嬰幼兒疫苗接種反應

@ 可能發生的症狀:

# 你擔心你的孩子正有對一次免疫注射有不良免疫反應。

# 對DTaP (白喉，破傷風，百日咳)，MMR(麻疹，腮腺炎，德國麻疹)，小兒麻痺，b型嗜血桿菌，Ａ型肝炎，Ｂ型肝炎，流行性感冒，水痘和肺炎球菌等疫苗的不良免疫反應都曾被報導過。

# 大多數不良的免疫反應發生在注射部位的會在2天內發生，而大部份一般不良的免疫反應或者發燒則在7天內發生。

# 劇烈的過敏反應非常少見，但是可能發生在任何疫苗的注射。

 

【何時看醫生守則】何時應該因為疫苗注射之不良免疫反應去看醫生

# 假使有下列情況立刻打119求救：

*呼吸或吞嚥困難

*無法動或非常虛弱

*無法或很難叫醒

# 假使有下列情況立刻帶去看醫生：

l  你小孩的表情或動作表現出很不舒服的樣子

l  年齡小於12週伴有發燒超過攝氏38度。（例外：發生在三合一疫苗注射的48小時內）

l  發燒超過攝氏40度

l  尖聲的、不尋常的哭聲持續1小時以上

l  哭鬧持續3小時以上

l  注射處周圍的發紅或紅斑大於1英吋

l  注射處周圍的發紅持續超過48小時(兩天)

# 假使有下列情況24小時內在白天(在早上9點到下午4點之間)帶去看醫生：

l  你認為你的小孩應該看醫師

l  發燒超過3天

l  注射處腫痛超過3天

l  麻疹疫苗的疹子(在注射完第6到12天發生)持續超過3天

# 假使有下列情況在平常上班日時間帶去看醫生：

l  你有其他問題或顧慮

 

@ 居家照護的原則

1. 疫苗注射的局部不良反應（除了口服小兒麻痺疫苗外的所有疫苗）

疼痛︰ 針對一開始在注射部位的疼痛：

·         可以用冰敷，每次20分鐘

·         給予口服acetaminophen或ibuprofen

發燒： 對於發燒超過華氏102度(攝氏39度)，給予口服acetaminophen（年齡超過六個月以上可以給ibuprofen）

 

2. 一般的反應： 所有的疫苗都可能造成輕微地易受驚嚇、躁動和睡不好。 這些通常是因為注射部位的疼痛，但有時則原因並不清楚。 有些小孩則是睡得比平常還多。 食慾和活動力的下降也很常見。 這些症狀並不需要任何治療，通常在24到48小時內會自行消失。

# 假使有下列情況帶去看醫生：

·         發燒持續超過3天

·         疼痛持續超過3天

·         注射處開始看起來有感染跡象

• 你孩子的情況變得更糟或是有出現任何“何時看醫生手則”中的症狀。

 

3. 水痘疫苗

·         注射處的疼痛或腫脹會持續1-2天（19%的小孩會發生）

·         在注射後17-28天之間，發燒持續1-3天（14%的小孩會發生）

發燒超過攝氏39度，給予口服acetaminophen或ibuprofen。 絕對不要因為發燒、疼痛而給予aspirin，另外水痘疫苗注射後6星期內也不可以用aspirin。（理由：有造成雷氏症候群的危險－一種罕見但嚴重的腦部疾病）

·         水痘般的疫苗注射紅疹(通常2個左右)會出現在疫苗注射的部位（約3%小孩會出現）

·         水痘般的疫苗注射紅疹(通常5個左右)會散佈在身體各處（約4%小孩會出現）

·         這種輕微的紅疹在疫苗注射後5- 26天開始出現，通常會持續幾天。

·         小朋友以這種疫苗注射紅疹還是可以去托兒所或學校。（理由：這些疹子實際上不具傳染力）

·         例外：假如是廣佈性、會滲液的病兆則應避免去學校。（理由：因為可能是真正的水痘）

·         小心：假如疫苗注射紅疹含有液體，要衣服或透氣膠帶覆蓋。

 

4. 三合一疫苗(白喉，破傷風，百日咳)或白喉&破傷風二合一疫苗： 下列無害的反應可能在三合一疫苗注射後產生：

·         注射部位的紅腫痛（約25%小孩會出現），會持續24到48小時

·         發燒（約25%小孩會出現），會持續24到48小時

·         輕微嗜睡（約30%小孩會出現），焦躁不安（約30%小孩會出現），食慾不好（約10%小孩會出現），會持續24到48小時

 

5. B型嗜血桿菌疫苗：

·         未曾有嚴重的不良反應被報導過

·         注射部位的疼痛或輕微發燒，也只有1.5%小孩會出現

 

6. A型肝炎疫苗：

·         未曾有嚴重的不良反應被報導過

·         注射部位的疼痛會在20%小孩身上出現，食慾變差會在10%小孩身上出現，頭痛會在5%小孩身上出現。通常不會發燒。

·         假如這些症狀出現，他們通常出現在疫苗注射後的3~5天且持續1~2天。

 

7. B型肝炎疫苗：

·         未曾有嚴重的不良反應被報導過。

·         注射部位的疼痛會在30%小孩身上出現，輕微發燒會在3%小孩身上出現。

·         因B型肝炎疫苗而造成發燒的情況很少見，任何小於3個月的嬰兒在B型肝炎疫苗注射後發燒都應該詳細檢查。

 

8. 流感疫苗：

·         注射部位的腫痛通常在注射後6-8小時內發生，會在10%小孩身上出現。

·         發燒至華氏101到103度（攝氏38.4- 39.5度）會在18%小孩身上出現。 發燒主要是發生在小小孩。

 

9. 麻疹疫苗： 麻疹疫苗可能造成發燒（約10%小孩會出現）和紅疹（約5%小孩會出現），通常發生在注射後6-12天。發燒通常介於攝氏38.4- 39.5度之間，且會持續2或3天。 這種輕微的粉紅色疹子主要分佈在軀幹，且會持續2或3天。 這些情況並不需治療。 你的小孩也不具傳染性。

# 假使有下列情況帶去看醫生：

·         疹子變得非常癢

·         疹子變成紫色斑點

·         疹子持續超過三天

 

10. 腮腺炎或德國麻疹疫苗：

除了偶而在注射處會有疼痛外，不會有其他不良反應。

 

11. 肺炎球菌疫苗：

·         注射部位的紅腫疼痛會在15~30%小孩身上出現。

·         輕微發燒，低於華氏102度（攝氏39度）會在15%小孩身上出現，持續1~2天。

·         不會有嚴重的不良反應

 

12. 小兒麻痺疫苗：

口服小兒麻痺疫苗不會有嚴重的不良反應。 注射型小兒麻痺疫苗偶而會造成一些肌肉酸痛。

 

 

Help Me Grow＜從小培育寶寶十要領＞周怡宏醫師

五大原則：

ü   從多小開始？（永遠不會太〝早〞）

ü   培育＝關愛＋教養（不包括溺愛）

ü   孩子並不會主動表演給父母看（而需先予教導）

ü   照顧和教養的方式決定一切（包括現在及未來）

ü   父母要懂得正確合理的方法（千萬不要揠苗助長，也不要矯枉過正）

 

十大要領：

◎    HMG要領  1- 懷孕時就給予寶寶適當情境訓練刺激

胎教的重要性不言可喻

◎    HMG要領 2- 出生後就給予寶寶半年以上完全母乳哺餵。

避免疾病，提供良好免疫保護；對短期與長期健康做最好的保證。並可以自然的促進親子互動。

◎    HMG要領3- 寶寶每天的生活中，都需要親子互動及訓練刺激。

吃喝拉睡是寶寶最基本的生活功能，除此之外，寶寶還有更值得學習的事情，包括社會性互動，即和父母、親友等週遭熟識者；以及自己本身感官及運動系統方面的刺激訓練。

◎    HMG要領4- 寶寶出生後就從環境中學習，包括能聽、能看、能感受愛帶養者的每一種作為。

◎    HMG要領5- 寶寶出生後，身體的肌肉骨骼機能就需要每日的活動訓練刺激，維持強化及協助發展。

◎    HMG要領6- 每天給寶寶嬰兒按摩及嬰兒運動2~3次，可以讓他充滿活力、促進能覺感官及四肢運動發展。

室內和戶外運動可以帶給寶寶不同刺激，擴大視野及強化效果。

◎    HMG要領7- 每天對寶寶說簡單而充滿愛意的話，也給他看適合年齡的圖畫書，可以使寶寶聽能視能有最大的啟發，變得愈來愈靈活。

◎    HMG要領8- 寶寶的日常照顧和疾病處置，與平時教育帶養方式密切相關。

◎    HMG要領9- 了解寶寶的發展里程的達成需要父母親有完整的認知以及定期健檢的配合。

◎    HMG要領10- 父母親一致的正確教養態度，是寶寶健康成長的不二保證。

 

結語：孩子的疾病與照護只不過是成長中的小部分，為有正確的教育帶養，配合持續維持的訓練刺激感官及動作，才能確保孩子的良好成長。

 

 讓寶寶從小享受並得到學習 Baby & Tummy time

-參考資訊(Australian Parenting Website)

https://raisingchildren.net.au/newborns/play-learning/play-ideas/tummy-time

 鼓勵孩子良好行為的15個要領

ENCOURAGING GOOD BEHAVIOUR: 15 TIPS

資料來源https://familiesforlife.sg/parenting/Babies/Pages/BabiesDevelopment/BabiesBehaviour/Babies_Encouraging_Good_Behaviour.aspx

How to encourage good behaviour in your child
A positive and constructive approach is often the best way to guide your child’s behaviour. This means giving your child attention when he behaves well, rather than just applying consequences when he does something you don’t like.
Here are some practical tips for putting this positive approach into action.

@ Be a role model 父母自己努力做為孩子榜樣
Use your own behaviour to guide your child. Your child watches you to get clues on how to behave – and what you do is often much more important than what you say. For example, if you want your child to say ‘please’, say it yourself. If you don’t want your child to raise her voice, speak quietly and gently yourself.

@ Show your child how you feel 讓孩子知道父母的感覺
Telling your child honestly how his behaviour affects you helps him see his own feelings in yours. And if you start sentences with ‘I’, it gives your child the chance to see things from your perspective. For example, ‘I’m getting upset because there is so much noise that I can’t talk on the phone’.

@ Catch your child being ‘good’當下贊美孩子的好行為
When your child is behaving in a way you like, give her some positive feedback. For example, ‘Wow, you’re playing so nicely. I really like the way you’re keeping all the blocks on the table’. This works better than waiting for the blocks to come crashing to the floor before you take notice and say, ‘Hey, stop that’.
This positive feedback is sometimes called descriptive praise because it tells children specifically what they’re doing well. Try to make six positive comments for every negative comment. And remember that if children have a choice between no attention or negative attention, they’ll often seek out negative attention.

@ Get down to your child’s level以孩子的身高角度溝通
When you get close to your child, you can tune in to what he might be feeling or thinking. Being close also helps him focus on what you’re saying about his behaviour. If you’re close to your child and have his attention, you don’t need to make him look at you.

@ Listen actively主動積極的傾聽與回應
To listen actively, you can nod as your child talks, and repeat back what you think your child is feeling. For example, ‘It sounds like you feel really sad that your blocks fell down’. When you do this, it can help young children cope with tension and big emotions like frustration, which sometimes lead to unwanted behaviour. It also makes them feel respected and comforted. It can even diffuse potential temper tantrums.

@ Keep promises永遠遵守對孩子的承諾
When you follow through on your promises, good or bad, your child learns to trust and respect you. She learns that you won’t let her down when you’ve promised something nice, and she also learns not to try to change your mind when you’ve explained a consequence. So when you promise to go for a walk after your child picks up her toys, make sure you have your walking shoes handy. When you say you’ll leave the library if your child doesn’t stop running around, be prepared to leave straight away.

@ Create an environment for good behaviour創造讓孩子表現好行為的環境
The environment around your child can influence his behaviour, so you can shape the environment to help your child behave well. This can be as simple as making sure your child’s space has plenty of safe, stimulating things for him to play with. Make sure that your child can’t reach things he could break or that might hurt him. Your glasses look like so much fun to play with – it’s hard for children to remember not to touch. Reduce the chance of problems by keeping breakables and valuables out of sight.

@ Choose your battles選擇適當的介入時機
Before you get involved in anything your child is doing – especially to say ‘no’ or ‘stop’ – ask yourself if it really matters. By keeping instructions, requests and negative feedback to a minimum, you create less opportunity for conflict and bad feelings. Rules are important, but use them only when it’s really important.

@ Be firm about whining當孩子胡亂哭鬧時要保持堅定
If you give in when your child is whining for something, you can accidentally train her to whine more. ‘No’ means ‘no’, not maybe, so don’t say it unless you mean it.

@ Keep things simple and positive讓教導孩子的方法保持簡單而正向
If you give clear instructions in simple terms, your child will know what’s expected of him – for example, ‘Please hold my hand when we cross the road’. And positive rules are usually better than negative ones, because they guide your child’s behaviour in a positive way. For example, ‘Please shut the gate’ is better than ‘Don’t leave the gate open’.

@ Give children responsibility – and consequences讓孩子負責任與接受後果
As your child gets older, you can give her more responsibility for her own behaviour. You can also give her the chance to experience the natural consequences of that behaviour. You don’t have to be the bad guy all the time. For example, if it’s your child’s responsibility to pack her lunch box and she forgets, the natural consequence is feeling hungry at lunch time.
At other times you might need to provide consequences for unacceptable or dangerous behaviour. For these times, it’s best to ensure that you’ve explained the consequences and that your child has agreed to them in advance.

@ Say it once and move on給予一次明確的指示並提醒孩子可能的後果
If you tell your child what to do – or what not to do – too often, he might end up just tuning out. If you want to give him one last chance to cooperate, remind him of the consequences for not cooperating. Then start counting to three.

@ Make your child feel important讓孩子覺得自己身為家庭一分子很重要

Give your child some simple chores or things that she can do to help the family. This will make her feel important. If you can give your child lots of practice doing a chore, she’ll get better at it, feel good about doing it, and want to keep doing it. And if you give her some praise for her behaviour and effort, it’ll help to build her self-esteem.

@ Prepare for challenging situations對可能發生的挑戰情境事先做好安排準備

There are times when looking after your child and doing things you need to do will be tricky. If you think about these challenging situations in advance, you can plan around your child’s needs. Give him a five-minute warning before you need him to change activities. Talk to him about why you need his cooperation. Then he’s prepared for what you expect.

@ Maintain a sense of humour父母要學習在教導中保持幽默感
It often helps to keep daily life with children light. You can do this by using songs, humour and fun. For example, you can pretend to be the menacing tickle monster who needs the toys picked up off the floor. Humour that has you both laughing is great, but humour at your child’s expense won’t help. Young children are easily hurt by parental ‘teasing’.