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Crying |
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哭鬧 |
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Crying should be distinguished from colic. Crying is the only means an infant has to signify distress. Causes may be mundane (eg, a neonate accustomed to the tight environment of the womb becoming frightened by unrestricted arm and leg movements) or serious (eg, ear infection, abdominal pain). Often there is no obvious cause. Persistent or prolonged crying, especially with signs of illness, requires a search for a cause. Crying almost always improves by 4 to 6 mo; when it does not, providers should suspect physical pain or tension within the family. |
應(yīng)將哭鬧與疝痛相區(qū)別�？摁[是嬰兒表達(dá)痛苦的唯一方式。它有可能是日常原因引起的（如習(xí)慣于子宮緊密環(huán)境的新生兒會因手足運動的自由而受到驚嚇)�？摁[常常無明顯原因。持續(xù)、長時間的哭鬧，特別是伴有生病癥狀，就必須尋找病因�？摁[幾乎總會在4－6個月時改善。如果確實沒有改善，就應(yīng)懷疑是否有身體疼痛或家庭關(guān)系緊張。 |
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Evaluation |
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評估 |
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History: History focuses on the amount, timing, and quality of the crying as well as any signs of illness. Reports of fever or URI suggest possible otitis media. Reports of diarrhea or vomiting suggest pain from a GI process, ranging from gastroenteritis to more serious conditions. Reports of extreme parental frustration suggest tensions within the family that may be reflected in the infant's behavior.醫(yī)學(xué).全在線www.med126.com |
病史：病史評估重點是哭鬧數(shù)量、時間、性質(zhì)及任何疾病癥狀。發(fā)燒或上呼吸道感染反映提示中耳炎可能。腹瀉或嘔吐反映提示胃腸道問題引起的疼痛，如胃腸炎甚至更嚴(yán)重的疾病。如反映父母極其失望，則提示家 關(guān)系緊張，并影響到嬰兒行為。 |
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Physical examination: Examination focuses on growth parameters and any signs of illness. Distorted or erythematous tympanic membranes suggest otitis media. Abdominal distention or masses suggest an intra-abdominal process causing pain. Fever and fussiness without an apparent cause may result from UTI. |
體檢：體檢重點是生長發(fā)育情況及疾病癥狀。鼓膜變形或紅斑提示中耳炎，腹脹或腹部腫塊提示腹內(nèi)病變引起疼痛。發(fā)燒或無明顯原因的生氣可能是泌尿道感染所致。 |
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Testing: In most cases, testing is unnecessary unless otherwise indicated by history and examination. |
化驗：多數(shù)情況無需化驗，除非在病史或體檢中發(fā)現(xiàn)其他指癥。 |
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Treatment |
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治療 |
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The clinician's role in managing crying is to present explanations and options to parents, who can then try different strategies to diminish the child's crying. Approaches vary with cause and age. Infants are often comforted by swaddling, ambient noise, and movement, as in rocking or swinging in a swing. Both infants and older children often respond to a ride in the car. If parents and physician are convinced that there is no serious cause for the crying, the infant may be allowed to cry for a short period (“5-minute rule”), then parents comfort the infant and re-start the clock. Often parents are relieved to know that they can let the infant cry, and often the infant will stop spontaneously before the prescribed period is over. |
在處理哭鬧時，臨床醫(yī)師的作用在于為父母提供解釋和處理方案，父母據(jù)此償試用不同的方法減少小兒哭鬧。所用方法因哭鬧原因和小兒年齡而異。嬰兒常常通過襁褓、環(huán)境聲音和運動進(jìn)行安撫，如搖、蕩秋千。乘車通常對嬰兒和幼兒都有效。如果父母和醫(yī)師都確信哭鬧并無嚴(yán)重原因，就可以任嬰兒哭一小會（“5分鐘規(guī)則”)，然后父母再去安慰，并重復(fù)這一作法。當(dāng)父母知道可以讓嬰兒哭時就會感到輕松，嬰兒也常常會在預(yù)定時間結(jié)束前自行停止哭鬧。 |
