

·         Timeline of child's developmental progress

·         Academic history

·         Interview with parents

·         Conversations with and observations of the child

·         Standardized assessments and questionnaires for child and parents

The Diagnostic and Statistical Manual of Mental Disorders (DSM), a guide published by the American Psychiatric Association, provides criteria for making a diagnosis based on the nature, duration and impact of signs and symptoms. Another commonly used diagnostic guideline is the International Classification of Diseases (ICD) from the World Health Organization.

Diagnosing mental illness in children can take time because young children may have trouble understanding or expressing their feelings, and normal development varies. Your child's health care provider may change or refine a diagnosis over time.

# How is mental illness in children treated?

Common treatment options for children who have mental health conditions include:

·         Psychotherapy. Psychotherapy is also known as talk therapy or behavior therapy. Psychotherapy is a way to address mental health concerns by talking with a psychologist or other mental health professional. With young children, psychotherapy may include play time or games, as well as talk about what happens while playing. During psychotherapy, children and adolescents learn how to talk about thoughts and feelings, how to respond to them, and how to learn new behaviors and coping skills.

·         Medication. Your child's health care provider or mental health professional may recommend a medication — such as a stimulant, antidepressant, anti-anxiety medication, antipsychotic or mood stabilizer — as part of the treatment plan. Your child's provider will explain risks, side effects and benefits of drug treatments.

# How can I help my child cope with mental illness?

You will play an important role in supporting your child's treatment plan. To care for yourself and your child:

·         Learn about the illness.

·         Consider family counseling that treats all members as partners in the treatment plan.

·         Ask your child's mental health professional for advice on how to respond to your child and handle difficult behavior.

·         Enroll in parent training programs, particularly those designed for parents of children with a mental illness.

·         Explore stress management techniques to help you respond calmly.

·         Seek ways to relax and have fun with your child.

·         Praise your child's strengths and abilities.

·         Work with your child's school to secure necessary support.


2023年5月3日 星期三

 語言- 教導嬰幼兒語言學習的原則與技巧

互動認識新事物

先天和後天因素都會影響小孩語言發展的速度,所以家長不應該將自己兒女與其他兒童比較,先天因素可以是腦部發展、智力影響,或是感官上缺陷,聽不到、看不見、身體殘障等,而且性別也有影響,女孩子一般會比同齡男生發展較快。後天因素是語言刺激和環境因素,例如照顧兒童時和他互動、玩耍、聊天,或是與其他小朋友玩、上學、社交等等都會影響。譬如一般三歲時會明白到概念性詞語和形容詞,家長可以了解自己兒女能否理解這些概念,雖然句子不長,但如果能說出有意義句子和能夠組合詞彙就足夠。」在後天因素上,家長可以觀察小童願不願意和其他人互動、學習新事物等,如果家長想小童更全面地學習語言,可以嘗試讓小童多參與社交活動,玩遊戲及聊天都是好方法。


咬字不清循循善誘

發音咬字不清亦在小童身上常見,有時候兒童會把發音相近的字混淆,舉例是將「狗」和「手」字都發音成「豆」。「咬字發音也應該由簡單到複雜,以廣東話來說,三至四歲的小朋友大致上能夠學習基本的發音,到約六歲時便應與大人無異。」「假若小朋友沒有聽力問題,但發音一直不能改善,便可考慮尋找言語治療師幫助糾正。家長亦可嘗試減慢語速,針對小童有問題的發音作強調重複或提供口形提示,但不應在一個具壓力的環境中指導,而是通過遊戲和聊天中教導發音,也不應恥笑、模仿、指責小童錯誤的咬字。掌握發音其實也是有一個次序的,由簡單單音節開始,例如是S音,就可以通過『蛇仔』遊戲和字卡,強調當中的S音,然後再由單音節變成單字、詞語,甚至是句子。」


口部肌肉勿忽略

兒童語言發展除了外在環境和先天性的影響,另外一項就是口部肌肉問題,徐敏儀表示兒童經常流口水,不願咀嚼食物或是抗拒面部肌肉的觸覺,例如不願刷牙、不願被觸摸嘴唇,都有機會是有口肌的問題,她進一步解釋:「好像是口肌過度敏感或敏感度不足,亦有機會影響語言發展,言語治療師會用一些工具幫助兒童強化下頷、舌頭、嘴唇的肌肉運動,以及力量訓練和協調,例如給小孩咬咀嚼棒、吹羽毛、肥皂泡等等,家長也應讓子女在一歲後逐漸減少吸啜奶嘴、不要將食物剪得太碎或給予太多流質食物,要按小朋友適時的能力而為,避免他們缺少咀嚼訓練。但要注意不是所有語言問題都與口肌有關,所以單純口肌運動並不可以改善全部發音問題,有時候小童是因為聽力或辨別發音出現問題。」^給小孩肥皂泡有助兒童強化下頷、舌頭、嘴唇的肌肉。


寓學於玩樂

不少家長認為觀看電視有助兒女學習語言,徐敏儀指雖然小童會感興趣,甚至是模仿、唱兒歌,但是屬於單向和被動的學習,而非自然正常的溝通方式,即是說小朋友背誦了內容、模仿唱歌,也不會幫助說話溝通,所以並非一個良好的學習語言環境,她強調通過遊戲學習語言才是最佳方法:「遊戲中不但能學習新的詞彙,聆聽和跟從指示,甚至有助社交和學習輪流對話的技術,而遊戲要由小朋友興趣着手,例如他們愛玩車子,就由此入手一同玩車子及溝通,擁有共同焦點最為重要。和兒童對話要直接簡單,也要減慢語速,盡量用多些生動詞語,抑揚頓挫強一點,也應該積極地鼓勵讚賞。盡量不要單向性由家長發問,讓小童能夠多元性對話,也不要固定遊戲種類,男孩子也可以玩『煮飯仔』,女孩子也可以玩車子,兒童才會接觸更多事物,學習更多詞彙。」


教授幼兒說話的基本技巧

1. 先學聽,後學講- 如欲與孩子說話,家長要懂得先取得他們的注意,方法包括:叫喊他的名字、輕輕拍一拍他。當孩子望著自己,家長便可以跟他說話。另外清靜環境能夠幫助孩子集中精神,聆聽別人說話。

2. 說話生動、清晰- 家長要利用柔和聲線跟孩子說話,音調亦可以多加抑揚頓挫,好等他覺得說話是件輕鬆和好玩的事,此外家長說話時要慢和清晰,否則幼兒可能聽不明白。

3. 行用簡易明白的字眼- 家長跟孩子說話,用詞要簡短易明,例如對兩歲前的小孩說:「俾杯杯。」而不是「俾個杯杯媽咪飲水。」

4. 營造輕鬆自然的氣氛- 不要強逼孩子在人面前說話和表演,要讓他們在輕鬆的氣氛和環境下學習說話。

5. 遵照孩子興趣- 跟隨孩子的興趣,讓孩子作主導,譬如小朋友愛玩積木,可以在遊戲時加入對話:「疊高高」、「砌車車,叻叻」。另外,要注意小孩玩耍時的心情是否愉快、精神是否良好,而且親子雙方都必須投入其中。

6. 把握說話的機會- 家長可以在日常生活跟孩子聊有關眼前的事物,或者日常的活動,例如新事物的名稱及用途,並鼓勵他們模仿大人將字詞說出來。

例如:跟孩子洗澡:和他談身體各部分; 到超級市場:告訴孩子你要買的東西;
跟孩子看書:形容一下書內的圖畫或說簡單的故事; 出外遊玩:告訴孩子沿途所見的事物。家長可以將相關的說話和動作連在一起,例如當媽媽在洗碗時說:「媽咪洗碗。」或當爸爸在掃地時說:「爸爸掃地。」

7. 利用問句- 家長可以利用各類型的問句,與孩子在日常進行交流,幫助提高他們的應對、理解、表達能力,譬如在進食時問:「好唔好食」、「飽飽未」、「食緊咩」等。

8. 鼓勵孩子自己說- 給予機會,有耐性地讓孩子自行表達想說的說話,家長可以在旁傾聽、猜想他要表達的意思。千萬不要讓兄姊代說,又或者在他們說話到一半時,打斷並幫他把話說完。

9. 對孩子的說話或發聲作出即時回應- 當孩子說話、發聲時,家長要盡可能即時回應,並且作出讚賞。不需要要求一字一句都要發音準確,如果咬字不清,把他說的話正確地複述一遍便可。但千萬不要重複模仿其錯音,以免學壞。

其實兒童語言發展應該循序漸進,一步一步慢慢學習,家長也要明白每個小童的成長環境各有不同,既有長處也有短處,用更多的時間發展語言並非壞事,所以不應與其他小童比較,家長也需要參與其中,互動更多,當然最主要是自然和愉快的環境下學習。

 

2023年5月2日 星期二

Starting Solid Foods 餵食嬰兒副食品

美國兒科醫學會資訊

https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Starting-Solid-Foods.aspx

Rice, oatmeal, or barley? What infant cereal or other food will be on the menu for your baby's first solid meal? Have you set a date?

At this point, you may have a plan or are confused because you have received too much advice from family and friends with different opinions.

Here is information from the American Academy of Pediatrics (AAP) to help you prepare for your baby's transition to solid foods.

# When can my baby begin solid foods?

Remember that each child's readiness depends on his own rate of development.

  • Can he hold his head up? Your baby should be able to sit in a high chair, a feeding seat, or an infant seat with good head control.
  • Does he open his mouth when food comes his way? Babies may be ready if they watch you eating, reach for your food, and seem eager to be fed.
  • Can he move food from a spoon into his throat? If you offer a spoon of rice cereal, he pushes it out of his mouth, and it dribbles onto his chin, he may not have the ability to move it to the back of his mouth to swallow it. That's normal. Remember, he's never had anything thicker than breast milk or formula before, and this may take some getting used to. Try diluting it the first few times; then, gradually thicken the texture. You may also want to wait a week or two and try again.
  • Is he big enough? Generally, when infants double their birth weight (typically at about 4 months of age) and weigh about 13 pounds or more, they may be ready for solid foods.

NOTE: The AAP recommends breastfeeding as the sole source of nutrition for your baby for about 6 months. When you add solid foods to your baby's diet, continue breastfeeding until at least 12 months. You can continue to breastfeed after 12 months if you and your baby want to. Check with your child's doctor about the recommendations for vitamin D and iron supplements during the first year.

# How do I feed my baby?

Start with half a spoonful or less and talk to your baby through the process ("Mmm, see how good this is?"). Your baby may not know what to do at first. She may look confused, wrinkle her nose, roll the food around inside her mouth, or reject it altogether.

One way to make eating solids for the first time easier is to give your baby a little breast milk, formula, or both first; then switch to very small half-spoonfuls of food; and finish with more breast milk or formula. This will prevent your baby from getting frustrated when she is very hungry.

Do not be surprised if most of the first few solid-food feedings wind up on your baby's face, hands, and bib. Increase the amount of food gradually, with just a teaspoonful or two to start. This allows your baby time to learn how to swallow solids.

If your baby cries or turns away when you feed her, do not make her eat. Go back to breastfeeding or bottle-feeding exclusively for a time before trying again. Remember that starting solid foods is a gradual process; at first, your baby will still be getting most of her nutrition from breast milk, formula, or both. Also, each baby is different, so readiness to start solid foods will vary.

NOTE: Do not put baby cereal in a bottle because your baby could choke. It may also increase the amount of food your baby eats and can cause your baby to gain too much weight. However, cereal in a bottle may be recommended if your baby has reflux. Check with your child's doctor.

​# Which ​​food should I g​ive my baby first?

Your baby's first foods are your choice. Whether you decide to make your own baby food or buy premade baby food, you have many options. However, keep the following in mind:

  • Foods should be soft or pureed to prevent choking.
  • Introduce one “single-ingredient" new food from any food group every 3 to 5 days. Look out for any reactions.
  • There is no evidence that waiting to introduce baby-safe (soft) foods, such as eggs, dairy, soy, peanut products, or fish, beyond 4 to 6 months of age prevents food allergy. However, testing for peanut allergy is recommended for babies with severe eczema and/or egg allergy. Check with your child's doctor about how and when to give peanut products.
  • There is no evidence that your baby will develop a di​​slike for vegetables if fruit is given first.
  • Be sure to include foods that provide iron and zinc, such as baby food made with meat or iron-fortified cereals.​
  • If you feed your baby premade cereal, make sure it is made for babies and is iron fortified. Baby cereals are available premixed in individual containers or dry, to which you can add breast milk, formula, or water.

Within a few months of starting solid foods, your baby's daily diet should include a variety of foods, such as breast milk, formula, or both; meats; cereal; vegetables; fruits; eggs; and fish.

# When can I give my baby finger foods?

Once your baby can sit up and bring her hands or other objects to her mouth, you can give her finger foods to help her learn to feed herself. To prevent choking, make sure anything you give your baby is soft, easy to swallow, and cut into small pieces. Some examples include small pieces of banana, wafer-type cookies, or crackers; scrambled eggs; well-cooked pasta; well-cooked, finely chopped chicken; and well-cooked, cut-up potatoes or peas.

At each of your baby's daily meals, she should be eating about 4 ounces, or the amount in one small jar of strained baby food. Limit giving your baby processed foods that are made for adults and older children. These foods often contain more salt and other preservatives.

If you want to give your baby fresh food, use a blender or food processor, or just mash softer foods with a fork. All fresh foods should be cooked with no added salt or seasoning. Although you can feed your baby raw bananas (mashed), most other fruits and vegetables should be cooked until they are soft. Refrigerate any food you do not use, and look for any signs of spoilage before giving it to your baby. Fresh foods are not bacteria-free, so they will spoil more quickly than food from a can or jar.

NOTE: Do not give your baby any food that requires chewing at this age, or any food that can be a choking hazard. Foods to avoid include hot dogs (including meat sticks, or baby food "hot dogs"); nuts and seeds; chunks of meat or cheese; whole grapes; popcorn; chunks of peanut butter; raw vegetables; fruit chunks, such as apple chunks; and hard, gooey, or sticky candy.

# What changes can I expect after my baby starts solids?

When your baby starts eating solid foods, his stools will become more solid and variable in color. Because of the added sugars and fats, they will have a much stronger odor, too. Peas and other green vegetables may turn the stool a deep-green color; beets may make it red. (Beets sometimes make urine red as well.) If your baby's meals are not strained, his stools may contain undigested pieces of food, especially hulls of peas or corn, and the skin of tomatoes or other vegetables. All of this is normal. Your baby's digestive system is still immature and needs time before it can fully process these new foods. If the stools are extremely loose, watery, or full of mucus, however, it may mean the digestive tract is irritated. In this case, reduce the amount of solids and introduce them more slowly. If the stools continue to be loose, watery, or full of mucus, talk with your child's doctor to find the reason.

# Should I give my baby juice?

Babies do not need juice. Babies younger than 12 months should not be given juice. After 12 months of age (up to 3 years of age), give only 100% fruit juice and no more than 4 ounces a day. Offer it only in a cup, not in a bottle. To help prevent tooth decay, do not put your child to bed with a bottle. If you do, make sure it contains only water. Juice reduces the appetite for other, more nutritious, foods, including breast milk, formula, or both. Too much juice can also cause diaper rash, diarrhea, or excessive weight gain.

# Does my baby need water?

Healthy babies do not need extra water. Breast milk, formula, or both provide all the fluids they need. However, it is OK to offer a little water when you begin to give your baby solid foods. Use an open, sippy or strawed cup and lmit water to no more than 1 cup (8 ounces) each day. Also, a small amount of water may be needed in very hot weather. If you live in an area where the water is fluoridated, drinking water will also help prevent future tooth decay.

# Good eating habits start early

It is important for your baby to get used to the process of eating—sitting up, taking food from a spoon, resting between bites, and stopping when full. These early experiences will help your child learn good eating habits throughout life.

Encourage family meals from the first feeding. When you can, the whole family should eat together. Research suggests that having dinner together, as a family, on a regular basis has positive effects on the development of children.

Remember to offer a good variety of healthy foods that are rich in the nutrients your child needs. Watch your child for cues that he has had enough to eat. Do not overfeed!

If you have any questions about your child's nutrition, including concerns about your child eating too much or too little, talk with your child's doctor.

 


比較餵食嬰兒輔助性食物(Complementary foods)方法

Caregiver feeding practice

Acceptance of new tastes and textures is central to the establishment of a healthy diet and can be encouraged by the inclusion of a wide variety of foods from the beginning of CF. Bitter tasting vegetables may prove difficult to accept in some infants. Studies have found that offering these early and repeatedly may encourage acceptance.

 

@Responsive feeding (RF)

when a caregiver responds appropriately to an infant’s cues of hunger or satiety, can help the establishment of a healthy dietary pattern.

RF avoids over-controlling feeding practices, such as pressuring children to eat, and discourages indulgent and uninvolved feeding styles, in which the caregiver feeds the child in response to signs of distress or in a disorganised manner.

If managed well, RF can minimise the risk of over-feeding or the development of fussy eating. Interventions to promote RF have shown success in achieving healthy diets and reducing the risk of overweight. The PSG recommends that complementary feeding should be carried out in a responsive manner.

 

@Baby led weaning (BLW)

where the infant is encouraged to self-feed with finger-foods has gained popularity

This approach is suggested to be less coercive and enables infants to regulate their energy intake. A study in the UK found that BLW led to earlier self-feeding, less food fussiness and greater food enjoyment.

BLW did not lead to lower energy or micronutrient intake and was not associated with increased risk of obesity. 

Available evidence is currently insufficient to support benefits of BLW over traditional CF.

 

 


嬰兒開始餵食副食品的適合年齡為何?

近年來母乳哺餵是國際的主流餵食方式根據世衛組織WHO的建議每一位嬰兒應該以純母乳直接哺餵直到兩歲為止,同時也指出,在嬰兒滿六個月之後,即應該開始每天提供副食品的餵食。但是,對於從小以奶瓶餵食(母乳或配方奶粉)者,由於容易較早產生厭奶的情形,而使得奶量減低,學者專家通常建議滿四個月之後即可以給予餵食副食品,以滿足嬰兒的適當營養需求;相對的,母乳哺餵的嬰兒通常厭奶機會低,若過早給予副食品反而剝奪持續母哺的機會。

過去研究也指出,照顧嬰兒者年齡越低、社經地位越低者、開發中國家或地區,都有較高比例在四個月之前給予嬰兒副食品。至於美國小兒科醫學會AAP則建議嬰兒在四到六個月之間才可以開始餵食副食品,過早餵食容易產生不利於嬰兒健康的狀況,例如嗆到窒息、過敏以及兒童肥胖等問題;但是如果晚於7-8個月大後才餵食,則容易造成營養不足、缺鐵性貧血以及生長落後等現象。

我國衛福部國民健康署目前的建議較傾向於WHO做法,亦即維持嬰兒以純母乳哺育到6個月滿6個月後再添加副食品的建議目的在於希望多鼓勵媽媽們多多餵哺母乳。更進一步說,媽媽們在考慮提供4-6個月之間的嬰兒副食品時,也應該要了解孩子在發展上的準備是否已經妥當(developmental readiness),也就是包括頸部已經挺直不會搖晃,可以扶持維持一段時間的坐姿,進行咀嚼時頭部不會晃動,湯匙餵食時舌頭不會有明顯的排出反射,以及對餐桌上食物表現出明顯的興趣等發展表現都是已經準備好的發展訊號。

由上可知,餵食副食品的時機選擇,與1) 文化差異、2) 照顧者經驗、3) 餵食方式的演變,以及4) 嬰兒的神經發展表現等因素都有關係,因此,結論是每一位嬰兒原則上應在4-6個月後在給予副食品,其中奶瓶餵食嬰兒至少要在滿四個月後才給予副食品,而親餵母乳的嬰兒則等到六個月之後才餵食副食品

 


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