托育机构特殊健康需求婴幼儿养育照护专家共识

Expert consensus on the nurturing care of infants and young children with special health needs in nursery institutions

摘要

本共识旨在为托育机构特殊健康需求婴幼儿(包括生长偏离、轻度心理行为发育偏离、慢性疾病稳定期患儿等)提供循证、安全、个性化的养育照护操作指南。基于“安全第一、个体化、回应性照护、医育结合、发展支持、尊重保密”六大原则,共识系统地提出了人员资质、制度建设、环境设施、协同机制等基本要求,并针对营养不良/超重肥胖、轻度心理行为发育偏离、食物过敏、癫痫、哮喘、早产儿等6类常见特殊健康需求婴幼儿,分别明确了照护目标与具体建议。同时,强调通过家-托-医三方协同,建立专案管理、动态监测预警与闭环转介机制,保障照护的连续性与高质量。本共识的实施将为托育服务标准化建设及政策制定提供科学依据,促进特殊健康需求婴幼儿的早期全面发展。

Abstract

This consensus aims to provide evidence-based, safe, and personalized practical guidelines for the nurturing care of infants and toddlers with special health needs (including those with growth deviations, mild psychological and behavioral developmental deviations, and chronic diseases in stable stages) in nursery institutions. Based on the six principles of "safety first, individualization, responsive care, integration of medical and nurturing care, developmental support, and respect for confidentiality", the consensus systematically proposes basic requirements regarding personnel qualifications, system construction, environmental facilities, and collaborative mechanisms. Furthermore, specific care objectives and recommendations are delineated for six common categories of infants and young children with special health needs: malnutrition/obesity, mild psychological and behavioral developmental deviations, food allergies, epilepsy, asthma, and preterm infants. Additionally, it emphasizes the establishment of a case management system, dynamic monitoring and early warning mechanisms, and a closed-loop referral process through the tripartite collaboration of families, nurseries, and medical institutions, ensuring continuity and high quality of care. The implementation of this consensus will provide a scientific basis for the standardization of nursery services and policy formulation, promoting the comprehensive early development of infants and toddlers with special health needs.

关键词

托育机构 / 特殊健康需求 / 养育照护 / 婴幼儿

Key words

nursery institutions / special health needs / nurturing care / infants and toddlers

[1] Villa-Velásquez J, Reynaldos-Grandón K, Chepo Chepo M,et al. Interdisciplinary approach to the care of children and adolescents with special health needs: An integrative review[J].Arch Argent Pediatr,2025,123(4):e202410577.
[2] 李廷玉,毛萌,江帆.儿童保健学[M].北京:人民卫生出版社,2024.
Li TY, Mao M, Jiang F.Child health care[M].Beijing:People's Medical Publishing House,2024.(in Chinese)
[3] 毛萌,邵婕,陈津津,等.《生长减缓婴幼儿的追赶生长:指导临床医师的专家建议》解读[J].临床儿科杂志,2024,42(5):390-398.
[4] 中国营养学会.中国居民膳食指南(2022)[EB/OL].(2022-04-26)[2026-03-29].http://dg.cnsoc.org/article/2021b.html
[5] World Health Organization. Guidelines on physical activity,sedentary behavior and sleep for children under 5 years of age[EB/OL].(2019-04-24)[2026-03-29].http://www.who.int/iris/handle/10665/311664.
[6] 中华医学会儿科学分会内分泌遗传代谢学组,国家儿童健康与疾病临床医学研究中心,中华医学会儿科学分会儿童保健学组,等. 婴幼儿肥胖管理专家共识(2025)[J]. 中华儿科杂志,2025,63(11):1182-1188.
The Subspecialty Group of Endocrinologic, Hereditary and Metabolic Diseases, the Society of Pediatrics, Chinese Medical Association;National Clinical Research Center for Child Health;the Subspecialty Group of Child Health Care, the Society of Pediatrics, Chinese Medical Association,et al.Expert consensus on the management of obesity in infant and toddler (2025)[J].Chin J Pediatr,2025,63(11):1182-1188.(in Chinese)
[7] 国家卫生健康委员会.7 岁以下儿童生长标准: WS/T 423-2022[S]. 北京:中国标准出版社,2022.
[8] Miller LE, Dai YG, Fein DA, et al. Characteristics of toddlers with early versus later diagnosis of autism spectrum disorder[J]. Autism, 2021, 25(2): 416-428
[9] 童梅玲. 婴幼儿养育照护中早期学习机会的创设[J].中国儿童保健杂志, 2024, 32(2):117-121.
Tong ML.Establishment of early learning opportunities in nurturing care[J].Chin J Child Health Care,2024,32(2):117-121.(in Chinese)
[10] 金曦,王惠珊,张悦.高危儿童保健指导手册[M].北京:北京大学医学出版社,2020.
[11] Clark-Gambelunghe Mb, Clark DA. Sensory development[J].Pediatr Clin North Am, 2015, 62(2):367-384.
[12] Katz E, Girolametto L. Peer-mediated intervention for preschoolers with ASD implemented in early childhood education settings[J].Topics Early Child Spec Educ,2013,33(3):133-143
[13] Nandi R, Luxon LM. Development and assessment of the vestibular system[J]. Int J Audiol,2008,47(9):566-577.
[14] 胡艳,梁晶晶,宋燕燕,等.医育结合模式下3岁以下婴幼儿照护服务的现状及展望[J].中国妇幼卫生杂志, 2024, 15(3):1-4.
Hu Y,Liang JJ,Song YY,et al.Current situation and prospects of child care services for children aged 0 - 3 based on the medical and educational integration model[J].Chinese Journal of Women and Children Health,2024,15(3):1-4.(in Chinese)
[15] 徐玉英, 王雪娜, 李佳, 等. 婴幼儿回应性照护的研究进展[J]. 中国儿童保健杂志, 2023, 31(1):71-75.
Xu YY,Wang XN,Li J,et al.Research progress in responsive caregiving for infants and toddlers[J].Chin J Child Health Care,2022,31(1):71-75.(in Chinese)
[16] Muraro A, Werfel T, Hoffmann-Sommergruber K, et al. EAACI food allergy and anaphylaxis guidelines: Diagnosis and management of food allergy[J].Allergy,2014, 69(8):1008-1025.
[17] Koletzko S, Niggemann B, Arato A,et al. Diagnostic approach and management of cow's-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines[J].J Pediatr Gastroenterol Nutr,2012, 55(2):221-229.
[18] Clark AT, Skypala I, Leech SC,et al. British Society for Allergy and Clinical Immunology guidelines for the management of egg allergy[J].Clin Exp Allergy,2010, 40(8):1116-1129.
[19] Wang J, Bingemann T, Russell AF,et al. The allergist's role in anaphylaxis and food allergy management in the school and childcare setting[J].J Allergy Clin Immunol Pract,2018,6(2):427-435.
[20] Berg AT, Symonds JD, Sampson JR. Early childhood epilepsies: Epidemiology, classification, aetiology, and socio-economic determinants[J].Brain,2021,144(9): 2879-2891.
[21] Hunter MB, Yoong M, Sumpter RE, et al. Neurobehavioral problems in children with early-onset epilepsy:A population-based study[J].Epilepsy Behav,2019,93: 87-93.
[22] National Institute for Health and Care.Epilepsies: Diagnosis and management[EB/OL].[2026-03-29].https://wjdpn.cn/epilepsy/medical-file-download.html.
[23] 中国抗癫痫协会.癫痫病学临床诊疗指南[M].北京:人民卫生出版社, 2015.
[24] Al-Biltagi M.Childhood epilepsy and sleep[J].World J Clin Pediatr, 2014, 3(3): 45-53.
[25] Krutoshinskaya Y, Sinha SR, Shvarts V, et al. The reciprocal relationship between sleep and epilepsy[J].J Pers Med,2024,15(1):118.
[26] Haridas B,Testino A,Kossoff EH.Ketogenic diet therapy for the treatment of pediatric epilepsy[J].Epileptic Disorders, 2025,27(2):144-155.
[27] Borowicz-Reutt K, Krawczyk M, Czernia J. Ketogenic diet in the treatment of epilepsy[J].Nutrients,2024,16(9): 1258.
[28] Perna S,Spadaccini D,Noli S,et al.Effects of classical ketogenic diet in children with refractory epilepsy:A retrospective cohort study[J].Nutrients,2022,14(9):1744.
[29] 中国医药教育协会儿科专业委员会,中华医学会儿科学分会呼吸学组哮喘协作组,中国医师协会呼吸医师分会儿科呼吸工作委员会,等.儿童支气管哮喘诊断与防治指南(2025患者与公众版) [J].中华实用儿科临床杂志, 2025, 40(5): 324-333.
China Medicine Education Association Committee on Pediatrics;Cooperative Group of Asthma, the Subspecialty Group of Respiratory, the Society of Pediatrics, Chinese Medical Association;Chinese Medical Doctor Association Committee on Respirology Pediatrics,et al.Guidelines for the diagnosis and optimal management of asthma in children (patient and public version, 2025)[J].Chin J Appl Clin Pediatr,2025,40(5):324-333.(in Chinese)
[30] 中华医学会儿科学分会呼吸学组, 中华儿科杂志编辑委员会, 中国医药教育协会儿科专业委员会.儿童支气管哮喘诊断与防治指南(2025)[J]. 中华儿科杂志, 2025, 63(4): 324-337.
The Subspecialty Group of Respiratory, the Society of Pediatrics, Chinese Medical Association;the Editorial Board, Chinese Journal of Pediatrics;China Medicine Education Association Committee on Pediatrics.Guidelines for the diagnosis and optimal management of asthma in children (2025)[J].Chin J Pediatr,2025,63(4): 324-337.(in Chinese)
[31] 中国医药教育协会儿科专业委员会,中华医学会儿科学分会呼吸学组哮喘协作组、慢性咳嗽协作组,中国医师协会呼吸医师分会儿科呼吸工作委员会,等. 婴幼儿反复喘息诊治、管理、预防临床实践循证指南(2025)[J].中华实用儿科临床杂志,2025,40(10):721-734.
China Medicine Education Association Committee on Pediatrics;Cooperative Group of Asthma, Cooperative Group of Chronic Cough, the Subspecialty Group of Respiratory, the Society of Pediatrics, Chinese Medical Association;Chinese Medical Doctor Association Committee on Respirology Pediatrics,et al.Evidence-based guidelines for clinical practice in the diagnosis, treatment, management, and prevention of recurrent wheezing in infants and toddlers(2025)[J].Chin J Appl Clin Pediatr,2025,40(10):721-734.(in Chinese)
[32] 国家呼吸系统疾病临床医学研究中心,中华医学会儿科学分会呼吸学组哮喘协作组,中国医药教育协会儿科专业委员会,等.中国儿童哮喘行动计划临床应用专家共识[J].中华实用儿科临床杂志,2021,36(7):484-490.
China National Clinical Research Center for Respiratory Diseases;Cooperative Group of Asthma, the Subspecialty Group of Respiratory, the Society of Pediatrics, Chinese Medical Association;China Medicine Education Association Committee on Pediatrics,et al.Expert consensus on clinical application of China Children's Asthma Action Plan[J].Chin J Appl Clin Pediatr,2021,36(7):484-490.(in Chinese)
[33] 中国医药教育协会儿科专业委员会,中华医学会儿科学分会呼吸学组哮喘协作组,中国医师协会呼吸医师分会儿科呼吸工作委员会,等.中国哮喘儿童运动处方专家共识[J].中华实用儿科临床杂志,2022,37(8):563-571.
China Medicine Education Association Committee on Pediatrics;Cooperative Group of Asthma, the Subspecialty Group of Respiratory, the Society of Pediatrics, Chinese Medical Association;Chinese Medical Doctor Association Committee on Respirology Pediatrics,et al.Expert consensus on exercise prescription for asthmatic children in China[J].Chin J Appl Clin Pediatr,2022,37(8):563-571.(in Chinese)
[34] 国家卫生和计划生育委员会办公厅.早产儿保健工作规范[J].中华围产医学杂志,2017,20(6):401-406.
General Office of National Health and Family Planning Commission of the People's Republic of China.Health care protocol for preterm infants[J].Chin J Perinat Med,2017,20(6):401-406.(in Chinese)
[35] 许梦雪,张羽宁,关宏岩. 关注婴幼儿养育照护及家庭指导热点问题[J].中国儿童保健杂志,2025,33(3):238-243.
Xu MX,Zhang YN,Guan HY.Focusing on key issues in caregiving for infant and toddlers and family nurturing guidance[J].Chin J Child Health Care,2025,33(3):238-243.(in Chinese)