關於 4 years old cognitive development ，我們在網路上蒐集到這些相關的討論、資訊與評價

睇晒佢。

112300 好想喊，多謝手足！

【文獻整合：產前後 (perinatal) 經母體接觸二噁英對兒童的影響】

撰文：香港人兒科醫生

關於二噁英的基本資料和毒性我就不再贅述了，詳細可以參閱 Dr K Kwong 所寫。我是兒科醫生，所以我參閱的文獻以二噁英對兒童的影響為主。 翻查 Pubmed，近年關於二噁英與兒童的研究，主要針對於產前後 (perinatal) 經母體接觸二噁英對兒童的影響。 這是因為發展中的胎兒對任何有神經毒性 (neurotoxic) 的物質最為敏感，所以理論上影響最大。 巧合的是，就在今年二月， 香港醫學雜誌 （Hong Kong Medical Journal) 就有一份關於香港兒童長達11年的跟進研究 [1]。 但大部分地區包括最近香港發表的研究都是針對 “background level of dioxin” 的影響，即是一般存在於環境的二噁英。 正常來說濃度不高，對嬰孩發展有短期，但無長期的惡性影響 [1-3]。

但問題是，我們現在是擔心被二噁英高度污染，所以參考越南當地的情況應該較適合。 研究人員發現，在受污染地區的媽媽體內的二噁英，比沒有受污染的地區高三至四倍 [4-5]。 研究發現，母親體內的二噁英含量越高，兒童的多方面發展越受到不利影響。 這包括：認知、語言、大小肌肉、身體協調和平衡、和讀寫能力 [5-8]。簡單來說，母親體內二噁英含量越高，兒童在以上各方面表現越差。 這個惡性影響，在跟進到八歲的小朋友身上依然見得到。 受影響的兒童以男孩為主 [6-9]。而且，有發現受影響兒童社交方面發展較弱，有自閉症譜系障礙的徵狀 [10]。

男孩子比較受母體二噁英的影響，又引伸到二噁英引致內分泌異常的問題。 胎兒會因為母親體內二噁英而影響到睪丸激素（testosterone)的分泌 [11-12]，而此激素的異常會影響胎兒腦部成長 （詳情太複雜，不詳述）。 二噁英亦會影響幼童的甲狀腺功能 [13]。

除了以上，還有兩點我覺得需要留意。 第一， 越南被橙劑 (Agent Orange) 毒害已經是多年前的事，但受污地區的婦女體內二噁英含量依然高。 亦有研究發現當年因為911事件世界貿易中心倒塌時釋出的二噁英污染物，經過十幾年後，當時在附近的兒童，體內二噁英含量依然比一般人明顯地高 [14]。 由此可見二噁英的毒害是可以影響深遠。

第二，絕大部分關於母嬰的研究，研究人員都是測量母乳內的二噁英含量做數據。這是因為二噁英是脂溶性的 (lipophilic)，在母乳的含量和身體積存的份量相約，而母乳是容易最獲得的樣本。 這亦表示，嬰孩會經由母乳繼續攝取二噁英。 世界衛生組織 （WHO）基於研究發現產前二噁英經胎盤對胎兒影響比產後經由母乳吸收影響為大，而且母乳有非常多的其他好處 （詳情請參考衛生署網頁）。 由於母乳餵哺的好處多於壞處，所以繼續建議母乳餵哺[15]。 但我認為婦女需要知道母乳含有二噁英這個事實，然後作決定 （informed choice)。

至於關於二噁英與胎兒先天性異常 （congenital abnormality) 和幼童/青少年的影響，我之後有時間/心機讀完書先再分享。

#香港人
#要平安
#記得去投票

1. Hui LL, Lam HS, Lau EY, NElson EA, Wong TW, Fielding R. Prenatal exposure to dioxins and subsequent neurocognitive and developmental function in Hong Kong Chinese children. Hong Kong Med J 2019 Feb;25 Suppl 3(1):35-39.

2. Koopman-Esseboom C, Weiglas-Kuperus N, Ridder MAJ, eat al. Effects of polychlorinated biphenyl/dioxin exposure and feeding type on infants’ mental and psychomotor development. Paediatrics 1996;97:700-6

3. Nakajima S, Saijo Y, Kate S, eat al. Effects of prenatal exposure to polychlorinated biphenyls and dioxins on mental and motor development in Japanese child raven at 6 months of age. Environ Health jPerspect 2006;114:773-8

4. Tai PT, Nishijo M, Anh NT, Maruzeni S, Nakagawa H, Van Luong H, Anh TH, Honda R, Kido T, Nishijo H. Dioxin exposure in breast milk and infant neurodevelopment in Vietnam. Occup Environ Med. 2013 Sep;70(9):656-62.

5. Tai PT, Nishijo M, Kido T, et al. DIoxin concentrations in breast milk of Vietnamese nursing mothers: a survey four decades after the herbicides spraying. Environ Sai Technology 2011;45:6625-32.

6. Pham NT, Nishijo M, Pham TT, Tran NN, Le VQ, GTran HA, Phan HAV, Nishijo Y, NIshijo H. Perinatal dioxin exposure and neurodevelopment of 2-year-old Vietnamese children in the most contaminated area from Agent Orange in Vietnam.

7. Tran NN, Pham TT, Ozawa K, Nishijo M, Nguyen AT, Tran TQ, Hoang LV, Tran AH, Phan VH, Nadia A, Nishijo Y, Nishijo H. Impacts of perinatal dioxin exposure on motor coordination and higher cognitive development in Vietnamese preschool children: a five-year follow-up. PLoS One 2016 Jan 29;11(1):e0147655.

8. Pham The T, Pham Ngoc T, Hoang Van T, Nishijo M, Tran Ngoc N, Viu Thi H, Hoang Van L, Tran Hai A, Nishijo Y, Nishijo H. Isn’t J Hyg EnvironHealth. 2019 Oct 3 pic:S1438-4639(19)30287-1.

9. Nakajima S, Saijo Y, Miyashita C, Ikeno T, Sasaki S, Kajiwara J, Kishi R. Sex-specific differences in effect of prenatal exposure to dioxin-like compounds on neurodevelopment in Japanese children: Sapporo cohort study. Environ Res 2017 Nov;159:222-231.

10. Nishijo M, Pham TT, Nguyen AT, Tran NN, Nakagawa H, Hoang LV, Tran AH, Morikawa Y, Ho MD, Kido T, Nguyen MN, Nguyen HM, Nishijo H. 2,3,7,8-Tetrachlorodibenzo-p-dioxin in breast milk increases autistic traits of 3-year-old children in Vietnam. Mol Psychiatry 2014 Nov;19(11):1220-6.

11. Anh NTP, Kido T, Honda S, Obama Y, Anh LT, Phuket HD, Vietnam NH, Manh HD, Okamoto R, Nakagawa H, Nakayama SF, Nguyen DD, Van Tung D, Van Chi V, Minh NH, Van Tran N. Androgen disruption by dioxin exposure in 5-year-old Vietnamese children: Decrease in serum testosterone level. Sci Total Environ 2018 Nov 1;640-641:466-474.

12. Araki A, Mitsui T, Miyashita C, Nakajima T, Naito H, Ito S, et al. (2014) Association between maternal exposure to di (2-ethylhexyl) phthalate and reproductive hormone levels in fetal blood: The Hokkaido study on environment and children’s health. PLOS ONE 9:e109039 10.1371/journal.pone.0109039

13. Baccarelli A, Giacomini SM, Corbetta C, Texas al. NEonatal thyroid function in sevens o 25 years after maternal exposure to dioxin. PLoS Med 2008;5:1133-42.

14. Kahn LG, Han X, Koshy TT, Shan Y, Chu DB, Kennan K, Transande L. Adolescents exposure to the World Trade Centre collapse have elevated serum dioxin and furan concentrations more than 12 years later. Environ Int 2018 Feb;111:268-278.

15. Van den Berg M, Kypke K, Kota A, Tritscher A, Lee SY, Magulova K, Fiedler H, Malisch R. WHO/UNEP global surveys of PCDDs, PCDFs, PCBs and DDTs in human milk and benefit-risk evaluation of breastfeeding. ARCH Toxicol 2017 jan;91(1):83-96

多謝各界專業人士繼續出聲😭😭😭
好sad既係有醫生搵到文獻指母乳會傳送母體的二噁英比bb
而二噁英對小朋友發育影響深遠，去到8歲都仲見得到影響😭😭😭💔💔💔💔
好sad......香港政府毒害我地既下一代
🖕🏿🖕🏿🖕🏿🖕🏿🖕🏿🖕🏿🖕🏿🖕🏿🖕🏿🖕🏿

#用選票擊退保皇黨
#放催淚彈果班垃圾都會自食惡果
#好傷心
#陳肇始無恥
#恥與為伍
#食衛局局長放棄全香港人健康

112300 好想喊，多謝手足！

【文獻整合：產前後 (perinatal) 經母體接觸二噁英對兒童的影響】

撰文：香港人兒科醫生

關於二噁英的基本資料和毒性我就不再贅述了，詳細可以參閱 Dr K Kwong 所寫。我是兒科醫生，所以我參閱的文獻以二噁英對兒童的影響為主。 翻查 Pubmed，近年關於二噁英與兒童的研究，主要針對於產前後 (perinatal) 經母體接觸二噁英對兒童的影響。 這是因為發展中的胎兒對任何有神經毒性 (neurotoxic) 的物質最為敏感，所以理論上影響最大。 巧合的是，就在今年二月， 香港醫學雜誌 （Hong Kong Medical Journal) 就有一份關於香港兒童長達11年的跟進研究 [1]。 但大部分地區包括最近香港發表的研究都是針對 “background level of dioxin” 的影響，即是一般存在於環境的二噁英。 正常來說濃度不高，對嬰孩發展有短期，但無長期的惡性影響 [1-3]。

但問題是，我們現在是擔心被二噁英高度污染，所以參考越南當地的情況應該較適合。 研究人員發現，在受污染地區的媽媽體內的二噁英，比沒有受污染的地區高三至四倍 [4-5]。 研究發現，母親體內的二噁英含量越高，兒童的多方面發展越受到不利影響。 這包括：認知、語言、大小肌肉、身體協調和平衡、和讀寫能力 [5-8]。簡單來說，母親體內二噁英含量越高，兒童在以上各方面表現越差。 這個惡性影響，在跟進到八歲的小朋友身上依然見得到。 受影響的兒童以男孩為主 [6-9]。而且，有發現受影響兒童社交方面發展較弱，有自閉症譜系障礙的徵狀 [10]。

男孩子比較受母體二噁英的影響，又引伸到二噁英引致內分泌異常的問題。 胎兒會因為母親體內二噁英而影響到睪丸激素（testosterone)的分泌 [11-12]，而此激素的異常會影響胎兒腦部成長 （詳情太複雜，不詳述）。 二噁英亦會影響幼童的甲狀腺功能 [13]。

除了以上，還有兩點我覺得需要留意。 第一， 越南被橙劑 (Agent Orange) 毒害已經是多年前的事，但受污地區的婦女體內二噁英含量依然高。 亦有研究發現當年因為911事件世界貿易中心倒塌時釋出的二噁英污染物，經過十幾年後，當時在附近的兒童，體內二噁英含量依然比一般人明顯地高 [14]。 由此可見二噁英的毒害是可以影響深遠。

第二，絕大部分關於母嬰的研究，研究人員都是測量母乳內的二噁英含量做數據。這是因為二噁英是脂溶性的 (lipophilic)，在母乳的含量和身體積存的份量相約，而母乳是容易最獲得的樣本。 這亦表示，嬰孩會經由母乳繼續攝取二噁英。 世界衛生組織 （WHO）基於研究發現產前二噁英經胎盤對胎兒影響比產後經由母乳吸收影響為大，而且母乳有非常多的其他好處 （詳情請參考衛生署網頁）。 由於母乳餵哺的好處多於壞處，所以繼續建議母乳餵哺[15]。 但我認為婦女需要知道母乳含有二噁英這個事實，然後作決定 （informed choice)。

至於關於二噁英與胎兒先天性異常 （congenital abnormality) 和幼童/青少年的影響，我之後有時間/心機讀完書先再分享。

#香港人
#要平安
#記得去投票

1. Hui LL, Lam HS, Lau EY, NElson EA, Wong TW, Fielding R. Prenatal exposure to dioxins and subsequent neurocognitive and developmental function in Hong Kong Chinese children. Hong Kong Med J 2019 Feb;25 Suppl 3(1):35-39.

2. Koopman-Esseboom C, Weiglas-Kuperus N, Ridder MAJ, eat al. Effects of polychlorinated biphenyl/dioxin exposure and feeding type on infants’ mental and psychomotor development. Paediatrics 1996;97:700-6

3. Nakajima S, Saijo Y, Kate S, eat al. Effects of prenatal exposure to polychlorinated biphenyls and dioxins on mental and motor development in Japanese child raven at 6 months of age. Environ Health jPerspect 2006;114:773-8

4. Tai PT, Nishijo M, Anh NT, Maruzeni S, Nakagawa H, Van Luong H, Anh TH, Honda R, Kido T, Nishijo H. Dioxin exposure in breast milk and infant neurodevelopment in Vietnam. Occup Environ Med. 2013 Sep;70(9):656-62.

5. Tai PT, Nishijo M, Kido T, et al. DIoxin concentrations in breast milk of Vietnamese nursing mothers: a survey four decades after the herbicides spraying. Environ Sai Technology 2011;45:6625-32.

6. Pham NT, Nishijo M, Pham TT, Tran NN, Le VQ, GTran HA, Phan HAV, Nishijo Y, NIshijo H. Perinatal dioxin exposure and neurodevelopment of 2-year-old Vietnamese children in the most contaminated area from Agent Orange in Vietnam.

7. Tran NN, Pham TT, Ozawa K, Nishijo M, Nguyen AT, Tran TQ, Hoang LV, Tran AH, Phan VH, Nadia A, Nishijo Y, Nishijo H. Impacts of perinatal dioxin exposure on motor coordination and higher cognitive development in Vietnamese preschool children: a five-year follow-up. PLoS One 2016 Jan 29;11(1):e0147655.

8. Pham The T, Pham Ngoc T, Hoang Van T, Nishijo M, Tran Ngoc N, Viu Thi H, Hoang Van L, Tran Hai A, Nishijo Y, Nishijo H. Isn’t J Hyg EnvironHealth. 2019 Oct 3 pic:S1438-4639(19)30287-1.

9. Nakajima S, Saijo Y, Miyashita C, Ikeno T, Sasaki S, Kajiwara J, Kishi R. Sex-specific differences in effect of prenatal exposure to dioxin-like compounds on neurodevelopment in Japanese children: Sapporo cohort study. Environ Res 2017 Nov;159:222-231.

10. Nishijo M, Pham TT, Nguyen AT, Tran NN, Nakagawa H, Hoang LV, Tran AH, Morikawa Y, Ho MD, Kido T, Nguyen MN, Nguyen HM, Nishijo H. 2,3,7,8-Tetrachlorodibenzo-p-dioxin in breast milk increases autistic traits of 3-year-old children in Vietnam. Mol Psychiatry 2014 Nov;19(11):1220-6.

11. Anh NTP, Kido T, Honda S, Obama Y, Anh LT, Phuket HD, Vietnam NH, Manh HD, Okamoto R, Nakagawa H, Nakayama SF, Nguyen DD, Van Tung D, Van Chi V, Minh NH, Van Tran N. Androgen disruption by dioxin exposure in 5-year-old Vietnamese children: Decrease in serum testosterone level. Sci Total Environ 2018 Nov 1;640-641:466-474.

12. Araki A, Mitsui T, Miyashita C, Nakajima T, Naito H, Ito S, et al. (2014) Association between maternal exposure to di (2-ethylhexyl) phthalate and reproductive hormone levels in fetal blood: The Hokkaido study on environment and children’s health. PLOS ONE 9:e109039 10.1371/journal.pone.0109039

13. Baccarelli A, Giacomini SM, Corbetta C, Texas al. NEonatal thyroid function in sevens o 25 years after maternal exposure to dioxin. PLoS Med 2008;5:1133-42.

14. Kahn LG, Han X, Koshy TT, Shan Y, Chu DB, Kennan K, Transande L. Adolescents exposure to the World Trade Centre collapse have elevated serum dioxin and furan concentrations more than 12 years later. Environ Int 2018 Feb;111:268-278.

15. Van den Berg M, Kypke K, Kota A, Tritscher A, Lee SY, Magulova K, Fiedler H, Malisch R. WHO/UNEP global surveys of PCDDs, PCDFs, PCBs and DDTs in human milk and benefit-risk evaluation of breastfeeding. ARCH Toxicol 2017 jan;91(1):83-96

10 TOYS THAT PROMOTE SPEECH AND LANGUAGE DEVELOPMENT

Children spend most of their time in play, helping them understand their environment and interact with people. Nothing beats toys that children can hold and share with others. Thinking of toys to buy for your children? Check these toys that are easily available in stores near you.

1. Activity Board (6 to 12 months)
Babies at this stage are developing their motor skills and are continuing to explore through their senses. They also start to learn cause and effect. An activity board allows babies to manipulate and see the effect of each touch and turn.

2. Shape Sorter (1 to 1 ½ years)
At this age, babies have increased problem solving and actions on objects. Suggested toys include shape sorters, stacking rings, and ball and hammer. Parents can use these for language stimulation as well.

3. Cooking Set (1 ½ to 2 years)
Children start to engage in pretend play. With the cooking set, a child can pretend to do familiar everyday actions directed towards themselves (e.g. baby is drinking from a cup). Parents are encouraged to play with their child by naming actions they do (info talk), pretending (e.g. “Let’s eat chicken,” Yummy!”), asking questions (e.g. “Where’s the spoon?”) and expanding verbal productions (e.g. “You said eat? Let’s eat yummy chicken!”).

4. Mr. Potato Head (1 ½ to 2 years)
This toy is great for teaching the concept of body parts and actions. The toy also encourages early pretend play like feeding Mr. Potato Head, putting it to sleep, or giving him a bath.

5. Doll House (2 to 3 years)
Building and fixing the doll house encourages varied play combinations, a skill expected of 2-3 year old children. Children at this age show varied actions and use varied phrases and sentence combinations (e.g. “I put chair,” “Boy get milk”).

6. Doctor Set (2 to 3 years)
Children start to pretend using less-familiar events and take on more roles. A trip to the doctor is one memorable activity that you can recreate with toys. Actions done are more complex and varied (e.g. go to the doctor, get a check up, go home) and role reversals are common (e.g. “I’m the doctor and you’re the patient”).

7. Blocks (3 to 4years)
Blocks are open-ended toys that will lend for imaginative play. Children can use these to make houses, farms, vehicles, and more to create scenes for their play.

8. Action Figures (3 to 4 years)
Children are now exposed to more roles. They enjoy play that involves characters they see in the community (e.g. doctor, pilot) and on TV (e.g. superheroes). They also create dialogues while playing with it.

9. Art Materials (4 to 5 years)
Children mainly use language to set scenes. Paint, crayons, clay, glue, and other materials can pave the way for any theme or character that the child may want to use.

10. Board Games (5 years and above)
Since children are now entering the school age, they enjoy games that will challenge and hone their thinking. Board games such as Snakes and Ladders, Cadoo, Scrabble, Candyland, etc. are recommended. These games also promote good social interaction.

#betterhearingandspeechmonth
#bhsm
#communicationforall
#withcommunicareitspossible

References:
• Cohen, E. (2018, January 23). Learning Language Through Play • Tandem Speech Therapy, Austin, TX. Retrieved from https://www.tandemspeechtherapy.com/2018/01/04/learning-language-through-play/
• “Age-by-Age Guide to Toys!” Parents, 13 Dec. 2017, www.parents.com/fun/toys/kid-toys/toys-for-all-ages/.
• Westby, C. (1980). Assessment of Cognitive and Language Abilities Through Play. Language Speech and Hearing Services in Schools, 11(3), p.154.