文明的代價?!──兒童現代病

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1996 / 10月

文‧張瓊方 圖‧薛繼光



文明為人類生活帶來了便利,但卻也相對地產生許多「副作用」。長期生活在「文明」環境中的人們,不知不覺地染上了「文明病」,高血壓、氣喘、恐慌症……越來越多。

科技解決問題,卻又帶來新問題。人類發明抗生素來殺細菌,細菌卻也產生了抗藥性的菌種。去年十二月,台灣繼其他文明國家之後,也出現了令醫界束手無策的「萬古黴素抗藥性腸球菌」。

曾幾何時,文明已經開始禍延下一代,原本免疫力、抵抗力就較成人弱的兒童,也開始出現文明的後遺症……

和父母站在一起,許多人會注意到這一代的兒童在身材上有青出於藍的趨勢。由於營養好、醫學進步,現在的孩子不僅人高馬大,而且身上再也找不到牛痘疤。

根據教育部體育司的調查,我國十二歲的兒童平均身高超過一五二公分、體重超過四十四公斤,比二十年前高了十幾公分,也重了十幾公斤。但這方面的優勢,並不表示他們的體能也同樣強過父母。

一位作家在形容台灣早年與現代兒童的差異時,曾經有過這樣的觀察:四十年前的孩子像土雞,平常打赤腳、吃蕃薯籤稀飯,爬到樹上偷摘水果被發現時,從樹上跳下來就跑;現在的孩子吃的是魚肉、維他命丸,不但樹爬不上去,從三階樓梯上跌下來就可能摔斷腿,在太陽底下站十分鐘也很容易暈倒……

科技將文明一步步向前推進,但文明對我們下一代的影響並非全然是正面。

物競「人」擇

首先,科技改變了原來大自然的淘汰機制,無論在不孕症治療、安胎技術、早產兒的照顧上,醫療科技都有長足的進步。因而,過去無法存活的胎兒也得以留存下來。台灣地區新生兒的死亡率從民國四十三年的百分之十六•七,下降至民國八十三年的百分之二•一,就是醫療科技進步的最好說明。

然而,科技只解決部份問題,過去無法存活的胎兒雖然得以活下來,卻可能出現過去沒有的問題。

一位綽號「小黃瓜」的早產兒,即將在十月一日歡度周歲,令人難以相信的是,小黃瓜只在媽媽的肚子裡待了二十四周,出生時體重僅僅六百五十公克。

一般而言,早產兒由於發育不健全,容易產生一些併發症。例如:肺部不成熟,呼吸喘急,日後可能演變成慢性肺部疾病。此外,容易眼睛失明;腸子較弱,有時會破;較容易引發敗血症等等。

根據日本的研究,三個體重過輕的早產兒中,有一個救不活,一個會有後遺症,一個得以健康存活。健康存活的孩子以活到七十歲估算,將來他對社會的產能貢獻會是當初投入救三個早產兒經費的三倍。

因此,日本的法律規定妊娠二十二周起的早產兒就必須救,比其他國家以妊娠超過二十四周的標準嚴格。

除了科技的進展、人道的考量外,另一個現實因素是出生率日益減少。越是「文明」的國家,出生率越低。在快要後繼無人的情況下,「早產兒」自然也就日受重視。

根據早產兒基金會的推估,台灣目前早產兒的出生率約在百分之八至十左右,與大部份已開發國家的百分之五至十相近。至於為何會早產?一半以上原因不明,其餘被認為可能與產婦年齡、壓力、抽煙喝酒等因素有關。

從傳染病到文明病

此外,經濟發展、社會富裕後,兒童常見的疾病也跟著改變。

吐、瀉、痘、疹是過去兒科的四大症。根據衛生署的「中華民國衛生統計」,民國四十多年,我國排名十大死因首位的是胃炎、十二指腸炎、腸炎,其次是肺炎等傳染疾病。台大流行病學研究所教授兼所長陳建仁指出,被傳染致死的大部份是抵抗力、免疫力較弱的老人和小孩。

預防注射減少許多兒童傳染疾病的發生率,抗生素的發明也降低了部份傳染病的危險性。行醫將近三十年的馬偕醫院副院長黃富源指出,小兒科門診中細菌引起的腦炎、肺炎、腦膜炎等疾病減少;取而代之的是像感冒引起的氣管炎、輪狀病毒腸炎、喉嚨發炎引起的發燒……等疾病。「這些病毒引起的疾病,不治療自己也會好,但是醫生在治療上反而更麻煩,」他笑說,除了預防併發症外,小兒科醫師主要工作是在安慰母親。

然而,一些過去少見的兒童重症卻紛紛出現。根據衛生署所做的衛生統計,從民國七十幾年起,除了排名第一位的意外事故外,先天畸形或惡性腫瘤、小兒癌症等重症,高居兒童死亡原因的第二、三位。

根據中華民國兒童癌症基金會的統計,從民國七十幾年起,台灣每年增加五百多個○至十八歲的癌症病童。換句話說,每一萬個兒童中,就有一個罹患癌症。

兒童癌症以血癌、腦瘤、淋巴腫瘤為主,由於目前成因未明,並無證據顯示兒童癌症的出現與環境的危害有關,也有可能是醫療診斷精進的結果。陳建仁指出,自從診斷技術進步後,兒童癌症並無明顯的增加趨勢。

文明的指標

其他一些疾病雖然不會導致死亡,卻也足以令父母頭痛,過敏疾病、肥胖症、心身症等都是例子。

有人說:「文明病是現代化的指標,比股價指數還準。」從過敏性疾病的盛行率來看,文明進步的國家確實比低度開發的國家高很多。

台大醫院小兒部過敏免疫風濕科醫師周正成指出,紐澳地區的氣喘盛行率約百分之二十,歐美國家約百分之十幾,台灣雖然「落後」先進國家七到十年,但正在「急起直追」中。

過敏性疾病是現在兒科的主要疾病,特別是氣喘、過敏性鼻炎等呼吸道過敏疾病,這類小病號的日益增加與空氣污染關係密切。

一般人觀念中,只有排放烏煙廢氣的工廠才是污染源,其實不然。台灣大學環境衛生研究所教授李芝珊指出,台北市最大的污染源是所謂的「移動污染源」——汽機車。汽機車排放的二氧化氮、二氧化硫等,都會刺激呼吸道,引發過敏。

除了移動污染源外,還有一種有別於工廠的「固定污染源」經常被忽略。像住家附近的乾洗店、餐廳、飯店,雖然沒有冒黑煙的煙囪,但它們排放的有機溶劑、油煙等都是污染物,甚至是可能的致癌物。

根據多所教學醫院長期的追蹤研究發現,新生兒在一歲以前暴露於較多的二氧化硫、二氧化氮及臭氧中,在滿三歲時,罹患氣喘的比率較高。

中國醫藥學院附設醫院中醫兒科最近發表一份研究結果,報告中指出,呼吸道過敏的兒童頭髮中,含鉛量比一般幼兒高出三倍。這更加證實,環境污染是造成呼吸道過敏的一項重要原因。

李芝珊指出,過去在空氣品質良好的情況下,可能要一百個過敏原才會讓人過敏;現在經由空氣中懸浮微粒、硫氧化物、氮氧化物等污染物的刺激,使人的抵抗力減弱,只要五十個過敏原就會讓人產生過敏反應。

與(共枕

然而,空氣污染並非造成小兒過敏疾病增加的唯一因素。台北市空氣品質不是全省最糟的,但是台北市呼吸道過敏、氣喘的罹病率卻是全台灣最高的。原因是,除了工業化帶來的環境污染外,高度都市化的台北市還有許多其他的文明「污染」。周正成指出,像文明進步帶來的劇烈競爭和壓力;飲食習慣改變,高熱量、高蛋白、高脂肪食物導致氣喘、皮膚過敏增加;牛奶代替母奶,使新生兒提早受到過敏原的刺激;居家環境改變,密閉式空調、厚重不易清洗的沙發、地毯、窗簾等裝璜,,使得過敏原容易滋生,而導致過敏性疾病增加。

過敏原又因氣候、環境不同而有地域之別。歐美等四季分明的國家,過敏原以室外的花粉為主,其次是貓、狗等寵物。紐澳、台灣則以室內的塵(、黴菌、蟑螂、棉絮等為主。根據調查,台灣地區具有過敏體質的學齡兒童,百分之九十五以上都對塵(過敏。

塵(是一種八隻腳的節肢動物,大小約只有一至三微毫米,肉眼根本看不見。它們以人體的皮屑為生,四季如春、終年潮濕的台灣和紐澳,正是塵(最喜歡的生長環境。

無處可逃

室內除了塵(之外,還有許多同樣是肉眼看不見的危害。多數人以為,雖然外面污染嚴重,但孩子躲在家裡多少可以避避難吧?其實可憐的現代兒童,即使連在家裡也難免要遭受「毒害」。

一般兒童待在室內的時間比戶外長,事實上室內環境同樣充斥著許多具有危害性的污染物。科技進步的結果,家家戶戶無不擺設各種新式家具、使用「高效能」電器用品、日用品,殊不知這些全都是污染源。三合板家具釋放出來的甲醛、尿素甲醛;地毯中暗藏黴菌、細菌、塵(,無線電話有電磁波輻射,電視機有輻射線……,現代兒童要避免毒害,恐怕真比登天還難了。

近代建築結構,為了節省能源,使得室內外空氣更不容易交換。根據研究,舊式建築一小時內的換氣率達百分之百,但較新且隔熱設施好的建築物,室內空氣的更換率只有百分之五十。在空氣不易流通的情況下,病毒細菌就更容易傳播。

吃到飽、吃到撐

都市化的結果,不僅造成兒童呼吸道的疾病增加,也影響了孩子的視力與體重。

台灣兒童近視的盛行率之高,有目共睹。台大視力保健中心醫師林隆光指出,三十幾年前,台灣地區小學畢業學童近視罹患率不到百分之二十。隨著文明的腳步,兒童近視人口也與日俱增。根據衛生署去年的調查,台灣地區六年級的學童半數以上罹患近視,國中三年級的罹患率增加到七成五,高中生更高達八成五。

除了盛行率較高,台灣兒童的近視也較他國「早發」。國外的孩子近視多在高中階段發生,我們則在小學階段就發生。

過去醫界將近視與體重過重的原因歸咎於遺傳,而今則普遍認為環境才是重要因素。

生活在都市叢林裡的孩子,越來越少機會親近青山綠水,每天不是看書、看電視,就是打電動、打電腦……。根據經濟學人週刊的報導,一年級學童每星期花在家庭作業上的時間,美國是一•八小時;日本三•七小時;台灣八小時。光從以上數據,不難看出台灣兒童近視盛行率高與早發的另一個原因。

眼睛不得休息,另一方面身體卻「休息」過度。家裡所有的設備都有遙控裝置,人只要躺在沙發上就能開電視、開冷氣,上下樓坐電梯,出門有汽車代步,社會進步、經濟富裕後,不但餐餐有魚有肉有雞蛋,街上以油炸、肉類、甜食為主的西式速食店林立,「吃到飽」餐廳也到處都是,一般人普遍吃過量、營養過剩,何況兒童不知節制,好吃就猛吃,自然而然就吃到飽、吃到撐,吃到個個成了小胖子。

孩子,我要你比別人強

除了身體問題,兒童心理問題也開始浮現。

「孩子,我要你比別人強!」、「別讓孩子輸在起跑點上!」這些雖已陳腔濫調,但還是現代父母經常掛在嘴邊、放在心上的座右銘。

現代社會生存競爭日益嚴重,書店裡到處可見《成功的秘訣》、《如何在三十歲以前致富?》之類的「勵志」書籍,可見社會的價值觀為何,哪個父母會不希望自己的孩子能「成功」、「出人頭地」?學校教育也沒有教孩子們要互相扶持,只是一味強調競爭,讀前段班、考好學校,將來才有「前途」。

眾多壓力加諸在孩子身上,有些孩子在達不到父母的期許、社會的要求下,就以疾病來「對抗」壓力,這也就是兒童心身症日益增加的原因。

黃富源表示,小兒科門診中,真正有病需要治療的孩子,大概只有百分之三十。「除了感冒那些病毒感染不需要治療外,很多其實是大人有病。」現代兒童的處境,黃富源一語道盡。

環境降低容忍度

不可諱言地,一個疾病會不會造成障礙或困擾,與環境密切相關。近年出現的兒童新病症:「分心過動症」,過去並非不存在,只是現代的環境使這個病症更加凸顯。

過去的環境寬敞、開放,父母的期待或標準也較為寬鬆,兒童即使有過動或分心的表現,也不是一個令人困擾的問題。長庚兒童醫院兒童心智科醫師吳佑佑指出,過動兒是在這個環境的適應力出現問題,當環境中的空間變窄了,活動量大的孩子就顯得處處受限;功課壓力越來越大,注意力不集中的孩子學習表現就顯得不如人意。

目前醫界認為「分心過動症」肇因於腦部損傷,因此過動兒的發生率,不會因為環境的改變而增加,但是父母親認為孩子過份好動,帶孩子就診的比例,確實因環境的改變而增加。換句話說,知識增加、文明進步導致父母的「容忍度」降低了。根據丘彥南的粗略推估,懷疑孩子是過動兒,帶來兒童心理衛生中心求診的,十個中大約有一半以上不是。

永遠的戰爭

總之,科技進步了,但是人類的疾病並沒有因此而減少,只是改頭換面,以另一種方式、面貌出現,並且常常更令人頭痛,人類與疾病的戰爭永遠沒有結束。然而,孩子無辜,現代的大人們,在努力步向「文明」時,如何讓文明對孩子的傷害減到最低?是個值得好好想想的問題。

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近期文章

EN

The Price of Progress?--Illnesses of--the Modern Child

Chang Chiung-fang /photos courtesy of Hsueh Chi-kuang /tr. by Jonathan Barnard


Civilization has brought humanity many conveniences, but it has its ill effects too. People who live in "civilized" environments for too long become afflicted with the "diseases of civilization": high blood pressure, asthma, panic disorders. . . it's a long and growing list.

While solving some problems, science and technology have caused others. Humanity has created antibiotics to kill bacteria, but bacteria have mutated to resist antibiotics. In December of last year, Taiwan, on the heels of many other developed nations, discovered an intestinal bacteria in patients that was resistant to all drugs.

Can it be that civilization is creating a legacy of misfortune, and that children, who have weaker immune systems and are less able to fight disease, have started to display the ill effects of civilization?

From seeing children standing next to their parents, many people have discerned a trend: Because of ample nutrition and advanced medicine, today's children are as big and sturdy as horses (and free from cow pox scars to boot).

According a study carried out by the physical education department of the Ministry of Education, children in Taiwan aged 12 have an average height of more than 152 centimeters and an average weight of more than 44 kilos, which means that they are more than 10 centimeters taller and more than 10 kilos heavier than children of the same age two decades ago. But this trend doesn't mean that they are in any better shape than their parents were.

Comparing the differences between earlier generations and Taiwan's youth of today, one writer has made this observation: "The children of 40 years ago were like free-range chickens, running around barefoot and eating yam porridge. When they were caught in a tree picking fruit, they'd just jump off and run. The children of today, on the other hand, eat lots of meat, sea food, and vitamin pills, but they aren't fit enough to climb a tree, would break a leg if they fell down three steps, and might well faint after 10 minutes out in the sun. . . ."

Science and technology pushes civilization forward a step at a time, but the effects of civilization on the next generation are not all positive.

The end of natural selection

First of all, science and technology have changed nature's system of weeding out the weak. In treating infertility, designing procedures to ensure safe births, and caring for premature babies, great strides have been made. As a result, babies survive today that never would have in years past. It was widely hailed as a miracle when "Cucumber," a baby delivered at 650 grams after only 24 weeks in the womb, survived to attend his first birthday party on October 1.

The infant mortality rate in Taiwan fell from 16.7 percent in 1954 to 2.1 percent in 1994. Its drop is the clearest demonstration of the advance in medical science and technology. But science and technology can only solve some problems, and babies that didn't used to survive may now end up with previously unencountered problems.

Generally speaking, because their development hasn't been complete, premature babies often have undeveloped lungs and gasp for air, which may lead to chronic respiratory problems. What's more, they are more likely to be blind, their intestines are weaker and prone to tear, and they tend to suffer from hematosepsis.

According to Japanese research, out of three extremely underweight premature babies, one won't survive, one will suffer deleterious after-effects, and one will live in good health. A healthy child will live an estimated 70 years, and his future contribution to society will be three times what it cost to save three premature babies.

Hence, Japanese law states that babies born after the 22nd week of pregnancy must be saved, which is much stricter than the 24- week standard used in most countries.

Apart from ethical concerns and considerations based on scientific progress, another factor is the declining birth rate. The more "civilized" a nation, the lower its birth rate. With future generations growing smaller, "premature babies" are naturally getting more attention.

According to the estimates of the ROC Premature Infant Association, the rate of premature births in Taiwan stands at about 8-10%, within the 5-10% range seen in the advanced industrial nations. What are the causes of premature births? Most researchers believe they aren't clear, though a few see links to the mother's age, the amount of stress she bears, and if she smokes or drinks.

Civilized diseases

With economic development and affluence, the diseases suffered by children are changing as well.

The four big pediatric problems used to be vomiting, diarrhea, chicken pox and measles. According to the Health Department's "ROC Health Statistics," in the 1950s the biggest killers of people in Taiwan were gastritis, duodenitis and enteritis. Pneumonia and other various infectious diseases were also in the top ten. Chen Chien-jen, the director of the Institute of Epidemiology at National Taiwan University, points out that most of those who got infected and died were the very young and very old, who had low resistance to disease.

Vaccinations have brought down the rate of children infected with such diseases, and the use of antibiotics has also somewhat lowered the risks to those who do get infected. Huang Fu-yuan, the vice superintendent of Mackay Memorial Hospital, who has been working in medicine for 30 years, notes that the encephalitis, pneumonia and meningitis which pediatricians had to deal with 30 years ago have largely been replaced with illnesses caused by viruses: trachitis, enteritis, fevers caused by viral throat inflammations, etc. "For the illnesses caused by these viruses, one will get better without treatment, which makes it harder for us doctors," Huang says laughing. Besides trying to prevent complications, the main job of a pediatrician is to console mothers.

And a number of serious children's illnesses rarely seen before have now been rearing their heads one after another. According to Health Bureau statistics, since the 1980s the second and third biggest killers of children have been congenital conditions and cancer (accidents are first).

According to the statistics of the ROC Children's Cancer Foundation, since the 1980s, about 530 children in Taiwan have been diagnosed with cancer every year. To put it another way, one out of every 10,000 children now suffers from cancer.

The most common cancers suffered by children are leukemia, brain cancer and lymphosarcoma. Yet because the causes for these cancers are not yet clear and there is so far no evidence to support an environmental connection, the rise of cancer rates among children might simply be a result of advances in diagnosis. Chen Chien-jen points out that since improved diagnostic techniques were widely adopted, there has been no marked rise in cancer rates among children.

Marks of civilization

Other illnesses-such as allergies, obesity, and mental illness-may not be fatal but can still cause parents big headaches.

Someone once said, "Civilization's diseases are the marks of modernization." The rate of allergies in developed nations, for instance, is far above the rate in undeveloped nations.

Chou Cheng-cheng, a pediatrician specializing in rheumatism at NTU Hospital points out that the rate of asthma in New Zealand and Australia is close to 20 percent and is in the teens in America and Europe. While Taiwan may be seven to ten years "behind" those advanced industrial nations, he points out that "we are quickly catching up."

Allergies, especially asthma, as well as various other respiratory allergies, such as those affecting the nose and throat, are the most common of child illnesses. The rise in the rate of these "little" illnesses is closely linked to air pollution.

Most people believe that only factories belching smoke count as sources of air pollution, but this a misconception. Li Chih-shan, a professor at the Graduate Institute of Environmental Health at NTU, points out that the greatest sources of pollution in Taiwan are mobile. Cars and motorcycles spew forth sulfur dioxide, nitrogen oxides, etc., which can irritate the breathing passages and cause allergies.

Apart from mobile sources of pollution, there are fixed sources of pollution other than factories which are often overlooked, including dry cleaners, restaurants and hotels. They may not belch black smoke, but the organic solvents and oily smoke that they do release are a form of pollution, and perhaps even carcinogenic.

According to long-term research carried out by several medical schools, children who are exposed to relatively large amounts of sulfur dioxide, nitrogen oxides and ozone are more likely to suffer from asthma by the age of three.

The pediatrics department of traditional Chinese medicine at China Medical College Hospital has recently released a study which claims that children who suffer from respiratory tract allergies have three times the amount of lead in their hair as normal children. This is further evidence that environmental pollution is a major cause of respiratory allergies.

Li Chih-shan points out that in the past, when the air quality was good, perhaps as many as 100 allergen particles would be needed to induce an allergic reaction. Now, with so many pollutants suspended in the air and with the irritation caused by sulfur oxides and nitrogen oxides, people have much lower resistance, and only 50 such particles may now do the trick.

Mighty dust mites

But then, air pollution is not the only factor contributing to children's allergies. Taipei's air quality is not the worst in the province, yet Taipei does have the highest rate of respiratory tract allergies and asthma. The reason is that apart from the air pollution incurred by industrialization, Taipei also has a lot of "civilization pollution." Chou Cheng-cheng points to the intense competition and pressures in modern society and changes in diet. High-calorie, high-protein and high-fat foods can cause asthma and skin allergies, and with cow's milk replacing mother's milk, newborns are more quickly being irritated by sources of asthma. Then there are changes to the home environment. Sealed-off and air-con-ditioned, with thick sofas and rugs and curtains that are hard to clean, homes are now excellent places for allergens to fester and reproduce, which has led to a rise in the rate of allergies.

The sources of allergies vary according to differences in climate and environment. In America and Europe, where there is a clear distinction between seasons, the principal source of allergies is pollen found outside, followed by pets like dogs and cats. In New Zealand, Australia and Taiwan, on the other hand, the main culprits are dust, mold, cockroaches and cotton fibers. According to a survey, 95 percent of the school-age children with allergies in Taiwan are allergic to dust mite eggs.

The dust mite is an eight-legged arachnid, which is only about 0.1-0.3 mm long, too small for the human eye to see. It lives on dander (shed human skin), and thrives in humid climates where it never gets too cold, such as those of Taiwan, New Zealand and Australia.

No place to hide

And dust mites aren't the only invisible threats.

Many people worry about the pollution outside, but can children hidden at home escape from danger? The fact is that pitiable modern children will find it hard to escape danger even at home.

Most children are at home more than they are outside, and the truth is that the indoor environment is full of dangerous pollutants. As a result of technological and scientific advance, every household has various kinds of new furniture, "high-efficiency" appliances and daily-use items-all of which are potential sources of pollution.

Plywood furniture emits formaldehyde. Rugs fester with mold, germs and dust mites. Wireless phones and televisions emit electromagnetic radiation. . . . It's not easy for a modern child to escape these environmental hazards.

To conserve energy, modern architecture makes it hard for air to circulate between the outside and the inside. In traditional buildings the air would be completely replaced within an hour, but in well-insulated modern buildings, the hourly rate of air replacement reaches only 50 percent. Where it is not easy for air to circulate, germs can more easily be transferred.

Bursting at the seams

Apart from causing more children to suffer from respiratory illnesses, urbanization has also affected children's vision and weight. That a high rate of children in Taiwan are near-sighted is obvious to any observer. Lin Lung-guang, who is a doctor at NTU Hospital's Vision Protection Center, points out that more than 30 years ago about 20% of students graduating from elementary school in Taiwan suffered from near-sightedness. With civilization's advance, the rate of near-sightedness has grown by leaps and bounds, and Health Department statistics show that the ranks of the near-sighted now include more than half of sixth graders, 75% of ninth-graders and 85% of those in senior high school.

Apart from this tremendous rise, the children of Taiwan become near-sighted at a much earlier age than those of other countries. Abroad most children go near-sighted in high school, whereas here it happens in elementary school.

In years past the medical community thought near-sightedness and obesity were hereditary. Today they are believed to be connected to environmental factors.

Children raised in the concrete jungles of modern cities have less and less opportunity to come in contact with green hills and clean water. Day after day, if they're not reading, they're watching television, playing video games or using the computer. According to a report in The Economist, a first grader in an average week spends 1.8 hours doing homework in America, 3.7 in Japan, and 8 in Taiwan. The above figures point to another reason why more Taiwanese children go near-sighted, and to why they go near-sighted at an earlier age.

Apart from the problem of eyes not getting enough rest, there is also the problem of bodies getting too much. Home appliances all have remote controls now, and from the sofa one can change the television channel and turn on the air conditioning. One ascends and descends in elevators, and sits in cars instead of walking. With social progress and economic prosperity, not only does every meal have fish, meat and eggs, but out on the street there is one Western fast-food concession after another whose fares are based around deep frying, meats and sweets. "All you can eat" restaurants are appearing everywhere too. People are simply eating too much, and the problem is even more serious for children, who have no self-control and "pig out" if they like what they are eating. Quite naturally they just eat until they're sated, until they're stuffed, until they're fat.

Child, grow big and strong

And psychological problems are mounting as well as physical ones.

"Child, be stronger than other people!" "Don't let your child lose the race in the starting blocks!" While these may be clich廥, it doesn't stop modern-day parents from repeating them and making them their mottoes.

Competition in today's society is growing more and more intense. In the bookstores, you can find such "ambition- inciting" titles as The Secret to Success or How to Get Rich Before You're 30. They shed light on society's values. What parents wouldn't want their children to be "successful" or "stand out from the crowd"? And schools don't teach children to work together, but just emphasize competition. Students compete to get into the more advanced classes and to test into the best high schools, for only then will they have "futures."

Under greater and greater pressure, some children, who can't meet their parents' and society's expectations, use illness to "resist" pressure, leading to a growing number of psychosomatic disorders suffered by children. Huang Fu-yuan says that perhaps only 30% of children in pediatric clinics really need treatment. "Besides those that have common-cold type of viruses and don't need medical treatment, often the problem seems to be with the parents," says Huang, getting to the heart of the matter.

Dropping tolerance levels

What can't be denied is that the environment is closely related to whether or not an illness becomes a serious problem. Attention disorders and hyperactivity among children, which have come to everyone's attention in recent years, existed previously; modern environments just make them much more obvious. The environment used to be open and free and parents' expectations and standards were laxer too, and so when children were distracted or hyperactive, it wasn't a problem that would cause people great difficulties.

Wu Yu-yu of the children's psychiatry department at Chang Gung Memorial Children's Hospital, says that hyperactive children have problems adapting to modern life. Children who are hyperactive find restricted environments frustrating and find homework pressures hard to bear. Children with attention disorders also underachieve academically.

Currently the medical community holds that the root cause of "hyperactivity" is injury to the brain, so the number of hyperactive children shouldn't rise because of environmental factors. But the number of parents who believe that their children are hyperactive and seek treatment for them clearly has risen as a result of environmental change. To put it another way, with progress and greater knowledge there is less tolerance for aberrant behavior. According to the rough estimate of Chiou Chan-nan, more than half of the children whose parents suspect them to be hyperactive and take them in for treatment are not actually hyperactive.

Eternal war

Generally speaking, science and technology have brought progress, but they haven't brought the end to human illness, which has just changed its guise to cause even more trouble. Humanity's war with disease is endless, and children are its innocent victims. How can adults ensure that civilization causes children as little harm as possible? That is a question well worth our consideration.

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(drawn by Lee Su-ling)

p.8

Children used to run through the fields; now they weave through the traffic. Civilization has brought conveniences but also a loss of freedom. (photo by Diago Chiu)

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Children who have grown up in the concrete jungle of a modern city can't climb trees, so street lamps will have to do. (photo by Pu Hua-chih)

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Music lessons are just one of the ways parents try to "cultivate" talents in their children. But for many children, they just become another source of pressure. (photo by Huang Lili)

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As verdant hills and clear water grow removed from children's lives, and television, video games and computers become ubiquitous, modern children are confined to cramped spaces even when at play.

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Habitually focusing their eyes at close objects for long periods, children are going near-sighted at growing rates.

Microscopic dust mites are our constant companions. (photo courtesy of Chou Cheng-cheng)

(right) Respiratory tract allergies are one of the major "diseases of civilization." The proportion of children with allergies and asthma has grown in step with "progress."

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Are the "diseases of civilization" a necessary evil that comes with progress? How can innocent children escape from the danger?

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