浓缩版
Bullying and harassment are often used interchangeably when talking about hurtful or harmful behavior. They are very similar, but in terms of definition, there is an important difference.

Bullying and harassment are similar as they are both about:

• power and control
• actions that hurt or harm another person physically or emotionally
• an imbalance of power between the target and the individual demonstrating the negative behavior
• the target having difficulty stopping the action directed at them

 The distinction between bullying and harassment is that when the bullying behavior directed at the target is also based on a protected class, that behavior is then defined as harassment. Protected classes include:

• race
• color
• religion
• sex
• age
• disability
• national origin

 
完整版

Although bullying and harassment are often used interchangeably when talking about hurtful or harmful behavior — and the behavior may look the same — there are important distinctions in the definition, laws, and protections for students experiencing harassment.

The first difference is in the definitions of bullying and harassment. For bullying, it’s important to note that while definitions vary from source to source, most agree that an act is defined as bullying when the behavior hurts, harms, or humiliates another person physically or emotionally. Those targeted by bullying behavior struggle to defend themselves and stop the action directed at them. There also is an “imbalance of power.” This means the student demonstrating the bullying behavior has more power; this can be physically, socially, or emotionally (for example, a higher social status, physically larger, or emotionally intimidating).

The definition of harassment outlines that the behavior is similar by its unwanted and hurtful actions. It can include unwelcome conduct such as verbal abuse, graphic or written statements, threats, physical assault, or other conduct that is threatening or humiliating, but the negative behavior is based on a student’s race, color, religion, sex, age, disability, or national origin. For example, bullying behavior meets the threshold of harassment when a student is being verbally bullied with demeaning language about their disability.

Students experiencing harassment also have protections at the federal level. The Office of Civil Rights (OCR) and the Department of Justice (DOJ) have stated that bullying is considered discriminatory harassment when based on a student’s race, color, religion, sex, age, disability, or national origin. If a student is experiencing discriminatory harassment, federally funded schools are obligated under federal law to address the behavior.

If you’re looking for more information on how schools are required to address the behavior, visit stopbullying.gov.
 
中文翻译：
本文地址：http://www.wjbb.com/know/1779
原文出处：http://www.pacer.org/bullying/resources/questions-answered/bullying-harassment.asp 收起阅读 »

 浓缩版
Bullying is different from conflict.

Conflict is a disagreement or argument in which both sides express their views.
Bullying is negative behavior directed by someone exerting power and control over another person.
Bullying is done with a goal to hurt, harm, or humiliate. With bullying, there is often a power imbalance between those involved, with power defined as elevated social status, being physically larger, or as part of a group against an individual. Students who bully perceive their target as vulnerable in some way and often find satisfaction in harming them.

In normal conflict, children self-monitor their behavior. They read cues to know if lines are crossed, and then modify their behavior in response. Children guided by empathy usually realize they have hurt someone and will want to stop their negative behavior. On the other hand, children intending to cause harm and whose behavior goes beyond normal conflict will continue their behavior even when they know it's hurting someone.

完整版

Why conflict isn’t all bad and why no one ever deserves to be bullied

If you are in a relationship with another human being, whether it’s a good friend or just someone who sits next to you in school, the chances are pretty good that you will be in conflict with that person at some point or have already had a conflict with that person. Where there are two people in a relationship, there likely will be disagreements and changes.

One friend might want to play video games; the other might want to go outside. One friend wants to go shopping; the other really doesn’t like shopping. Your classmate always wants to be first in line and so do you. Your brothers fight over who has a bigger part of their room, trying to make sure it’s exactly the same down to the inch. Things like that happen every day.

Conflict is a natural part of human relationships as people grow and change. Even though it can cause us stress and can hurt, conflict is not bullying. Conflict happens between two people who are equal in the relationship (think: friends or classmates or co-workers) but have two different points of view about what’s going on. Sometimes this escalates into a disagreement that’s so strong people become really emotional. There might be strong words used and lots of big feelings involved. It may take time to sort things out.

In conflict, when things are equal between people, both sides usually want the issue to be resolved. They don’t want the conflict to keep going on; they want to make things better and they want the relationship to continue in a healthy way. Neither person wants to keep hurting the other, so both people will try to do things to improve the situation. Sometimes, conflict can even be helpful in a relationship that needs to change, providing an opportunity to improve something that’s not going right between the parties.

With bullying, the person (or group of people) who is doing the bullying means to hurt the other person. The hurt or harm is done on purpose to make the bullying target feel like less of a person. There is always something unequal about the relationship between the two people; maybe the person bullying is physically stronger and creates fear because of that, or maybe the person bullying is more popular and has the kind of social power that can turn a whole group against one person.

Whichever type of power a person with bullying behavior has, they will use it over the person who is being bullied to make them feel less than who they are. Of course, the person who is being bullied does not want this treatment and did nothing to deserve being treated this way.

Bullying scenarios might look like this: Someone convinces a group to tease another student based on their looks; someone threatens to beat a person up because of how they talk; somebody posts something untrue and hurtful online about someone else; or someone trips a classmate and makes everyone laugh at the person falling down. The harm is done deliberately and the intent is to cause the other person to suffer in some way.

The bullying behavior is usually repeated, or threatened to be repeated, over and over. Someone who is bullying may decide to leave out a friend by giving them the cold shoulder and excluding them from group activities. Someone may use a false statement or other mean word toward another every time they see them, or go on social media in an attempt to damage their reputation. Even the threat of behavior like this causes unwanted and undeserved pain for the target.

Think about it this way:

• Conflict, while sometimes uncomfortable, can be an opportunity for equal partners in the situation to learn how to solve problems. This will happen by both people working the problem out through healthy and positive means.
• Bullying is done by someone perceived to be more powerful than the target and is unwanted, negative, and meant to cause harm to the bullying target through physically or emotionally damaging means that are repeated or threatened to be repeated.

 The next time you are in a conflict with someone (and there will likely be a next time!), try and remember that inside every conflict is a hidden opportunity to make your relationship better by learning to speak up for yourself and express your needs. Remember that conflict between two human beings is normal and is bound to happen.Remember as well, that bullying is not the same as conflict. Bullying is meant to cause hurt or harm. Bullying is not something that anyone deserves to have happen to them and they have the right to feel safe.Conflict ResolutionThe difference between bullying and conflict is important to note, because conflict resolution or mediation strategies are sometimes misused to solve bullying problems. These strategies can send the message that both children are partly right and partly wrong, or that “We need to work out the conflict between you two.” These messages are not appropriate in cases of bullying (or in any situation where someone is being victimized). The appropriate message to the child who is being bullied should be “Bullying is wrong and no one deserves to be bullied. We are going to do everything we can to stop what is happening to you.”Teen Perspective:In one way or another, conflict is a part of everyday experience. Even if it is something small, which it typically is, there is the constant navigation of the complexities of human relationships. This is normal, and minor conflicts typically don’t make someone feel unsafe or threatened.The questions to ask yourself when you are unsure about the tone of a certain conversation or encounter to determine if it is bullying include:

• Are we equals in this situation?
• Do I feel victimized or targeted by an individual or a group?
• Do I feel safe?
• Do I feel that the person or group has intentionally hurt or humiliated me?

Sometimes, it can be easy to minimize a bullying situation because you don’t really want to deal with the realities of what is happening to you. It is easy to get into a pattern of qualifying bullying as conflict in order to avoid facing the actual problem, when really it is something that you don’t deserve and something that requires outside intervention. It can be helpful to ask these questions to yourself, as it can help you sort out the reality of your particular situation.Blog PostIs it a Conflict or is it Bullying? Helping Our Kids Learn the Difference.Written by staff at PACER's National Bullying Prevention CenterThird graders Nick and Kevin weren’t close friends, but they played foursquare together every recess they could. They battled every point during games that were always loud because the foursquare group was serious about the game. There were often disagreements about fouls and rules but they were generally able to work it out. The adults on recess duty did a nice job of monitoring the players, and they carried laminated sets of rules in case the players needed “help” with disputes. Yet, “It’s not fair!” was often shouted across the playground during recess.One day Kevin came home and told his mother, Jennifer, that he’d been bullied. Jennifer, alarmed, asked for details.“Nick pushed me on the playground,” Kevin said. He told Jennifer that he and Nick had argued about a ball that was “on the line,” and that a teacher asked both boys to sit on the bench to cool off during the rest of recess. “It’s not fair! He started it, but we both got punished,” Kevin said. Kevin didn’t think that Nick’s apology was punishment enough.Had Nick bullied Kevin? Was Nick too aggressive, but not to the point of bullying Kevin? Or were both boys at fault? Jennifer wasn’t sure what to think. She called the school to ask for more details.When a parent hears a story like this, it isn’t always clear what has happened or what the consequences should be. Jennifer was torn between feeling she might not have heard the whole story, and wanting to fix things for Kevin.Here are some helpful ways to distinguish between a conflict and bullying behavior:Conflict looks like:

• Disagreement or argument in which both sides express their views
• Equal power between those involved
• Behavior usually stops when one child realizes they are hurting another

 Bullying looks like:

• Intent of behavior is to hurt, harm, or humiliate
• Person bullying has more “power” such as being more popular or physically stronger
• Negative behavior continues even when hurt or harm occurs

 It can be hard for parents when their children are involved in difficult, confusing situations. Nevertheless, it’s important for parents to realize that conflict between children is inevitable – and that sometimes their child won’t like or agree with the outcome. Parents can help their children handle these situations by:

• Asking open-ended questions about what happened
• Listening more than talking
• Offering support
• Helping their child problem solve

 
It’s easier for a child to confide what is happening to them when they know their parent is in their corner. Conflict situations are great teachable moments. Parents can help their children learn the skills necessary to express their own views and help create their own solutions.

A cautionary note: if behavior crosses the line from conflict to bullying, it’s not up to the child being bullied to fix the situation. While it can be important for the child to help create a plan for change, adults are responsible for making and enforcing rules so that all the children involved are safe.
 
中文翻译：
本文地址：http://www.wjbb.com/know/1778
原文出处：http://www.pacer.org/bullying/resources/questions-answered/conflict-vs-bullying.asp 收起阅读 »

 浓缩版
Bullying is an intentional behavior that hurts, harms, or humiliates a student, either physically or emotionally, and can happen while at school, in the community, or online. Those bullying often have more social or physical “power,” while those targeted have difficulty stopping the behavior. The behavior is typically repeated, though it can be a one-time incident.

Students often describe bullying as when “someone makes you feel less about who you are as a person.”

Note: Definitions vary greatly. These are not legal definitions. Find your state’s law and definition at StopBullying.gov
 
完整版

What is bullying? At first glance, it might appear that this behavior is easy to define. A common image of bullying might be of a physically intimidating boy beating up a smaller classmate, or of one child shoving another inside a hallway locker. While that is still considered bullying, it's important to know that bullying behaviors can be much more complex and varied than historical stereotypes.

For example, while some bullying is physical and easy to recognize, bullying can also occur quietly and covertly, through gossip or on a smart phone or the internet, causing emotional damage.

As a starting point, there are elements that are included in most definitions of bullying. Although definitions vary from source to source, most agree that an act is defined as bullying when:

the behavior hurts, humiliates, or harms another person physically or emotionally, and
those targeted by the behavior have difficulty stopping the action directed at them, and struggle to defend themselves, and there is also a real or perceived “imbalance of power,” which is described as when the student with the bullying behavior has more “power,” either physically, socially, or emotionally, such as a higher social status, or is physically larger or emotionally intimidating, and
repetitive behavior; however, bullying can occur in a single incident if that incident is either very severe or arises from a pattern of behavior


Many definitions also include:

• The types of bullying: The behavior can be overt and direct, with physical behaviors such as fighting, hitting, or name calling, or it can be covert with emotional-social interactions, such as gossiping or leaving someone out on purpose. Bullying can also happen in person, online, or through smart phones and texts.
• Intent on the part of the student with bullying behavior: “It is intentional, meaning the act is done willfully, knowingly, and with deliberation to hurt or harm.” But there is some controversy with this statement as some assert that not all bullying behavior is done with intent or that the individual bullying doesn’t always realize that their behavior is hurting another individual.
• Distinction about amount and duration: Many definitions indicate that bullying is “repeated,” but the reality is that bullying can be circumstantial or chronic. It might be the result of a single situation, such as being the new student at school, or it might be behavior that has been directed at the individual for a long period of time.
• The implications for all students: It is also important to note that bullying is not just about the implications for those targeted by the behaviors, but that the behavior can impact all students in the school, including those who witness the behavior and those that engage in the behavior.
• Additional factors: These can include the differentiation between bullying and harassment, enumeration of protected classes, statements around the use of technology, how the behavior impacts educational performance, and the physical locations that would fall under the jurisdiction of school sanctions.

Students often describe bullying as when “someone makes you feel less about who you are as a person.”

Note: This is not a legal definition. Rather it is a way to help students understand what bullying is. For a legal definition, consult your state’s law on bullying. You can find your state’s law at StopBullying.gov.
 
中文翻译：
本文地址：http://www.wjbb.com/know/1777
原文出处：http://www.pacer.org/bullying/resources/questions-answered/how-is-bullying-defined.asp 收起阅读 »

您和你5个月大的宝宝一起在阳光明媚的沙滩上沐浴阳光，您给自己涂上了厚厚的防晒霜，那么您5个月大的宝宝是否也应该涂上防晒霜呢？美国食品和药品管理局（FDA）的儿科医师Hari Cheryl Sachs博士告诉我们，答案是一般不要（Not usually）。

Sachs博士说：“6月龄以下的婴儿应该尽可能在户外接触到充足的阳光，但是应当避开早上10点至下午2点这段时间，因为这个时间段的紫外线太强了。”
对于儿童和成人来说，防晒霜是一种推荐的防晒方式。为什么婴儿就不一样了呢？

Sachs博士解释说：“和成人相比，婴儿的皮肤屏障发育并不成熟，同时相较于年长的儿童和成人，婴儿的体表面积/体重的比值也更大。这两方面则意味着婴儿的皮肤会接触更多防晒霜中的化学成分，增加了防晒霜的副作用的风险。”

Sachs博士说到：“对于婴儿来说，最好的防晒方式是待在阴凉处。如果户外没有树荫或者房檐等阴凉处，您可以自己动手给婴儿推车加上一把遮阳伞或者遮阳棚。如果您所处的地方这些办法都无法使用，应该咨询您的儿科医生有关婴儿防晒的相关事宜。”

遮挡阳光

美国儿科学会（AAP）建议，在户外时为了防止婴儿晒伤，应当给婴儿穿戴轻便的长裤长袖衣服并带上遮住颈部的宽檐帽。质地紧密的衣服比质地稀疏的衣服防晒效果好。同时也应当注意，虽然棒球帽很可爱，但是它不能遮挡颈部和耳朵处的阳光，这两个部位也是婴儿容易晒伤的地方。

夏季的高温天气也给婴儿带了一些其他的挑战。

Sachs博士说：“在高温坏境下，出汗是一种非常重要的散热方式，但是小婴儿的这项功能并没有发育完全，它不能像成人一样通过汗液蒸发来带走多余的热量。所以你应当确保宝宝不会过热。同时在高温坏境下，婴儿也很容易发生脱水，应当不时的给他们喂一些配方奶或者母乳，这两种食物都能保证他们获得充足的水分。”

婴儿防晒贴士

以下是一些6月龄以下婴儿的夏季户外防晒建议：

1.尽可能地让宝宝待在阴凉处；
2.在给宝宝使用任何防晒霜之前都应当咨询儿科医生；
3.保证宝宝穿的衣服能遮住全部皮肤并且有防晒作用。一个常识：把宝宝的衣服放在您手上，如果衣服很透您能看见自己的手，那么这样的衣服就不具备防晒效果；
4.给宝宝带上能够遮阴的宽檐帽；
5.时刻关注宝宝是否出现了晒伤和脱水的症状，这些症状包括：易激惹、皮肤泛红和哭闹不止；
6.如果宝宝晒伤了，应当立即到阴凉处避免阳光直射，并且在晒伤的部位冷敷；
7.补水！在阳光下应每隔几分钟就给宝宝喂一点母乳或者配方奶，同时注意要使用冷藏杯来储存防止它们变质。

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：2016年6月6日
发布日期：2012年6月24日
 
中文翻译：木夕
本文地址：http://www.wjbb.com/know/1776
原文出处：https://www.fda.gov/forconsumers/consumerupdates/ucm309136.htm 收起阅读 »

如果你很关心家里的狗狗，请谨慎行事，不要在吃东西的时候会时不时地丢给它一些你的食物。一些人类的食物对于狗来说可能是有害的，甚至是致命的。

人类和动物在饮食方面有何不同？

美国食品与药品监督管理局的兽医Carmela Stamper博士说：“动物机体处理食物的方式和人是完全不同的。人体可以分解食物和其中的一些化学成分，但是狗狗却不行。”

她解释道:“虽然人类有时候会对食物产生严重的过敏反应，但狗狗却不会。狗狗对于食物的过敏反应更多的表现在皮肤和耳朵上。”

此外，一种食物可能只对一个品种的狗狗有害，而对其他品种的狗狗却没有什么影响。这种现象和很多因素有关，包括狗狗的基因组成、体型和它摄入食物的数量。Carmela Stamper博士解释说：“一条大型拉布拉多犬摄入一小节黑巧克力不会有什么问题，但是如果换做是一只吉娃娃则会引起严重的疾病。

特别注意哪些食物不能喂给狗狗吃？

Stamper博士说：“在夏季，我们要格外小心在野餐和烧烤时吃的食物。”下面这些食物你应当拒绝喂给你的狗狗：
 

• 生肉。生肉中含有大肠杆菌、沙门氏菌和其他有害细菌。举个例子，当你在制作汉堡包肉饼、牛排和鸡胸肉这些烧烤食材时，请确保它们远离你的爱从厨房叼食物的狗，你在处理生肉时给它们一两块没有任何好处。Stamper博士提醒大家：“食品安全对你和你的宠物都同样重要。”不要用手直接抓生肉喂给你的狗狗，除非你会及时洗手。反过来也一样。Stamper说到，“人们会因为给宠物直接用手喂食后不洗手，再用手直接吃三明治或者披萨而感染疾病。”
• 葡萄、葡萄干、黑加仑可损伤某些狗狗的肾。Stamper博士说：“并非所有的狗狗吃了这三种食物都会发生肾损害，但是如果你是因为想给你的狗狗提供一个营养全面的健康饮食，那你就大错特错了。”那么其他的水果能不能给狗狗吃呢？Stamper博士说：“苹果和香蕉是可以喂给狗狗的。但是你要确保你喂给狗狗的只是苹果，而没有苹果核。”
• 油炸食品和高脂食品不仅仅能使你的狗狗感到肚子疼，还可能引发一种威胁它们生命的疾病-胰腺炎。即使你的狗狗眼巴巴的望着这些食物，你也一块也不能给它们。
• 发霉的食物人不能吃，狗狗也不能吃。如果你把发霉的奶酪或者汉堡包面包扔进了垃圾桶，请确保你的狗狗翻不到这些垃圾。同样的，如果你的堆肥堆是你的狗狗经常去的地方，也要确保你的狗狗够不着那些发霉的残羹剩饭。
• 洋葱、大蒜和葱（包括洋葱粉和大蒜粉）对你的狗狗有害，特别是大型犬。如果你放了很多洋葱粉和大蒜粉在你的萨尔萨辣酱、腌泡汁或豆子里，请确保你的狗狗吃不到这些食物和食物残渣。
• 过咸的食物也不利于你的狗狗的健康。Stamper博士说：“给狗狗喂一两片薯片或者椒盐脆饼不会对它们的健康造成危害。”但是如果你的狗狗吃了整整一包薯片或者椒盐脆饼，那么就有问题了。这时候，应当确保你的狗狗摄入足够多的水。

 
另外两种狗狗不能吃的食物成分
夏威夷果（Macadamia nuts）会对狗狗的健康产生严重的危害。如果你外出野餐时打包了白巧克力夏威夷坚果饼干，请把饼干妥善的放在野餐盒里并且不会被狗狗吃到。

最后，很多狗主人知道巧克力不能喂给狗狗吃，但是他们也许不知道木糖醇（许多无糖食品中使用的一种糖替代品）对狗狗来说是致命的。木糖醇广泛应用于无糖口香糖、无糖糖果、无糖口腔用品和一些花生酱或者其他坚果酱中。Stamper博士说：“如果你习惯给你的狗狗的药丸上涂一层花生酱，或者把花生酱放在它们的咀嚼玩具中，请仔细检查花生酱的食物成分配料表，确保其中不含木糖醇。

关于猫的一些建议

为什么我们重点关注了狗吃的食物而没有提及猫呢？Stamper博士说：那是因为相较于狗而言，猫对食物非常挑剔，而且也不容易摄入那些对它们有害的食物。Stamper博士补充说：但是猫对洋葱、大蒜、洋葱粉和大蒜粉非常敏感，所以应当确保提供给它们的食物中不含有这些成分。

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。

发布日期：2016年7月21日
 
中文翻译：木夕
本文地址：http://www.wjbb.com/know/1775
原文出处：https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm512230.htm 收起阅读 »

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这是很常见的问题，生完孩子以后，婆婆也经常会给你多准备一些各种各样的荤菜，虽然在你怀孕之前，她通常是会把这些好吃的东西留给她儿子的。但是一旦怀孕以后，特别是生完孩子母乳喂养的时候，婆婆会特别的关心你，把儿子扔在一旁，鸡鸭鱼肉的把你伺候好，你心里可能也会明白，这是为了她孙子或孙女的。

好了，挑拨婆媳关系的话不能说多了，不然婆婆看了会真的不开心的。

问我这个问题的可能是产妇本人，也可能是婆婆，不过无所谓啦，其实大家的目的是一致的，就是想办法给宝宝带来更多的营养。

其实，有研究表明，无论你是采用什么样的食谱，母乳的成分其实基本上不会有很大的改变，吃燕窝海参与吃普通的鸡鸭鱼肉没什么两样。

当然，吃的东西不同，采用不同的油盐酱醋辣椒大蒜调料，母乳的口味上可能会有些不同。爱吃辣的妈妈们，未来宝宝长大了，会很自然的喜欢和习惯吃辣，因为乳汁中细微成分的改变会帮助宝宝塑造口味。有人做过母乳研究，发现烧菜使用盐比较多的妈妈的母乳中，钠的含量会比较高，也就是说妈妈的奶比较“咸”一些。

所以，母乳还是有地方风味的，也是有个人风味的。但是除此之外，其他的成份的变化不是太大。

所以，对于母乳喂养的妈妈来讲，吃什么不必太讲究。原则上是适量、均衡、多样化，只要荤素搭配好就可以了，关键是合乎自己的口味，喜欢吃，吃得下。

哪怕退一万步讲，你就是一点荤菜不吃，也没那么可怕。

在中国，估计大约有5000万素食者，这个数字还在逐年上升，吃素的孕妇和母乳妈妈会越来越多。

同是素食者还有不同，Veggie 和Vegan还是不一样的。

Veggie（素食主义者）：这些人不食用飞禽、走兽、鱼虾等动物类食品，只吃粮食、蔬菜和水果等植物，世界各国或不同文化中的素食主义有所不同，有些素食主义者可食用蜂蜜、奶类和蛋类等“荤菜”。

Vegan（严格素食主义者）：这些人只吃素食，连奶、蛋、蜂蜜等食品也不吃，甚至不使用动物制品如皮革、羊毛等。

在自然界，很多食草类的哺乳动物从来不吃荤，生出来的孩子照样挺好的，我们喝的牛奶就是只吃草不吃肉的牛妈妈分泌出来给牛宝宝吃的。在几百年前，人类也很少有机会吃荤的。对于素食者来讲，如果自己可以接受，怀孕后可以吃些荤菜；如果不喜欢，完全没有必要逼着自己吃荤，但是饮食结构还是要进行适当调整的。在整个孕期，如果能调整平衡好饮食结构，素食者唯一需要额外补充的只有维生素B12。

我们的身体非常神奇，我们的母亲非常伟大，无论妈妈吃什么，我们的身体总能很好地分泌高质量的母乳。
 
本文作者：段涛医生
本文地址：http://www.wjbb.com/know/1774
原文出处：http://weibo.com/ttarticle/p/show?id=2310474137062394665153 收起阅读 »

 孩子生完了，每天你都会很忙，但是忙来忙去就是那几件事，每天要考虑的无非就是：如何喂孩子，孩子哭了怎么办，如何能多睡一会，如何减轻体重。

产后减轻体重有三大法宝：管住嘴、迈开腿、喂母乳，和平时不一样的就是多了一个。

如果你在整个孕期体重控制的比较好，减肥起来就不会有太大的障碍和困难，通常几个月就可以恢复孕前体重。但是如果你孕前就超重或者是孕期体重增加超标，可能会需要更长的时间才能达到减肥的目标，可能会需要1年，甚至1年以上。

如果孕期体重控制不好，产后体重也控制不下来，那么你未来保持超重的概率会非常大。

不着急

你身上这些膘是花了10个月贴上去的，别指望很快就能去掉，得慢慢来，不着急。一般的规律是，在产后42天来进行检查时会把整个孕期增加的体重减去一半，剩下的一半会在产后6-12月之间减下来。

减重太快并不好，因为快速减重需要严格的饮食控制，运动量比较大，不利于身体健康状况的恢复。

一般在宝宝满2个月以后再考虑减轻体重的各种措施，不要给自己太大的压力，每周减轻体重的目标一般不要超过1斤。

不要节食

对多数妈妈来讲，正常的，健康的，平衡的饮食会自然的让你逐渐减掉怀孕以来增加的体重，没有必要节食，是可以尽情享用美食的。

产后饮食的原则是：不要节食、量要够，但是也不要超量。

也就是说不要多吃，也不要少吃，正常就可以了。正常的吃一日三餐，如果中间饿了，可以加一些卡路里比较少的餐点，例如苹果，橙子，胡萝卜，全麦的小饼干，酸奶等。

如果正常饮食减轻体重的效果不明显，可以控制饮食，通常要每天减少大约500卡路里的摄入，但是每天的卡路里的摄入总量不要低于1800卡路里，因为总的热卡太少会影响母乳的分泌量。

均衡营养的食物搭配

和孕期一样，哺乳期妈妈的饮食依然要遵循适量、均衡、多样化的原则，在选择食物的搭配时要考虑到有足够的营养，但是卡路里和脂肪的含量不要太高。

还可以继续服用多种维生素，因为你自己的饮食搭配很难能够做到各种维生素、矿物质和营养要素的平衡。

各种的海鲜特别是海鱼是很好的选择，例如三文鱼等，因为这些海鱼身体里含有大量的DHA，对孩子的大脑神经系统的发育是有益处的。

你身体的恢复和孩子的生长发育还需要蛋白质，所以食物中要包括瘦肉类，蛋禽类，以及富含植物蛋白的豆类。

当然，不要忘记多喝牛奶，因为母乳喂养时你身体的钙质会通过乳汁传送给宝宝，你需要及时的补充钙质。

如果对牛奶不耐受，可以考虑喝酸奶。如果不喜欢喝牛奶或者酸奶，可以考虑继续服用钙片。

多喝水

要多喝水，不要喝含糖的饮料，包括果汁。

多喝水有好处，首先是水喝多了你吃的就会少一些，还有多喝水可以帮助你加快新陈代谢。

喝水的量够不够可以用两个最简单的方法来判断，首先是小便的颜色，颜色深说明喝水不够。其次是小便的次数，喝水够的话一般每3-4小时会小便一次。

多运动

运动可以帮助你消耗更多的卡路里减轻体重，还可以让你的骨骼和肌肉更强壮，帮助你有好的情绪来对抗抑郁。运动以后你会有一定程度的疲劳，这可以帮助你克服睡眠障碍，睡得更香更好。

对于顺产的妈妈，一般建议产后2个月以后可以开始恢复运动，一开始的时候不用太着急，先恢复到孕前60-70%的运动强度和运动量，然后逐渐增加运动量，一般产后3-4个月基本上可以恢复到孕前的100%的运动强度和运动量。

如果是剖宫产，可以在3个月以后逐渐恢复运动，但是2个月以后可以先开始多散步。

最简单和有效的方式是快步走，逐渐过渡到慢跑和快跑，还可以配合游泳和瑜伽。

母乳喂养

母乳喂养是否能帮助减轻体重还是有一定争议的，但是支持的证据会更多一些。支持母乳喂养可以帮助减轻体重的理论依据主要有两点：一是母乳中是含有一定量的脂肪的，坚持4-6个月的母乳喂养可以让你至少带走1kg的脂肪。二是母乳喂养时你会大约每天额外消耗大约300卡路里的热量，当然这额外消耗的卡路里可能会在饮食中自动补充回来的。

母乳喂养时不建议减重太快，如果每周减重超过1斤以上的话，就有可能会影响乳汁的分泌。

保证睡眠

睡得好，减重的效果才会好。睡得少压力大会让你释放更多的皮质激素和其他的压力相关的激素，这会让你增加体重。

睡不好，心情不好，你也不大会主动的去运动，这是一个恶性循环。

很多人会采取“宝宝睡，我也睡”的方法，保证每天能睡足7-8个小时。

寻求专业帮助

如果以上的各种方法你都很认真地去尝试了，但是依然没有效果，那你就不要自己去瞎折腾了，最好去寻求专业医生的帮助，特别是营养师的指导和帮助。
 
本文作者：段涛医生
本文地址：http://www.wjbb.com/know/1773
原文出处：http://weibo.com/ttarticle/p/show?id=2310474135570065504258 收起阅读 »

 每年的8月1日-7日是世界母乳喂养周，今年的主题是“母乳喂养，共同坚持”。为了配合世界母乳喂养周，特准备此文献给大家。

都说母乳喂养好，执行起来困难可真不少。母乳喂养坚持不易，这需要医务人员和新妈妈们共同携手，一起努力，才有可能真正做到保护、支持和促进母乳喂养。

母乳喂养的宣传是个理念问题，但是真的要去做的话，就成了技术问题。单纯喊口号是没有意义的，有很多的问题需要技术解决方案。

多数情况下，母亲都能通过哺乳抚养自己的婴儿，母乳喂养说简单其实也很简单，顺其自然就好，宝宝想吃，乳汁就来了。

但是，对于不少的新妈妈来讲，母乳喂养可真的没那么简单：产后最初2天，初乳少，宝宝排出胎粪，生理性体重下降，妈妈好担心：家里人都说我奶少，宝宝哭吵，喂不饱，要不要加配方奶？产后第3-5天开始，乳房开始变得沉甸甸，有些甚至会肿胀变硬，疼痛加剧，发低烧，怎么办？要不要找开奶师？去哪里找开奶师？最好开奶师能够帮助疏通乳房，缓解疼痛。

其实，乳房的这些表现都是再正常不过的泌乳生理过程，不要过于担心。为了给大家更专业的解答，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。

产后2天，乳汁少，宝宝吃不饱怎么办？

首先，我们要明白，这是一个很正常不过的泌乳生理过程。乳房不像水龙头，乳汁也不是水龙头里的水，你一打开它就会来。

在孕期雌激素刺激乳房导管发育，而孕酮刺激乳房腺体发育，同时也抑制乳房中的泌乳素受体，这也是为什么孕期乳房罩杯会变大，但是没有泌乳现象的原因。

随着分娩后妈妈孕酮水平下降，刹车解除，乳腺腺体开始接受泌乳素的作用，生产乳汁的马达就开始运转起来了，催产素收缩乳腺导管发生泌乳。而刺激泌乳素和催产素分泌的油门是来自婴儿对乳房频繁吸吮，感觉刺激从乳头传输到下丘脑，刺激垂体释放催产素和泌乳素进入血液传送到乳房。

一般这个大量产奶的过程需要2天时间，正常情况下，在产后最初的48小时，妈妈泌乳都很少，在产后48～96小时乳汁产量才会明显增加。这就解释了上面我们说到的几乎所有妈妈都会经历的泌乳过程。

为了证明这个过程的真实存在，给大家看一篇大样本数据，这篇文章发表在2015年1月儿科权威杂志PEDIATRICS上面。研究者分析了美国北加州一家医院2009-2013阴道分娩的孕周≥36周的纯母乳喂养的新生儿共8.3万人次的体重变化发现，新生儿平均体重下降在产后24h是4.2%，48h是7.1%，72h是6.4%，在产后48h不久之后，所有新生儿的体重都开始回升了，对于纯母乳喂养的新生儿来说，体重回升意味着摄入妈妈乳汁的增加。认识到这一点，妈妈们要做的事情就是让宝宝早吸吮、频繁吸吮（每天至少8次）、按需喂养。

宝宝是妈妈最好的“开奶师”，宝宝早期的频繁吸吮，能把原本储存在乳房中的初乳吸出，疏通乳房导管，为后面大量下奶腾出空间，妈妈乳房肿胀也会轻些；另外吸吮时频繁的刺激乳头，油门踩的越足，妈妈的泌乳潜能就会被激发越大。

初乳量不多，但为新生儿提供了丰富的浓缩营养，对于健康足月新生儿，每天8-12次的哺乳完全能满足新生儿的能量需求。当然，刚开始母乳喂养时妈妈看不到宝宝到底吃了多少，担心自己的初乳不能满足宝宝的需求，这是完全可以理解的。这可以通过监测宝宝的大小便次数和体重情况来间接反映，一般新生儿出生后前5天的小便次数与其出生天数相符，3天将在子宫里积攒的墨绿色粘稠的胎粪排出后逐渐转为绿色过渡便，第5天转为黄色母乳便。正常新生儿生理性体重下降不超过出生体重的10%，在第10天恢复到出生体重。

的确，有些妈妈由于一些原因大量下奶的时间会延迟，比如剖宫产，妊娠糖尿病等，或新生儿转移乳汁不够，比如舌系带紧，吸吮力不足等，这些都会通过新生儿排出量减少，体重下降过多表现出来。一般在医院里，体重下降超过7%，宝宝就会被重点关注和给予加强喂养。因此，妈妈们要淡定，是否要加配方奶，由儿科医生说了算，爱婴医院是你们坚强的后盾，为母乳喂养保驾护航。

产后3-5天，乳房肿胀怎么办？

对于乳房肿胀，很多妈妈知道，但对其发生准备不足，也不知道如何处理。基本在产后第3天开始，有些妈妈会发现衣服变紧了，一觉醒来发现双侧乳房又肿又痛，几乎不能碰，这就是乳房肿胀。乳房在泌乳素的作用下，奶水开始大量分泌，乳腺腺泡因为奶水而扩张，然后引起周围乳导管受到压迫，又进一步引起继发性血管和淋巴管压迫，表现乳房肿胀，压痛感。

一般乳房肿胀在产后3-5天发生，症状高峰期持续1-2天，有些会延迟到产后第9-10天出现。乳房肿胀个体差异大，表现也多样性，有些表现为乳房充盈，有些则是非常严重的肿胀和压痛。一般认为此时发生一定程度的乳房肿胀是正常的。

研究表明，产后头2天花越多时间哺乳，引起的乳房肿胀的情况越少。每侧乳房每次哺乳时尽量喂到松软再换另一边，可以减少乳房肿胀发生。也就是说，宝宝越多吸吮，妈妈乳管越通畅，乳腺腺泡中乳汁排出越多，肿胀情况发生越少。所以我们说，宝宝是妈妈最好的“开奶师”。

适当的处理乳房肿胀对于成功的长期哺乳很重要。缓解乳房肿胀的症状的关键在于软化乳房后排出乳汁，缓解疼痛。大量的文献提示，刮痧、热敷和按摩结合乳汁排出，可有效缓解乳房肿胀和不适；卷心菜和冷敷可以缓解疼痛和不适，但对缓解肿胀无效。

由国际泌乳顾问协会（internationallactation consultant association，ILCA）官方杂志 Journal of Human Lactation 2016年刊出的文章中详细介绍了治疗性的乳房按摩处理乳房肿胀的方法，妈妈可以在家中自行完成，具体软化乳房方法如下：

用指尖从乳晕开始温柔的从乳晕向腋下按摩乳房，以减少肿胀并促进婴儿含接；用指尖非常温柔的交替反式按压乳晕，软化乳晕帮助婴儿含接；一旦乳晕软化，宝宝就能含接，可以继续轻轻按摩同时喂奶。轻柔按摩的动作包括轻轻的振动和打圈按摩。随着肿胀减轻，乳房软化，按摩和手挤奶交替促进乳汁排出缓解乳汁淤积。开始如果自己完成有困难，可以求助于专业的医护人员帮助，医护人员会手把手教你完成软化乳房和手挤乳的技巧，因为这是配合哺乳的实施，不是一次能解决的。

不建议找那些市场上非医疗机构的“开奶师”，这些“开奶师”水平参差，良莠不齐，乳腺科门诊经常会看到那些被“开奶师”揉的又红又肿的乳房，过度按摩会使原本肿胀的乳房组织损伤，继发乳腺炎。

另外，如果卷心菜和冷敷都不能缓解乳房疼痛，可以口服布洛芬消炎止痛，这对母婴都是安全的。

乳房肿胀期间，乳腺上皮细胞产生反馈抑制蛋白，随着该物质浓度增加，下丘脑接收减少分泌泌乳素信号，从而抑制乳汁产生，所以乳房肿胀都会自行缓解，但长时间的肿胀，会对维持泌乳造成负面影响。因此，正确及时缓解乳房肿胀，可以降低早期离乳的可能性。

生后最初的2周是母乳喂养建立的关键时期，母乳喂养不是妈妈一个人的事，新手妈妈会遇到这样那样的问题，也会遇到各种“专家”和“砖家”的指导。但是请注意，来自专业医疗机构的专业人士的指导很重要，很多医院都有专门的母乳喂养门诊，遇到困难时，这些专业人员会给你专业的指导。

让我们共同坚持，促进母乳喂养。

本文作者：段涛医生
本文地址：http://www.wjbb.com/know/1772
原文出处：http://weibo.com/ttarticle/p/show?id=2310474134525931262404 收起阅读 »

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怀孕本来是一件开心的事情，但是随着各种检查手段的频繁使用和检查水平的逐步提高，怀孕越来越成为一件令人胆战心惊的事情，因为查的越多，看到的问题越多，引起的担心和干预也就越多。

对于相当一部分人来讲，除了刚知道怀孕的头几天很开心很兴奋以外，接下来的每一次检查都是揪心的，整个早孕期简直就是步步惊心。

抽血会说你孕酮水平低或hCG水平低，

做超声会说你孕囊旁有出血，

如果再加上有阴道少许出血，

医生要么会让你在家里严格卧床休息吃保胎药打黄体酮，

要么就是把你收进医院保胎。

孕囊旁出血是一种最常见的早孕期异常超声表现，也被称为“胎膜后积血”或“绒毛膜下出血”。文献报道的总体的发生率波动范围比较大，在4%-48%之间，发生率的高低主要取决于研究的人群，如果是正常的早孕人群，孕囊旁出血的发生率会比较低，如果是早孕期阴道出血的人群，孕囊旁出血的发生率可以高达40%以上。

早孕期发生孕囊旁出血后，超声检查时可以发现在胚囊边上会有低回声的区域出现，其形态可为新月形、三角形或环形。多数情况下孕囊形态正常或轻微变形，胚胎的心跳也在正常范围之内，这种情况下继续妊娠的可能性很大。如果胎心搏动较弱或者变慢，孕囊变形明显，则发生流产的可能性很大。

出现孕囊旁出血，并不意味着就会发生流产，以下的几个因素会增加流产的风险：孕囊变形，胎心搏动变弱或者变慢，孕囊旁出血的面积比较大，同时出血阴道流血。

孕囊旁出血的多少可以依据孕囊与周边出血面积的比例来评估，小面积出血指的是出血面积小于孕囊周边的1/3，中等面积出血为孕囊周边的1/3-1/2，大面积出血占孕囊周边的2/3或更大。

临床研究发现，与正常对照组相比，孕囊旁出血轻、中度者自然流产率无明显增加，孕囊旁重度出血者自然流产率明显增加，是对照组的2-5倍。

还有人以孕囊旁出血面积的最大径线长度与胚芽长度的比值来预测发生自然流产的风险，当孕囊旁出血面积的最大径线长度/胚芽长度 > 2.5时，流产的风险明显增加。

有研究发现，当孕囊旁出血面积大于280mm^2时，提示可能会发生阴道出血。

当然，以上的这些结论仅适用于非IVF妊娠的患者。近期的研究发现，如果是IVF的早孕患者出现孕囊旁出血时，并不会明显增加自然流产的风险，孕囊旁出血可能和IVF技术本身有一定的相关性，并不是流产的高危因素。

对于有阴道流血等先兆流产症状的孕妇来讲，如果超声检查发现有孕囊旁出血，自然流产的风险会增加。

临床研究发现，对于出现孕囊旁出血的患者，补充孕激素等保胎措施并不能有效的降低自然流产的发生率。所以，一旦超声检查发现孕囊旁出血，不建议常规采用卧床休息和补充黄体酮等措施来进行保胎，可以定期进行超声检查来随访孕囊的形状、胎心率和出血面积的变化情况。

本文作者：段涛医生
本文地址：http://www.wjbb.com/know/1771
原文出处：http://weibo.com/ttarticle/p/show?id=2310474133076132339895 收起阅读 »

西柚汁和西柚是健康饮食的一部分。西柚含有身体工作所需的营养素——维生素C和钾。

但是当西柚汁影响到您服用的药效，尤其是当你有高血压或心律失常(不规则或不正常的心跳)时，这对您是不利的。

美国食品和药品监督管理局(FDA)的Shiew Mei Huang博士说，这种食品和药物的相互作用是一个令人担忧的问题。FDA要求一些口服的处方和非处方(OTC)药物需警告在服用的同时禁止饮用西柚汁或吃西柚。

下面是一些与西柚汁同服可能会引起问题(相互作用)的药物例子:

• 一些可以降低胆固醇的他汀类药物，如舒降之(辛伐他汀)和立普妥(阿托伐他汀)。
• 一些治疗高血压的药物，如心痛定和喜乐锭(两种都是硝苯地平)。
• 一些器官移植排斥药物，如山地明和新山地明(两者都是环孢霉素)。
• 一些抗焦虑药物，如丁螺环酮。
• 一些治疗克罗恩病或溃疡性结肠炎的皮质类固醇药物，如Entocort EC和Uceris(两者都是布地奈德)。
• 一些治疗心律失常的药物，如: Pacerone和 Nexterone（两者都是胺碘酮)。
• 一些抗组织胺药物，比如Allegra (非索非那定)。

 西柚汁不会影响上述类别中的所有药物。这种相互作用的严重程度取决于您的体质、药物和喝的西柚汁的量。和您的医生、药剂师或其他医疗保健提供者谈一谈，并阅读您的处方或非处方药物所提供的信息:

• 您的药物是否会受到影响。
• 如果会受到影响的话，你可以喝多少西柚汁。
• 其他什么水果和果汁也会像西柚汁一样影响您的药物。

 西柚汁如何影响药物疗效大多数药物都与西柚汁相互作用，黄博士说：“西柚汁可以让更多的药物进入血液。如果血液里药物太高，副作用可能会更多。”例如，如果你在服用某种他汀类药物来降低胆固醇的同时喝了大量的西柚汁，那么过量的药物可能会留在你的体内，增加您的肝脏和肌肉损伤的风险，从而导致肾衰竭。在小肠的一种叫做CYP3A4的重要酶的帮助下，许多药物被分解(代谢)。西柚汁可以阻止CYP3A4的作用，因此，更多的药物进入血液，停留在体内的时间更长。结果是:您体内的药物太多了。黄博士说，肠内的CYP3A4酶的数量随人而异。有些人有很多酶，有些人则较少。所以即使服用相同的药物，西柚汁对人的影响也可能不同。尽管几十年前科学家们就已经知道，西柚汁会导致某些药物在体内含量过多，但黄教授说，最近的研究发现，西柚汁对其他几种药物产生的效果则相反。她说:“西柚汁能导致更少的非索非那定进入血液，”降低了这种药物的效果。非索非那定(品牌名称Allegra)既可以作为处方药，也可以作为非处方药用来缓解季节性过敏的症状。如果服用了橙汁或苹果汁，非索非那定可能也不会起作用，因此药品标签上标明“不要同果汁一起服用”。为什么会产生这个相反的效果?西柚汁不会改变新陈代谢，但它会影响人体中被称为药物转运体的蛋白质，这种蛋白质有助于将药物转移到我们的细胞中去吸收。黄博士说，这种影响的结果是进入血液的药物减少了，药物起不到相应的作用。西柚汁如何影响某些药物 当药物被吞下时，它们可能会被酶分解(代谢)，或通过在小肠中发现的细胞内的转运体被吸收。西柚汁会对这些酶和转运体产生影响，导致体内药物过多或过少。 一些药物，如用来降低胆固醇的他汀类药物，被酶分解。西柚汁可以阻止这些酶的作用，增加体内的药物含量，并可能引起更多的副作用。其他的药物，如用来治疗过敏的Allegra(非索非那定)，被转运到身体的细胞中。西柚汁可以阻止转运蛋白的作用，减少体内的药物含量，从而可能导致药效降低。 您是否应该避免西柚汁或其他果汁

• 询问您的医生、药剂师或其他健康护理人员，在服用药物时是否可以同时服用西柚汁。
• 阅读处方药物的药物指南或患者信息单，看看西柚汁是否会影响您的药物。
• 阅读非处方药品上的药品标签，它会告诉您是否不应该喝西柚汁或其他果汁。
• 如果您的药不能和西柚汁同服，一定要检查果汁或果汁饮料的标签，看看是否含西柚汁。
• 酸橙（通常用于制作橘酱），柚子和橘柚(橘子和西柚杂交所得)可能和西柚汁有一样的作用。如果您的药物与西柚汁相互作用，一定不要吃这些水果。

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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：2017年7月18日
发布日期：2012年2月22日

中文翻译：Andrea鱼姑娘
本文地址：http://www.wjbb.com/know/1770
原文出处：https://www.fda.gov/forconsumers/consumerupdates/ucm292276.htm 收起阅读 »