儿童厌食症的危险因素研究

目的 探讨儿童厌食症的危险因素,以降低儿童厌食症的患病率。方法 采用问卷调查方式和病例对照研究方法收集150例厌食症儿童 （病例组）和150例正常儿童 （对照组）的一般资料,采用单因素分析和多因素logistic逐步回归分析研究儿童厌食症的危险因素。结果 单因素分析显示,病例组和对照组在添加辅食月龄、喂养方式、儿童是否喜欢肉食、是否喜欢蔬菜、是否喜欢咸食、是否常进食零食和/或饮料、是否边吃边玩、家长是否要求儿童按时进食等方面的差异有统计学意义 （P < 0.05）。多因素logistic回归分析显示,添加辅食时间晚 （OR=5.408）、常进食零食和/或饮料 （OR=11.813）、喜欢边吃边玩 （OR=6.654）是儿童厌食症的主要危险因素;而喜欢肉食 （OR=0.093）、喜欢蔬菜 （OR=0.272）以及家长要求儿童按时进食 （OR=0.079）是儿童厌食症的保护因素。结论 适时添加辅食、合理膳食、培养儿童正确的饮食和生活习惯可以减少儿童厌食症的发生。     

7～24月龄婴幼儿喂养指南的科学依据

正7~24月龄婴幼儿喂养指南的核心推荐:(1)继续母乳喂养,满6月龄起添加辅食;(2)从富含铁的泥糊状食物开始,逐步添加达到食物多样;(3)提倡顺应喂养,鼓励但不强迫进食;(4)辅食不加调味品,尽量减少糖和盐的摄入;(5)注重饮食卫生和进食安全;(6)定期监测体格指标,追求健康生长。1继续母乳喂养,满6月龄起添加辅食WHO推荐,在婴儿出生的前6个月纯母乳喂养,     

婴儿牛奶蛋白过敏的危险因素：多中心调查分析

目的 通过多中心临床研究了解婴儿牛奶蛋白过敏（CMPA）发生的危险因素。方法 以2016年6月至2017年5月于深圳市6家医院儿科门诊就诊的1 829例1~12月龄婴儿为调查对象,通过问卷调查,筛选CMPA可疑病例,然后进行食物回避激发试验以确诊CMPA。采用多因素logistic回归分析调查婴儿CMPA发生的危险因素。结果 1 829例患儿中,82例确诊为CMPA（4.48%）。多因素logistic回归分析显示,母亲食物过敏（OR=4.91,95% CI：2.24~10.76）、母亲孕期使用抗生素（OR=3.18,95% CI：1.32~7.65）、开始添加辅食月龄小于 < 4个月（OR=3.55,95% CI：1.52~8.27）是CMPA的独立危险因素（P < 0.05）,而纯母乳喂养（OR=0.21,95% CI：0.08~0.58）和 > 6个月添加辅食（OR=0.38,95% CI：0.17~0.86）是CMPA的保护因素（P < 0.05）。结论 小于4月龄添加辅食、母亲食物过敏、母孕期使用抗生素是婴儿CMPA发生的危险因素。     

268例儿童缺铁性贫血影响因素分析

目的探讨儿童缺铁性贫血(IDA)影响因素及影响贫血程度的相关危险因素。方法回顾性分析自2003年3月至2014年10月收住广东医学院附属医院儿科的268例明确诊断IDA患儿病例资料,设同期非贫血组患儿进行对照。结果本研究中男、女性患儿检出率分别为16.1%和31.3%。儿童IDA相关危险因素多因素Logistic回归模型分析结果:年龄、断奶时间、4~6个月添加辅食、挑食、体重增长过快、母亲文化程度等组间差异有显著性(P<0.05)。影响儿童IDA贫血程度因素Logistic回归结果示:不同分娩医院组间差异有显著性(P=0.026,OR=1.438,95%CI1.048~2.099),不同出生体重患儿间差异有显著性(P=0.008,OR=0.414,95%CI 0.217~0.791)。结论儿童IDA应着重以综合预防为主,加大儿童营养保健知识普及范围,实施个体化辅食添加方案。     

6~12月龄婴儿缺铁性贫血的危险因素分析及对神经心理发育的影响

目的 探讨6~12月龄婴儿中、重度缺铁性贫血(IDA)的危险因素,并初步了解IDA对婴儿神经运动发育的影响及其气质特点。方法 326例6~12月龄IDA患儿为研究对象,按贫血程度分为轻度(176例)、中度(111例)、重度(39例)组 ,采用多因素logistic回归分析对中、重度IDA的危险因素进行调查。另选取同期年龄、性别等背景相匹配的346例非IDA儿童作为对照组。IDA和对照组两组均使用儿童Gesell婴幼儿发育量表、气质量表进行智能发育及气质的评估。结果 单因素分析显示,性别、出生体重、胎龄、多胎、母亲孕期贫血、母亲缺乏IDA相关知识与贫血程度有关(P< 0.05)。以轻度IDA组为对照,多因素logistic回归分析显示,多胎、早产、低出生体重(< 2 500 g)、母亲孕期贫血、母乳喂养、母亲缺乏IDA相关知识是重度贫血的危险因素(OR> 1,P< 0.05);早产,母乳喂养、混合喂养是中度贫血的危险因素(OR> 1,P< 0.05)。IDA组Gesell总发育商、大运动、适应行为、精细动作得分较对照组低(P< 0.05)。IDA组难养型及中间偏难养型气质的比例较高(P< 0.05)。IDA组活动水平、节律性、适应性、坚持性维度得分较对照组高(P< 0.05)。结论 早产、多胎、低出生体重、喂养方式、母亲孕期贫血及母亲缺乏IDA相关知识与6~12月龄婴儿IDA贫血程度相关。IDA患儿神经运动发育落后,消极气质类型居多,需加强对患儿心理行为问题的重视,指导家长选择恰当的喂养及教育方式。     

早期喂养方式对不同时期儿童体质量的影响

目的探讨早期婴儿喂养方式对儿童体质量的影响。方法选择儿保门诊健康婴儿918名,根据其出生后6个月的喂养方式分为母乳喂养组、混合喂养组和人工喂养组,在生后3,5,8,12,18,24,60个月测量体质量,进行年龄别体质量标准差评分(WAZ)、身长别体质量标准差评分(WHZ)及60月龄体质量指数(BMI)测定,调查辅食添加时间等资料,并进行分析和统计学处理。结果3月龄母乳喂养组儿童在体质量、WAZ、WHZ占优势,差异均有统计学意义(F=4.12,5.66,5.79Pa<0.05);12,18,24月龄混合喂养儿童在WHZ占优势,差异均有统计学意义(F=3.46,3.08,3.12Pa<0.05),母乳喂养持续时间≥12个月的儿童,5岁时肥胖发生率最低;婴儿期的母乳喂养持续时间越长,儿童5岁时肥胖发生率越低,趋势检验有统计学意义(χ2=17.3538P<0.05),辅食添加时间以人工喂养儿最早,人工喂养儿5岁时肥胖发生率也最高(χ2=13.0382P<0.05)。结论加强持续母乳喂养的信心,减少使用奶瓶,避免过早添加辅食,顺利度过因婴儿生长加速、母乳分泌量相对不足的短暂危机期,坚持持续母乳7个月以上,进行婴儿的合理喂养和适时添加辅食的教育等对避免儿童期肥胖的发生非常必要。     

包头地区6岁以下儿童缺铁性贫血相关因素分析

目的 了解包头地区6岁以下儿童不同年龄缺铁性贫血发生情况,探讨其影响因素,从而有效降低贫血的患病率.方法 对700例首次就诊于我院儿科的1个月~6岁儿童喂养方式、辅食添加、母亲产前出血、妊娠高血压综合征等情况进行统计和分析,并检测血常规.结果 贫血检出率:1~4个月组为11.8%,~12个月组45.2%,~3岁组31.8%,~6岁组13.1%.1~4个月组贫血发生率较低,母亲产前出血、妊娠高血压综合征与婴儿贫血有关.5~12个月组贫血发生率较高,是否合理添加辅食与贫血相关;1~6岁幼儿与偏食、挑食及饮食不规律等不良饮食习惯有关.结论 加强围生期保健,减少低出生体质量儿的出生率,婴儿期母乳喂养的同时注意适时、适量、合理添加辅食是减少婴儿期贫血的有力措施.幼儿期应平衡膳食结构,克服不良饮食习惯.     

西藏自治区那曲地区人民医院儿科住院婴幼儿营养不良现状及影响因素分析

目的 了解西藏自治区那曲地区人民医院儿科1~36月龄住院婴幼儿的营养现状及影响因素,为进一步提高那曲地区婴幼儿身体素质及健康水平提供参考依据.方法 对2015年1月至2016年12月期间首次在我科住院的婴幼儿基本情况(如性别、年龄、身长、体重、疾病等)及喂养状况(如生后6个月及12个月的喂养方式、添加辅食时间等)进行详细登记.以WHO推荐的儿童生长发育标准计算各项指标的Z评分,评价儿童营养不良状况及其影响因素.结果 共1371例1~36月龄婴幼儿纳入研究,男753例,女618例,男女性别比为1.2:1;其中生长迟缓、低体重、消瘦发病率分别为25.31%(347例)、18.75%(257例)、6.13%(84例);不同月龄婴幼儿(1 ~6个月、7 ~12个月、13 ~24个月、25~36个月)的生长迟缓、低体重及消瘦的发病率无明显差异(P>0.05);6个月内婴儿喂养方式及添加辅食(糌粑糊)时间均对营养不良发病率有明显影响,纯母乳喂养营养不良的发病率最低28.88%(93/322),糌粑糊添加时间越早,营养不良发病率越高.结论 那曲地区人民医院儿科住院婴幼儿营养不良发病率高,应对婴幼儿家长大力宣传正确喂养观念,早期母乳喂养为主,及时、合理添加辅食,以改善婴幼儿的营养状况,进而提高其健康水平.     

中国九市不同喂养方式婴儿体格生长水平的横断面调查

目的 调查不同喂养方式婴儿体格生长水平的现状和差异。方法 1~<12月龄婴儿的母乳喂养、辅食添加及体格生长数据来自2015年“第五次中国九市7岁以下儿童体格发育调查”。1~<6月龄婴儿的喂养方式分为纯母乳喂养、部分母乳喂养和人工喂养,~<12月龄的喂养方式分为持续母乳喂养和人工喂养。不同喂养方式婴儿体重、身长及头围生长水平比较采用方差分析或t检验。结果 共纳入1~<12月龄婴儿59 170人。1~<6月龄纯母乳喂养率、部分母乳喂养率和人工喂养率分别为48.6%、37.4%和14.0%,~<12月龄持续母乳喂养率和人工喂养率分别为59.9%和40.1%。1~<6月龄纯母乳喂养婴儿平均体重略高于部分母乳喂养婴儿,差值范围为0.06~0.20 kg;也略高于人工喂养婴儿,差值范围为0.09~0.22 kg。6~<12月龄持续母乳喂养婴儿平均身长低于人工喂养婴儿,差值范围为-0.3~-0.1 cm。不同喂养方式在6~<12月龄体重、1~<6月龄身长及1~<12月龄头围上差异均无统计学意义。不同喂养方式婴儿体重、身长及头围生长模式与WHO儿童生长标准相似,但总体上体重和身长平均生长水平略高于WHO儿童生长标准。结论 不同喂养方式生长模式相似,在生后的前半年纯母乳喂养婴儿的生长水平略高于部分母乳喂养和人工喂养婴儿,在后半年持续母乳喂养婴儿的生长水平略低于人工喂养婴儿。     

石景山区婴儿辅食添加情况及影响因素调查

目的寻找婴儿辅食添加中存在的问题,调查其影响因素。方法在固定的保健门诊日由儿保医师对保健体检的婴儿母亲或喂养人进行问卷调查。并对调查结果进行分析。结果1.辅食早加率(<4个月)23.9%,辅食早加行为与不同喂奶方式比较差异有显著意义(P<0.05)。2.本地区辅食开始添加的时间74%选择4～6个月;开始添加的品种较为适宜(蛋黄或米粉);但肉豆类适时(6～8个月)添加率不足30%,未添加率达30%左右,且应用频数低,与成人1周膳食频度比较有显著性差异。3.母亲在喂养中起着重要作用,但未注意到行为习惯的培养,尚缺乏喂养知识。结论婴儿辅食喂养中存在着一些问题,需要改善。关键是要对起重要作用的母亲进行教育。     

A comparative study of feeding pattern of infants in rural and urban areas

A study of feeding habits of 500 urban and of 500 rural children was carried out. Breast feeding was more common in rural areas than in the urban area. In the rural area most children were weaned onto solids without intervening supplementary feeds with fresh or artificial milk. In those who received supplementary milk, fresh cow's milk was commonly selected in rural areas as against dried milk powder in urban areas. Breastfed infants of both rural and urban areas gained weight adequately upto 6 months. However beyond 6 months weight gain in urban children was more than in rural children probably due to early introduction of solids. The average weight at 24 months was more in rural areas than in the urban. This is probably due to the rural children being covered under the ICDS scheme and receiving supplementary nutrition. Many of the mothers failed in lactation because of the taboos in their food habits which prevented them from taking an adequate balance diet.     

Caesarean section and gastrointestinal symptoms, atopic dermatitis, and sensitisation during the first year of life.

AIMS: To investigate the effect of caesarean section on gastrointestinal symptoms, atopic dermatitis, and sensitisation to nutritional allergens in infants. METHODS: A total of 865 healthy full term neonates with parental history of allergy participating in the prospective German Infant Nutritional Intervention Program (GINI) were exclusively breast fed during the first four months of life and had a one year follow up. Data were obtained by follow up visits at age 1, 4, 8, and 12 months, weekly diaries for the first six months, and measurement of total and specific IgE at birth and 12 months. RESULTS: Infants born by caesarean section (147/865, 17%) had a greater risk of diarrhoea (OR(adj) 1.46, 95% CI 1.022 to 2.10) and sensitisation to food allergens, both in adjusted (OR(adj) 2.06, 95% CI 1.123 to 3.80) and stratified analyses (by cord blood IgE). Caesarean delivery was not associated with colicky pain and atopic dermatitis. CONCLUSION: Caesarean delivery might be a risk factor for diarrhoea and sensitisation in infants with family history of allergy. Further research in this area seems warranted as choosing caesarean section becomes increasingly popular.     

Feeding practice of infants and their correlates in urban areas of Beijing, China

BACKGROUND: Optimal feeding practice in the first year of life is crucial for the survival and health of infants, and has long-term consequences in later life. However, non-optimal feeding practices exist widely. The present study aims to explore various constraints to optimal feeding practices in the first year of life of infants in urban areas of Beijing, China. METHODS: A cross-sectional study was conducted in urban areas of Beijing from 4 July to 20 August, 1998. Two hundred and fifty-one mothers of infants aged 6-12 months were chosen from six child health centers in three different urban districts in Beijing. A self-administered structured questionnaire was used to collect data regarding feeding practices and potentially related factors. RESULTS: Feeding practice for most of the infants was in accordance with the national and international recommendations. However, the rate of incidence of exclusive breast-feeding at 3 months of age was lower than that recommended by the World Health Organisation (WHO) (55.8%), and the introduction of solid/semisolid food before 4 months of age was found in approximately 19.3% of the infants. Cow's milk was given to 21.2% of infants from 6 months of age as the sole source of milk or as a supplement. Maternal education level (OR = 2.44, 95% CI: 1.42-4.19, P < 0.05), employment (OR = 2.05, 95% CI: 1.13-3.74, P < 0.05) and antenatal nonexclusive breast-feeding plans (OR = 4.10, 95% CI: 2.24-7.50, P < 0.001) were found to be correlated to inappropriate feeding practices. CONCLUSIONS: The feeding practices for most of the urban infants was found to be in accordance with the Chinese government and WHO recommendations; however, non-optimal feeding practices presenting as the early cessation of breast-feeding and the introduction of solid/semisolid foods existed. Information regarding optimal feeding practices should be disseminated to mothers and medical professionals in China, to ensure optimal infant health.     

Association of diarrhea with anemia among children under age five living in rural areas of Indonesia

The high incidence of anemia of infection among children in developing countries is not well characterized. We investigated the relationship between diarrhea, fever and other risk factors for anemia in young children in the community. The relationship between risk factors for anemia was examined in a cross-sectional study of 85 229 children, aged 6-59 months, from impoverished families in rural areas of Indonesia. The prevalence of anemia was 56.1% among the study subjects. Those considered anemic were more likely to be younger, male, stunted, underweight, wasted, to have low maternal and paternal education and to have current diarrhea or history of diarrhea in the previous 7 days compared with children without anemia (all P < 0.0001). In separate multivariate models adjusted for age, sex, stunting, maternal age and education, and weekly per capita household expenditure, current diarrhea (OR 1.15, 95% CI 1.07-1.325, P < 0.0001) and a history of diarrhea in the previous 7 days (OR 1.16, 95% CI 1.09-1.25, P < 0.0001) were associated with an increased risk of anemia. In similar models, current fever had a borderline association with anemia (OR 1.14, 95% CI 0.98-1.32, P = 0.09). We conclude that diarrhea is a contributing factor of anemia among young children living in rural areas in Indonesia.     

Determinants of inappropriate complementary feeding practices in young children in Sri Lanka: secondary data analysis of Demographic and Health Survey 2006-2007

Inappropriate complementary feeding increases risk of undernutrition, illness and mortality in infants and children. This paper aimed to determine the factors associated with inappropriate complementary feeding practices in Sri Lanka. The Sri Lanka Demographic and Health Survey 2006-2007 used a stratified two-stage cluster sample of ever-married women 15-49 years, and included details about foods given to children aged 6-23 months during the last 24 h. The new World Health Organization indicators for infant and young child feeding (IYCF) - (introduction of solid/semi-solid or soft foods; minimum dietary diversity; minimum meal frequency; and minimum acceptable diet) were calculated for 2106 children aged 6-23 months. These indicators were examined against explanatory variables with multivariate analyses to identify factors associated with inappropriate practices. Eighty-four per cent of infants aged 6-8 months were introduced to complementary food. The proportion of infants aged 6-8 months who consumed eggs (7.5%), fruits and vegetables other than those rich in vitamin A (29.6%) and flesh foods (35.2%) was low. Of children aged 6-23 months, minimum dietary diversity was 71%, minimum meal frequency 88% and minimum acceptable diet 68%. Children who lived in tea estate sector had a lower dietary diversity and minimum acceptable diet than children in urban and rural areas. Other determinants of not receiving a diverse or acceptable diet were lower maternal education, shorter maternal height, lower wealth index, lack of postnatal visits, unsatisfactory exposure to media and acute respiratory infections. In conclusion, complementary feeding indicators were adequate except in the 6-11 months age group. Subgroups with inappropriate feeding practices should be the focus of IYCF promotion programs.     

Early introduction of fish decreases the risk of eczema in infants

BACKGROUND: Atopic eczema in infants has increased in western societies. Environmental factors and the introduction of food may affect the risk of eczema. AIMS: To investigate the prevalence of eczema among infants in western Sweden, describe patterns of food introduction and assess risk factors for eczema at 1 year of age. METHODS: Data were obtained from a prospective, longitudinal cohort study of infants born in western Sweden in 2003; 8176 families were randomly selected and, 6 months after the infant's birth, were invited to participate and received questionnaires. A second questionnaire was sent out when the infants were 12 months old. Both questionnaires were completed and medical birth register data were obtained for 4921 infants (60.2% of the selected population). RESULTS: At 1 year of age, 20.9% of the infants had previous or current eczema. Median age at onset was 4 months. In multivariable analysis, familial occurrence of eczema, especially in siblings (OR 1.87; 95% confidence interval (CI) 1.50 to 2.33) or the mother (OR 1.54; 95% CI 1.30 to 1.84), remained an independent risk factor. Introducing fish before 9 months of age (OR 0.76; 95% CI 0.62 to 0.94) and having a bird in the home (OR 0.35; 95% CI 0.17 to 0.75) were beneficial. CONCLUSIONS: One in five infants suffer from eczema during the first year of life. Familial eczema increased the risk, while early fish introduction and bird keeping decreased it. Breast feeding and time of milk and egg introduction did not affect the risk.     

Infant and young child feeding in western Uganda: knowledge, practices and socio-economic correlates

In a cross-sectional household survey conducted in the rural district of Hoima, western Uganda, 720 child/mother pairs were recruited using a two-stage cluster design. Infant and young child feeding knowledge and practices were assessed in relation to recommendations and household socio-economic factors. Age specific feeding patterns were described using frequencies, proportions and life-tables. Logistic regressions were done with feeding practice as dependent and socio-economic factors as independent variables. Breastfeeding was universal (99%) with a median duration of 21 months. Pre-lacteal use was high (43%), with educated mothers more prone to the practice. Using a 24-hour recall: the median duration of exclusive breastfeeding was 3.5 months; 10% of infants were bottle-fed; 92% of the 0-5 month-old infants breastfed 6 or more times; 21% of 2-3 month-olds received complementary food instead of breast milk only and 19% of 6-8 month-olds were only breastfed instead of receiving complementary food. Of children 12 months and above, 42% were complemented twice or less and 49% complemented 3 or 4 times. Only 36% of breastfeeding children between 6-23 months received dairy milk. Over 50% of mothers did not know that adding oil to complementary food could improve it. The least poor were more likely, than the poorest, to use dairy milk (OR 3.9, CI 1.6-9.6); and educated mothers were more likely to prepare special complementary foods than the un-educated (OR 2.7, CI 1.1-6.2). Emphasis should be on promotion of exclusive breastfeeding, timeliness of complementary feeding and socio-economic empowerment.