Infant Feeding & GER-Wenzl 2003

合集下载

护理诊断

我国常用的护理诊断1.知识缺乏2.疼痛3.焦虑4.活动无耐力5.有感染的危险6.恐惧7.生活自理缺陷8.营养失调：低于机体需要量9.体温过高10.清理呼吸道无效11.睡眠型态紊乱12.气体交换受损13.有皮肤完整性受损的危险14.便秘15.躯体移动障碍16.皮肤完整性受损17.有受伤的危险18.体液不足19.有体液不足的危险20.体液过多一、交换(Exchanging)营养失调：高于机体需要量(Altered Nutrition：More Than Body Requirements) 营养失调：低于机体需要量(Altered Nutrition：less Than Body Requirements) 营养失调：潜在高于机体需要量(Altered Nutrition：Potential for More Than Body Requirements)有感染的危险(Risk for Infection)有体温改变的危险(Risk for Altered Body Temperature)体温过低(Hypothermia)体温过高(Hyperthermia)体温调节无效(Ineffective Thermoregulatlon)反射失调(Dysre flexia)便秘(Constipation)感知性便秘(Perceived Consttipation)结肠性便秘(Colonic Constipation)腹泻(Diarrhea)大便失禁(Bowel Inconttinence)排尿异常(Altered Urinary Elimination)压迫性尿失禁(Sires Incontlnence)反射性尿失禁(Reflex Incontlnence)急迫性尿失禁(Unge Incontlnence)功能性尿失禁(Functional Incontlnence)完全性尿失禁(Total Incontlnencd尿储留(Urinary Retentron)组织灌注量改变(肾、脑、心肺、胃肠、周围血管)(Altered Tissue Perfuslorl( Renal，Cereral，Cardlopulmonary Gastrolntestlnal，Peripheral)) 体液过多(Fluid Volume Excess)体液不足(Fluid Volume Deficit)体液不足的危险(Risk for Fluid VolUme Deficit)心输出量减少(Deer。

护理诊断中英文

（1）交换（Exchanging）营养失调：高于机体需要量（Altered Nutrition：More Than Body Requirements）营养失调：低于机体需要量（Altered Nutrition：less Than Body Requirements）营养失调：潜在高于机体需要量（Altered Nutrition：Potential for More Than Body Requirements）有感染的危险（Risk for Infection）有体温改变的危险（Risk for Altered Body Temperature）体温过低（Hypothermia）体温过高（Hyperthermia）体温调节无效（Ineffective Thermoregulatlon）反射失调（Dysre flexia）便秘（Constipation)感知性便秘（Perceived Consttipation）结肠性便秘（Colonic Constipation）腹泻（Diarrhea）大便失禁（Bowel Inconttinence）排尿异常（Altered Urinary Elimination）压迫性尿失禁（Sires Incontlnence）反射性尿失禁（Reflex Incontlnence）急迫性尿失禁（Unge Incontlnence）功能性尿失禁（Functional Incontlnence）完全性尿失禁（Total Incontlnencd尿储留（Urinary Retentron）组织灌注量改变（肾、脑、心肺、胃肠、周围血管）（Altered TissuePerfuslorl（Renal，Cereral，Cardlopulmonary Gastrolntestlnal，Peripheral）体液过多（Fluid Volume Excess）体液不足（Fluid Volume Deficit）体液不足的危险（Risk for Fluid VolUme Deficit）心输出量减少（Deer。

什么是人工喂养跟混合喂养英语作文

什么是人工喂养跟混合喂养英语作文Artificial Feeding and Mixed Feeding: An Overview.Feeding an infant is one of the most crucial aspects of parenthood. It not only ensures the growth and development of the baby but also lays the foundation for a healthy lifestyle. There are three primary feeding methods: breastfeeding, artificial feeding, and mixed feeding. In this article, we will focus on artificial feeding and mixed feeding, exploring their definitions, advantages, disadvantages, and considerations for parents.Artificial Feeding.Artificial feeding, also known as bottle-feeding, involves the use of formula milk or other liquid foods to nourish the baby. This method is typically chosen by parents who cannot breastfeed for various reasons, such as medical conditions, personal choice, or work commitments.Advantages of Artificial Feeding:1. Convenience: Artificial feeding offers greater flexibility and convenience. Parents can prepare and store formula milk ahead of time, making it easier to feed the baby on the go.2. Customizability: Formula milk can be customized to meet the specific nutritional needs of the baby. This allows parents to choose a formula that suits their baby's age, weight, and health conditions.3. Bonding: Although breastfeeding is often associated with bonding, artificial feeding can also promote a strong bond between parent and child. Parents can still cuddle and interact with their babies during feeding time.Disadvantages of Artificial Feeding:1. Cost: Formula milk can be quite expensive,especially if it is purchased regularly. This can be a financial burden for some families.2. Nutritional Imbalance: If not properly prepared or chosen, formula milk may not provide the baby with all the necessary nutrients. This can lead to nutritional imbalances and health issues in the long run.3. Digestive Issues: Some babies may experience digestive issues such as gas, constipation, or diarrhea when fed formula milk. This may require parents to experiment with different formulas to find one that suits their baby's digestive system.Mixed Feeding.Mixed feeding combines breastfeeding and artificial feeding. This method is often chosen by mothers who want to breastfeed but cannot produce enough milk to meet thebaby's demand. By supplementing with formula milk or solid foods, mothers can ensure that their babies receive enough nourishment.Advantages of Mixed Feeding:1. Best of Both Worldss: Mixed feeding allows babies to benefit from both breast milk and formula milk. Breast milk provides antibodies and nutrients that support the baby's immune system, while formula milk can help meet the baby's nutritional needs.2. Flexibility: Mixed feeding offers flexibility to mothers who want to breastfeed but cannot produce enough milk. By supplementing with formula, they can ensure that their babies receive enough nourishment.3. Gradual Transition: Mixed feeding can serve as a gradual transition from breastfeeding to exclusive formula feeding. This allows babies to adapt to new foods and feeding methods gradually.Disadvantages of Mixed Feeding:1. Confusion: Mixed feeding can be confusing for both parents and babies. Parents may struggle to determine the optimal balance of breast milk and formula milk, and babiesmay have difficulty adapting to the changing consistency and taste of their food.2. Potential for Overfeeding: If not monitored carefully, mixed feeding may lead to overfeeding, which can cause weight issues and other health problems in babies.3. Logistical Challenges: Mixed feeding requires more preparation and organization than exclusive breastfeeding or formula feeding. Parents need to keep track of their baby's feeding schedule, prepare and store breast milk or formula milk, and clean and sterilize feeding equipment regularly.Conclusion.Artificial feeding and mixed feeding are both viable options for parents who cannot or choose not to breastfeed their babies. Each method has its own advantages and disadvantages, and the best choice for a family depends on their specific needs and circumstances. Parents should consult with their healthcare provider to determine thebest feeding method for their baby and to ensure that their baby receives adequate nutrition and care.。

护理诊断-医学英语(英语学习资料)

128个护理诊断-医学英语(英语学习资料)NANDA通过的以人类反应型态（Human ResPonse Patterns）的分类方法。

现将人类反应型态分类方法的128个护理诊断分列如下：（1）交换（Exchanging）营养失调：高于机体需要量（Altered Nutrition：More Than Body Requirements）营养失调：低于机体需要量（Altered Nutrition： less Than Body Requirements）营养失调：潜在高于机体需要量（Altered Nutrition：Potential for More Than Body Requirements）有感染的危险（Risk for Infection）有体温改变的危险（Risk for Altered Body Temperature）体温过低（Hypothermia）体温过高（Hyperthermia）体温调节无效（Ineffective Thermoregulatlon）反射失调（Dysre flexia）便秘（Constipation）感知性便秘（Perceived Consttipation）结肠性便秘（Colonic Constipation）腹泻（Diarrhea）大便失禁（Bowel Inconttinence）排尿异常（Altered Urinary Elimination）压迫性尿失禁（Sires Incontlnence）反射性尿失禁（Reflex Incontlnence）急迫性尿失禁（Unge Incontlnence）功能性尿失禁（Functional Incontlnence）完全性尿失禁（Total Incontlnencd尿储留（Urinary Retentron）组织灌注量改变（肾、脑、心肺、胃肠、周围血管）（Altered Tissue Perfuslorl（ Renal， Cereral， Cardlopulmonary Gastrolntestlnal，Peripheral）体液过多（Fluid Volume Excess）体液不足（Fluid Volume Deficit）体液不足的危险（Risk for Fluid VolUme Deficit）心输出量减少（Deer.a.ed CardlacouPu）气体交换受损（Imnaired Gas Exc5anse）清理呼吸道无效（Ineffecthe AirwayImPairedMucous3 Membrance）皮肤完整性受损（ImPaired Skin Integrity）有皮肤完整性受损的危险（Risk for ImPaired Skin Integrity）调节颅内压能力下降（ Decreased AdaPtive CaPacityIntracranial）精力困扰（Energy Field distubance）（2）沟通（Communicating）语言沟通障碍（impaired VerbalCommunlcatlon）（3）关系（Relating）社会障碍（Impaired Soial Interatlon）社交孤立（Social Isolition）有孤立的危险（Risk for.Lonelines.）角色紊乱（Altered Role Performance）父母不称职（Altered Parenting）有父母不称职的危险（Risk for Altered Parenting）有父母亲子依恋改变的危险（Risk for Altered Parent／Infant／Child Att8Chffi6llt）性功能障碍（Sexual Dysfunction）家庭作用改变（Altered Family Process）照顾者角色障碍（Caresiver Role Strain）有照顾者角色障碍的危险（Risk for Caregiver Role Strain）家庭作用改变：酗酒（Altered Family Process： Alcoholism）父母角色冲突（Parental Role Conflict）性生活型态改变（Altered SexualityPatterns）（4）赋予价值（Valuing）精神困扰（Spiritual Distress）增进精神健康：潜能性（Potential for Enhance Spiritual Well-Belug）（5）选择（Choosing）个人应对无效（Ineffctive Individual Coping）调节障碍（ImPaired Adjustment）防卫性应对（Defensive Coping）防卫性否认（Ineffective Denial）家庭应对无效：失去能力（ Ineffective Family Coping：Disabling）家庭应对无效：妥协性（Ineffectiv Family Coping：Compromised）家庭应对：潜能性（Family CoPing： Potential for Growth）社区应对：潜能性（Potential for Enhanced Community CoPing）社区应对无效（Ineffective Community Coping）遵守治疗方案无效（个人的）（Ineffective Management of Therapeutic Regimen）（Individual）不合作（特定的）（Noncompliance）（Specitfy）遵守治疗方案无效（家庭的）（Ineffective Management of Therapeutic Regimen：（（Families）遵守治疗方案无效（社区的）（Ineffective Management of Thera－peutic Regimen： Community）遵守治疗方案有效（个人的）（Effective Management of Thera－peutic Regimen：Individual）抉择冲突（特定的）（Decisional Conflict）（Specify）寻求健康行为（特定的）（Health Seeking Behaviors）（Specity）（6）活动（Moving）躯体移动障碍（ImPaired Physical Mobility）有周围血管神经功能障碍的危险（Risk for PeriPheralNeurovas－cular Dysfunction）有围手术期外伤的危险（Risk for Perloperatlve Positioning Injury）活动无耐力（Activity Intolerance）疲乏（Fatigue）有活动无耐力的危险（Risk for Activity Intolerance）睡眠状态紊乱（SleepPattern Disturbance）娱乐活动缺乏（Diversional Activity Deficit）持家能力障碍（Impaired Home Maintenance Management）保持健康的能力改变（Altered Health Maintenance）进食自理缺陷（Feeding Self Care Deficit）吞咽障碍（Impaired Swallowing）母乳喂养无效（Ineffective Breast Feeding）母乳喂养中断（Interrunted Breast1ceding）母乳喂养有效（Effective Breast feeding）婴儿吸吮方式无效（Ineffective Infant Feeding Pattern）沐浴／卫生自理缺陷（Bathing／Hygiene Self Care Deficit）穿戴／修饰自理障碍（Dressing／Grooming Self Care Deficit）入厕自理缺陷（Toileting Self Care Deficit）生长发育改变（Altered Growth and Development）环境改变应激综合征（Relocation Stress Syndrome）有婴幼儿行为紊乱的危险（ Risk for Disorganized Infant Behavior）婴幼儿行为紊乱（Disorganized Infant Behavior）增进婴幼儿行为（潜能性）（potential for Disorganized Infantganlzed Infantkhavlor）（7）感知（Perceiving）自我形象紊乱（Body Imagse Disturbance）自尊紊乱（SolfEsteem disturbance）长期自我贬低（Chronic Low Self Esteem）情境性自我贬低（Situational Low Self Esteem）自我认同紊乱（Personal Identity disturbance）感知改变（特定的）（视、听、运动、味、触、嗅）（Sensory／PerceptualAlterations）（specify）（Visual，Auditory，Kinesthetlc，Gustatory，Tao－tile，Olfactory）单侧感觉丧失（Unilateral Neglect）绝望（Honelessness）无能为力（Powerlessness）（8）认知（Knowing）知识缺乏（特定的）（Knowledge Deficit）（Specify）定向力障碍（Impaired Environmental Interpretation）突发性意识模糊（Acute Confusion）渐进性意识模糊（Chronic Confusion）思维过程改变（Altered Thought Processes）记忆力障碍（ImPaired Memoryy）（9）感觉（Feeling）疼痛（Pain）慢性疼痛（Chronic Pain）功能障碍性悲哀（Dysfunctional Crievins）预感性悲哀（AnticiPatory Crieving）有暴力行为的危险：对自己或对他人（Risk for Violence：Self-Directed or drected at Others）有自伤的危险（Risk for Self－Mutilation）创伤后反应（Post－Trauma Response）强奸创伤综合征（RaPe－Trauma Syndrome）强奸创伤综合征：复合性反应（Repe－Trauma Syndrome：Compound Reaction）强奸创伤综合征：沉默性反应（ Rape－Trauma Syndrome：Silent）焦虑（Anxiety）恐惧（Fear）。

护理常用128个护理诊断

NANDA通过的以人类反响型态〔Human ResPonse Patterns〕的分类方法。

现将人类反响型态分类方法的128个护理诊断分列如下：〔1〕交换〔Exchanging〕营养失调：高于机体需要量〔Altered Nutrition：More Than Body Requirements〕营养失调：低于机体需要量〔Altered Nutrition：less Than Body Requirements〕营养失调：潜在高于机体需要量〔Altered Nutrition：Potential for More Than Body Requirements〕有感染的危险〔Risk for Infection〕有体温改变的危险〔Risk for Altered Body Temperature〕体温过低〔Hypothermia〕体温过高〔Hyperthermia〕体温调节无效〔Ineffective Thermoregulatlon〕反射失调〔Dysre flexia〕便秘〔Constipation〕感知性便秘〔Perceived Consttipation〕结肠性便秘〔Colonic Constipation〕腹泻〔Diarrhea〕大便失禁〔Bowel Inconttinence〕排尿异常〔Altered Urinary Elimination〕压迫性尿失禁〔Sires Incontlnence〕反射性尿失禁〔Reflex Incontlnence〕急迫性尿失禁〔Unge Incontlnence〕功能性尿失禁〔Functional Incontlnence〕完全性尿失禁〔Total Incontlnencd尿储留〔Urinary Retentron〕组织灌注量改变〔肾、脑、心肺、胃肠、周围血管〕〔Altered TissuePerfuslorl〔Renal，Cereral，Cardlopulmonary Gastrolntestlnal，Peripheral〕体液过多〔Fluid Volume Excess〕体液缺乏〔Fluid Volume Deficit〕体液缺乏的危险〔Risk for Fluid VolUme Deficit〕心输出量减少〔Deer.a.ed CardlacouPu〕气体交换受损〔Imnaired Gas Exc5anse〕清理呼吸道无效〔Ineffecthe Airway Clearance〕低效性呼吸型态〔Ineffective Breathing Pattern〕不能维持自主呼吸〔Inability to Sustain SPontaneous Ventilation〕呼吸机依赖〔Dysfunctional Ventilatory Weaning ResPonse，DVWR〕有受伤的危险〔Risk for Injury〕有窒息的危险〔Risk for Suffocation〕有外伤的危险〔Risk for Trauma〕有误吸的危险〔Risk for Aspiration〕自我防护能力改变〔Altered Protection〕组织完整性受损〔ImPaired Tissue Integrity〕口腔粘膜改变〔Altered Oral Mucous Membrance〕皮肤完整性受损〔ImPaired Skin Integrity〕有皮肤完整性受损的危险〔Risk for ImPaired Skin Integrity〕调节颅内压能力下降〔Decreased AdaPtive CaPacityIntracranial〕精力困扰〔Energy Field distubance〕〔2〕沟通〔Communicating〕语言沟通障碍〔impaired VerbalCommunlcatlon〕〔3〕关系〔Relating〕社会障碍〔Impaired Soial Interatlon〕社交孤立〔Social Isolition〕有孤立的危险〔Risk for.Lonelines.〕角色紊乱〔Altered Role Performance〕父母不称职〔Altered Parenting〕有父母不称职的危险〔Risk for Altered Parenting〕有父母亲子依恋改变的危险〔Risk for Altered Parent／Infant／Child Att8Chffi6llt〕性功能障碍〔Sexual Dysfunction〕家庭作用改变〔Altered Family Process〕照顾者角色障碍〔Caresiver Role Strain〕有照顾者角色障碍的危险〔Risk for Caregiver Role Strain〕家庭作用改变：酗酒〔Altered Family Process：Alcoholism〕父母角色冲突〔Parental Role Conflict〕性生活型态改变〔Altered SexualityPatterns〕〔4〕赋予价值〔Valuing〕精神困扰〔Spiritual Distress〕增进精神健康：潜能性〔Potential for Enhance Spiritual Well-Belug〕〔5〕选择〔Choosing〕个人应对无效〔Ineffctive Individual Coping〕调节障碍〔ImPaired Adjustment〕防卫性应对〔Defensive Coping〕防卫性否认〔Ineffective Denial〕家庭应对无效：失去能力〔Ineffective Family Coping：Disabling〕家庭应对无效：妥协性〔Ineffectiv Family Coping：Compromised〕家庭应对：潜能性〔Family CoPing：Potential for Growth〕社区应对：潜能性〔Potential for Enhanced Community CoPing〕社区应对无效〔Ineffective Community Coping〕遵守治疗方案无效〔个人的〕〔Ineffective Management of Therapeutic Regimen〕〔Individual〕不合作〔特定的〕〔Noncompliance〕〔Specitfy〕遵守治疗方案无效〔家庭的〕〔Ineffective Management of Therapeutic Regimen：〔〔Families〕遵守治疗方案无效〔社区的〕〔Ineffective Management of Thera－peutic Regimen：Community〕遵守治疗方案有效〔个人的〕〔Effective Management of Thera－peutic Regimen：Individual〕抉择冲突〔特定的〕〔Decisional Conflict〕〔Specify〕寻求健康行为〔特定的〕〔Health Seeking Behaviors〕〔Specity〕〔6〕活动〔Moving〕躯体移动障碍〔ImPaired Physical Mobility〕有周围血管神经功能障碍的危险〔Risk for PeriPheralNeurovas－cular Dysfunction〕有围手术期外伤的危险〔Risk for Perloperatlve Positioning Injury〕活动无耐力〔Activity Intolerance〕疲乏〔Fatigue〕有活动无耐力的危险〔Risk for Activity Intolerance〕睡眠状态紊乱〔SleepPattern Disturbance〕娱乐活动缺乏〔Diversional Activity Deficit〕持家能力障碍〔Impaired Home Maintenance Management〕保持健康的能力改变〔Altered Health Maintenance〕进食自理缺陷〔Feeding Self Care Deficit〕吞咽障碍〔Impaired Swallowing〕母乳喂养无效〔Ineffective Breast Feeding〕母乳喂养中断〔Interrunted Breast1ceding〕母乳喂养有效〔Effective Breast feeding〕婴儿吸吮方式无效〔Ineffective Infant Feeding Pattern〕沐浴／卫生自理缺陷〔Bathing／Hygiene Self Care Deficit〕穿戴／修饰自理障碍〔Dressing／Grooming Self Care Deficit〕入厕自理缺陷〔Toileting Self Care Deficit〕生长发育改变〔Altered Growth and Development〕环境改变应激综合征〔Relocation Stress Syndrome〕有婴幼儿行为紊乱的危险〔Risk for Disorganized Infant Behavior〕婴幼儿行为紊乱〔Disorganized Infant Behavior〕增进婴幼儿行为〔潜能性〕〔potential for Disorganized Infant ganlzed Infantkhavlor〕〔7〕感知〔Perceiving〕自我形象紊乱〔Body Imagse Disturbance〕自尊紊乱〔SolfEsteem disturbance〕长期自我贬低〔Chronic Low Self Esteem〕情境性自我贬低〔Situational Low Self Esteem〕自我认同紊乱〔Personal Identity disturbance〕感知改变〔特定的〕〔视、听、运动、味、触、嗅〕〔Sensory／PerceptualAlterations〕〔specify〕〔Visual，Auditory，Kinesthetlc，Gustatory，Tao－tile，Olfactory〕单侧感觉丧失〔Unilateral Neglect〕绝望〔Honelessness〕无能为力〔Powerlessness〕〔8〕认知〔Knowing〕知识缺乏〔特定的〕〔Knowledge Deficit〕〔Specify〕定向力障碍〔Impaired Environmental Interpretation〕突发性意识模糊〔Acute Confusion〕渐进性意识模糊〔Chronic Confusion〕思维过程改变〔Altered Thought Processes〕记忆力障碍〔ImPaired Memoryy〕〔9〕感觉〔Feeling〕疼痛〔Pain〕慢性疼痛〔Chronic Pain〕功能障碍性悲哀〔Dysfunctional Crievins〕预感性悲哀〔AnticiPatory Crieving〕有暴力行为的危险：对自己或对他人〔Risk for Violence：Self-Directed or drected at Others〕有自伤的危险〔Risk for Self－Mutilation〕创伤后反响〔Post－Trauma Response〕强奸创伤综合征〔RaPe－Trauma Syndrome〕强奸创伤综合征：复合性反响〔Repe－Trauma Syndrome：Compound Reaction〕强奸创伤综合征：沉默性反响〔Rape－Trauma Syndrome：Silent〕焦虑〔Anxiety〕恐惧〔Fear〕。

幼儿进餐保育员工作流程

幼儿进餐保育员工作流程英文回答：Infant Feeding Caregiver Workflow.1. Preparation.Gather necessary materials: bibs, spoons, bowls, plates, food, drinks, and any special equipment.Wash hands thoroughly with soap and water.Prepare feeding area by cleaning and setting up as needed.Assist infant with hand washing if necessary.2. Feeding.Position infant comfortably for feeding, eitherupright or lying down as appropriate.Offer food or drink slowly and gently, allowing infant to pace themselves.Monitor infant's hunger and fullness cues, and adjust feeding accordingly.Clean up any spills or messes promptly.Encourage infant to participate in feeding as much as possible, such as holding their spoon or cup.3. Post-Feeding.Burp infant to release any trapped air.Wipe infant's face and hands clean.Change soiled diapers or clothing as needed.Assist infant with hand washing and teeth brushing ifappropriate.Document feeding details, including food and drink type, amount consumed, and any observations or concerns.4. Observation.Monitor infant's feeding patterns, preferences, and behaviors.Observe for any signs of food allergies or sensitivities.Note any developmental milestones or challenges.Report any concerns or changes to the supervising nurse or healthcare professional.5. Safety.Ensure all equipment used for feeding is clean and safe.Supervise infant at all times during feeding.Follow all safety guidelines and protocols.Report any potential hazards or concerns.6. Communication.Communicate feeding details and observations to the parents or guardians.Provide guidance and support to parents on infant feeding practices.Collaborate with the healthcare team to ensure continuity of care.中文回答：幼儿进餐保育员工作流程。

婴儿喂养态度现状调查

婴儿喂养态度现状调查摘要】本研究采用中文版IIFAS量表（lowa infant feeding attitude scale,IIFAS)调查成都H医院门诊建卡孕妇婴儿喂养态度的现状，并进一步分析其可能的影响因素，以期筛选出有奶粉喂养倾向的高危人群，进而采取有效的护理干预措施，为提高母乳喂养率提供科学依据。

【关键词】婴儿喂养态度，奶粉喂养，母乳喂养母乳喂养已被视为全球婴幼儿喂养的黄金标准，母乳是婴儿最理想的食物，母乳喂养有利于婴儿身心和认知的健康发展。

世界卫生组织，联合国儿童基金会向全球的母亲建议“纯母乳喂养至6个月，之后适当添加辅助食品并继续母乳喂养至两年或更长的时间”[1]。

母乳喂养对婴儿、母亲、家庭以及社会都具有其他喂养方式无可比拟的优势，尤其对婴儿而言，合理的母乳喂养对婴幼儿存活、生长发育、健康和营养都极为重要。

然而在中国,虽然卫生部门一直倡导母乳喂养,但母乳喂养率并没有提高,反而呈下降趋势，从1998年至2014年的这16年期间，中国的母乳喂养率下跌近40%，2014年3月，国家卫生与计划生育委员会公布数据显示，我国0～6月婴儿纯母乳喂养率为27.8%，其中农村30.3%，城市仅为15.8%，远低于国际平均水平38%[2]。

婴儿喂养态度是人们对婴儿喂养方法所持有的看法和信念，分为奶粉喂养态度和母乳喂养态度[3]。

婴儿喂养态度作为内在因素能预测和决定母乳喂养行为[4]。

Dodgson[5]等的母乳喂养计划行为理论提出,母乳喂养态度决定意图,而意图是预测行为的最佳指标，影响因素中婴儿喂养态度是非常重要的原因，了解婴儿喂养态度以便预测喂养行为，从而提前干预，可为有效地增进母乳喂养行为。

本文研究采用中文版IIFAS量表（lowa infant feeding attitude scale,IIFAS)调查成都H医院住院孕妇婴儿喂养态度的现状，为提高母乳喂养率提供有效的护理干预措施提供数据。

1.研究对象与方法1.1研究对象纳入标准：妊娠中晚期孕妇，单胎，自愿接受问卷调查。

128个护理诊断

NANDA确定的128个护理诊断NANDA通过的以人类反应型态（Human ResPonse Patterns）的分类方法。

现将人类反应型态分类方法的128个护理诊断分列如下：一、交换（Exchanging)营养失调：高于机体需要量（Altered Nutrition：More Than Body Requirements)营养失调：低于机体需要量（Altered Nutrition：less Than Body Requirements)营养失调：潜在高于机体需要量（Altered Nutrition：Potential for More Than Body Requirements)有感染的危险（Risk for Infection)有体温改变的危险（Risk for Altered Body Temperature)体温过低（Hypothermia)体温过高（Hyperthermia)体温调节无效（Ineffective Thermoregulatlon)反射失调（Dysre flexia)便秘（Constipation)感知性便秘（Perceived Consttipation)结肠性便秘（Colonic Constipation)腹泻（Diarrhea)大便失禁（Bowel Inconttinence)排尿异常（Altered Urinary Elimination)压迫性尿失禁（Sires Incontlnence)反射性尿失禁(Reflex Incontlnence)急迫性尿失禁(Unge Incontlnence)功能性尿失禁（Functional Incontlnence)完全性尿失禁（Total Incontlnencd尿储留（Urinary Retentron)组织灌注量改变（肾、脑、心肺、胃肠、周围血管）（Altered Tissue Perfuslorl( Renal，Cereral，Cardlopulmonary Gastrolntestlnal，Peripheral))体液过多（Fluid Volume Excess)体液不足（Fluid Volume Deficit)体液不足的危险（Risk for Fluid VolUme Deficit)心输出量减少（Deer。

1、下载文档前请自行甄别文档内容的完整性，平台不提供额外的编辑、内容补充、找答案等附加服务。
2、"仅部分预览"的文档,不可在线预览部分如存在完整性等问题,可反馈申请退款(可完整预览的文档不适用该条件!)。
3、如文档侵犯您的权益，请联系客服反馈,我们会尽快为您处理(人工客服工作时间：9:00-18:30)。

Effects of Thickened Feeding on Gastroesophageal Reflux in Infants: A Placebo-Controlled Crossover Study Using Intraluminal Impedance Tobias G.Wenzl,MD,MRCPCH*;Sabine Schneider,MD*;Frank Scheele,MD*;Jiri Silny,PhD‡;Gerhard Heimann,MD,PhD*;and Heino Skopnik,MD,PhD*ABSTRACT.Objective.Thickening of formula feed-ings is part of the therapeutic approach for gastroesoph-ageal reflux(GER)in infants.However,its mechanism of action,especially regarding the occurrence of nonacid (pH>4)GER,has not yet been clearly described.The aim of this randomized,placebo-controlled crossover study was to examine the influence of formula thickened with carob(St.John’s bread)bean gum on acid and nonacid GER.Methods.Infants with recurrent regurgitation and without other symptoms were fed alternately(A-B-A-B-A-B)with thickened(A)and nonthickened(B)but oth-erwise identical formula.Documentation of GER epi-sodes during the study was performed by simultaneous intraesophageal impedance measurement(intraluminal electrical impedance;IMP)and pH monitoring.The IMP technique is able to detect bolus movements inside a luminal organ.The use of multiple measuring segments on a single catheter allowed the analysis of direction, height,and duration of the bolus transport.Continuous videorecording and visual surveillance of regurgitation frequency and amount resulted in a severity score. Results.Fourteen infants(42؎32days old)were examined during6feeding intervals each for a total measuring time of342hours.A total of1183GER epi-sodes and83episodes of regurgitation were registered. Regurgitation frequency(15vs68episodes)and amount (severity score0.6vs1.8)were significantly lower after feedings with thickened formula.The difference regard-ing the occurrence of GER documented by IMP was also pronounced(536vs647episodes).Although not statisti-cally significant,maximal height reached by the refluxate in the esophagus was decreased after thickened feedings. Mean GER duration and the frequency of acid(pH<4) GER were not altered.Conclusions.Thickened feeding has a significant ef-fect on the reduction of regurgitation frequency and amount in otherwise healthy infants.This effect is caused by a reduction in the number of nonacid(pH>4) GER episodes,but also because of a decrease of mean reflux height reached in the esophagus.However,the occurrence of acid GER is not reduced.The combination of IMP and pH monitoring allows the complete registra-tion and description of these GER episodes.Thickening of formula feedings with carob bean gum is an efficient therapy for uncomplicated GER in infants.Pediatrics 2003;111:e355–e359.URL:/cgi/ content/full/111/4/e355;gastroesophageal reflux,infants,thickened feeding,intraluminal electrical impedance tech-nique,placebo-controlled study.ABBREVIATIONS.GER,gastroesophageal reflux;IMP,intralumi-nal electrical impedance;Formula A,thickened;Formula B,non-thickened.T he thickening of formula feedings is part of the stepwise therapeutic approach for gastro-esophageal reflux(GER)in infants.1–4Esopha-geal pH monitoring is considered a standard test to diagnose GER.3,5,6However,buffering gastric acidity and frequent feeding of infants are known to prolong periods of hypoacidity,and,especially after feed-ings,reflux events with pHϾ4are not detected by pH monitoring.7,8Even so,to investigate the effects of thickened(Formula A)feedings,most studies re-lied on the validity of esophageal pH monitoring for the diagnosis of GER.9–13Carob(St.JohnЈs bread)bean gum is a galactoman-nan,which is refined from the carob tree,Ceratonia siliqua.Both rice cereal and bean gum are used in dietary preparations as thickening agents.As op-posed to rice cereal,which is broken down by sali-vary amylase,bean gum is not split by these en-zymes and thus maintains its thickening effect also after reaching the stomach.It provides no nutritional value and does not alter the energy distribution of infant formula.2The objective of this prospective,randomized,pla-cebo-controlled crossover study was to evaluate the effect of formula thickened with carob bean gum2on the number and the characteristics of acid(pHϽ4) and nonacid(pHϾ4)GER events by using a combi-nation of pH monitoring and the pH-independent multiple intraluminal electrical impedance(IMP) technique.8,14–17METHODSOtherwise healthy infants with recurrent regurgitation that fulfilled the inclusion criteria(Table1)were evaluated.During the initial surveillance period of3consecutive days,regurgitation frequency and amount were documented.To exclude GER sec-ondary to other medical conditions,the following prestudy exam-inations were performed:complete blood count,total immuno-globulin E,radioallergosorbent test(cowЈs milk protein,casein,␣-lactalbumin,␤-lactoglobulin),skin prick test(formula before study entry,both study formulas,normal saline,histamine),ul-trasound of the abdomen and head,urinalysis,and stool cultures. Any abnormal finding from these examinations resulted in exclu-sion from the study.During the following24-hour prestudy phase,all included infants were switched from their initial for-mula to Formula B(Table2).From the*Kinderklinik and‡Helmholtz-Institut fu¨r Biomedizinische Tech-nik,Universita¨tsklinikum Aachen,Aachen,Germany.Received for publication Jul29,2002;accepted Dec2,2002.Reprint requests to(T.G.W.)Kinderklinik,Universita¨tsklinikum Aachen,Pauwelsstr.30,D52074Aachen,Germany.E-mail:t.wenzl@PEDIATRICS(ISSN00314005).Copyright©2003by the American Acad-emy of Pediatrics./cgi/content/full/111/4/e355PEDIATRICS Vol.111No.4April2003e355Investigation for GER was performed by combined measure-ment of intraesophageal pH and multiple electrical impedance.8,17 The principle of IMP registration is based on the measurement of electrical impedance changes between2neighboring electrodes during the passage of a bolus inside a luminal organ.By arranging multiple electrodes sequentially on a catheter,the direction of bolus movement can be described.In this study,a single flexible catheter with7impedance electrodes(outer diameter1.5mm), representing6bipolar impedance channels(Helmholtz-Institut fu¨r Biomedizinische Technik,Aachen,Germany),and a pH-sen-sitive antimony electrode was used.A GER episode is defined as a decrease in impedance starting in the most distal channel and subsequently extending orally to the more proximal channels.The catheter was passed transnasally under fluoroscopy.The distance between each impedance electrode was1.5cm,resulting in a totalmeasuring length of9cm.Measuring segments were positioned from just above the cardia(channel6)to the pharynx(channel1), with the pH sensor situated at the level of channel5,ie,ϳ3cm above the gastroesophageal junction.The acquisition rate of pH and impedance signals was50Hz per channel.The infants were randomized to receive the2study formulas in an alternate fashion.The order of treatment was randomly as-signed by a computer-generated method with the individual in-fant as the unit of randomization.Formula A contained0.4%carob bean gum and was otherwise identical with Formula B(Table2). During the study period,group I received alternate feedings be-ginning with Formula A(A-B-A-B-A-B)and group II received alternate feedings beginning with Formula B(B-A-B-A-B-A),ac-cording to the crossover study design and their randomization. Study formulas were prepared by a second independent caregiver after breaking the randomization code.The study phase lasted for at least24hours and at least6feedings,and was continued for at least2hours after the sixth feeding.During the study,each infant was fed with its individual feeding intervals and by the same caregiver.The study groups(I or II)were blinded to the investi-gators during the study and the data analysis.Regurgitation amount and time were documented in a protocol by continuous visual surveillance and by continuous videorecord-ing.The amount of a single regurgitation was scored visually as:Յ5mL;Ͼ5mL;about half of the feeding;or the complete feeding. The online regurgitation protocol was verified and eventually amended by analysis of the videorecording.Severity of regurgi-tations after a single feeding was quantified by a scoring system (Table3).11All impedance and pH data were stored simultaneously in a computer system at bedside.Data analysis for GER events was performed using custom software(Motility;Helmholtz-Institut fu¨r Biomedizinische Technik,Aachen,Germany)and visual vali-dation.Impedance recordings were visually analyzed for the typ-ical IMP pattern of GER,indicated by a retrograde esophageal volume flow(Fig.1).In this study,GER was diagnosed only if this typical pattern was noted in the esophageal impedance.Documentation during each GER included the minimal pH value,the maximal height reached by the refluxate in the esoph-agus,and the duration of GER.GER duration was defined as time after the onset of a reflux episode needed to reach50%of the initial impedance value in the most distal impedance channel(channel 6),which corresponds to a clearanceϾ90%of the reflux volume in the measuring segment.8Mean values were calculated for most parameters,including regurgitation score and reflux height,eventually resulting in“vir-tual”decimal values(Tables4and5).Statistical analysis was performed using the paired Wilcoxon test(SAS/STAT8.01;SAS Institute,Cary,NC).Significance was established by a value of PϽ0.05.The study protocol was approved by the Ethics Committee of the Medical Faculty of the University Aachen(Aachen,Germany). Before beginning any evaluation of an infant,written informed consent was obtained from the parents.RESULTSFourteen infants(mean age at study42Ϯ32days; 9female,5male)that fulfilled the inclusion criteria were examined.There were no dropouts during the prestudy or the study phase.No infant showed signs of a secondary cause of GER or regurgitation.Seven infants were randomized to study group I,and7 infants to study group II.The study formula was tolerated well by all infants.During a total measuring time of342hours,83 regurgitations(15after Formula A,68after Formula B;PϽ.0003)were documented by visual surveil-lance and video analysis.Calculated from3feeding periods in each infant,the mean regurgitation score for a single feeding was0.6after Formula A,and1.8 after Formula B(PϽ.003).Seven infants(50%)did not regurgitate at all after Formula A;1(7%)of these 7infants also did not regurgitate at all after Formula B.A total of1183GER episodes(536after Formula A, 647after Formula B;PϽ.02)were detected by the typical pattern in the impedance tracings.Reflux events occurred in all patients.For technical reasonsTABLE1.Inclusion and Exclusion Criteria for Infants Entering StudyInclusion Criteria Exclusion CriteriaRecurrent regurgitations:Ͼ5regurgitations of at least a small volume(5mL),or at least1regurgitation of at least half of the feeding per day,during a surveillance period of3consecutive dϽ4mo oldBody weightϾ2000gExclusively formula-fed No orϽ5regurgitations of a small volume (5mL)per d,during a surveillance period of3consecutive dSuspected food allergyGastroenteritisOther acute infectionApneas and/or bradycardias Regurgitation secondary to other cause Medication influencing esophageal motilityposition of Formula A and Formula BFormula A and B Per100gPowder Per100mL FormulaEnergy(kcal)46766 Protein(g)12.2 1.72 Whey:casein20:8020:80 Lipids(g)21 3.0 Carbohydrate(g)588.2 Additionally in Formula ACarob bean gum(g)3.4TABLE3.Regurgitation Score After a Single Feeding Score Severity0No regurgitation11regurgitation ofՅ5mL22regurgitations ofՅ5mL,and/or1regurgitation ofϾ5mL3Ͼ2regurgitations ofՅ5mL,and/orϽ3regurgitations ofϾ5mL4Ն3regurgitations ofϾ5mL5Regurgitation of about half of the feeding6Regurgitation of the complete feedinge356THICKENED FEEDING AND GASTROESOPHAGEAL REFLUXthe pH of 5GER in 1patient (number 11)could not be determined.A total of 377(32.0%)GER were acidic (pH Ͻ4),and 4(0.3%)alkaline episodes (pH Ͼ7)were recorded.Calculated mean GER height was impedance channel 2.6after Formula A,and impedance channel 2.5after Formula B (P ϭ.08),with channel 1being the most proximal channel.Mean GER duration was 36.2seconds after Formula A,and 33.9seconds after Formula B (P ϭ.3).The number of acid GER episodes (pH Ͻ4)was 177after Formula A and 200after Formula B (P ϭ.6).The majority of reflux events was nonacid (801nonacid GER vs 377acid GER;P Ͻ.007).Calculated mean GER height was impedance channel 2.5duringa nonacid GER,and impedance channel 2.6during an acid GER (P ϭ.2).Mean GER duration of a nonacid GER was 30.4seconds,and of an acid GER 43.1seconds (P Ͻ.05).Data from individual infants are summarized in Tables 4and 5.DISCUSSIONThere has been controversial discussion as to whether there is a place for thickened feeding in the therapeutic regimen for GER in infants.1,4,18How-ever,in most studies examining this question,the diagnostic tool used to detect GER episodes was pH monitoring.3,5,6Various authors using pHmonitor-Patient NumberGroup Regurgitation Frequency (n )After Formula Regurgitation Score After Formula GER Episodes (n )After Formula GER Height(Impedance Channel)After FormulaGER Duration (Seconds)AfterFormula Acid GER (n )After Formula AB A B A B A B A B A B 1II 314 6.59.57396 2.6 2.815.413.143592II 12 1.010.01225 3.2 2.522.036.7333I 020 2.0722 3.3 3.056.385.52144I 6127.57.56456 2.2 2.122.817.520265II 00002736 2.9 2.432.532.317136I 020 2.03639 2.6 2.530.731.4547II 070 5.54953 2.7 2.656.035.724288I 17 1.0 6.56782 2.2 2.229.326.927219I 13 5.0 3.04338 2.0 1.952.332.32310II 020 2.02740 2.6 2.920.720.21111II 040 5.02839 2.9 2.626.519.5101112I 050 5.02851 2.5 2.243.328.66413II 12 1.0 2.02328 2.6 2.848.267.44414I 263.513.552422.22.050.328.4139All figures calculated as mean values,resulting in “virtual ”decimal values for regurgitation score and GER height.(Group I:infants fed A-B-A-B-A-B;Group II:infants fed B-A-B-A-B-A)./cgi/content/full/111/4/e 355e 357ing in their studies did not find a significant influ-ence on acid(pHϽ4)GER.9,10,13It is known from previous studies that the majority of reflux events in the infant age group are nonacid(pHϾ4),especially because of postprandial gastric neutralization after milk feedings.7,8These GER episodes are undetect-able by pH monitoring.17Therefore,we used the pH-independent IMP technique in combination with pH monitoring7,8,14and continuous visual and video surveillance.To exclude secondary causes of GER,infants were evaluated carefully before entering the study.11To exclude an influence of the different infant formulas fed before the study on the results,all infants re-ceived the same Formula B during the final prestudy day.To exclude interference by handling variation because of caregiver experience,each individual in-fant was fed by the same caregiver during the whole study phase.Initially,the study was designed as double-blind and placebo-controlled.When apply-ing strict study criteria,we found that by their ap-pearance the2study formulas could be distin-guished by experienced personnel.Therefore,“double-blind”was deleted from the study design. However,during data analysis,the study groups, and thus the order of treatment,were blinded to the investigators.Furthermore,in the chosen crossover design,each individual infant served as its own con-trol.There was a significant decrease of regurgitation frequency and amount(score)after feeding Formula A.Half of the infants did not regurgitate at all after Formula A.This effect was mostly caused by a sig-nificant reduction of GER episodes after Formula A, with GER events occurring in every single infant. It is known from previous studies8that most GER episodes reach the uppermost impedance channel (channel1,located in the pharynx).This is true for GER with and without regurgitation.In light of these findings,the slight reduction of reflux height reached in the esophagus after Formula A,although not sta-tistically significant(Pϭ.08),probably also contrib-uted to the decrease of regurgitation frequency.19 However,there was no significant difference in reflux height regarding acid versus nonacid GER.As demonstrated previously,10,13the occurrence of acid (pHϽ4)GER was not significantly reduced after thickened feeding.Because the majority(68%)of re-flux events was nonacidic(pHϾ4),one must assume that especially their reduction led to a decrease of regurgitation frequency.Alkaline(pHϾ7)GER epi-sodes were rare(0.3%),and their role is not yet clear in this age group.There has been concern about a suspected increase of regurgitation amount after thickened feeding as a result of delayed retrograde and anterograde gastro-esophageal motility.9This could not be confirmed by our study results.Mean GER duration was not sig-nificantly prolonged after feeding Formula A.As expected from previous studies using pH monitoring and impedance,8,15the duration of acid GER was longer than that of nonacid GER.This is because of a delay of acid clearance versus volume clearance. The effects of thickened feeding were analyzed in detail with this study.The combination of pH and impedance measurement was able to deliver valu-able new information regarding gastroesophageal motility.7We conclude from our results that formula thickened with carob bean gum2is an efficient ther-apy for uncomplicated GER and regurgitation in in-fants.There is an obvious advantage of using pre-thickened feedings versus individually added thickener regarding hygiene and handling.Follow-ing the recommendations,thickened formula should only be used under medical supervision and after parental advice and reassurance.1,3,18,20,21ACKNOWLEDGMENTSWe thank the nurses of the Fru¨h und Neugeborenen Station, Universita¨tsklinikum Aachen,Germany,for their enormous sup-port during the study;Dr Ing.Morten Trachterna for his technical expertise;and Dipl.Math.Thorsten Reineke for statistical advice.This study was supported in part by a grant(87/96-S1;to T.G.W.)from START,Medizinische Fakulta¨t,Rheinisch-West-fa¨lische Technische Hochschule Aachen,Germany.The work was published previously in abstract form(J Pediatr Gastroenterol Nutr. 2000;31:S206).Study formulas were provided by Milupa,Friedrichsdorf,Ger-many.TABLE5.Details of GER Episodes in Individual Infants After6Feedings:Nonacid(pHϾ4)Versus Acid(pHϽ4)GERPatient Number Group GER Episodes(n)GER Height(Impedance Channel)GER Duration(Seconds) Nonacid Acid Nonacid Acid Nonacid Acid1II67102 2.6 2.810.216.7 2II316 2.7 3.224.466.7 3I1316 3.4 2.836.5112.6 4I7446 2.2 2.220.020.9 5II3330 2.6 2.733.930.7 6I669 2.4 3.229.344.6 7II5052 2.6 2.827.562.7 8I10148 2.2 2.328.027.9 9I765 2.0 1.844.716.4 10II652 2.8 2.520.323.0 11II4121 2.7 2.920.425.9 12I6910 2.3 2.631.053.1 13II438 2.6 3.158.062.5 14I7222 2.1 2.040.739.8 All figures calculated as mean values,resulting in“virtual”decimal values for GER height.(Group I:infants fed A-B-A-B-A-B;Group II:infants fed B-A-B-A-B-A).e358THICKENED FEEDING AND GASTROESOPHAGEAL REFLUXREFERENCES1.Vandenplas Y,Belli D,Benhamou P,et al.A critical appraisal of currentmanagement practices for infant regurgitation—recommendations of a working party.Eur J Pediatr.1997;156:343–3572.Vandenplas Y,Lifshitz JZ,Orenstein S,et al.Nutritional management ofregurgitation in infants.J Am Coll Nutr.1998;17:308–3163.Rudolph CD,Mazur LJ,Liptak GS,et al.Guidelines for evaluation andtreatment of gastroesophageal reflux in infants and children:recom-mendations of the North American Society of Pediatric Gastroenterol-ogy and Nutrition.J Pediatr Gastroenterol Nutr.2001;32(suppl2):S1–31 4.Carroll AE,Garrison MM,Christakis DA.A systematic review of non-pharmacological and nonsurgical therapies for gastroesophageal reflux in infants.Arch Pediatr Adolesc Med.2002;156:109–1135.Vandenplas Y,Goyvaerts H,Helven R,Sacre L.Gastroesophageal re-flux,as measured by24-hour pH monitoring,in509healthy infants screened for risk of sudden infant death syndrome.Pediatrics.1991;88: 834–8406.Mahajan L,Wyllie R,Oliva L,Balsells F,Steffen R,Kay M.Reproduc-ibility of24-hour intraesophageal pH monitoring in pediatric patients.Pediatrics.1998;101:260–2637.Sondheimer J.Expanding the definition of GE reflux.J Pediatr Gastro-enterol Nutr.2002;34:511–5128.Wenzl TG.Investigating esophageal reflux with the intraluminal im-pedance technique.J Pediatr Gastroenterol Nutr.2002;34:261–2689.Vandenplas Y,Sacre k-thickening agents as a treatment for gas-troesophageal reflux.Clin Pediatr.1987;26:66–6810.Bailey DJ,Andres JM,Danek GD,Pineiro-Carrero ck of efficacyof thickened feeding as treatment for gastroesophageal reflux.J Pediatr.1987;110:187–18911.Vandenplas Y,Hachimi-Idrissi S,Casteels A,Mahler T,Loeb H.Aclinical trial with an“anti-regurgitation”formula.Eur J Pediatr.1994;153:419–42312.Borrelli O,Salvia G,Campanozzi A,et e of a new thickenedformula for treatment of symptomatic gastroesophageal reflux in in-fants.Ital J Gastroenterol Hepatol.1997;29:237–24213.Khoshoo V,Ross G,Brown S,Edell D.Smaller volume,thickenedformulas in the management of gastroesophageal reflux in thriving infants.J Pediatr Gastroenterol Nutr.2000;31:554–55614.Wenzl TG,Skopnik H.Intraluminal impedance:an ideal technique forevaluating pediatric gastroesophageal reflux disease.Curr Gastroenterol Rep.2000;2:259–26415.Wenzl TG,Schenke S,Peschgens T,Silny J,Skopnik H,Heimann G.Association of apnea and nonacid gastroesophageal reflux in infants: investigations with the intraluminal impedance technique.Pediatr Pul-monol.2001;31:144–14916.Peter CS,Sprodowski N,Bohnhorst B,Silny J,Poets CF.Gastroesoph-ageal reflux and apnea of prematurity:no temporal relationship.Pedi-atrics.2002;109:8–1117.Wenzl TG,Moroder C,Trachterna M,et al.Esophageal pH monitoringand impedance measurement:a comparison of two diagnostic tests for gastroesophageal reflux.J Pediatr Gastroenterol Nutr.2002;34:519–523 18.Aggett PJ,Agostoni C,Goulet O,et al.Antireflux or antiregurgitationmilk products for infants and young children:a commentary by the ESPGHAN committee on nutrition.J Pediatr Gastroenterol Nutr.2002;34: 496–49819.Orenstein SR,Magill HL,Brooks P.Thickening of infant feedings fortherapy of gastroesophageal reflux.J Pediatr.1987;110:181–18620.Orenstein SR,Shalaby TM,Putnam PE.Thickened feedings as a cause ofincreased coughing when used as therapy for gastroesophageal reflux in infants.J Pediatr.1992;121:913–91521.Martin AJ,Pratt N,Kennedy D,et al.Natural history and familialrelationship of infant spilling to9years of age.Pediatrics.2002;109: 1061–1067/cgi/content/full/111/4/e355e359。