Behaviour Archives

Bedtime Blues

May 7, 2022 Return

It is 10:00 pm, and your toddler insists on playing horse with her father. When the two of you finally convince the bundle of energy to go to bed, you can only groan when you feel a tug on your sheets, what seems like seconds after you have closed your eyes. You look through bleary eyes at the clock – 1.00 am – and try not to groan as your little darling tells you, “Mummy, pee-pee!!”

If you are like many parents, you may believe that you can finally get some reprieve from those late nights of night feeding and comforting your crying baby once your child enters her toddler years. However, you soon realise that you have just moved on to another phase of Parenthood: the Sleepless Years.

There are many possible reasons why your toddler does not seem to have an “off” button. Some toddlers give their parents a hard time during bedtime due to separation anxiety (as their parents often leave them alone for a while to complete their chores), while others may just be that way naturally, taking a while before they fall asleep. Some adults take a while to fall asleep while others drift off to dreamland the moment their heads hit the pillow – toddlers are like that too.

Fortunately, there are some things you can do to establish a routine with your toddler, so that she would go to sleep at a reasonable hour and let you go to work the next morning without looking like a cranky zombie.

Wind your toddler down before bedtime.

Your toddler will be less likely to fall asleep when it is bedtime if she is an excited bundle of energy. Therefore, a few hours before bedtime, slow things down around the house. Keep a calm and quiet environment, make her put away her toys and switch off the TV or iPad ahead of bedtime, dim the lights a little and let her enjoy some low-key activities such as story time. As your toddler’s energy level slowly ebbs as bedtime draws near, you would have an easier time getting her to fall asleep.

Establish the “3B” routine.

3B stands for bath, book and bed. Each day, leading up to your toddler’s bedtime, establish a fun routine comprising bathtime, a bedtime story and then, tucking your toddler in, pulling the covers over her. You can also try singing your toddler to sleep if you need a break from reading her favourite story for so many times.

It may be a challenge to get your toddler to stick to this routine, so use the creativity and even, sneakiness that every parent instinctively has. For example, you can offer rewards such as an extra story if your toddler follows the routine without much fuss.

Initially, your toddler may call you to come back to read her another story or just to be with her a little longer. Break this habit gently by telling her that you need to be away for a while so she needs to stay in her bed, and you will check on her 5 minutes later. If she keeps calling you to come back, wait a longer time each time before you check up on her again. Once your toddler realizes that you are never far away, she will feel safe enough to fall asleep on her own.

Your toddler will also come up with other tactics to delay being sent to bed. Something will always need to be done right away, or a toy will be missing and you need to help her find it. You can anticipate these requests in advance and incorporate them into the daily pre-bedtime routine. For instance, placing your toddler’s favourite water bottle next to her bed will stop those repeated requests for water. You can also allow her one request before you leave her to sleep. This way, she will feel that she is getting her way and will be more inclined to go to sleep.

Let the toddler make some choices.

Toddlers love to feel important and that they are getting their way, so play to your toddler’s inner diva by offering her some choices in certain matters, such as her choice of pajamas and the story she wants you to read to her. The trick here is to offer only 2 options, options that would make you happy regardless of whichever your toddler chooses. Yes, this seems sneaky, but parents are allowed to be sneaky when it comes to their children.

Be firm, hold your ground.

Like everything else in parenting, you have to be resolute and stick to your decisions despite the tears, pitiful begging, wailing and blubber your toddler throws your way. It may be tempting to give in just that once and let your toddler watch the iPad a little longer, but every time you cave in, your toddler becomes more confident of her power over you and subsequent bedtimes will continue to be power struggles.

However, try to be patient as well, as losing your temper will only make the situation worse.

Have a comfortable bedroom.

Toddlers, like most adults, sleep best in dark and well-ventilated bedrooms. Make sure that your toddler sleeps on a comfortable mattress, and if she tends to kick off the sheets while she sleeps, let her wear some socks should she get cold at night. Also, make sure that sounds of the TV or other distractions cannot be easily heard from the bedroom. This will allow your toddler to continue sleeping while you sneak out to catch up on your favourite TV shows.

If your toddler is scared of the dark, try comforting her by telling her that you are close and she is safe. You can also leave a small light on to assure her. If she manages to sleep well, praise her for her courage. Avoid belittling or mocking her fears, as this will only intensify her anxiety. In the meantime, try to find out possible reasons for her fear. She may be watching things that she finds frightening on the TV or iPad.

Who’s afraid of bedtime?

Some toddlers are afraid of the dark, sleeping alone or whatever they imagine is hiding under the bed – or sometimes all 3 at once. This is because, at their age, toddlers have yet to learn how to differentiate between what is real and what is not.

Eventually they will outgrow such fears, but there is a possibility that such fear can cause lingering psychological damage if handled poorly by the parents.

If your toddler repeatedly brings up her fears during bedtime, try the following:

Be supportive. Even if the idea of a giant monster hiding under the bed may seem absurd to you, humour your toddler and comfort her by making a show of checking under the bed and saying loudly that there is nothing there before you tuck her into bed. If she is scared of the dark, keep a small light on or let her sleep close to you so that she can feel your presence nearby. If you have to leave her alone for a short while, keep the bedroom door slightly open so that she can see that you are still close enough to her.
Avoid frightening situations. Avoid subjecting your toddler to violent or scary stories – this may include some popular fairy tales! Keep a calm, quiet and soothing atmosphere around the house in the evening leading up to her bedtime to help soothe her nerves. You can also read her bedtime stories of children overcoming their fears to inspire her to overcome her own fears.

Another tip you can try is to offer your toddler a symbolic talisman – such as a small torchlight for a toddler who is terrified of the dark, or a favourite doll for one who is scared of sleeping alone – so that she can hold on to it and find some comfort while she tries to sleep.

References:

Aha! Parenting at www.ahaparenting.com

Parenting at www.parenting.com

Baby Center at www.babycenter.com

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Have No Fear, My Brave Little One

May 7, 2022 Return

WORDS LIM TECK CHOON

Most of us have heard of the story of Little Red Riding Hood. The version we are familiar with is one of many retellings that had been passed down from parent to child over centuries.But do you know that there is a lesser known version, as retold by the Brothers Grimm, which saw Little Red Riding Hood, having survived her encounter with the Big Bad Wolf, meeting another similar wolf in the woods?

She eventually sets a trap by pouring the water her grandmother had boiled some sausages in into a river. Lured by the smell of sausages, the trips into that river and drowns. Little Red Riding Hood then happily goes home, knowing that she will never be threatened by wolves ever again.

Real life isn’t a fairy tale, as much as we may sometimes wish it to be, and hence, children who are fearful may need a little help and support to deal with their fears. Clinical psychologist Shazeema Mashood Shah shares with us some insight as to how we can help our own Little Red Riding Hoods and Peter Pans overcome the Big Bad Wolves and Captain Hooks that cause them fears and anxieties.

DON’T BE AFRAID OF BEING AFRAID

Everyone feels fear. It isn’t just kids who harbour anxieties about the great and frightening unknown, we grown-ups and parents do too. Whether it’s a fear of flying or of heights, our fears are rarely rational. No matter how much we are presented with evidence on how statistically small our chances are of dying in a plane crash, for example, our fear of flying may remain a tough one to douse.

Shazeema points out that if we adults still have a hard time tamping down our fears sometimes, children often have a harder time. After all, they are still learning about the world, and there is still much that is confusing and even frightening about it.

Childhood is a time for many ‘firsts’ – first time at school, first time being away from parents and home, first time meeting strangers, first time making friends, first time using the toilet without aid from their parents… for many children, the idea of doing these strange new things may fill them with anxiety and even fear.

THE PSYCHOLOGY OF FEAR

What we know so far about fear is that our brain has a ‘fear centre’ called the amygdala, which is located in the temporal lobe region.

Shazeema says that being afraid is not necessarily a negative thing. “Being scared is one type of survival instinct,” she explains, pointing out that we are often afraid of things that are inherently capable of causing great harm to us. “When we are afraid, our body is also primed to run,” she adds. Our heart races faster as it pumps more blood to our organs in anticipation of a burst of activity (either running away or fighting), and with that, we experience other sensations usually associated with fear, such as sweaty palms, nervousness, trembling and more.

Research has found that there is a consistent response to fearful threats across different species. The brains of rats and humans, for example, respond similarly to these threats. However, the types of threats can differ from one person to another. One child may be scared of the dark and can only be comforted by having her beloved puppy by her side, for example, while her brother has no problems with the dark but is afraid of dogs instead.

The bottom line is that fear is not a sign of weakness. It’s perfectly normal for a child (and grown- up) to have fears. It is only an issue when fear becomes so overwhelming that it prevents us from leading a normal life.

Reference: Dzierzak, L. (2008, October 27). Factoring fear: what scares us and why. Scientific American. Retrieved from www.scientificamerican.com/article/factoring-fear-what-scares

“MOMMY, I DON’T WANT TO BE A SCAREDY-CAT ANYMORE…”

If our children are often fearful, we as parents sometimes may end up worsening their fears by trying to downplay their fears as silly or becoming overprotective and over- coddling them. All these may cause the child to keep their fears to themselves instead, so that Mom and Dad won’t become angry or worried.

Shazeema has a few pointers to ensure that parents can help and support their children’s efforts to manage their fears.

#1 COMMUNICATE WITH OUR CHILDREN

“Children may not always voice their fears to parents,” Shazeema points out. They may not know how to describe their fears, for example, or they may be reticent because of worry about how their parents will react.

One thing we can do is to open up more to our children. “Encourage frequent conversations with them,” Shazeema suggests. “Let them know that they can always talk to you about anything, no matter how silly it may be.” A good place to start is at the dining table, through conversations during family meals.

In the meantime, we should listen to what our children tell us. Let them speak, and we can let them know our thoughts once they have finished. If we are too quick to judge, scold or correct our children before they finish, they may feel discouraged from opening up to us in the future.

#2 REACH OUT TO OUR CHILDREN’S TEACHERS AND OTHER PEOPLE WHO ARE CLOSE TO THEM

Our children may not open up to us readily, or prefer to keep things to themselves because they are worried about how people will react if these things come out into the open. When this happens, we may overlook signs that our children are experiencing emotional distress.

Therefore, Shazeema recommends building up a good rapport with our children’s teachers as well as our children’s friends and their parents. That way, we can ask them how our children are faring in their company. Sometimes, they may approach us if they feel that our children are having emotional issues.

#3 ARE WE INDIRECTLY FANNING OUR CHILDREN’S FEARS?

One thing that we parents sometimes overlook is that our children may be anxious or afraid as a response to our own reaction to various situations.

“If we let our anxieties show, our children will also behave the same way, thinking that it is the ‘normal’ way to react,” Shazeema says.

Therefore, it is worth taking time to discover whether we too are prone to being anxious and fearful. If our own responses are making our children anxious, it may be worth making the effort to manage our anxieties first.

#4 HELP OUR CHILDREN MANAGE THEIR FEARS, NOT SHELTER THEM

If our children are anxious or unhappy, it is natural to want to keep them from experiencing the source(s) of their fears. However, there is also a likelihood that, if we do this, we are only reinforcing their fears in the long run.

Shazeema suggests a better way: as parents, we can help them learn to tolerate their anxieties, so that they can still function to their best capability despite their emotional turmoil. This way, they will also learn how to deal with new or worrying situations in the future.

For example, our child is afraid to sleep in the dark. Instead of letting her sleep in a lit room, there are other things we can do. “We can place a soft lamp at the bedside table,” she says as an example, “or tell our child to try to sleep, and Mommy and Daddy will check up on them soon.”

Sometimes the child’s fears may feel irrational or silly, especially if we are already cranky or tired after a long day’s work, but we should remember that there are many things about this world that are still unfamiliar and hence frightening to our children. It is worth having some patience and keeping a good sense of humour when it comes to our children’s anxieties. Shazeema points out that, how we help our children cope with their fears and anxieties when they are young will be valuable when they become adults and have to deal with even more emotionally challenging situations.

TRY TO AVOID ASKING QUESTIONS OR SAYING THINGS THAT MAY INFLAME OUR CHILD’S FEARS. FOR EXAMPLE, IF OUR CHILD IS AFRAID OF AN UPCOMING CONCERT PERFORMANCE, AVOID MENTIONING HOW EVERYONE WILL BE WATCHING HER OR THE RISK OF FUMBLING DURING THE PERFORMANCE. FOCUS ON THE POSITIVE, SUCH AS HOW PROUD WE ARE OF HER GETTING TO BE ON STAGE.

#5 BE POSITIVE AND SUPPORTIVE, BUT DO SO WITHIN REALISTIC EXPECTATIONS

We should not make promises that we can’t keep. For example, if our children are fearful of the upcoming examinations, we shouldn’t promise that they will surely pass the exams or the exams will be easy. If they don’t do well, this will only reinforce their fears and possibly even make them think twice about taking your future advice to heart.

Instead, we can tell them that they will be okay. It is the same with trying to get our children to try something new – instead of telling them that it will be fun (because they may not agree even after trying it), assure them that we will do it together with them, they will be fine, and if they still don’t like it, it’s fine; we can do something else after this. HT

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Fun & Inexpensive Ways to Get Your Kids to Learn New Things

May 7, 2022 Return

Words Lim Teck Choon

1. Set up a weather station. Have your kids measure rainfall using empty drink bottles or jars and record the daily temperature using a thermometer for a start. They can record everything in a diary. As they become more knowledgeable about the weather, they can graduate to using home-made wind vanes to record the direction of the wind and home-made anemometers to measure wind speed. Hint! There is plenty of information online on how to set up a weather station for kids using simple materials.

1. Learn a new language together. The whole family can attend a class or watch the relevant YouTube videos together. Practising together afterwards only adds to the fun.

1. Visit historical monuments and geographical landmarks using Google Maps. Google Maps (www.google.com/maps) allows you to “bring” your kids to visit places such as the Pyramids of Giza, the Statue of Liberty, Mount Everest and more without having to get on a plane. Switch to satellite view to let your kids view these landmarks in 3D.

1. Bring the family to visit a farm. This will let your kids discover what chicken, cows, ducks and more really look like. It will also introduce them to concepts such as agriculture, livestock breeding and more.

Make new clothes out of old. If you are worried that your kids will grow up never being able to sew a seam or stitch a button, throw regular weekend sessions for the whole family to transform old clothes into fashionable delights. Let your kids practice adding hems, buttons and ribbons to these old clothes. For added fun, photograph the results for the family Facebook or Instagram. HT

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Dads, take care of yourselves too

May 7, 2022 Return

WORDS RACHEL SOON

Parenting is hard, especially when juggling it with household responsibilities and careers. While dads trying to help mums with parenting duties may be thought of as ‘tough guys’, self-care is as important for him as for her.

‘Self-care’ may bring up images of spa days and long baths, but what it really means is “pouring into yourself the resources you need to perform at your best,” according to Jennifer Wolf, a parenting coach and former writer for Verywell Family. She breaks self-care down into five key facets:

Physical self-care.

This covers ‘typical’ bits of a healthy lifestyle; exercise, balanced diets, hydration and sleep. You don’t have to treat these as hit-or- miss targets, like “I have to exercise 20 minutes for 3 times a week, or else”. Instead, work them in as little daily habits, like taking the stairs instead of the lift, and adding more vegetables to your mixed rice plate. Every bit helps strengthen your body.

Emotional self-care.

This means acknowledging how you feel about events. Fathers are allowed to feel frustration, anger, nervousness and other negative emotions. What’s more important is working out those feelings safely, rather than trying to bottle them up.

It can help to share your thoughts with your partner, your close friends, or even parent support groups. If you feel reluctant to open up to people you know, you could try writing in a journal, or finding an anonymous online forum for parents.

Relational self-care.

It can be easy for a parent’s world to narrow down to a small planet with just themselves, work and their child. Spend some time with other connections in your life who care about you. Even a casual meal chit- chatting with siblings or a movie night out with your old gang of friends can help refresh you and put your challenges into perspective.

Cognitive self-care.

Our brains have a constant need to learn and grow. Naturally, raising a child is itself a huge learning and growing experience, but it’s important to engage in low-stakes learning experiences as well, whether it’s new skills (gardening, learning a new language, music, etc), or small activities like catching up on news, reading a book or playing puzzle games.

Spiritual self-care.

Religious practices such as meditation or prayer can help “broaden your sense of self in relation to the rest of the world”, says Wolf. If you’re not particularly religious, quiet moments out in nature (a slow walk in a park, hiking, or a few minutes sitting on a bench outdoors) can also help you become more mindful of the wider world and relieve some feelings of internal pressure. HT

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New Parents Special

May 7, 2022 Return

WORDS LIM TECK CHOON

Dr Yong Junina Fadzil

Consultant Paediatrician & Paediatric Cardiologist

Klinik Pakar Kanak-Kanak Junina

Parenting can be both a joyous and nerve-wrecking experience for a new parent In this special feature, we’ll share with you some of the things you can expect and how to make sense of the chaos in the first few weeks.

This feature is also a special celebration of a new phase in New Parents—we’re planning exciting events of which this feature is just a sample. Don’t forget to check out our Raising a Champ class, see the end of this feature!

MAKING SENSE OF parenthood

So that’s a baby. Your baby. Your heart is full to bursting with love, happiness and awe—and you may also be panicking inside. How will you be a good parent? Can you be a good parent? How about…

Relax. Calm down. Take it from a consultant paediatrician and mother-of-three: it’d be fine. More than fine, in fact – it’d be an adventure of a lifetime!

What is the one thing many new parents tend to overlook when they are embarking on the parenthood journey?

To have fun and enjoy being parents! Some parents view their babies as a project, and they do a lot of research beforehand. However, every baby has their own quirks and personality; what works for one baby may not work for another.

Therefore, don’t have a rigid viewpoint when it comes to the rules of parenting. Be flexible, go with the flow, and make changes as necessary to accommodate your baby.

What are some general rules of the thumb for parents?

Know the basics. Make sure you know the fundamentals, such as when and how to feed as well as how to keep your baby clean, when to give your baby their shots, etc.

Update your dos and don’ts. Recommendations on safe practices may change with new findings, and what was once practiced may now be considered potentially harmful, so keep yourself updated via books and the Web. Don’t blindly trust everything you read and hear, though – check and double-check the facts with relevant healthcare practitioners.

Monitor your baby’s growth. This can be done with the assistance of a paediatrician.

Do you have any advice for parents who are worried about their babies falling sick?

Always refer to a doctor. I’ve seen parents who prefer to post their concerns on social media, but the people responding to these concerns are often not medically trained. Also, they only have the parents’ words to go by—they do not see the baby and hence cannot make any proper diagnosis (if they are even qualified to do so). The advice given may be wrong and even dangerous for the baby.

The one thing parents need to be aware of is that a baby can become really ill in the blink of an eye, and there is rarely time for the parents to experiment on different types of medications.

Therefore, consult a doctor first and foremost when it comes to the baby’s health!

General practitioner or paediatrician—what’s the difference?

Paediatrician are doctors who, after graduating from medical school, spend a few more years training specifically to understand, diagnose, and manage health issues in children. That’s why they are also called ‘doctors for children’.

As a paediatrician’s patients are exclusively children, a paediatric clinic has equipment and devices designed to accommodate a child’s smaller size. The paediatrician’s clinic also dispenses medications with dosages that are adjusted for children.

General practitioners, also called family doctors, are not specialized in paediatrics. That’s not to say that they are unqualified to treat children—it’s just that a paediatrician is usually more well-versed to manage a child’s more serious or complicated health issues. Also, some parents may have better peace of mind knowing that their children are cared for by a dedicated children’s health specialist.

One last thing: let’s talk about the meddling parents…

It depends on the advice. If it’s sound advice, such as always boiling water before use, of course it’s worth following. When the advice is based on superstition, however, here’s a handy tip: use the paediatrician as your shield!

If the advice isn’t sound but you want to keep the peace, try saying that you have discussed with your paediatrician, who advised against it. Many paediatricians are familiar with the issue of good- intentioned, meddlesome parents with ill-informed advice (they may even have such parents!) and will likely take your side. If the parents are being difficult, try bringing them to the paediatrician’s clinic for a discussion.

WHAT’S GOING TO HAPPEN AS IT GETS CLOSER TO THE BIG DAY

Have you noticed how most information available on motherhood often leads up to the big day, only to then skip forward to after the baby has arrived? Instead of leaving you to rely on anecdotal stories from other people—which may be contradictory, exaggerated or even misleading—we’ll let you in on what really happens.

What’s Labour, Exactly?

Simply put, labour is the series of contractions in your uterus. It opens or dilates and thins or effaces in preparation for you to give birth to your baby.

How Else Does Your Body Prepare for Delivery?

The placenta and umbilical cord send nourishment to the baby
The amniotic sac (bag of water) holds the fluid that surrounds your baby
The perineum is the area between the vaginal opening and the anus
The vagina is the birth canal
The pubic symphysis joint lies between the pelvic bones and allows the baby to pass through
The cervix is the narrow opening of the uterus
The mucous plug helps keep bacteria out of the uterus

Challenging positions

If your baby is not in a safe position for birth, or if there is a problem with the placenta, you may need special care. A caesarean section may also be needed. Common problems include:

Cephalopelvic disproportion (CPD): Baby’s head is too big for the pelvis.

Breech position: Baby is positioned with feet or buttocks first.

Transverse position: Baby lies horizontally the pelvis.

Placental abruption: Placenta separates from the uterus.

Placenta previa Placenta blocks the cervix.

Your baby moves into position: Babies often move down between the pelvic bones (descend) before birth. If this is your first pregnancy, this may happen 2-4 weeks before labour. With repeat pregnancies, the baby may not ‘drop’ until labour begins. The baby usually moves down head first. When the baby drops, you may find it easier to breathe. You may also feel more pressure on your bladder, causing you to urinate more often.

THE MOM’S GUIDE TO STAYING SANE & HEALTHY IN THE EARLY DAYS OF MOTHERHOOD

If you can’t love yourself, how can you love anybody else? RuPaul Andre Charles

A GUIDE TO FEELING LIKE YOUR OLD SELF AGAIN

Go with the flow. Plans and schedules usually get thrown out the window during the early days, so prioritize the bare essentials of keeping yourself and your baby well. The rest? Well, just go with the flow. You’ll figure out a routine eventually!

Keep track of medical matters. Speaking of schedules and plans, it will be good to record all required medical matters such as doctor’s appointments (for you and your baby) and medical check-ups (Pap smear, mammogram, etc). That way, you are less likely to overlook health-related matters.

Move, move, move! Exercise energizes you and helps you get back to your pre-pregnancy weight, and it is also a good pick-me-up activity. Sneak walking into your daily routine as much as possible, or join a yoga class.

Eat well and healthily! It can be tempting to skip meals when you are busy, but don’t. You
need to keep eating healthy, balanced meals like you used to, so that you can stay healthy and energized for both you and your kid.

Keep in touch with yourself. Don’t lose yourself in the bustle of TLC for the baby, your job, household chores, etc. Take some time out every day for you and you alone, such as having a cup of your favourite coffee or catching up on shows on Netflix while the baby is asleep. Devote an evening once a week just for you and your partner.

Keep in touch with the outside world. It can be tough to deal with the chaotic newness of
parenthood when you let your new, busy schedule cut you off from your other family members and friends. Try to devote some time once a week, or if that’s not possible, once a month to catch up with them. If you can’t leave the house to meet them,
invite them over for a meal.

Don’t skimp on sleep. It may be tempting to sleep less when you have so much to do, but remember, sleep recharges and reenergizes your body. Take a nap whenever you can during the day to make up for sleepless nights. It is also good to avoid cigarettes, alcohol and other substances that can affect your ability to sleep well. HT

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Fasting for Children

May 3, 2022 Return

Dr Yong Junina Fadzil Consultant Paediatrician

Once again, the holy month of Ramadan is upon us. For parents with young children, fasting is the time to impress upon them the empathy one feels for the less fortunate. It is also a time for spiritual reflection – for many Muslim children, their early experiences in fasting can build a lifelong foundation for virtuous living.

“Ideally, if you follow religious standards of Islam, children should start fasting only when they reach puberty. However, in our society, many children wish to follow what their parents do and are curious about fasting. They may want to try fasting at a younger age,” says Dr Yong Junina Fadzil, a consultant paediatrician.

She adds that the most important thing is to make sure that children want to fast on their own will without being forced by their parents. “You need to allow them to explore their curiosity and support them.”

For example, children might start fasting later in the day and buka puasa earlier. “It’s actually all right to let them do that,” she says.

Eat and drink well

Dr Junina advises that children aged 9 years old and above, and who have not attained puberty can fast, provided their weight is within the healthy range and they don’t have any chronic illnesses like diabetes.

Parents can wake their children as late as possible before imsak and serve them a proper meal like rice with dishes. If their children want to break fast at lunchtime, they should be allowed to do so. When encouraged thus, children may want to extend their fast over time.

When breaking fast, children can be given dates to increase their blood sugar levels. This must be followed with a proper balanced meal consisting of carbohydrates, protein, fats, vegetables and fruits.

After breaking fast, children should drink a lot of plain water, malted drinks and milk to prevent dehydration. It’s best to avoid caffeinated beverages. Caffeine causes them to urinate often, becoming easily dehydrated. Before they go to bed, they can have supper consisting of beverage and kuih.

Children with illnesses must take medications regularly. Islam allows such children to be excluded from fasting, says Dr Junina.

The meaning of fasting

Fasting is generally synonymous with abstinence from food but it’s actually more than that – it’s a whole way of life. Besides abstaining from food, children should also be taught to abstain from other things like hurting their siblings and eating in public.

“The benefits of fasting for children are spiritual, so ideally, when you expose them to the practices of Ramadan it is to create an awareness of how fortunate they are and how less fortunate some people are,” says Dr Junina. “This will teach them the meaning of compassion.”

For children who are too young to understand the concept of fasting, they may feel that the fasting month is a month of torture. They will resort to cheating by eating in their bedroom or bathroom, and drinking tap water when they take ablution.

“Respect their limitations and encourage them to do the best they can,” advises Dr Junina. Parents do not have to worry or fret if their child is unable to do everything right, as the time will come when they reach puberty. With puberty comes the maturity to accept, understand and better practise the act of fasting. They will do what is needed for them throughout the fasting month often on their own free will.”

Tips for parents

Wake your children up for sahur as late as possible.
Make sure they drink enough water, as well as nourishing drinks like milk.
Make sure they eat enough – buka puasa and sahur should consist of 2 main meals like dinner and lunch, with healthy snacks in between.
Always encourage and support their efforts – don’t judge them. Instead, let them break their fast when they want to, at their own pace and capability.

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KITCHEN TIME WITH THE TODDLER

April 29, 2022 Return

WORDS LIM TECK CHOON

There are a few good reasons to share your kitchen time with a toddler. One, seeing their parent prepare the foods will increase the toddler’s interest in their foods come mealtime. Two, it’s another opportunity to bond with the little one. Finally, three—by aiming for the long run and cultivating your toddler’s interest in foods and food preparation, you are raising a child who would one day be able to cook for themselves, their own families… and you!

Get a high chair
Place your toddler in a high chair in a safe corner of the kitchen. That way, you can both keep an eye on your kid and get meals ready for the family.

Let the kid think they are helping
If your kid insists on wanting to help (or, in some cases, taking over from you), you can let them feel important by giving them very simple chores.

For instance, if your kid shows interest in your efforts while stirring a pot, you can give them a small bowl of cool gravy and let them have fun stirring it from the safety of the high chair.

When they are older, let them help

Let them do simple chores, such as passing over a fruit for you from the fridge, helping you wash the vegetables and setting the spoons and forks on the dining table.

You can also look up simple recipes that you and your kid can prepare together.

Also, don’t forget to get them to help in the cleaning up! HT

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The Butterfly Children

April 29, 2022 Return

Children who have epidermolysis bullosa (EB for short) go by names such as ‘cotton wool babies’ and ‘crystal skin children’. Closer to home, we have opted for the term ‘butterfly children’. While these names sound like something straight out of a children’s storybook, their ‘cutesy-ness’ belie the dangerous nature of this skin disorder.

Those of you who do not have any inkling of what EB is may be thinking, ‘Why haven’t I heard about this if it’s such a serious condition?’ Consultant Paediatrician Dr Leong Kin Fon clarifies, “EB is extremely rare. The World Health Organization reports that for every 1 million Malaysians, only 10 have EB. This means there are now approximately only 300 Malaysians with EB.”

Epidermolysis bullosa explained

So, what is EB really? And why are kids with EB called ‘butterfly children’? “The term ‘butterfly children’ came about because the skin of an EB patient is very tender and fragile like a butterfly’s wings,” Dr Leong explains. “Our skin is divided into 2 layers – the epidermis and the dermis. Normally, situated between these 2 layers are anchor-like structures which prevent them from moving independently from each other. But in individuals with EB, these ‘anchors’ are either relatively fewer or not present at all. As a result, any movement (eg, scratching, rubbing or injury) that causes trauma or friction between the layers can induce painful sores and blisters.”

Elaborating further, he says, “The amount of blisters present depends on the severity of a patient’s EB. Some will get only a few blisters but others can experience a lot. Blisters typically form on the hands and feet but they may also appear on the inside of the oral cavity like the mouth, stomach and oesophagus (the tube which connects the mouth to the stomach). Those with more severe forms of EB also experience blistering in other body parts including the nails, teeth and hair.”

And then, there were three types

Delving into the various kinds of EB, Dr Leong says, “There are 3 main types: EB simplex, dystrophic EB and junctional EB. International data shows that out of these 3, the most common one is EB simplex in which blistering affects the epidermis (upper layer of the skin). Out of 100 patients, 90 have EB simplex.”

What about Malaysian data, then? He says, “I work in a paediatric ward so most of the cases which I come across are either dystrophic EB or junctional EB. For both dystrophic EB and junctional EB, blistering occurs in the basement membrane of the dermis (deeper layer of the skin). Junctional EB affects the middle part of the basement membrane whereas dystrophic EB strikes at the lower part of the basement membrane. Junctional EB is the rarest of the 3.”

It runs in the family

If you are a parent, you may now be wondering how to protect your child from this dreaded condition. However, it is not something which can be prevented like the common cold or measles. Dr Leong says, “EB is a genetic disorder. It’s most often inherited from parents; the parents either have EB or are carriers of the faulty gene. But sometimes – though, very rarely – the genetic fault occurs spontaneously.”

Does that mean people with EB should avoid starting a family? He advises, “Well, it boils down to the type of EB. In the case of EB simplex, the symptoms are milder so I wouldn’t go as far as to stop couples (where one or both partners have EB simplex) from having kids. This is because even if their child does end up with EB simplex, the condition is still manageable with the appropriate lifestyle modifications.”

What about couples with more severe forms of EB, then? “For these couples, I’d recommend genetic screening. There are prenatal tests such as amniocentesis which can test the unborn child for EB at the 11th week of pregnancy. If the child is confirmed to have EB, these couples are then offered counselling. We have professionally trained counsellors who are more than ready to assist and advise them on how to cope.”

It’s complicated

Touching on the complications of EB, Dr Leong recalls, “It differs from one person to another. I have friends in Singapore who never showed any symptoms of EB until they enrolled for military service. Blisters only began developing on their bodies especially their feet because of the intense physical training. For people like them, EB isn’t much of a hindrance unless when performing physical activity.”

However, things aren’t always so easy for other EB patients. “Blisters which develop on the skin of children with severe forms of EB don’t heal as quickly – hence, increasing their risk of infections such as sepsis which can lead to organ failure.”

Sepsis aside, other complications which can arise include:

Deformed limbs

“The toes or fingers of someone with severe EB can fuse due to excessive scarring. Should that happen, surgery is necessary to remove the scar tissue and to restore mobility.”

Malnutrition

“Scarring doesn’t merely occur on limbs. Over time, scarring may also develop in the oesophagus. I’ve had patients in their early teens whose oesophagus had narrowed over the years so much so that they are incapable of swallowing anymore. We have to resort to connecting a feeding tube to their stomach – a procedure known as gastrostomy. This way, patients can be fed directly into their stomach.”

Death

“Severe forms of EB do increase one’s mortality risk. For instance, babies who are unable to breathe and eat normally due to excessive blistering are likely to die in childhood.”

‘Is there a cure?’

Dr Leong is no stranger to this question as it is no doubt on the mind of every parent with a child who has EB. “It’s the question that I get asked most frequently.” And his answer is the same every time. “There isn’t a cure for EB but that doesn’t spell the end. EB is incurable but it is manageable,” he says encouragingly.

“The main goal of EB treatment is to avoid blisters and its related complications. This is why parents or caregivers need to be well-versed with the proper methods of wound care,” he stresses. He cites some examples:

Use silicone dressing on blister-induced wounds instead of a normal dressing as the latter can further aggravate the wounds
Apply substances with strong hydrating properties like petroleum jelly to keep the wound area constantly moisturized
Puncture blisters with a sterile needle to stop blisters from spreading.

In addition to wound care, ensuring your child has regular check-ups is another aspect of EB management. “Regular visits to the dentist are important to check for blisters or irritation in the child’s mouth.”

“Wound care is tedious and can seem like a lot to take in at the beginning but remember that your child’s doctor is always there to guide you. In time, you’ll get better at taking care of your child,” he assures.

‘You aren’t alone’

“Living with EB can be very stressful for both parent and child. As if the physical suffering brought on by EB isn’t enough, they have to deal with stigma and social isolation as many people still have the misconception that if they were to touch someone with EB, they will be infected with it. Then, there’s also the financial burden that comes along with treatment. Bandages and dressings can be expensive,” says Dr Leong.

This is why patient and caregiver support is so vital. Dr Leong who is also President of DEBRA Malaysia, a non-profit organization which offers support to the EB community by funding research and by providing free services for patients who are in need, advises, “EB is a life-long disease. Although it cannot be cured, it can be controlled with proper care. The blisters can actually decline over the years if they are tended to accordingly. Therefore, don’t be afraid to seek help if your child has EB. Talk to your child’s paediatrician about your concerns or you can get in touch with DEBRA Malaysia. We at DEBRA Malaysia will do our best to help you and your child. Remember, you aren’t alone.”

Should you have enquiries, you can contact DEBRA Malaysia at:

Tel : + 603 9283 2868 or +6012 3913328
Email : debramalaysia@gmail.com
Address : D-5-1, Block D, Menara Uncang Emas, Jalan Loke Yew, 55200 Kuala Lumpur.

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Does Your Child Have a Lazy Eye?

April 28, 2022 Return

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Karen Mcmain Orthoptist, Dalhousie University, Canada

Recently, orthoptist Karen McMain from Dalhousie University, Canada, visited Tun Hussein Onn National Eye Hospital (THONEH) to train and share her experiences with local eye care specialists. Despite her busy schedule, Ms McMain managed to find some time to share with us some insight on lazy eye.

HT: In the old days, lazy eye was considered by superstitious people to be a “curse” or the result of sinister supernatural forces. What is lazy eye, actually?

KM: Lazy eye, also known as amblyopia, is a common childhood eye condition in which a child’s sight in one eye does not develop as it should.

I personally feel that the term “lazy eye” is inaccurate, as the eye is not really lazy. It would be more accurate to say “lazy brain” as amblyopia, the medical term for lazy eye, is actually a developmental problem within the brain.

What happens is that, normally, the brain and the eyes work together to produce vision. When a child has amblyopia, the brain does not acknowledge the vision from the lazy eye and focuses on the vision from the other eye. If the lazy eye is not stimulated properly, the visual brain cells do not mature normally.

HT: What are the causes of this condition?

KM: Most commonly, it is due to the misalignment of the two eyes – a condition called strabismus. As a result of strabismus, the eyes are not aligned in the same direction, the eyes can cross in (esotropia) or turn out (exotropia). This misalignment prevents the eyes from focusing together on an image and may cause double vision. To overcome the double vision, the child’s developing brain chooses to ignore the image from the eye that is not straight, causing the vision in that eye to become lazy.

Differences in the way each eye processes vision can also be a factor, such as when one eye suffers from nearsightedness, farsightedness or astigmatism.

Sometimes but very rarely, the condition can also be caused by obstruction or cloudiness that prevents light from getting through one eye. Such obstructions can be due to cataract, eye tumours or droopy eyelids. Such amblyopia is called deprivation amblyopia.

HT: What happens if the condition is left untreated?

KM: Amblyopia is the most common cause of partial or total blindness in one eye, affecting 3% of children. Studies have shown that sufferers also face a significantly higher risk of losing vision in their good eye, either from injury or eye disorders such as macular degeneration.

HT: What are the treatment options for this condition?

KM: The most common treatment for amblyopia is to force the brain to start using the ‘bad’ eye.

This is done by first correcting any underlying problem in that particular eye. Then, we either put a patch over the ‘good’ eye or blur the vision in the ‘good’ eye with eye drops, to force the ‘bad’ eye to be used. The eye drop method is less commonly used in countries like Malaysia, which has a very sunny climate, as these drops dilate the pupil making the eye very sensitive to bright light.

Treatment is often helped by having the ‘bad’ lazy eye do periods of close work such as drawing or reading. The child will wear a patch over the ‘good’ eye during these activities.

Most children with amblyopia will also need glasses to help them focus their vision.

The doctor will discuss with parents what treatment is most appropriate for their child and their type of amblyopia.

HT: Do you have any advice for parents worried about their children’s eye health?

KM: I recommend all children to be screened for amblyopia, preferably at specialist centres, before they are school-aged. Young children have the greatest potential for successful treatment even though recent studies show that treatment in older children can also improve their vision.

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Helping Children with Dyslexia: I Have Dyslexia

April 28, 2022 Return

A dyslexic student’s diagnosis of her condition is both empowering and reassuring.

Blair Kenney was in her second year of Yale University when she was diagnosed with dyslexia.

She had always read more slowly than her peers. Her parents would dismiss her concerns by telling her that she worried too much and she should not compare herself to other people. Blair would also spend so much time checking and re-checking her written answers that she would always be the last person to finish her tests. Yet, her teachers did not feel that anything was amiss; they told her that she was just a “stressed-out overachiever”.

As a result, Blair saw herself as someone with below-average intelligence, always struggling to keep up with her peers. It was only when she saw a learning specialist and received an official diagnosis that her confidence received a much-needed boost.

“When I first heard that I had dyslexia, I was overwhelmed with emotions; I was angry, sad, and very confused,” she wrote in an article for the Yale Centre for Dyslexia and Creativity. “With time, I began to see my diagnosis as a self-affirmation. I had been correct in suspecting that I had a problem with learning, when many of the adults around me said that the only issue was my anxiety.”

The diagnosis gave Blair the confidence to accept her weaknesses and explore ways to overcome them. She wrote, “Instead of criticizing myself for being slow in school, I started to explore how I was different; and I began to see these differences as a reflection of the unique way my mind worked, not as a lack of intelligence.”

Education was also a little less stressful as she felt comfortable enough about her dyslexia to laugh at her mistakes and would cut herself some slack now and then.

Spurred by her experiences, she intended to carve a career for herself by helping other children who may need support in developmental and learning issues.

How about your child?

Blair managed to find herself and embraced her strength after becoming diagnosed with dyslexia. Clearly, the diagnosis gave her a better understanding of her condition and the confidence to reach for her dreams despite her condition.

Does your child have learning problems? Do you suspect that he or she has dyslexia? In this Mini-Report, qualified and experienced educational and clinical psychologist Selina Ding Wai Eng will share with you how you can help a dyslexic child to also achieve his or her dreams.

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Category: Behaviour

Bedtime Blues

Wind your toddler down before bedtime.

Establish the “3B” routine.

Let the toddler make some choices.

Be firm, hold your ground.

Have a comfortable bedroom.

Who’s afraid of bedtime?

Have No Fear, My Brave Little One

DON’T BE AFRAID OF BEING AFRAID

“MOMMY, I DON’T WANT TO BE A SCAREDY-CAT ANYMORE…”

Fun & Inexpensive Ways to Get Your Kids to Learn New Things

Dads, take care of yourselves too

New Parents Special

MAKING SENSE OF parenthood

WHAT’S GOING TO HAPPEN AS IT GETS CLOSER TO THE BIG DAY

THE MOM’S GUIDE TO STAYING SANE & HEALTHY IN THE EARLY DAYS OF MOTHERHOOD

Fasting for Children

Eat and drink well

The meaning of fasting

Tips for parents

KITCHEN TIME WITH THE TODDLER

The Butterfly Children

Epidermolysis bullosa explained

And then, there were three types

It runs in the family

It’s complicated

Deformed limbs

Malnutrition

Death

‘Is there a cure?’

‘You aren’t alone’

Does Your Child Have a Lazy Eye?

Helping Children with Dyslexia: I Have Dyslexia

A dyslexic student’s diagnosis of her condition is both empowering and reassuring.

How about your child?