幼兒事故傷害與其主要照護者睡眠剝奪之關聯探討

兒童事故傷害為造成孩童死亡的主要原因，和先天性或內科疾病不同，事故傷害是可以預測且加以預防的。相較於其他年齡層的兒童，0-4歲兒童因為神經肌肉系統發育仍不成熟，再加上不了解周遭環境是否危險，因此這階段兒童的安全與否跟照顧者有更大的相關性。已有文獻顯示照護者疏忽為事故傷害發生之主要原因。照顧者的監督品質受到許多因素影響，如母親教育程度較低，照顧者的心理健康狀況，是否有飲酒或是服用藥物等。以往研究發現睡眠剝奪與意外事故相關，主要因為睡眠不足會改變認知功能，包括警覺性下降，注意力的不集中以及專心程度降低。此外，睡眠剝奪不只影響心理健康狀態，同時也會影響認知功能，加總起來極有可能會影響照顧者的監督品質。然而以往沒有任何研究探討照顧者睡眠品質與幼兒事故之間的相關性。因此本研究以病例對照研究法，實證探討照顧者睡眠剝奪與幼兒事故傷害之間關聯性。主要研究目的如下：一、探討幼兒主要照顧者之睡眠品質二、分析幼兒事故傷害與主要照顧者睡眠品質之相關性三、分析幼兒事故傷害與其他主要照顧者主觀因素之影響本研究的研究樣本為0-4歲幼童的主要照顧者。收案條件為年齡在0-4歲之間的孩童在收案期間因為意外傷害到衛生福利部雙和醫院急診室就醫。對照組則與病例組依年齡及性別配對。之後利用電話問卷調查方式以及病歷回顧方式收集相關資料。最後病例組有效問卷為301份，對照組為299份。本研究發現，超過8成的幼兒主要照顧者有『睡眠困擾』的煩惱。當主要照顧者若有睡眠困擾則幼兒因為意外事故至醫療院所就醫為沒有睡眠困擾的2倍。主要照顧者若有白天功能障礙，則幼兒有較高的傾向因為意外事故至醫療院所就醫。若主要照顧者有『睡眠效率』差的問題，則幼兒發生意外事故到醫療院所就醫的機會較低。睡眠剝奪為現代社會普遍存在的問題，尤其超過80%的幼兒主要照顧者都有睡眠困擾之問題。因主要照顧者睡眠剝奪與幼兒事故傷害相關，若能了解其作用機轉便能制定合適的教育以及介入方式，降低幼兒事故傷害。

關鍵字

幼兒事故傷害；睡眠剝奪；主要照顧者

並列摘要

Unintentional injury remains the leading cause of death for children. Injuries are not inevitable, they can be prevented or controlled. Compared with other age groups, infants and toddlers (0-4 years old) are more vulnerable to accidents. Not only they are not fully aware of the surrounding environment; moreover, their motor skill and neurologic development are not mature. Their own safety relies on caregivers more than any other age group. Therefore adequate parental supervision is an important strategy to keep infants and toddlers to stay away from the injury. Many factors such as substance abuse, single motherhood, large family size, poor socioeconomic status, etc. may have effects on parental supervision. Maternal mental health is also recognized associated with increased risk of injury in children. Sleep deprivation is recognized as a risk factor of unintentional injuries. It not only alters cognitive abilities, also results in negative mood status. Therefore sleep deprivation of caregiver might attribute to unintentional injuries of children under the effects of negative mood and poor daytime cognitive functions. This study design was a retrospective Case-Control study. Infants and toddlers (0-4 years old) were enrolled as case group if they visited the emergency department of Shaung-Ho Hospital due to unintentional injuries during Sep 1st 2013 to March 30th 2014. Children in the control group were matched with case group by age and gender. We collected related variables by chart review and telephone questionnaire survey. Our study showed odds of medically attended injuries were increased for children whose caregivers have “sleep disturbance”. Odds of medically attended injuries had the trend to be increased for children whose caregivers had poor “daytime dysfunction”. Children had lower probability of medically attended injuries if their caregivers had poor “habitual sleep efficiency”. To our knowledge, this is the first analysis to look at the association between caregiver’s sleeping quality and child injury. Our result provides evidence that caregiver’s sleeping condition might attribute to medically attended injury in children. Through which kind of mechanism that caregiver’s sleeping condition attribute to child injury remains unknown. Further research might be required.

並列關鍵字

Toddler injury ； Caregivers ； Sleep deprivation

參考文獻

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幼兒事故傷害與其主要照護者睡眠剝奪之關聯探討

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