Many kids (and parents) who have seen Luke Skywalker battle Darth Vader with a light saber think lasers are cool.

What they may not know is this: When operated unsafely, or without certain controls, the highly-concentrated light from lasers—even those in toys—can be dangerous, causing serious eye injuries and even blindness. And not just to the person using a laser, but to anyone within range of the laser beam.

The U.S. Food and Drug Administration is concerned about this potential danger to children and those around them and in 2014 issued a guidance document (PDF 60K) on the safety of children’s toy laser products.

“A beam shone directly into a person’s eye can injure it in an instant, especially if the laser is a powerful one,” explains Dan Hewett, health promotion officer at the FDA’s Center for Devices and Radiological Health.

Moreover, eye injuries caused by laser light usually don't hurt. Vision can deteriorate slowly and, therefore, may go unnoticed, for days and even weeks. Ultimately, the damage could be permanent, Hewett says.

Some examples of laser toys are:

• lasers mounted on toy guns that can be used for “aiming”;
• spinning tops that project laser beams while they spin;
• hand-held lasers used during play as “light sabers”; and
• lasers intended for entertainment that create optical effects in an open room.

The FDA Regulates Lasers
A laser creates a powerful, targeted beam of electromagnetic radiation that is used in many products, from music players and printers to eye-surgery tools. The FDA regulates radiation-emitting electronic products, such as lasers (including children’s toy laser products), and sets radiation-safety standards that manufacturers must meet.

Toys with lasers are of particular interest to the FDA because children can be injured by these products. Because they are marketed as toys, parents and kids alike may believe they’re safe to use.

For toys to be considered minimal risk, the FDA recommends that the levels of radiation and light not exceed the limits for Class 1, the lowest level in regulated products as defined by the International Electrotechnical Commission (IEC).

Lasers used for industrial and other purposes often need higher radiation levels for their intended functions. But these higher levels are not needed for children’s toys—and if they are present, they can be dangerous.

Hand-held laser pointers—often used  in business and higher education to help illustrate presentations—have increased in power 10-fold or more over the last decade. And while adults may buy a laser pointer for use in work, kids often play with them for amusement.

The fact that lasers can be dangerous may not be evident, particularly to the children who inappropriately use them as toys, or to the adults who supervise them.

Laser Safety: Tips to Keep in Mind
Remember that laser products are generally safe when they follow the legal limits and are used as directed. But lasers can cause harm if not used properly. The FDA recommends the following general safety tips for consumers.

Never aim or shine a laser directly at anyone, including animals. The light energy from a laser aimed into the eye can be hazardous, perhaps even more than staring directly into the sun.
Do not aim a laser at any vehicle, aircraft, or shiny surface. Remember that the startling effect of a bright beam of light can cause serious accidents when aimed at a driver in a car, for instance, or otherwise negatively affect someone doing another activity (such as playing sports).
Look for an FDA-recommended IEC Class I label on children’s toy lasers. The label says “Class 1 Laser Product,” which would clearly communicate that the product is of low risk and not in a higher emission level laser class.
Do not buy laser pointers for children, or allow children to use them. These products are not toys.
Do not buy or use any laser that emits more than 5mW power, or that does not have the power printed on the labeling.
Immediately consult a health care professional if you or a child suspects or experiences any eye injury.

You can watch the FDA’s video on laser pointer safety [disclaimer icon] for more information.

Updated: November 24, 2017

中文翻译：
本文地址：http://www.wjbb.com/know/1819
原文出处：https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm363908.htm 收起阅读 »

Most people have had an X-ray taken at some time during their lives — perhaps checking for a possible broken bone or during a visit to the dentist. X-ray exams provide important information to physicians about how to treat their patients. However, X-rays use ionizing radiation, and these imaging exams must be carefully and judiciously used on pediatric patients.

While the level of risk from the radiation associated with X-rays is small, especially when compared with the benefits of an accurate diagnosis, health care professionals must be especially sensitive to their appropriate use in children. Pediatric patients generally require less radiation than adults to obtain a quality image from an X-ray exam, so doctors must take extra care to “child size” the radiation dose.

FDA's Role

The FDA's Center for Devices and Radiological Health (CDRH) regulates medical imaging devices. Among its responsibilities is keeping consumers and health care professionals informed about the importance of minimizing unnecessary radiation exposure during medical procedures.

The level of ionizing radiation from X-ray imaging is generally very low, but can contribute to an increased risk of cancer. Because children have longer expected lifetimes ahead of them for potential effects to appear and the risk for cancer is not fully understood, it’s important to use the lowest radiation dose necessary to provide a diagnostic exam.

The FDA is committed to protecting the health of children by providing guidance to manufacturers and users of imaging devices to help lower the exposure to radiation from X-ray exams. The FDA has regulatory oversight of X-ray imaging devices and the companies that make them. To better address radiation safety concerns, the FDA has been encouraging both equipment improvements and better user information.

The FDA also promotes the adoption of improved radiation safety guidelines by professional organizations for both facilities and personnel.

Recommendations

In a new guidance FDA recommends that medical X-ray imaging exams be optimized to use the lowest radiation dose needed. These exams, which include computed tomography (CT), fluoroscopy, dental, and conventional X-rays, should be performed on children and younger patients only when the health care provider believes they are necessary to answer a clinical question or to guide treatment.

The FDA defines the pediatric population as birth through 21 years old. However, the optimization of image quality and radiation dose in X-ray imaging depends more on a patient’s size than their age. Smaller patients require less radiation to obtain a medically useful image. Technically, the patient’s body thickness (the distance an X-ray travels through the body to create the image) is the most important consideration when “child-sizing” an image protocol.

Unnecessary radiation exposure during medical procedures should be avoided. However, X-rays and CT scans should never be withheld from a child or adult who has a medical condition where the exam could provide important health care information that may aid in the diagnosis or treatment of a serious or even life-threatening illness.

What Parents Can Do

The FDA encourages parents and caregivers to talk to their child’s health care provider about X-rays and suggests:

• Keeping track of their child's medical-imaging histories
• Asking the referring physician about the benefits and risks of imaging procedures, such as: How will the exam improve my child's health care? Are there alternative exams to X-rays that are equally useful?
• Asking the imaging facility: How does the facility use reduced radiation techniques for children? Is there any advanced preparation necessary? Report any adverse events to the FDA.

The Role of Health Care Professionals

Health care professionals are responsible for ensuring there is justification for all X-ray imaging exams performed on pediatric patients. They should also consider whether another type of imaging exam that does not expose the patient to ionizing radiation, such as ultrasound or magnetic resonance imaging, could be used to obtain the same result.

The FDA encourages health care professionals and hospital administrators to refer to guidelines and instructions provided at the agency’s Pediatric X-ray Imaging web portal.

For more information visit the FDA’s Pediatric X-ray Imaging website.

January 9, 2018

中文翻译：
本文地址：http://www.wjbb.com/know/1818
原文出处：https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm591750.htm 收起阅读 »

Dietary supplementation is approximately a $30 billion industry in the United States, with more than 90 000 products on the market. In recent national surveys, 52% of US adults reported use of at least 1 supplement product, and 10% reported use of at least 4 such products.1 Vitamins and minerals are among the most popular supplements and are taken by 48% and 39% of adults, respectively, typically to maintain health and prevent disease.

Despite this enthusiasm, most randomized clinical trials of vitamin and mineral supplements have not demonstrated clear benefits for primary or secondary prevention of chronic diseases not related to nutritional deficiency. Indeed, some trials suggest that micronutrient supplementation in amounts that exceed the recommended dietary allowance (RDA)—eg, high doses of beta carotene, folic acid, vitamin E, or selenium—may have harmful effects, including increased mortality, cancer, and hemorrhagic stroke.

In this Viewpoint, we provide information to help clinicians address frequently asked questions about micronutrient supplements from patients, as well as promote appropriate use and curb inappropriate use of such supplements among generally healthy individuals. Importantly, clinicians should counsel their patients that such supplementation is not a substitute for a healthful and balanced diet and, in most cases, provides little if any benefit beyond that conferred by such a diet.

Clinicians should also highlight the many advantages of obtaining vitamins and minerals from food instead of from supplements. Micronutrients in food are typically better absorbed by the body and are associated with fewer potential adverse effects. A healthful diet provides an array of nutritionally important substances in biologically optimal ratios as opposed to isolated compounds in highly concentrated form. Indeed, research shows that positive health outcomes are more strongly related to dietary patterns and specific food types than to individual micronutrient or nutrient intakes.

Although routine micronutrient supplementation is not recommended for the general population, targeted supplementation may be warranted in high-risk groups for whom nutritional requirements may not be met through diet alone, including people at certain life stages and those with specific risk factors (discussed in the next 3 sections and in the Box).


Box.Key Points on Vitamin and Mineral Supplements
General Guidance for Supplementation in a Healthy Population by Life Stage

Pregnancy: folic acid, prenatal vitamins

Infants and children: for breastfed infants, vitamin D until weaning and iron from age 4-6 mo

Midlife and older adults: some may benefit from supplemental vitamin B12, vitamin D, and/or calcium

Guidance for Supplementation in High-Risk Subgroups

Medical conditions that interfere with nutrient absorption or metabolism:

Bariatric surgery: fat-soluble vitamins, B vitamins, iron, calcium, zinc, copper, multivitamins/multiminerals

Pernicious anemia: vitamin B12 (1-2 mg/d orally or 0.1-1 mg/mo intramuscularly)

Crohn disease, other inflammatory bowel disease, celiac disease: iron, B vitamins, vitamin D, zinc, magnesium

Osteoporosis or other bone health issues: vitamin D, calcium, magnesiuma

Age-related macular degeneration: specific formulation of antioxidant vitamins, zinc, copper

Medications (long-term use):

Proton pump inhibitorsa: vitamin B12, calcium, magnesium

Metformin: vitamin B12 ( Inconsistent evidence.)

Restricted or suboptimal eating patterns: multivitamins/multiminerals, vitamin B12, calcium, vitamin D, magnesium


Pregnancy
The evidence is clear that women who may become pregnant or who are in the first trimester of pregnancy should be advised to consume adequate folic acid (0.4-0.8 mg/d) to prevent neural tube defects. Folic acid is one of the few micronutrients more bioavailable in synthetic form from supplements or fortified foods than in the naturally occurring dietary form (folate). Prenatal multivitamin/multimineral supplements will provide folic acid as well as vitamin D and many other essential micronutrients during pregnancy. Pregnant women should also be advised to eat an iron-rich diet. Although it may also be prudent to prescribe supplemental iron for pregnant women with low levels of hemoglobin or ferritin to prevent and treat iron-deficiency anemia, the benefit-risk balance of screening for anemia and routine iron supplementation during pregnancy is not well characterized.

Supplemental calcium may reduce the risk of gestational hypertension and preeclampsia, but confirmatory large trials are needed.2 Use of high-dose vitamin D supplements during pregnancy also warrants further study.2 The American College of Obstetricians and Gynecologists has developed a useful patient handout on micronutrient nutrition during pregnancy.

Infants and Children
The American Academy of Pediatrics recommends that exclusively or partially breastfed infants receive (1) supplemental vitamin D (400 IU/d) starting soon after birth and continuing until weaning to vitamin D–fortified whole milk (≥1 L/d) and (2) supplemental iron (1 mg/kg/d) from 4 months until the introduction of iron-containing foods, usually at 6 months.5 Infants who receive formula, which is fortified with vitamin D and (often) iron, do not typically require additional supplementation. All children should be screened at 1 year for iron deficiency and iron-deficiency anemia.

Healthy children consuming a well-balanced diet do not need multivitamin/multimineral supplements, and they should avoid those containing micronutrient doses that exceed the RDA. In recent years, ω-3 fatty acid supplementation has been viewed as a potential strategy for reducing the risk of autism spectrum disorder or attention-deficit/hyperactivity disorder in children, but evidence from large randomized trials is lacking.

Midlife and Older Adults
With respect to vitamin B12, adults aged 50 years and older may not adequately absorb the naturally occurring, protein-bound form of this nutrient and thus should be advised to meet the RDA (2.4 μg/d) with synthetic B12 found in fortified foods or supplements.6 Patients with pernicious anemia will require higher doses (Box).

Regarding vitamin D, currently recommended intakes (from food or supplements) to maintain bone health are 600 IU/d for adults up to age 70 years and 800 IU/d for those aged older than 70 years. Some professional organizations recommend 1000 to 2000 IU/d, but it has been widely debated whether doses above the RDA offer additional benefits. Ongoing large-scale randomized trials (NCT01169259 and ACTRN12613000743763) should help to resolve continuing uncertainties soon.

With respect to calcium, current RDAs are 1000 mg/d for men aged 51 to 70 years and 1200 mg/d for women aged 51 to 70 years and for all adults aged older than 70 years. Given recent concerns that calcium supplements may increase the risk for kidney stones and possibly cardiovascular disease, patients should aim to meet this recommendation primarily by eating a calcium-rich diet and take calcium supplements only if needed to reach the RDA goal (often only about 500 mg/d in supplements is required).2 A recent meta-analysis suggested that supplementation with moderate-dose calcium (<1000 mg/d) plus vitamin D (≥800 IU/d) might reduce the risk of fractures and loss of bone mass density among postmenopausal women and men aged 65 years and older.

Multivitamin/multimineral supplementation is not recommended for generally healthy adults.8 One large trial in US men found a modest lowering of cancer risk,9 but the results require replication in large trials that include women and allow for analysis by baseline nutrient status, a potentially important modifier of the treatment effect. An ongoing large-scale 4-year trial (NCT02422745) is expected to clarify the benefit-risk balance of multivitamin/multimineral supplements taken for primary prevention of cancer and cardiovascular disease.

Other Key Points
When reviewing medications with patients, clinicians should ask about use of micronutrient (and botanical or other dietary) supplements in counseling about potential interactions. For example, supplemental vitamin K can decrease the effectiveness of warfarin, and biotin (vitamin B7) can interfere with the accuracy of cardiac troponin and other laboratory tests. Patient-friendly interaction checkers are available free of charge online (search for interaction checkers on drugs.com, WebMD, or pharmacy websites).

Clinicians and patients should also be aware that the US Food and Drug Administration is not authorized to review dietary supplements for safety and efficacy prior to marketing. Although supplement makers are required to adhere to the agency’s Good Manufacturing Practice regulations, compliance monitoring is less than optimal. Thus, clinicians may wish to favor prescription products, when available, or advise patients to consider selecting a supplement that has been certified by independent testers (ConsumerLab.com, US Pharmacopeia, NSF International, or UL) to contain the labeled dose(s) of the active ingredient(s) and not to contain microbes, heavy metals, or other toxins. Clinicians (or patients) should report suspected supplement-related adverse effects to the Food and Drug Administration via MedWatch, the online safety reporting portal. An excellent source of information on micronutrient and other dietary supplements for both clinicians and patients is the website of the Office of Dietary Supplements of the National Institutes of Health.

Clinicians have an opportunity to promote appropriate use and to curb inappropriate use of micronutrient supplements, and these efforts are likely to improve public health.

中文翻译：
本文地址：http://www.wjbb.com/know/1817
原文出处：http://jamanetwork.com/article.aspx?doi=10.1001/jama.2017.21012


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The genes in your body’s cells play an important role in your health — indeed, a defective gene or genes can make you sick.

Recognizing this, scientists have been working for decades on ways to modify genes or replace faulty genes with healthy ones to treat, cure or prevent a disease or medical condition.

Now this research on gene therapy is finally paying off. Since August 2017, the U.S. Food and Drug Administration has approved three gene therapy products, the first of their kind.

Two of them reprogram a patient’s own cells to attack a deadly cancer, and the most recent approved product targets a disease caused by mutations in a specific gene.

What Are Cells and Genes? How Do They Interact?

What is the relationship between cells and genes?

Cells are the basic building blocks of all living things; the human body is composed of trillions of them. Within our cells there are thousands of genes that provide the information for the production of specific proteins and enzymes that make muscles, bones, and blood, which in turn support most of our body’s functions, such as digestion, making energy, and growing.

How Gene Therapy Works

Sometimes the whole or part of a gene is defective or missing from birth, or a gene can change or mutate during adult life. Any of these variations can disrupt how proteins are made, which can contribute to health problems or diseases.

In gene therapy, scientists can do one of several things depending on the problem that is present. They can replace a gene that causes a medical problem with one that doesn’t, add genes to help the body to fight or treat disease, or turn off genes that are causing problems.In order to insert new genes directly into cells, scientists use a vehicle called a “vector” which is genetically engineered to deliver the gene.

Viruses, for example, have a natural ability to deliver genetic material into cells, and therefore, can be used as vectors. Before a virus can be used to carry therapeutic genes into human cells, however, it is modified to remove its ability to cause an infectious disease.

Gene therapy can be used to modify cells inside or outside the body. When it’s done inside the body, a doctor will inject the vector carrying the gene directly into the part of the body that has defective cells.

In gene therapy that is used to modify cells outside of the body, blood, bone marrow, or another tissue can be taken from a patient, and specific types of cells can be separated out in the lab. The vector containing the desired gene is introduced into these cells. The cells are left, to multiply in the laboratory, and are then injected back into the patient, where they continue to multiply and eventually produce the desired effect.

Before a Gene Therapy Can Go On the Market …

Before a company can market a gene therapy product for use in humans, the gene therapy product has to be tested for safety and effectiveness so that FDA scientists can consider whether the risks of the therapy are acceptable in light of the benefits.

Gene therapy holds the promise to transform medicine and create options for patients who are living with difficult, and even incurable, diseases. As scientists continue to make great strides in this therapy, FDA is committed to helping speed up development by prompt review of groundbreaking treatments that have the potential to save lives.

December 19, 2017

中文翻译：
本文地址：http://www.wjbb.com/know/1816
原文出处：https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm589197.htm 收起阅读 »

Whether you’re a ghost or zombie, vampire or witch, poor costume choices—including decorative (colored) contact lenses and flammable costumes—and face paint allergies can cause injuries that haunt you long after Halloween.

Enjoy a safe and happy Halloween by following these guidelines from FDA, the Consumer Product Safety Commission, and the Centers for Disease Control and Prevention:

• Wear costumes that say “flame resistant” on the label. If you make your costume, use flame-resistant fabrics such as polyester or nylon.
• Wear bright, reflective costumes or add strips of reflective tape so you’ll be more visible; make sure the costumes aren’t so long that you’re in danger of tripping.
• Wear makeup and hats rather than masks that can obscure your vision.
• Test the makeup you plan to use in advance. Put a small amount on the arm of the person who will be wearing it. If a rash, redness, swelling, or other signs of irritation develop where the makeup was applied, that's a sign of a possible allergy.
• Vibrantly colored makeup is popular at Halloween. Check FDA’s list of color additives to see if the colors are FDA approved. If they aren’t approved for their intended use, don’t use them. This is especially important for colored makeup around the eyes.
• Don’t wear decorative (colored) contact lenses unless you have seen an eye care professional for a proper fitting and been given instructions for how to use the lenses.

 
Safe Treats

Eating sweet treats is also a big part of Halloween fun.
Before you or your children go trick-or-treating, remember these tips:
•Don’t eat candy until it has been inspected at home.
•Eat a snack before heading out to avoid the temptation of nibbling on a treat before it has been inspected.
•In case of a food allergy, check the label to ensure the allergen isn’t present. Tell children not to accept—or eat—anything that isn’t commercially wrapped.
•Parents of very young children should remove any choking hazards such as gum, peanuts, hard candies, or small toys from the Halloween bags.
•Inspect commercially wrapped treats for signs of tampering, such as an unusual appearance or discoloration, tiny pinholes, or tears in wrappers. Throw away anything that looks suspicious.
 
For partygoers and party throwers, FDA recommends the following tips for two seasonal favorites:

•Unpasteurized juices and juices that have not been further processed are at higher risk of food- borne illness. Look for the warning label to identify juice that hasn’t been pasteurized or otherwise processed, especially packaged juice products made on site. If unsure, always ask if juice has been pasteurized or not. Normally, juice in boxes, bottles or cans from your grocer’s frozen food case, refrigerated section, or shelf has been pasteurized.

•Before bobbing for apples—a favorite Halloween game—reduce the risk of bacteria by thoroughly rinsing the apples under cool running water. As an added precaution, use a produce brush to remove surface dirt.
 
Eye Safety

FDA joins eye care professionals—including the American Academy of Ophthalmology, the American Association for Pediatric Ophthalmology and Strabismus, the Contact Lens Association of Ophthalmologists and the American Optometric Association—in discouraging consumers from using illegal decorative (colored) contact lenses. These are contact lenses that have not been approved by FDA for safety and effectiveness. Consumers should only use brand name contact lenses from well-known contact lens companies.
 
If you have never worn contact lenses before, Halloween should not be the first time you wear them. Experts warn that buying any kind of contact lenses—which are medical devices and regulated as such—without an examination and a prescription from an eye care professional can cause serious eye disorders and infections, which may lead to permanent vision loss. Despite the fact that it’s illegal to sell decorative contact lenses without a valid prescription, FDA says the lenses are sold on the Internet and in retail shops and salons—particularly around Halloween.

The decorative lenses make the wearer’s eyes appear to glow in the dark, create the illusion of vertical “cat eyes,” or change the wearer’s eye color.

Although unauthorized use of decorative contact lenses is a concern year-round, Halloween is the time when people may be inclined to use them, perhaps as costume accessories. When they are bought and used without a valid prescription, without the involvement of a qualified eye care professional, or without appropriate follow-up care, it can lead to significant risks of eye injuries, including blindness.

本文刊载于FDA的消费者更新专栏上，此栏目专门刊载FDA所管理产品的最新消息。

更新日期: October 20, 2017
发布日期: October 26, 2010

中文翻译：
本文地址：http://www.wjbb.com/know/1815
原文出处：https://www.fda.gov/forconsumers/consumerupdates/ucm230283.htm 收起阅读 »

我们家正在进行房屋翻新，现为施工的最后阶段。最近我们了解到我们家这种修建于1978年之前的房屋可能使用了含铅油漆。在将孩子搬回翻新后的房屋之前，我们应该做些什么呢？

​​
 
在英文当中，分娩叫做Labor and Delivery，临产以后就是Labor，宫口开全以后生的过程就是Delivery。Labor的另外一个更加常见的意思是“劳动”。从定义就可以看得出来，生孩子是一个体力活，就是一个劳动过程，你通常要Labor劳动10-20个小时才能把孩子生出来。根据研究，整个分娩的过程是相当耗能量的，生个孩子消耗的能量不亚于跑一个马拉松，请注意，不是“半马”，而是“全马”。

对于足月的孕妇来讲，子宫的肌肉是全身最强有力的肌肉，比男人的二头肌和胸大肌要强大得多。在Labor的整个过程中，子宫需要消耗很多的卡路里，而且在生孩子的过程中多数妈妈的胃口并不是太好，通常情况下摄入的热卡并不多，所以真正强大的是女人，是伟大的子宫，男人只是貌似强大而已。一旦遇到真正的挑战，往往首先撑不住的是男人，如果让女人的子宫肌和男人的二头肌＋胸大肌来一场“扳手腕”的比赛的话，赢的肯定是子宫。

既然生孩子相当于跑马拉松，需要消耗很多的能量，在分娩过程中照理应该好吃好喝才对，但很不幸的是，美国ASA（美国麻醉师学会）是不建议孕妇在分娩过程中吃东西的，只允许喝一些不含任何颗粒物的纯液体，例如水，ACOG（美国妇产科医师学会）也是采用了ASA的推荐。

中国的现状如何？

现状是百花齐放，有些医院从来不知道什么是ASA和ACOG，在分娩过程中，产妇照吃照喝，鸡蛋挂面和人参汤是一起上的。有些医院的正常分娩是助产士主导的，更加倾向于采取国外助产士的做法，对于低风险的产妇，是鼓励饮水和进食的。虽然和第一种的做法一样，但是根本的区别在于第二种做法是主动的选择，是有其相关的循证医学证据支持的。第三种是采用美国ASA和ACOG的做法，产程中不允许进食，只允许喝不含任何颗粒物的饮料，多数是要静脉补充液体的。

分娩过程中究竟能不能吃东西？

分娩过程中不允许吃喝是有历史原因的，还有一个专有的名词： “NPO” ，这来自于拉丁文“nil per os”，意思是“nothing by mouth，不能吃任何东西”。

NPO源自于1940年代，在那个年代，如果分娩过程中有指证进行剖宫产或者是进行分娩镇痛的话，采用的麻醉方式是吸入麻醉或者是注射药物让产妇入睡而感觉不到疼痛。那时候的麻醉技术还不是太安全，容易发生胃内容物返流吸入到肺部引起严重的并发症甚至死亡。所以，那时候提出NPO是有道理的。

但是，现在的麻醉技术已经有了很大的进步，已经变得很安全，而且在分娩过程中，无论是需要进行剖宫产还是实施分娩镇痛，采用的基本上是硬膜外或者是腰麻－硬膜外联合麻醉（epidural, spinal or combined spinal-epidural），很少有人用全麻。

在全麻使用很少的情况下，在吸入综合征发生很罕见的情况下，继续坚持NPO的意义在哪里呢？

其实，在分娩过程中禁食会导致产妇的满意度下降，消耗这么大还不让吃东西，心里不舒服啊。心里不舒服也就算了，禁食时间长了可能还会引起脱水或者是酮症，导致产妇出现恶心、呕吐、头痛或者是虚脱。虽然静脉补充液体可以解决脱水和酮症的问题，但是静脉补液会限制产妇的活动，躺在床上无法很好的起来活动，无法很好实施自由体位待产与自由体位分娩。

随着临床研究证据的积累，不同的学术组织对分娩期饮食的态度也在发生着变化，以下的学术组织是推荐低风险的产妇在分娩过程中可以根据自身的情况选择进食与饮水或喝饮料的。

世界卫生组织：The World Health Organization （WHO）（“Care in normal birth: a practical guide. Technical Working Group,”1997）

美国护士-助产士学会：The American College of Nurse-Midwives （ACNM）（“Providing Oral Nutrition to Women in Labor,” 2016）

英国NICE指南：NICE Clinical Guidance for the United Kingdom （Delgado Nunes et al.2014）

加拿大妇产科学会：The Society of Obstetricians and Gynecologists of Canada （SOGC）（Lee et al.2016）

但是，美国ACOG（妇产科医师学会）和美国ASA（麻醉师学会）的推荐依然是，低风险的产妇在分娩过程中不可以进食，可以饮水或喝饮料（不含颗粒物）。

The American College of Obstetricians and Gynecologists （ACOG）（Committee on Obstetric Practice, 2009）

The American Society of Anesthesiologists （ASA）（“Practice Guidelines for Obstetric Anesthesia,” 2016）

在最近发表的一个声明中，美国妇产科医师学会（ACOG）的态度发生了松动，虽然依然不建议在分娩过程中进食，但是认为支持这一做法的证据不足，需要进一步的审视和探讨（“Committee Opinion No. 687: Approaches to Limit Intervention During Labor and Birth,” 2017）。

说了这么多，我的看法是什么？

对于低风险的产妇（占了人群中的大多数）来讲，分娩过程中可以吃也可以喝啊，只要你觉得想吃，胃也能接受，就吃呗，就喝呗。


分娩过程中吃什么喝什么？

在临产以后和分娩过程中，你的胃口一般不会太好，也不一定能吃得下很多东西。所以食物的选择还是以清淡为主，有点类似平时感冒时吃的食物，要容易准备，吃起来方便，容易消化，不能太油腻，不能太辣，不能太咸，也不能太甜。

蛋白质：不要吃大鱼大肉，一是不一定吃得下，即使是吃得下也不好消化，还是建议吃一些容易消化吸收的蛋白质，例如鸡蛋、酸奶等。

碳水化合物：碳水化合物的选择就多了去了，有中式和西式，中餐还有南北口味的不同，面包、麦片、饼干、粥和面条都可以。很多人会选择鸡汤面、皮蛋瘦肉粥、小馄饨等。

水果与小食：各种水果包括苹果、香蕉、葡萄、瓜类都可以，有人很喜欢在分娩过程中吃些巧克力补充能量。

水与果汁：最简单的饮料就是水，但是中西方在饮水方面还是有区别的，中国人一般会推荐喝热水或温水，常温水也可以接受。但是国外的推荐是临产以后和分娩的时候嘴里含小的冰块，估计绝大多数的国人是无法接受的。可以喝各种果汁，特别是鲜榨的果汁，其中推荐最多的是椰子水，不仅是口感好，还富含很多的电解质。但是不推荐喝橙汁，因为橙汁可能会引起一些人的恶心或呕吐。

能量饮料：能量饮料可以给你快速补充水分、碳水化合物、电解质、矿物质和某些能量成分，让你的身体快速恢复，给子宫“充电”，适应生孩子这个“马拉松”的挑战。但是在选择能量饮料（运动饮料）的时候，要尽量避免那些含很多色素和果糖玉米糖浆的运动饮料。

除了能量饮料，还有人推荐鸡精。
本文作者：段涛医生
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 答案是肯定的。只要乳房产奶，就可以进行母乳喂养，但可能会面临挑战。通常宝宝只有含住乳晕才能有效转移乳汁，突出的乳头有助于他们找到乳头和含接乳房。妈妈乳头内陷时，宝宝找不到乳头，初生宝宝口腔又相对较小，吸吮力相对较弱，含接乳房会有困难；但随着宝宝的成长，小嘴能含住乳晕时就没问题了。

妈妈应该有明确哺乳目标：首先要保证乳房泌乳量和宝宝摄入量足够。可以先尝试亲喂；如果乳汁转移不足，可以进行吸乳，然后将吸出乳汁喂给宝宝；做到按需喂养，每日8-12次；同时要关注宝宝的大小便和体重变化。在此基础上，可以逐步进行尝试，熟能生巧，最后达到成功亲喂。

乳头内陷，如何实现亲喂？

首先，辨别真性内陷和假性内陷

乳头一般分为5个类型，具体见下表。妈妈可以测试一下，如果挤压牵拉乳头部位后表现为内陷，才是真性内陷。良性真性乳头内陷的发生率在1.7%-3.5%。

来源：Core Curriculum for Lactation Consultant Practice. Third Edition.2013: 271

其次，尝试和选择合适的乳头突出方案

哺乳前帮助乳头突出。可以按摩或冷敷乳头，或用任何可以产生负压的方法拉出乳头，如使用吸乳器等。宝宝找乳时，妈妈可以用食指从乳晕下部往里向上推，帮助乳头挺出来（图1）。

采用乳房三明治式喂养。这种方法适用于伸展性好的乳房。妈妈一手保持U型或C型托住乳房，同婴儿嘴巴平行方向压扁乳房，再塑“乳头”；另一手托住宝宝的头颈部，帮助宝宝找乳，确保宝宝张大嘴深含接。还可以挤出一些乳汁，维持宝宝持续吸吮（图2）。

采用乳头罩替代乳头（图3）。选择大小合适的乳头罩，能卡在乳头根部且不疼痛。注意同样要确保宝宝的嘴深含接在乳晕上。

乳头乳管保留矫正术。2016年发表在The Breast 杂志上的一篇关于良性乳头内陷治疗的系统综述给出了明确建议。对于真性乳头内陷，无创治疗是无效的；有创治疗分为乳管保留（图4）和乳管损伤（图5）二种矫正术，前者复发率低为0.6%，且不影响母乳喂养，后者复发率高为9.9%，并影响母乳喂养。因此，乳管保留矫正术是治疗真性乳头内陷的首选方案。备孕前，如果想进行乳头矫正，可以咨询乳腺外科医生。

最后，家庭支持和鼓励很重要

乳头内陷的妈妈会有内疚感，羞愧感，实施亲喂需要更多技巧和磨合，家庭成员如果说话不注意，会无意中伤害妈妈的自信心。应注意避免负面话语，如“宝宝吸不到妈妈的奶，好可怜！”“乳头条件不好，就不要尝试亲喂了，大人孩子都吃力”等。

我们可以换一种方式给予鼓励：“妈妈多和宝宝在一起，吃吃就会了”“先让宝宝吸，待会我帮你泵奶”，等等。事实证明，那些母乳喂养成功实施的案例都离不开家庭成员的鼓励和支持。
 
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人生苦短，孕期太长，及时行乐，好孕一场。

怀孕了，你婆婆可能会对你提很多的要求，你婆婆的儿子也可能会对你提很多的要求，你妈妈也可能会对你提很多的要求，你的产科医生也可能会对你提很多的要求，但是说归说，你自己大可不必太委屈自己。

人是社交动物，不能说怀孕了就完全停下来，啥事都不能做，连各种聚会也不能参加了。如果真的如此，那可就真的是10个月“有期徒刑”立即执行了，那你就真的就只是一个传宗接代的工具了。其实，十月怀胎的“有期徒刑”是可以保外就医的，是可以监外执行的，是可以及时行乐的，各种趴体还是可以参加的，不过有些“条例”是应该遵守的。

什么？不知道啥是趴体？

好吧，先普及一下概念。

趴体：就是party啦，是时下年轻人的说法，以前老的说法是派对。

轰趴：是家庭趴体，也就是home party，老头老太请老同事老朋友来家里那叫“聚餐”，年轻人不想和老人一样，所以就弄了个时髦的名字叫“轰趴”。

轰趴来的都是亲密好友，吃的都是家庭美食，玩的都是有趣游戏，放的都是轻松音乐，衣着不用很正式，氛围可以很轻松，可以有主题，也可以没有主题。

人以群分，物以类聚，怀孕以后，很多人会把你自动分类到另外一个“特殊群体”，各种明显不适合你的趴体大家就不会邀请你了，不过有些趴体还是可以参加的。

就算是别人不邀请你，你自己还可以呼朋唤友搞趴体的嘛，例如可以搞“大肚子轰趴”，“新手妈妈轰趴”。就像不养狗的人无法理解一帮养狗的人凑在一起为什么会有那么多的共同话题一样，没有怀孕生过孩子的人也无法理解大肚婆和新妈妈们嘴里的那些术语，也不会对这些话题感兴趣。

怀孕不仅仅会改变你的生理和心理，还会完全改变你的生活方式和社交圈，一旦10个月的“有期徒刑”结束，“刑满释放”以后，你就再也回不到过去了，因为你身上会长久地挂着一个小“拖油瓶”，你将会进入一个陌生的新世界。

好吧，新生活开始了，welcome to the new strange frustrating fascinating touching world.

准妈妈聚会趴体“三别”条例：

别端着

怀孕了，你就别去参加那些高大上的需要端着的趴体了，那是要着盛装、穿礼服、穿高跟、炫珠宝、秀手袋、扮高雅、比心机、吃不饱、穿不暖的。

别吵闹

夜店也就算了，音乐开得震天响，讲话喊得嗓子痒，啤酒喝得膀胱胀，就算你受得了，肚子里的宝宝受不了。你以前也年轻过了，也荒唐过了，也轻狂过了，也疯过了，也嗨过了，也玩过了，该太平了，该回归了，该收心了，该收手了。

肚子里的宝宝就是你人生旅途的刹车，宝宝也是你生活旅途的领航员，TA会带你去另外一条路：那里湖面总是澄清，那里空气充满宁静，那里大地充满生机，那里音乐总是轻松，那里气氛自然清新，那里阳光格外灿烂。

祝福你的人生从此与众不同。

别太累

孕期可以多参加一些轻松的家庭团圆会、闺蜜畅聊会、孕妈交流会等等，这些聚会有助于改善心情、增加孕育经验，能给孕妈的无聊生活增添更多的小情调。

觥筹交错尽虚佞，推杯换盏无真衷，各种的无聊应酬也就算了；通宵达旦搓麻将，废寝忘食喝老酒，这种不健康的玩法还是能推就推，能躲则躲吧。

对于四川女人来讲，闲在家里不打麻将，好像很难，要想玩得控制好时间，图个乐就可以，千万别粘在凳子上，久坐容易腰酸背痛，加重下肢水肿。

你的脸有几分憔悴，你的眼有残留的泪，你的唇美丽中有疲惫。

累了吧，散了吧，认了吧，算了吧，放了吧，早点回家着床吧。

怀孕不常有，趴体可以常有；

天大地大不如肚子大，情面重要朋友重要不如肚子里的宝宝重要。
 
本文作者：段涛医生
本文地址：http://www.wjbb.com/know/1811
原文出处：http://weibo.com/ttarticle/p/show?id=2310474145759703417809

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 母乳喂养很重要，母乳喂养问题多，你继续问，我继续为你回答。关于很常见的如何应对哺乳时乳头疼痛，特邀请我的同事，上海市第一妇婴保健院护理部副主任，新生儿护理专家，国际认证专业哺乳顾问（IBCLC）赵敏慧为大家解答这个问题。

什么是哺乳时乳头疼痛？

哺乳时乳头疼痛是早期母乳喂养最常见问题，与宝宝含接吸吮密切相关，表现为哺乳时妈妈乳头疼痛，哺乳后乳头变形、如果不予以及时纠正，长时间摩擦会使乳头表面形成水泡，继而发展为皮肤破损，疼痛进一步加剧。

早期哺乳时乳头疼痛通常发生在产后第2-3天，如果被忽略，对于妈妈来说，除了难以忍受的疼痛之外，乳头创面长期存在，还有可能会继发乳腺炎，乳房脓肿，也可能导致早期离乳。

哺乳时乳头疼痛的常见原因有哪些？

2017年发表在Breastfeeding Medicine一项大样本研究显示，有28.1%的妈妈在产后一周内经历了哺乳时乳头疼痛，9.6%的妈妈在产后第7天乳头疼痛仍然存在。导致乳头疼痛最常见的原因依次是不正确的喂养体位和含接（72.3%），宝宝舌系带过紧（23.2%）和妈妈产奶过多（4.4%）。而给予早期正确指导和处理后，大多数乳头疼痛和破损都可以在1-2周好转，不影响后期的纯母乳喂养率。

发生哺乳时乳头疼痛，妈妈如何应对？

首先，纠正宝宝含接乳房。

含接的正确部位是乳晕，宝宝嘴巴要张的很大，口角角度大于100度，嘴唇外翻吸附在乳晕上，舌头裹住妈妈乳头，将乳头稳定在上颚软硬颚交接处，达到深含接（配图1）。宝宝正真吸吮部位是乳晕而非乳头，哺乳过程中乳头是不痛的，只会在含接初期有些异样感觉，哺乳后乳头也是不变形的。妈妈切记：哺乳时乳头疼痛表明宝宝含接位置不对，应重新深含接，而不是强忍疼痛继续哺喂。如果发现哺乳后乳头变形，在下一次哺喂时，应尝试更深的含接。

正确的哺乳姿势对于保证宝宝正确含接和协调吸吮至关重要。哺喂时，宝宝头和身躯要在一直线上（宝宝耳、肩及髋部呈一直线），头略微后仰（宝宝的胸腹部紧贴妈妈腹部时才能做到）的V型姿势（配图2）。在该种姿势下，宝宝的下巴贴在乳房上，口腔上方能见更多乳晕，鼻孔可见，形成不对称含接（配图1）。而这样哺乳姿势，是宝宝呼吸道最通畅，吸吮-吞咽-呼吸最协调的姿势。妈妈可以尝试自己扭着头或低头吞咽，再与上述姿势做个比较，就能体会到其中的奥妙了。

其次，检查一下宝宝舌系带。

舌系带是舌底连接口底与舌的粘膜，正常情况下，宝宝舌尖伸出能超过下颌牙龈。舌系带过紧则限制了舌体自由前伸和上抬，宝宝通常只能含住乳头而非乳晕，吸吮时挤压乳头，乳头发生变形和疼痛。舌系带过紧发生率在3.2%-4.8%，如果有家族史，其发生率更高。约25%-44%舌系带过紧的宝宝会发生哺乳困难，妈妈乳头疼痛，乳量供应降低，宝宝体重增长不良和早期离乳。舌系带切开术可以治疗大多数舌系带过紧，舌运动自然纠正。如果妈妈发现宝宝舌系带限制了舌尖到达下颌牙龈和上抬，或舌尖端呈“V”或心型，哺乳时乳头疼痛，纠正含接后仍不能缓解，应考虑舌系带过紧（配图3）。可以带宝宝到儿童口腔专科就诊，听取医生的建议。

最后，感受一下乳汁流速。

乳汁流速过快时，宝宝为了控制母乳流速而咬住乳头发生乳头疼痛。这通常发生在妈妈喷乳反射时，宝宝摇头摆脑，握紧小拳头，TA是在控制乳汁流速，避免被呛到。当流速慢时，宝宝长时间的吸吮也会导致乳头疼痛。建议妈妈避免乳房过度充盈，可以先挤掉些乳汁再喂；流速慢时，也不要长时间无效吸吮，可以尝试增加哺乳频率。

哺乳正常情况下是不疼的。如果发生疼痛，要及时给予纠正。如果不能缓解，请及时咨询专业人士，爱婴医院母乳喂养门诊可以为大家提供专业母乳喂养指导。妈妈不要着急，如果暂时亲喂实施困难，可以先喂挤出的母乳，保证宝宝摄入，随后慢慢解决问题。

配图1  深含接（口角角度大于100度，嘴唇外翻吸附在乳晕上，舌头在上颚软硬颚交接处），不对称含接（下巴贴乳房，口腔上方有更多乳晕，鼻孔可见）

来源：Breastfeeding: Learning the Dance of Latching. ILCA’s INSID TRACK. Journal ofHuman Lactation, 2007,23(1) :111-112.


配图2  正确哺乳姿势，宝宝头和身躯在一直线，宝宝腹部与妈妈腹部相贴，头略微后仰的V型姿势

来源：CoreCurriculum for Lactation Consultant Practice. Third Edition. 2013: 510
                                                          

配图3 舌系带过紧，舌系带限制了舌的运动，成V型

来源： My Baby Has Tongue-Tie: What Does This Mean?ILCA’s INSID TRACK. Journal of Human Lactation.2014, 30(2):244-245
 
本文作者：赵敏慧
本文地址：http://www.wjbb.com/know/1810
原文出处：http://weibo.com/ttarticle/p/show?id=2310474144676855750175 收起阅读 »