標籤：

背寶寶也要較真科學！——背巾背帶相關的科學論文、書籍與科學研究

05-19
背寶寶也要較真科學！——背巾背帶相關的科學論文、書籍與科學研究

雖然我已經在背戴基礎系列文章中翻譯了很多英文資料，說明了背戴寶貝的注意事項和好處，但還是經常收到一些客戶的疑問，比如「新生兒可不可以豎背？是不是必須搖籃背？」這樣的最基礎的問題。

為了更好地集中回答一些基礎性的問題，也為了結論更加權威，我特地進一步收集了科學研究和論文、書籍列出的觀點。

在下面，我列出我的總概括，然後給出文獻的摘要和出處。如果你不滿意我的翻譯，可以直接看英文（甚至可看全篇原文）。反之，如果嫌棄文章太長，可以只看我每一節開頭的總結以及圖片，想多看點的可以再看看我的每一段的翻譯。

內容包括：

  • 長時間平躺的風險？
  • 為什麼要抱孩子？
  • 豎抱豎背安全嗎？
  • 為什麼豎背？
  • 總結和展望

長時間平躺的風險？

長時間躺著的的風險：

  • 導致扁頭綜合征（頭部某個部位長時間受壓，重力會使得那個部位變得扁平。越小的寶寶頭骨越軟越容易扁平。）；
  • 平躺時候伸直雙腿，可能對於髖關節的發育不利；
  • 嬰兒自然彎曲的C型脊柱被迫伸直；

II-2級證據

美國兒科學會的研究顯示，長時間躺在床上或推車上，重力會使得接觸床面的身體部位變得扁平（扁頭綜合征），並減退肌肉張力。

Research backed by the American Academy of Pediatrics states that 「with prolonged immobilization on a firm mattress or a flat bed (as in a stroller), the constant influence of gravity flattens the body surface against the mattress producing positional disorders and infants with decreased muscle tone」.

----Short, M. (1996). The Effects of Swaddling versus Standard Positioning in Very Low Birth Weight Infants.Neonatal Network. 15(4).from cebp.nl/vault_public/fi

II-3級證據

很多家長喜歡讓小嬰兒在嬰兒搖椅、安全座椅中長時間睡眠，因為在那裡「他們睡得更好」。抬高的頭部位置能夠減輕胃食管返流，讓寶寶睡得更香。在嬰兒清醒狀態下，可能繼續躺著玩耍——很多寶寶會喜歡電動搖椅、鞦韆的搖晃，玩嬰兒健身架，或者喜歡坐汽車去兜風。雖然這些工具能給家長減輕一些負擔，但家長們必須警醒這些工具可能給孩子的頭部造型帶來的影響。

在出生後的頭5個月之內，在嬰兒搖椅或者嬰兒汽車上長時間睡覺的嬰兒，他們的頭顱變形比平躺在床墊上的嬰兒更加複雜。在這些設備中的活動自由度比在床上更少。在這種堅硬的，有坡度的表面上，嬰兒的後腦勺會變得平且長，形成「長斜坡」，腦袋的後半部高度明顯增加。

另外嬰兒往往因為脖子缺乏力量，無法控制頭部在有坡度的躺椅中居中放置，頭部常常歪斜在一側，靠在安全座椅的側邊，導致左右兩側的頭顱被壓平，形成「方形」腦袋。另外由於頭部歪斜睡眠時候，肩膀擠壓耳垂，耳骨也出現了畸形。

We are aware that because many infants are quite content in their car seats or swings, well-intending parents respond by leaving them there and orienting toys or other entertain-ment to accommodate. Battery-operated swings, although they provide some relief for the parent, are probably used in greater frequency and for longer periods than their old hand-crank predecessors.

In those infants who were reported to have slept in car seats or swings for long periods of time (often the ?rst 3 to 5 months of life), the resulting deformity took on a very dis-tinctive look (Figures 1 to 3). In fact, in many of these cases, our clinicians were actually able to identify the infants who had slept in these devices before the parents disclosed this information. The cranial distortion results from the unique restrictions placed on infants while they are in these devices. The surface presented to the infant』s occiput is much more rigid and unyielding than a mattress and is often oriented at an angle to the back of the head. When the head rests against this hard, sloping surface for long periods, a brachycephalic con?guration is most frequently the result. The occiput in this situation, however, is not just ?attened uniformly, as in brachycephaly, but often can develop a superior-posterior slope and an associated increase in posterior head height.

Another feature frequently observed in these infants is a 「squaring」or 「cornering」of the back of the head. When placed in these devices as newborns, the infants have very malleable craniums and have not yet developed suf?cient head and neck control to maintain their heads in midline against gravity. Subsequently, the head often comes to rest in a corner of the car seat or swing, where it is restricted along two planes. The resulting deformity is a squaring of the parietal-occipital region and compensatory growth on the contralateral side resulting in asymmetrical head height. This situation is further exacerbated by the presence of a torticollis, which again does not allow the infant to maintain its head in midline.

In conclusion, although 「normal」use of infant car seats and swings should not be considered a signi?cant risk factor for the development of deformational plagiocephaly, it is important to recognize that the potential does exist to deform the cranium with extended use of these devices. We have demonstrated several examples in which this has occurred. The resulting deformity can often be more complex than what is traditionally seen from plagio- cephaly resulting from sleeping supine on a mattress; in the last several years, we have observed a number of infants whose heads seem to have been deformed in this manner.

----Littlefield, T. R., 2003, Car seats, infant carriers, andswings: Their role in deformational plagiocephaly, J. Prosthetics &Orthotics, v. 15(3), p. 102-106.

以上三個嬰兒照片均來自本篇論文。

III級證據

讓嬰兒躺著，會使得嬰兒自然彎曲的C型脊柱被迫伸直。研究顯示讓嬰兒的脊柱伸直並不是一個很好的生理學姿勢，不但會給脊柱帶來壓力，而且對於嬰兒髖關節的發育不利。

髖關節脫位示意圖（重點看圓圈中內容）

上圖來自國際髖關節學會網站

Laying your infant flat on his back stretches the c-curved spine into a straight line, against his natural shape. Research shows that keeping an infant』s spine straight is not a sound physiological position. In addition to stressing the baby』s spine it can also negatively influence the development of your baby』s hip joints.

----Kirkilionis, E. (2002). Carrying an Infant: More than the Possibility of Child Transport. Kosel.

III級證據

在一天中多數時間躺著，不利於髖關節發育，還很可能導致扁頭綜合症、和低肌張力。

Not only is spending most of the day flat on your back bad for your hips but infants who lie frequently on their backs in a stroller may end up with plagiocephaly (deformed skulls, flattened on the back or side) and deformed bodies with poor muscle tone (Bonnet,1998).

----Bonnet, E.. (1998 ). In Points made during discussions regarding the carrying of Infants and small children, Published in Krankengymnastik 50 Jg (1998) No.8

III級證據

用推車推著寶貝在街區中散步幾次，並不會會給寶貝的生理髮育帶來浩劫。但一個真實的數據是，在西方，3周到3個月大的嬰兒，平均每天被抱著的時間只有2.5小時。

This does not mean that laying flat for a couple of walks around the block in a stroller is going to wreak havoc on your baby』s physical development. But the truth is that the average Western infant between three weeks and three months of age is carried a little more than two and a half hours a day.

----Heller, S. (1997). The Vital Touch: How Intimate Contact With Your Baby Leads To Happier, Healthier Development. Holt Paperbacks.

III級證據

推車本身並不是壞東西，背戴寶寶和使用推車並不互斥。但嬰兒在推車中最好能面朝家長，一旦他發出想要被抱的暗示，家長就能及時回應並滿足。

Strollers are not 「bad」 per se. To go further, babywearing and strollers need not be mutually exclusive as long as an infant is content and his cues are responded to when he signals that he needs to be held (seated and facing his mother is preferable to encourage interactions and communication)

----Zeedyk, S.. (2008). What』s Life in a Baby Buggy Like? The Impact of Buggy Orientation on Parent-Infant Interaction and Infant Stress.

為什麼要背孩子？

多抱多背孩子，好處多多：

  • 嬰兒可充滿安全感，安靜而警覺地認識世界；
  • 更少的哭鬧；
  • 刺激前庭，增加空間安全感；
  • 和母親在一起時候免疫力增強；
  • 有助於預防扁頭綜合征；
  • 背著孩子可以實現肌膚相親的袋鼠式照料，對於早產兒是一種安全健康的照料方式。可以讓孩子溫暖，穩定心率和呼吸，延長睡眠時間，延長安靜警覺的時間，減少哭鬧，增加體重增長，增加哺乳。

和嬰兒的親密接觸不止是情感需求，它對於嬰兒就像空氣一樣重要。

I級證據

傳統早產兒的照料方式是母嬰長時間分離，嬰兒在恆溫箱中照顧。最近的研究顯示這樣有負面影響。母嬰肌膚接觸的方式可作為一種替代，對於指標穩定的早產兒有已被證實的好處。論文開展了一個非盲的隨機臨床試驗，34個低體重嬰兒參與了試驗。結論是採用肌膚相親的袋鼠照顧法的新生兒，比起用恆溫箱照顧的，臨床指標更好更穩定。

袋鼠照料和恆溫箱方式的利弊對比

點擊圖片可以查看大圖

圖片來自internewskenya.org/data

AIM:Conventional care of prematurely born infants involves extended maternal-infant separation and incubator care. Recent research has shown that separation causes adverse effects. Maternal-infant skin-to-skin contact (SSC) provides an alternative habitat to the incubator, with proven benefits for stable prematures; this has not been established for unstable or newborn low-birthweight infants. SSC from birth was therefore compared to incubator care for infants between 1200 and 2199 g at birth.

CONCLUSION:Newborn care provided by skin-to-skin contact on the mothers chest results in better physiological outcomes and stability than the same care provided in closed servo-controlled incubators. The cardio-respiratory instability seen in separated infants in the first 6 h is consistent with mammalian "protest-despair" biology, and with "hyper-arousal and dissociation" response patterns described in human infants: newborns should not be separated from their mothers.

Bergman, N. J., Linley, L. L., & Fawcus, S. R., 2004, Randomized controlled trial of skin-to-skin contact from birth versus conventional incubator for physiological stabilization in 1200 g to 2199 g newborns., Acta Paediatrica, v. 93, p. 779-785. ncbi.nlm.nih.gov/pubmed

I級證據

嬰兒的哭泣通常從0-6周逐漸增加，之後在4月齡以內逐漸減少。在這些哭泣中以夜啼居多。這些「正常」的哭泣，可以通過增加背或抱寶寶的次數減少，也就是說，除了餵奶，和響應寶寶的哭泣之外，還要儘可能多地抱寶寶。在一個隨機對照的實驗中，99對母嬰被分成兩組，一組增加背抱孩子，另一組控制背抱次數。在哭泣的巔峰——寶寶6星期大時，多被背和抱的那組孩子哭鬧總體減少43%（其中夜間哭鬧減少51%）。哭鬧的減少與嬰兒滿足感的增加以及哺乳頻率的增加有關。哺喂的時長和睡眠時間與背和抱孩子的時長沒有相關性。

The crying pattern of normal infants in industrialized societies is characterized by an overall increase until 6 weeks of age followed by a decline until 4 months of age with a preponderance of evening crying. We hypothesized that this "normal" crying could be reduced by supplemental carrying, that is, increased carrying throughout the day in addition to that which occurs during feeding and in response to crying. In a randomized controlled trial, 99 mother-infant pairs were assigned to an increased carrying or control group. At the time of peak crying (6 weeks of age), infants who received supplemental carrying cried and fussed 43% less (1.23 v 2.16 h/d) overall, and 51% less (0.63 v 1.28 hours) during the evening hours (4 PM to midnight). Similar but smaller decreases occurred at 4, 8, and 12 weeks of age. Decreased crying and fussing were associated with increased contentment and feeding frequency but no change in feeding duration or sleep. We conclude that supplemental carrying modifies "normal" crying by reducing the duration and altering the typical pattern of crying and fussing in the first 3 months of life. The relative lack of carrying in our society may predispose to crying and colic in normal infants.

----Hunziker, U. A., & Barr, R. G., 1986, Increased carrying reduces infant crying: A randomized controlled trial., Pediatrics, v. 77(5), p. 641-648.ncbi.nlm.nih.gov/pubmed?

其它相關文獻：

II-2級證據

5、Barr, R., et al., 1991, Crying in !Kung San infants: a test of the cultural specificity hypothesis., Dev. Med. Child Neurol., v. 33, p. 601-610.ncbi.nlm.nih.gov/pubmed?

II-1級證據

採用袋鼠照顧法的新生兒的睡眠時間，比沒有採用袋鼠照顧法的嬰兒明顯增加。在袋鼠照顧期間，新生兒情緒更好，呼吸和心率更穩定，血氧飽和度也保持穩定。

There was a significant increase in sleep time for the neonates during K Care as compared to when they were not receiving K Care. The neonates exhibited less agitation, apnea, and bradycardia episodes and maintained stable oxygen saturation during K Care.

----Messmer, P. R., Rodriguez, S., Adams, J., Gentry, J. W., Washburn, K., Zabaleta, I., & Abreu, S., 1997, Effect of Kangaroo care on sleep time for neonates., Pediatr. Nurs., v. 23(4), p. 408-414. ncbi.nlm.nih.gov/pubmed?

II-2級證據

從出生頭一個月就開始背著，每天至少背一個小時的寶寶，到2個月和五個月大的時候，仍舊吃母乳的概率比沒有被背著的孩子更高。

This study investigated whether the use of baby carriers with term infants during the first month of life is associated with increased breastfeeding rates. It found that infants carried for at least one hour per day during the first month of life breastfed more frequently at two and five months than those who were not carried.

----Use of baby carriers to increase breastfeeding duration among term infants: the effects of an educational intervention in Italy, A Pisacane, P Continisio, C Filosa, V Tagliamonte, G I Continisio 2012

III級證據

背著寶貝能夠鍛煉脖子和核心肌肉的力量。當孩子頭部還未穩定時，在背巾中可以嘗試短暫的控制頭部，比如轉個方向看世界，當疲勞的時候就可以把頭靠在媽媽的胸口。父母也可以很方便的幫助孩子變換頭部朝向。

背著寶貝有助於預防和矯正扁頭綜合征，原理是避免頭部某個部位長時間受壓。矯正頭型的原理是多多變換姿勢，避免長時間受壓，尤其是應該最小化在推車搖椅等平躺器具當中的時間。雖然很多兒科醫生建議通過每天半小時的tummy time來幫助矯正頭型，但是很多新生兒並不太喜歡趴著，且每天能夠趴著的時間也很有限。手抱孩子容易疲勞，背著孩子能夠很大程度上延長頭骨不受壓力的時間，幫助矯正頭型。

抱新生兒的六種姿勢，注意對頭部和背部的支撐

圖片來自WikiHow，How to hold a baby

When you wear your baby, he is working neck and core stability. Another benefit that babywearing can provide is repositioning the baby』s head. When you are wearing your child in a carrier on your front, most babies will try and practice holding their heads steady for short periods to look at the world around them. They may rest one check or the other against your chest as their neck muscles begin to tire out. This has the added benefit of the parent being able to reposition the baby』s head from one side to the other, thus gently stretching his neck muscles, which is a recommended treatment for torticollis (asymmetrical tightening of the neck muscles). What the baby is not doing is resting any pressure on the back of the head.

Another of the recommendations from the literature on the prevention of plagiocephaly is that infants should spend as little time as possible in positioning devices like swings, bouncers and car seats (when not riding in the car) which put pressure on the back of the skull. Once again, wearing the infant prevents putting pressure on the infant』s developing skull. In general, the use of cranial molding orthotics (helmets) is only indicated when repositioning and/or physical therapy has not produced desired results.

In many cases, babywearing can achieve the goals of repositioning (keeping pressure off the flattened area of the infants head) in a manner that is not just tolerable, but enjoyable for all parties involved.

----Talking Heads: An Occupational Therapist』s Perspective on Positional Plagiocephaly and Babywearing, Sara Kift 2015

III級證據

對於早產兒，肌膚相親的袋鼠式照料在西歐廣泛流行，早產兒只穿著紙尿褲，擁抱在母親獲母親懷中，肌膚貼著肌膚。西歐和美國的研究數據顯示了這種方式的安全性和有效性。通過這種方式，嬰兒足夠暖和，並且有更規則的心率、呼吸，更深的睡眠和安靜的警覺，更少的哭鬧，沒有增加感染的風險，更好的體重增長。並且有助於更多的乳汁分泌和更長久的哺乳。父母和嬰兒緊密相連，更加自信能照顧好他們。

Skin-to-skin ("kangaroo") care for preterm infants is becoming widespread in Western Europe. During this care the mother holds her diaper-clad premature infant against her skin beneath her clothing and allows self-regulatory access to breast-feeding. Fathers hold their infants skin-to-skin also. Research projects in Western Europe and the United States provide data that support the safety and effectiveness of this method. Infants held skin-to-skin are warm enough and have regular heart rate and respirations, more deep sleep and alert inactivity, less crying, no increase in infections, greater weight gain, and earlier discharge. Lactation is more productive and of greater duration. Parents become attached to their infants and feel confident about caring for them. This research is summarized and annotated in a table, along with descriptive reports and videotapes. These data can be used by health care professionals to make informed decisions about offering kangaroo care opportunities to selected parents and their preterm infants.

----Anderson, G.C., 1991, Current knowledge about skin-to-skin (kangaroo) care for pre-term infants, J. Perinatol., v. 11(3), p. 216-226.ncbi.nlm.nih.gov/pubmed

III級證據

抱著，輕輕搖晃或搖擺可以刺激嬰兒的前庭，使得他們的空間安全感更好。多數嬰兒，一天大多數時間都離開母親在各種搖椅推車中度過，會使得他們長大後容易頭暈（因為前庭刺激不充分），並且容易缺乏空間中的安全感（比如恐高，害怕坐飛機等）。

Carrying, rocking and swaying stimulate an infants』 vestibular apparatus and helps them to feel secure in space. Most babies today spend most of their day apart from their mothers in a container or in a stroller leaving them prone to vertigo, and a feeling of physical insecurity in space in general. Interestingly enough, the fear of flying and the fear of heights which plagues many of today』s adults can often be traced back to not being carried as an infant. Carried babies feel secure and are less apt to develop space related phobias.

----Montagu, A. (1986). Touching: The Human Significance of the Skin. Harper Paperbacks.

III級證據

和母親分開的時候，嬰兒的免疫力下降。它的身體產生的白細胞減少。當母親重新和他相聚，他的免疫力又重新增強。

Upon being separated from his mother, a baby』s immune system weakens. His body literally stops producing as many leukocytes. But when mother rejoins him, he strengthens again (Montagu, 1986).

----Montagu, A. (1986). Touching: The Human Significance of the Skin. Harper Paperbacks.

其它相關文獻：

III級證據

Durand, R., Hodges, S., LaRock, S., Lund, L., Schmid, S. Swick, D., et al., 1997, The effect of skin-to-skin breast-feeding in the immediate recovery period on newborn thermoregulation and blood glucose values., Neonatal Intensive Care, v. 10, p. 23-29.

III級證據

當遠古我們還是獵手和植物採集者的時候，嬰兒總是由母親抱著。雖然文明在變化，但是嬰兒與母親近距離接觸的需求沒有改變。嬰兒需要母親的親密擁抱，以感到安全，他們的生理髮育，心理發育，大腦發育都有賴於此。和嬰兒的親密接觸不止是情感需求，它對於嬰兒就像空氣一樣重要。

「Virtually all of our biochemistry and physiology are fine-tuned for the conditions of life that existed when we were hunters and gatherers, in which babies were held by their mothers,」 McKenna writes. Our culture may be changing, but our evolutionary need for touch remains the same. Babies』 brains have evolved to expect closeness and proximity-to be held-for their safety, their psychological growth, physical growth, mental growth, to aid and stabilize their physiological processes and keep their immune systems strong」 (Field, 69-74). 「Touch is not an emotional fringe benefit. It』s as necessary as the air we breathe」 (Heller, 5)

----Heller, S. (1997). The Vital Touch: How Intimate Contact With Your Baby Leads To Happier, Healthier Development. Holt Paperbacks.

其它相關文獻：

II-1級證據 Anisfeld, E., Casper, V., Nozyce, M., & Cunningham, N., 1990, Does infant carrying promote attachment? An experimental study of the effects of increased physical contact on the development of attachment., Child Dev., v. 61(5), p. 1617-27. ncbi.nlm.nih.gov/pubmed

II-3級證據 Christensson, K., Cabrera, T., Christensson, E., Uvn?s–Moberg, K., Winberg, J., 1995, Separation distress call in the human neonate in the absence of maternal body contact., Acta Paediatr., v. 84(5), p. 468-73. ncbi.nlm.nih.gov/pubmed?

II-1級證據 Christensson, K., Siles, C., Moreno, L., Belaustequi, A., de la Fuente, P., Lagercrantz, H., Puyol, P., & Winberg, J., 1992, [Temperature, metabolic adaptation and crying in healthy full-term newborns cared for skin-to-skin or in a cot]., Jordemodern. v. 105(11), p. 397-9. ncbi.nlm.nih.gov/pubmed

III級證據

我們的身體就像一個感官聚寶盆，那些微笑的溫暖、芬芳的氣味和開懷大笑的震顫，伴著愛撫的觸摸，將整個感官世界呈現在我們懷抱的嬰兒面前，觸手可及。嬰兒通過和我們的肌膚接觸獲得觸覺刺激，通過它的小手小腳和我們身體之間的壓力感而獲得本體感。當我們哺乳時候，她獲得了觸覺、味覺和嗅覺的刺激，並通過我們身體的移動獲得前庭刺激（當豎背哺乳時候，寶寶努力平衡頭部位置以吃到奶，也可鍛煉前庭）。當嬰兒四處觀察時獲得視覺刺激，當我們溫柔耳語時候獲得聽覺刺激，當我們變換背戴姿勢時候獲得肌肉運動的刺激。反之當我們把嬰兒放置在各種容器中的時候（比如推車、床），尤其是當我們看不見嬰兒的臉的時候，這些豐富的感官滋養都不再有。

「Our body is a sensual cornucopia where smiles, aromas and laughter mingle amid undulating caresses that put the entire sensory world at our baby』s fingertips. Our baby gets tactile or cutaneous stimulation from our skin touching hers and proprioception from the pressure of her limbs flexed into our body. She gets tactile, olfactory, and gustatory stimulation if we nurse, of our milk, and vestibular stimulation from the gentle stimulation of our movements and, when held upright, from her efforts to right her head and maintain her balance. She gets visual stimulation when she looks all around her, auditory impulses as we whisper endearments, and kinesthetic stimulation as we change her to the other side… when we put our babies in a container, and especially if out of sight all of this sensory nourishment is lost.」 (Heller,112)

----Heller, S. (1997). The Vital Touch: How Intimate Contact With Your Baby Leads To Happier, Healthier Development. Holt Paperbacks.

III級證據

讓新生兒離開媽媽，自己躺著，是對於孩子的誤解。新生兒渴盼被緊緊擁抱並隨著母親輕輕搖晃，通過和母親連續的觸覺接觸和溫暖的身體支持，隨著媽媽一起逐漸認識更廣闊的空間。

「To remove the newborn baby from his mother and place it on its back or on its front on a flat surface, often uncovered is to fail to understand the newborn』s great need for enfoldment, to be supported rocked and covered from all sides, and that the infant may only gradually be introduced to the world of more open spaces. From the supporting, continuous, tangible presence of his mother the infant will gradually come to move some distance toward the outside world」.

----Montagu, A. (1986). Touching: The Human Significance of the Skin. Harper Paperbacks.

豎背豎抱安全嗎？

正確的豎背是安全的。

正確的豎背，給予孩子的全身均勻而良好的支撐，能夠非常好地貼合孩子當前階段的自然生理造型。正確的豎背並沒有強迫新生兒豎脖子或獨坐，因為有足夠的外界支撐，嬰兒的脊柱從造型到受力情況都是符合階段發展規律的。

不同月齡的寶寶在背巾中的透視圖

可以豎背多久？理論上正確的豎背多久都不會損傷脊柱（但是需要留意孩子的意願，如果他不想再被背著也要及時響應，建議每次最多2小時左右就換個造型，或者可以手抱一會，或者就把孩子放下來）

什麼是正確的豎背？各個月齡段孩子造型如圖，具體安全守則請看背戴寶貝（baby wearing)基礎系列——Safety（安全要點），具體工具如何使用才能正確還需要背戴指導。

I級證據

通過多達14個隨機對照實驗得出結論。證實了使用袋鼠照顧、用手臂抱和用背巾正確背，對於早產兒和足月新生兒，都是安全的。

對於早產兒可以縮短住院時間，減少發病率，更高的純母乳率和更長的哺乳延續時間，更好的體重增長，父母更自信。對於足月新生兒，好處包括更好的生理狀態和運動協調性，更好的溫度適應性，更好的鎮痛效果（比如腸絞痛）。軟結構的背戴工具，使得母親更容易響應孩子被抱的需求，並且更安全地抱著孩子。因為這些好處，應該鼓勵母嬰肌膚接觸，手臂抱以及安全的背戴孩子。

----HOLD ME CLOSE: ENCOURAGING ESSENTIAL MOTHER/BABY PHYSICAL CONTACT,Excerpt from Blois, Maria Blois, MD,「Birth: Care of Infant and Mother: Time Sensitive Issues.」 Best Practices in the Behavioral Management of Health from Preconception to Adolescence, edited by William Gordon and Jodie Trafton. Los Altos: Institute for Disease Management. 2007-8. pp. 108-132

I級證據

上圖為雙胞胎早產兒，圖片來自英文維基kangoroo care詞條

一項在醫院中進行的公開的隨機對照試驗。1084名體重小於2kg的嬰兒被追蹤，其中有746名被分為兩組，382名採用袋鼠式照顧法，其餘364名採用傳統恆溫箱的照顧方式。382名袋鼠媽媽照顧式的寶寶，每天24小時以豎抱的姿勢，肌膚貼肌膚在母親胸前，並用一塊布料妥當固定住嬰兒。其餘364名嬰兒待在恆溫箱中直到達到出院條件。兩組嬰兒之後都被跟蹤直到12個月的矯正月齡，其中有90%的測試嬰兒在12個月時候可被用於評估。報告數據包括死亡率，感染報告，早產兒出院後的再次住院情況，以及生長情況和哺喂方式。

結果：兩組嬰兒的生長指標基本一致。恆溫箱組嬰兒的尿路感染頻率更高，袋鼠媽媽照顧法一組的嬰兒達標出院後，重新住院的時間更少。

結論：袋鼠式照料法對於臨床指標穩定的低體重新生兒是安全的。

BACKGROUND:

In 1978, kangaroo mother care (KMC) was proposed as a caring alternative for low birth weight (LBW) infants. We are reporting here early outcomes of a randomized, controlled trial comparing KMC to traditional care.

METHOD:

An open randomized, controlled trial was conducted in a large tertiary care hospital. All newborn infants </=2000 g, surviving the neonatal period and being eligible for a minimal care unit, were included. A total of 1084 newborns </=2000 g were followed, and 746 were randomized-382 to KMC and 364 to traditional care. KMC infants were discharged after randomization, regardless of weight or gestational age. Infants spent 24 hours per day in an upright position, in skin-to-skin contact, and attached to the mothers chest. After randomization, control infants remained at the minimal care unit until meeting usual discharge criteria. Both groups are being followed up to 12 months of corrected age; 679 (90%) were available for evaluation when they reached term (40 to 41 weeks of postconceptional age). The present paper reports early outcomes (when reaching term) including mortality, infectious episodes, hospital stay after eligibility, and growth and feeding patterns.

RESULTS:

Both study groups were similar regarding all baseline variables but weight at eligibility. The risk of dying was similar in both groups (relative risk = 0.59, 95% confidence interval 0.22-1. 6). There were no differences in growth indices. Nosocomial infections were more frequent in control infants. Hospital stay after eligibility was shorter in KMC, primarily for infants </=1800 g.

CONCLUSIONS:

These results show that KMC is a safe approach to the care of clinically stable LBW infants. Our findings provide the necessary scientific support to a method that is already incorporated in the care of LBW infants at many hospitals around the world and at different levels of care.

----Charpak, N., Ruiz-Pelaez, J. G., Figueroa, Z., & Charpak, Y., 1997, Kangaroo mother versus traditional care for newborn infants </=2000 grams: A randomized, controlled trial., Pediatrics, v. 100(4), p. 682-688. ncbi.nlm.nih.gov/pubmed

II-1級證據

新生兒喜歡保持一種自然蜷縮的造型，他的膝蓋會自然收起到他的胸部下方。

Newborns are almost impossible to stretch out unless wrapped or swaddled. When you place an infant flat on his back, his thighs will usually be pulled up towards his chest.

----Schon, R. (2007). Natural Parenting-Back to Basics in Infant Care. 5(1), 102-183. from Evolutionary Psychology from epjournal.net/filestore

II-2級證據

給予嬰兒腿部背部良好支持，符合生理學的豎背工具，就像媽媽的手臂自然擁抱寶寶的造型一樣，並不會損害孩子的脊柱和腿部。

Upright baby carriers that support the legs, carrying a baby as a mother would naturally would in arms, does not compromise a baby』s spine or hips.

----Kirkilionis, E. (2002). Carrying an Infant: More than the Possibility of Child Transport. Kosel.

II-2級證據

當一個孩子，在合適的背戴工具中，豎立地，面對面地，以合理的造型包裹在家長身上，布料給予均勻的牢固的包裹，以保證小寶寶既不會陷入布料中（導致脊柱過度彎曲），也不會阻礙呼吸。這樣有背巾的支持，孩子可以以大寶寶的視角來豎立地觀察世界，並安全地嘗試控制自己的頭部。

「a child .. placed upright in a suitable baby carrier or embraced firmly and properly in a wrap, supported and upright against the body of the parents, firmly embraced by the fabric, which ensures that even the smallest little one will not sink into himself ending in an over-curvature of the spine, staying out of the danger zone of the little head being forced into a position that will compromise the breathing. The upright supported posture allows even very small babies moving patterns that are usually not seen until two to three month later. Free from the chore of controlling and holding his little head while trying to stabilize against gravity, an infant secured in a wrap for example can hold and turn his own head early on.」

----Dr. Evelin Kirkilionis, Deutsch Hebammenzeitschrift 7/2010

III級證據

腹部貼腹部擁抱寶寶，可以減少嬰兒的腹部暴露於外界，有利於嬰兒的體溫調節，減少能量消耗，更好消化食物。另外還能夠保護他們的感覺器官和重要身體器官。

Infants use less oxygen which conserves energy and waste less calories. They digest their food better. It is also the best position for thermoregulation because of reduced stomach exposure. Also, we have more efficient temperature regulating cells and more fat on the back side of our bodies as well. When we hold our infants stomach- to- stomach we are protecting all the receptor and vital organs (Montagu, 1986).

----Montagu, A. (1986). Touching: The Human Significance of the Skin. Harper Paperbacks.

III級證據

母親用手臂，支撐嬰兒的身體和大腿，使得它膝蓋上收，身體微傾斜。符合生理學的背戴工具，就像媽媽的手臂自然擁抱寶寶的造型一樣，給予嬰兒腿部背部良好支持。

A mother using either her arms or a simple piece of cloth, supports her baby』s legs in a flexed (with the knees bent) abducted (away from midline) position supporting the hip and the spine. Instead of fabric at the crotch which contributes no leg support, or swaddling the legs which is too restrictive, ergonomic carriers put the baby in the position that supports the legs just as a mother』s arms would. The flexed abducted position is what infants are hard-wired to assume when picked up.

----Schon, R. (2007). Natural Parenting-Back to Basics in Infant Care. 5(1), 102-183. from Evolutionary Psychology from epjournal.net/filestore

更多關於Kangoroo Care的研究論文：

I級證據 Ferber, S.G., Makhoul, I.R., 2004, Skin contact (kangaroo care) shortly after birth on the neurobehavioral responses of the term newborn: a randomized, controlled trial., Pediatrics, v. 113(4), p. 858-65. ncbi.nlm.nih.gov/pubmed?

II-3級證據 Meyer, K., & Anderson, G. C., 1999, Using kangaroo care in a clinical setting with fullterm infants having breastfeeding difficulties., Am. J. Matern. Child Nurs., v. 24, p. 190-192. ncbi.nlm.nih.gov/pubmed

II-2級證據 Moore ER, Anderson GC, Bergman N., 2007, Early skin-to-skin contact for mothers and their healthy newborn infants., Cochrane Database of Syst. Rev., v. 3, Art. No.: CD003519. ncbi.nlm.nih.gov/pubmed

II-2級證據 Durand, R., Hodges, S., LaRock, S., Lund, L., Schmid, S., Swick, D., Yates, T., & Perez, A., 1997, The effect of skin-to-skin breastfeeding in the immediate recovery period on newborn thermoregulation and blood glucose values., Neonatal Intensive Care, v. 10, p. 23-29.

II-1級證據 Tessier R., Cristo, M., Velez, S., Giron, M., Ruiz-Palaez, J. G., Charpak, Y., et al., 1998, Kangaroo mother care and the bonding hypothesis., Pediatrics, v. 102(2), e17.ncbi.nlm.nih.gov/pubmed

II-2級證據 Wahlberg, V., Affonso, D., & Persson, B., 1992, A retrospective comparative study using the kangaroo method as a complement to standard incubator care., European J. Public Health, v. 2(1), p. 34-37. eurpub.oxfordjournals.org

II-2級證據 Pelaez-Nogueras, M., Field, T. M., Hossain, Z., & Pickens, J., 1996, Depressed mothers』 touching increases infants』 positive affect and attention in still-face interactions.,Child Dev., v. 67, p. 1780-1792. ncbi.nlm.nih.gov/pubmed?

II-1級證據 Kangaroo Care (Skin Contact) Reduces Crying Response to Pain in Preterm Neonates: Pilot Results, R Kostandy R, Pain Management Nursing, 9(2) 2008

為什麼豎背？

豎背有哪些好處？

  • 有利於嬰兒警覺而安靜的觀察世界；
  • 緩解嬰兒胃食管返流癥狀，一定程度上預防中耳炎；
  • 貼合孩子的自然生理造型，可能有利於髖關節發育；
  • 多豎背能減少頭部某個區域長時間受壓，預防扁頭綜合征。（前面章節已有論據）
  • 和家長腹部貼腹部有利於體溫調節；（前面章節已有論據）

II-2級證據

豎背可緩解嬰兒的胃食管返流癥狀，並預防中耳炎。

Wearing your baby upright can actually be a preventative measure against ear infections and can help ease the symptoms of GERD.

----Schon, R. (2007). Natural Parenting-Back to Basics in Infant Care. 5(1), 102-183. from Evolutionary Psychology from epjournal.net/filestore

其它相關文獻：

Douglas, P. S., 2005, Excessive crying and gastro-oesophageal reflux disease in infants: Misalignment of biology and culture., Med. Hypotheses, v. 64(5), p. 887-98.ncbi.nlm.nih.gov/pubmed

II-2級證據

對於習慣後背孩子的非洲人口，進行髖關節情況的調查，認為髖關節發育不良的超低發病率主要是由於他們後背孩子的習俗。並且認為雙腿併攏的背法會增加髖關節發育不良的風險。但論點仍舊需要對於非洲以外地區人口的大量臨床試驗的進一步證實。

----Back-carrying Infants to Prevent Developmental Hip Dysplasia and its Sequelae: Is a New Public Health Initiative Needed?，S Graham, J Manara, L Chokotho, W Harrison Journal of Pediatric Orthopedics 35 (1) 2015

II-3級證據

有大量的流行病學證據顯示，將嬰兒髖關節緊緊內收包裹的背戴工具，對髖關節發育會帶來不利影響。

相比於雙腿併攏的橫背更推薦豎背

圖片指示了相關性而並非因果性

圖片來自國際髖關節學會網站

There is abundant epidemiological evidence for the negative effects on hip development of wrapping, swaddling or carrying susceptible babies with hips tightly adducted and extended, as well as confirmatory animal studies.

----Increase in late diagnosed developmental dysplasia of the hip in South Australia: risk factors, proposed solutions，K Studer, N Williams, G Antoniou, C Gibson, H Scott, W Scheil, B Foster, P Cundy MJA 204 (6) 4 April 2016

III級證據

嬰兒豎抱姿勢時間越長，他們越警覺和安靜。即使是大部分時間都在睡覺的新生兒，一旦被抱起並靠在我們的肩膀上，就會停止哭泣並活躍起來。不過如果是在嬰兒椅中呈豎直狀態，嬰兒並不會像在家長的懷抱中豎抱那樣警覺。對於還不會獨坐的嬰兒，豎抱能讓他們有機會學習到更多。

----Heller, S. (1997). The Vital Touch: How Intimate Contact With Your Baby Leads To Happier, Healthier Development. Holt Paperbacks.

III級證據

在90年代，由於醫學上的保守，許多家長在嬰兒出生的頭幾周都是橫抱孩子。但如今在德國，橫抱已經不再普遍。如今在德國大多數家長都在孩子一出生就開始豎背。這個變化也要感謝Mrs.Kirkilionis博士關於嬰兒背帶工具的不懈研究，他的研究得到了骨科、兒科醫生、理療師的認可。豎背有利於髖關節的健康發育。

總結和展望

在總結之前，我們必須了解，因為背戴寶寶的領域，還未被很多科學雜誌所重視，所以發表相關論文的概率並不高（不是熱門話題），間接地使得很多研究學者或者機構不傾向於做相關研究。雖然背戴寶貝很多潛在的好處似乎顯而易見，但很少研究者去進行相關的隨機對照試驗以進一步證實。

除了相關科學研究之外，國際背戴產業聯盟（Baby Carrier Industry Alliance, BCIA）的行業峰會和研究，一些發達國家的背巾背帶相關行業標準，和行業共識也非常重要，因為雖然科學論文是前沿，但是產業化的標準更是將可重複大量驗證的科學事實應用於實際。目前BCIA官網，以及許多國際老牌大牌的背巾網站如Didymos，已經取消在網站上示範搖籃背（雖然一些半傾斜寶寶面部清晰可見的背法還是可以用，但大家的共識是更推薦豎背）。寶寶頭部淪陷在布料中的搖籃背已經導致多起嬰兒死亡事故並且已經被召回（如下圖）。

另外說到背巾質量，如果大家查閱BCIA官網認證的背巾品牌名單（babycarrierindustryalliance.org），就會發現國產的品牌沒有一家上榜，究竟差距在哪裡，大家可以進一步看我的公眾號了解相關知識，後面也還會更新。

根據著名國際背戴組織網站2015年8月發布的《Babywearing Research – Part 2: Relevant Research》文章中對於目前背戴寶寶相關的科研成果的總結，以及本文前面所列的相關文獻的結論，總結如下：（babywearinginternational.org）

關於頭型：

背戴寶寶有助於避免頭部某個區域長時間受壓，進而有助於預防扁頭綜合征。

需要進一步數據支持：

背戴工具應用於如斜頸和扁頭綜合征的預防和治療，會有多大的好處？

關於髖關節，以下論點已經被充分的證實：

  • 嬰兒的髖關節健康很重要；
  • 不是所有的嬰兒都生來就有有健康的髖關節；
  • 髖關節體檢（必要時拍片）很重要；

需要進一步數據支持：

  • 背戴工具的種類和背戴姿勢對於髖關節的有利或不利影響；
  • 「欠佳的背戴姿勢」有哪些，對於髖關節健康的影響有哪些？
  • 背戴寶寶怎樣才能有效的被用於髖關節發育不良的干預治療？最佳的實踐指南如何？

關於母子聯繫和袋鼠育兒，已經被充分的證實的：

  • 背戴寶寶有利於母子的身心聯繫；
  • 背戴孩子能夠有效減少嬰兒的哭泣；
  • 袋鼠育兒法，是可測量、可重複驗證的成功嬰兒照料方式。

需要進一步數據支持：

  • 背戴工具如何幫助與孩子在身心聯結上有困難的照料者（比如養父母）？
  • 背戴工具支持實現袋鼠育兒法的系統性指南如何？尤其是對於早產兒？

關於背戴姿勢和背戴安全：

  • 新生兒正確地豎背，是安全的；
  • 背戴姿勢能保證呼吸暢通不被遮擋非常重要；
  • 必須保證始終可以看到孩子的臉；
  • 在背戴之前必須檢查背戴工具是否有損壞；

需要進一步數據支持：

  • 肚子貼肚子的豎背，在多大的程度上，更有利於保證呼吸通暢？
  • 搖籃背有多大的不安全性？
  • 豎背的好處包括核心肌肉的發育，胃食管返流的控制等。

科學總是在進步的，期待未來能有更多相關的研究指導我們更好的應用和享受背戴工具。

最後，也是非常重要的是，正如美國消費產品安全委員會CPSC所認可的（Consumer Product Safety Commission），在使用背戴工具的時候，「教育」非常重要。也就是說，必須有可靠的人，告訴你很多正確使用的相關知識。關於背巾使用的安全要點，我已經總結在公眾號之前的文章中，以後還會有更多的升級和更新。當然對於某個具體的產品來說，正確的一對一的使用指導也是非常重要的，哪怕簡單如背帶也不是隨便拿來就能用得對。

在我的淘寶店鋪「背戴之愛」購買國際BCIA聯盟認證品牌的背巾背帶，就可以獲得一對一的使用指導。在元宵節結束之前（2018.3.2 24點），轉發此文到朋友圈並截圖，新客戶均可獲得在店鋪首次購買背巾背帶的20元減免，減免有效期為元宵節結束後5天內（2018.3.7,24點）。算是給大家的元宵小禮物。

當然最重要的是別忘了關注我的公眾號。

您可能還感興趣：

背戴寶貝（baby wearing)基礎系列——Safety（安全要點）

背戴寶貝（baby wearing)基礎系列——How（背戴姿勢的選擇、冬天夏天和睡眠時如何背寶寶）

有環背巾，編織背巾，Mei Tai，背帶這些背戴神器該怎麼選？

有環背巾教程——反轉背法（flipped）（新生兒可用）

致最美的背巾媽媽們（時尚、智慧、溫情？遠不止於此......這篇最美的買家秀顛覆你對背戴工具的認識）

更多背巾教程請關注公眾號獲取。

本文嘗試根據循證醫學的證據等級分類（分類僅供參考）。

附：循證醫學證據等級表：

I級證據：自至少一個設計良好的隨機對照臨床試驗中獲得的證據；

II-1級證據：自設計良好的非隨機對照試驗中獲得的證據；

II-2級證據：來自設計良好的隊列研究或病例對照研究(最好是多中心研究)的證據；

II-3級證據：自多個帶有或不帶有干預的時間序列研究得出的證據。非對照試驗中得出的差異極為明顯的結果有時也可作為這一等級的證據；

III級證據：來自臨床經驗、描述性研究或專家委員會報告的權威意見。

媽媽天天向上

只發乾貨，更新不多，卻篇篇嚴謹較真，誠心滿滿的小號。

長按二維碼關注 獲取原創文章

背巾教程 | 早教機測評

繪本清單 | STEM益智玩具 | 幼兒桌游

weixin.qq.com/r/jkNcRI- (二維碼自動識別)

本公眾號內容均系本人原創，轉載請經過本人許可並註明出處，未經許可盜用必維權到底。


推薦閱讀：

※臘八節，你過了嗎？
※[開箱]冰寶人生的第一部車-來自德國Gesslein F6推車

TAG:育兒 | 嬰兒車 |