追加：第 20 节第 16、17 条，婴儿每天补维生素 D、洗澡防烫

2026-10-14。两条都追加在第 20 节末尾，没有插在中间。本节加完 17 条，不到 20 条，不补节首导览。

查重

  • 维生素 D：全书只有第 6 节第 3 条（不缺维生素 D 的人）讲成人别为长寿去补，它的备注里写着「婴幼儿还是按医生说的补」，但没有剂量、时间和理由。第 6 节第 30 条讲骨折后补钙补维 D。婴儿怎么补没有条目，不算重复。新条目备注指回第 6 节第 3 条，反向指路请主任务补。
  • 洗澡防烫：第 13 节第 14 条讲烫伤后冲凉水（急救），第 2 节泡澡条讲成人，第 20 节第 5 条讲冲奶粉水温。没有讲怎么防婴儿被洗澡水烫的条目，不算重复。

四问

  • 维生素 D：① 每个新生儿家庭都会碰上；② 国内常见的误区是 6 个月内就给孩子补钙，或者觉得吃配方奶、晒太阳就不用补；③ 动作明确（每天补、6 个月内不补钙、不自己加量）；④ 有卫健委原文和国际共识。
  • 洗澡防烫：① 每个家庭都要给婴儿洗澡；② 很少有人知道 60 ℃ 上下的热水几秒钟就能烫成三度；③ 动作明确，本书没有；④ 有 WHO 报告、美国 CPSC、AAP、NHS 原文。

第 16 条：维生素 D

1. 国家卫生健康委办公厅 (2020) 婴幼儿喂养健康教育核心信息

  • URL：https://www.gov.cn/zhengce/zhengceku/2020-08/01/content_5531915.htm（2026-10-14 curl 直连取到）
  • 原文：「婴儿从出生开始，应当在医生指导下每天补充维生素D 400-800国际单位，促进生长发育。正常足月婴儿出生后6个月内一般不用补充钙剂。」
  • 国内写的是 400 到 800，国际共识写 400。标题写 400，收益栏把国内原文照录，说人话写「量按医生说的给」。

2. Munns CF 等 (2016) 佝偻病全球共识

  • DOI：https://doi.org/10.1210/jc.2015-2175，JCEM 101(2):394-415，PMID 26745253，全文 PMC4880117（Europe PMC 全文接口返回 500，改从 pmc.ncbi.nlm.nih.gov 带代理取到）
  • 推荐：「400 IU/d (10 μg) is adequate to prevent rickets and is recommended for all infants from birth to 12 months of age, independent of their mode of feeding. (1⊕⊕⊕)」（1 是强推荐，⊕⊕⊕ 是中等质量证据）
  • 11 个组织：摘要「The consensus group, representing 11 international scientific organizations」。
  • 土耳其数据：「no cases of radiographically confirmed rickets were seen after administration of 400 IU/d of vitamin D for 12 months, whereas the incidence was 3.8% in Turkish infants and young children who did not receive supplementation」。
  • 全球无报告：「Worldwide, there have been no reports of radiographically confirmed rickets in infants or children receiving 400 IU on a regular, daily basis.」

3. Beser E, Cakmakci T (1994) East Afr Med J 71(6):358-362，PMID 7835254

  • 摘要原文：「Rickets was not seen where 400 IU of vitamin D was administered, while incidence for the twelve-month period was calculated as 3.8% in the other group.」研究在土耳其东北部 21 个村子，3 到 36 个月的孩子。
  • 不是随机分组（一组给建议、一组给 400 IU），所以证据等级定 B。

4. Specker BL 等 (1992) J Pediatr 120(5):733-739，DOI 10.1016/s0022-3476(05)80236-7

  • 摘要原文：「256 term infants from two northern and two southern cities in China were studied in a randomized trial of vitamin D supplementation (100, 200, or 400 IU/day) during the first 6 months of life.」；「Cord serum 25-hydroxyvitamin D concentrations were lower in the north than in the south (5 vs 14 ng/ml (12.5 vs 35.0 nmol/L)」；「None of the infants had rickets at 6 months of age.」；「it may be prudent to supplement the diet with vitamin D at a dose of 400 IU/day.」
  • 12.5/35.0 ≈ 0.36，条目写「约三分之一」。这项研究里补 100 IU 的也没得佝偻病，条目照实写了「三组都没有」。

5. Tan ML, Abrams SA, Osborn DA (2020) Cochrane CD013046.pub2，PMID 33305822

  • 背景：「Vitamin D levels are low in breast milk and exclusively breastfed infants are at risk of vitamin D insufficiency or deficiency.」
  • 结果：「vitamin D at 400 IU/day ... may reduce the incidence of vitamin D insufficiency (25-OH vitamin D < 50 nmol/L) (RR 0.57, 95% CI 0.41 to 0.80; participants = 274; studies = 4; low-certainty). However, there was insufficient evidence to determine if vitamin D given to the infant reduces the risk of vitamin D deficiency ... or the incidence of biochemical or radiological rickets (all very-low certainty).」
  • RR 0.57 写成「少约四成」。

6. AAP, Where We Stand: Vitamin D & Iron Supplements for Babies（Last Updated 5/24/2022）

  • URL：https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Vitamin-Iron-Supplements.aspx（带代理取到）
  • 原文：「children should wear sunscreen, hats, and protective clothing when outdoors for extended periods of time ... For this reason, the AAP recommends that all infants receive a vitamin D supplement (unless they are consuming more than 27 ounces per day of commercial formula that has the vitamin D supplement added.」；「Vitamin D supplements of 400 IU (10 mcg) per day are recommended for babies up until age one year」
  • 27 盎司 ≈ 798 毫升，条目写「约 800 毫升」。和国内「所有婴儿都补」不一致，写在备注里。

7. Gallo S 等 (2013) JAMA 309(17):1785-1792，DOI 10.1001/jama.2013.3404

  • 摘要原文：「The 1600-IU/d dosage was discontinued prematurely because of elevated plasma 25(OH)D concentrations.」；「Growth and bone mineral content did not differ by dosage.」研究在加拿大蒙特利尔。

证据等级与收益量级

  • B：共识是强推荐，但防佝偻病的数字来自没有随机分组的比较；Cochrane 合并的随机试验只看到维生素 D 水平的改善，看不出佝偻病少没少。
  • 收益中，凭判断：3.8% 对 0 按机械规则会落「大」，但那是土耳其高危农村、非随机；国内婴儿佝偻病发生率没查到。

第 17 条：洗澡防烫

1. US CPSC, Avoiding Tap Water Scalds (Document 5098)

  • URL：https://www.cpsc.gov/s3fs-public/5098.pdf（带代理下载，pdftotext 可抽）
  • 原文：「Most adults will suffer third-degree burns if exposed to 150 degree water for two seconds. Burns will also occur with a six-second exposure to 140 degree water or with a thirty second exposure to 130 degree water. Even if the temperature is 120 degrees, a five minute exposure could result in third-degree burns.」
  • 6 秒、30 秒两档原文只说 burns，没说几度，条目写「也会烫伤」，只有 2 秒和 5 分钟两档写了三度。
  • 换算：150 ℉ = 65.6 ℃，140 ℉ = 60 ℃，130 ℉ = 54.4 ℃，120 ℉ = 48.9 ℃。

2. AAP, Bathing Your Baby（Last Updated 7/6/2025）

  • URL：https://www.healthychildren.org/English/ages-stages/baby/bathing-skin-care/Pages/Bathing-Your-Newborn.aspx
  • 原文：「Fill the basin with 2 inches of water that feels warm—not hot—to the inside of your wrist or elbow.」；「Never bathe your baby in running water」；「The AAP recommends that the hottest temperature at the faucet should be no more than 120 degrees Fahrenheit to help avoid burns.」；「hot water scalds are the top cause of burns among babies and young children」；「Most child drownings inside the home occur in bathtubs, and more than half of bathtub deaths involve children under 1 year of age.」

3. NHS, Washing and bathing your baby（Page last reviewed 23 July 2024）

4. WHO, UNICEF (2008) World report on child injury prevention, 第 4 章 Burns

  • 题录页：https://iris.who.int/handle/10665/43851。页面是前端渲染，正文用 DSpace 接口取：/server/api/pid/find?id=10665/43851 拿 uuid，/server/api/core/items/<uuid>/bundles?embed=bitstreams 列出英、中文 PDF 和对应的 .txt 文本层，直接下 .txt。
  • 中文版原文：「婴幼儿皮肤比成年人薄，较低的温度就可能使之烧伤，而且烧伤的程度会更深（77）」
  • 中文版原文：「在美国，通过教育计划同控制热水水龙头温度由60℃降至49℃的法规相结合的措施，华盛顿州因家用热水导致的烫伤数量降低（111，112）。」
  • 澳大利亚（中文版专题 4.4）：「全国范围内淋浴间水龙头的热水温度最高不超过50℃」；「从1989年到1996年，0-4岁年幼儿童因烫伤导致的住院比率降低了13%」；「最严重的烫伤（包括住院在10天及以上的）发生率下降最为明显——在该运动第二阶段之后的两年内降低了30%」。英文版对应「hot water taps in bathrooms」，条目写「浴室热水龙头」。
  • 1 岁以下（英文版）：「Infants under the age of one year are still at significant risk for burns, even in developed countries. The burns they suffer are most commonly the result of scalds from cups containing hot drinks or contact burns from radiators or hot-water pipes」。这一段在讲高收入国家，条目照写「在高收入国家」。
  • 没有采用：报告写「加拿大的一项研究……发现该措施可降低56%的烫伤（58）」。核了第 58 号文献，是 Han RK 等 (2007) Injury Prevention 13:248-253（DOI 10.1136/ip.2006.014480），摘要写的是「a projected 56% reduction」，是对一项「proposed」措施的模型预测，不是实测，所以不写。

5. Erdmann TC 等 (1991) Pediatrics 88(3):572-577，PMID 1881739

  • 摘要原文：「Five years after a 1983 Washington State law required new water heaters to be preset at 49 degrees C (120 degrees F)」；「Mean temperature in 1988 was 50 degrees C compared with 61 degrees C in 1977.」；「Eighteen burn victims were identified from July 1979 through May 1988, for an average admission rate of 2.4 per year, compared with 5.5 per year in the 1970s. Compared with the 1970s, total body surface area burned, mortality, grafting, scarring, and length of hospital stay were all reduced」
  • 2.4/5.5 = 0.44，降了 56%，说人话写「少了一半多」。前后对比，不是分组试验。

6. 国内儿童烧伤住院统计

  • Xu JH 等 (2014) Burns 40(8):1780-1788：「A total of 61,068 cases were included」；「Children under 3 years old were at the highest risk of injury. Scalds were the commonest burns (87.59%).」
  • Zhu L 等 (2013) Burns 39(5):1004-1011：「Among children hospitalized burns, the percentage of children younger than three years was 69.9%」；「Scald burns accounted for 89.79%」
  • Han D 等 (2022) Front Public Health 10:751615：「scalds (90.63%)」；「The median age was 2 years」
  • 三项都没有把洗澡水单独拆出来，条目写「被热的液体烫伤的占 87.6% 到 90.6%」，不写成洗澡水的比例。

7. WHO (2007) Legionella and the prevention of legionellosis

  • 题录页：https://iris.who.int/handle/10665/43233，正文同样走 DSpace 接口取 .txt。
  • 原文：「In domestic and public hot-water systems, control measures for reducing the proliferation of Legionella must not increase the risk of scalding, particularly for children, the elderly or people with disabilities.」
  • 原文：「The temperature of hot water reached within one minute at the tap should not be less than 50 ºC, except where thermostatic mixer valves are installed.」
  • 原文（示例水安全计划）：「Minimum flow temperature of 60°C to be maintained in water leaving the heating unit, and of 50°C at the tap」
  • 原文：「This can be achieved by lowering water temperatures throughout distribution systems or by installing thermostatic mixing valves close to the point of water use.」
  • 这条是标题里「能设出水温度的热水器」那个限定的依据：储水式热水器调低温度和防军团菌冲突，条目让储水式的靠先冷后热、试温，或装恒温混水阀。

证据等级与收益量级

  • B：华盛顿州和澳大利亚都是立法前后对比，CPSC 是烫伤阈值，没有研究算过「试水温」这个动作本身能少多少烫伤。
  • 收益中，凭判断：华盛顿州住院降 56% 按机械规则会落「大」，但那是改热水器温度的全州政策，不是家长个人动作；国内洗澡水烫伤没有单独数字。

没收的

  • 国内官方关于洗澡水温、热水器温度的科普：国家卫健委站内搜索被限频，没取到，条目没写国内官方提示。
  • 水温计的价格：没有来源，成本栏不写价格。