Category: Developmental Milestones

Jamilah Binti Abdul Jamil   Dietitian

Watching a child grows up brings bittersweet joy to every parent: sweet joy as the child is spreading his wings and finding his way in this world, with a touch of bitter – just a little! – because it is always hard to watch a child grow up and need you a little bit less each day.

Fasting, and discovering the spiritual joy in the abstinence, is one of the milestones that a Muslim parent would want her child to experience. HealthToday asked dietitian Jamilah Binti Abdul Jamil on how a parent can best introduce the act of fasting into a child’s life.

HT: Ms Jamilah, when is the best age for a child to begin fasting?

JAJ: The parents need to consider several things when introducing fasting to their children. Some children may find it easier to fast, while others, such as those with hyperactivity, may find it more difficult. The parents will be the best people to evaluate if their children are ready to fast or not.

Parents can introduce the idea of fasting and its purpose to their children from as early as 3-4 years old. This is the time when their children will ask many questions such as why the moon is following them when they are in the car, and, no doubt, they will ask their parents why they are not eating. This is a good opportunity to share why, as Muslims, they are required to fast.

Parents can start encouraging their children to fast at age 7, but they should not be too strict about it. Depending on a child’s attitude, general health and nutrition, the child may or may not have an easy time fasting. It is fine if they fast for only half a day – the Malays call this “puasa yang yok”. The whole idea here is to give the child a “taste” of fasting and to instil in them the desire to fast during Ramadan.

If the child has health conditions such as type 1 diabetes and asthma, the parents should consult a doctor or dietitian before encouraging the child to fast.

HT: When is the right time for a child to try fasting for the full month?

JAJ: Children should be introduced to fasting in stages.

They can start by fasting for 2 hours a day. Once they have become used to this, the hours can be increased to 4 hours, half a day, and eventually a full day.

If the child is 9 years old (almost reaching puberty) and has successfully practised fasting in previous years, then parents can encourage the child to try fasting for the entire month. However, do not force the child if he cannot do it. Let him try again next Ramadan.

For younger children, let them break their fast early when they show signs of tiredness.

The bottom line here is, parents need to be alert to signs such as the child looking rather tired during the day and be considerate in not forcing the child to do something he is not ready for. The most important thing at the end of the day is the take-home message and values the parents are trying to instil in their children.

HT: How about children who are sickly? What considerations should the parents have in mind while preparing and supporting the child to fast for the first time?

JAJ: Chapter 2 of Al-Quran verse no. 184 makes it explicitly clear that those who have illness or medical condition, and if fasting can be detrimental to their health, are exempted from fasting.

Depending on the type of medical condition and its seriousness, parents should not be demanding about getting their children to fast. They may postpone introducing fasting until a time when the children’s condition is more ready (mentally and physically).

Type 1 diabetes (T1DM):

Children with T1DM are not encouraged to fast. However, a study called EPIDIAR which involved 13 countries showed that 43% of T1DM patients fasted at least for half of the Ramadan month (15 days). Fasting should only be encouraged in children with good glycaemic control and regular blood glucose monitoring at home.

A few studies have shown that it is safe to fast among adolescents with T1DM. Thus, Ramadan fasting is achievable in older children and for those who have had T1DM for a long time.

It is especially important for parents to talk to a doctor, dietitian and diabetes educator before they introduce a child with T1DM to fasting. There are important considerations, such as insulin adjustment, the right eating habits during Ramadan and how to monitor sugar levels and what to do should hypoglycaemia happen.

Asthma:

While fasting, a lack of fluid intake may cause dehydration and dryness of the inner lining of the respiratory airways. In children with asthma, this can worsen the constriction of the airways in the lungs (bronchoconstriction), causing the child to cough, wheeze and experience shortness of breath. Therefore, parents with asthmatic children should discuss with a doctor on whether or not it is safe for their child to fast, as well as to equip themselves with the knowledge on what to do should any complications arise.

HT: How can parents support their children’s effort to fast?

JAJ: First of all, parents need to get the child to understand the purpose of fasting and why Islam wants its “ummah” to fast for a month. Let the child know why fasting is compulsory, and how the child’s daily routine would change during Ramadan. For example, the child would need to sleep earlier than usual to wake up in time for sahur, school may finish earlier too, and they probably will not be able to go to the park or enjoy other activities affected by fasting as often as before.

Also, parents should realise that their children look up to them as role models. Thus, it is important that parents are setting a good example for their children. They should practice sahur, pray on time, drink plenty of plain water between iftar and sahur, eat balanced meals with fruits and vegetable, go for Tarawih prayers, bestowed alms upon the poor, and more.  

HT: For children who are fasting for the first full month, what are the good buka puasa habits that the parents can inculcate in the child?

JAJ: Well, parents can do the following.

• Have iftar with the entire family. This will promote greater bonding among the family members.
• Recite doa and break the fast with dates (tamar/rutab) and plain water to follow the sunnah.
• Eat in moderation. Make sure meals are balanced.
• Limit intake of sweetened foods and beverages and high fat foods.
• Teach the children about gratitude.

The following are tips for healthy eating during Ramadan:

• Prepare sahur and iftar meals that promote more satiety (rich in complex carbohydrates such as fruits, vegetables, whole grains and other food high in dietary fibre).
• These meals should be balanced (containing food from all food groups in the right amounts) and nutrient-dense.
• Eat slowly to avoid indigestion especially at iftar.
• Encourage drinking more water to maintain hydration.
• Limit intake of food that is high in salt or sodium.

Here are some ideas for a healthy Ramadan meal for children, courtesy of Jamilah:

Iftar

• White rice with grilled chicken/fish and vegetables
• Chicken kebab
• Fish/ chicken porridge
• Vegetable soup with pasta
• Grilled fish with sweet potatoes and vegetables

Sahur

• Baked beans/ eggs with whole meal toast
• Fruit yoghurt or smoothies
• Oat porridge
• Cereals with milk
• Pancakes

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For your little child, the world is full of new and joyful discoveries. Unfortunately, it is only a matter of time when he experiences his first wound.

If your child comes to you with tears, the first thing you should do is to keep your cool. Getting worked up would only terrify your child further. Here are some things you can do to help your child calm down while seeing to his wound: 

• Keep calm. You may feel tempted to scold him, especially when you have been warning him so many times to stop climbing up the tree. Instead, take a deep breath and comfort him with a hug and some reassuring words.
• Wash your hands. Despite the urgency you may be feeling at that moment, take some time to wash your hands with soap and water first. This way, your hands are free from germs that may infect the wound. (Don’t forget to wash them again after treating your child’s wound!)
• For little cuts such as scrapes and abrasions, you can first rinse the wound with water to clean off any dirt or debris (be prepared for tears when you do this). You can then apply an antiseptic ointment or solution to the wound before covering it with an adhesive gauze or plaster.
• For more serious wounds such as large cuts or larcerations, especially on the face and neck, your child may need stitches. It is best to bring your child to a doctor for proper medical care.
• Throughout the whole experience, your child may continue to cry. Say comforting things such as: “Mummy is going to apply some medicine now, it will hurt a little bit, but you will be fine afterwards!” You can also promise to give him a treat after the treatment, such as ice cream, so that he has something pleasant to keep his mind on.

A word on “plasters”

Like most children, your child may be up and running again, his tears forgotten, once you have seen to his wound. Antiseptic plasters, or simply “plasters” to many of us, are a good way to keep his cuts clean from dirt and germs that may cause infection. If you have a problem keeping them on your child for more than a few minutes, try these tips:

• Paste a first aid tape over the plaster to make it “stick” better.
• Cut along the middle ofthe plaster strip’s adhesive part into two smaller strips. Wrap the lower strips as usual, but arrange the upper strips so that they cross in an “X”.

References:

About Kids’ Health. Available at www.aboutkidshealth.ca

KidsHealth. Available at www.kidshealth.org 

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Dr Selina Ding Wai Eng   Clinical & Educational Psychologist, Ding Child Psychology Centre

When a child shows signs of having problems at catching up in school, parents get understandably worried. Failure to learn can affect a child’s ability to secure a good future.Furthermore, it can affect the child’s self esteem. However, when extra help in the form of tuition classes and such fail to show improvements in the child, what can the parents do?

According to Dr Selina Ding, a clinical and educational psychologist, there are many reasons why a child could have learning difficulties.

“Perhaps the child simply lacks exposure and needs time to adapt,” she suggests. “Or perhaps the child is suffering from specific learning disabilities, such as dyslexia.”

Learning Dysfunctions

• Dyslexia. This condition affects not only one’s ability to read – it also affects the way the brain processes, stores and retrieves information.
• Dyspraxia or developmental coordination disorder (DCD). This condition affects a person’s motor skills. There are varying degrees of dyspraxia – some may have mild forms of this condition, while others are more affected. Learning skills such as writing are negatively impacted by it.
• Dyscalculia. People with dyscalculia have problems understanding the concept of numbers or solving even basic sums. They may also have problems trying to tell the time.
• ADD/ADHD. People with attention deficit (hyperactivity) disorder (ADHD) are typically restless, erratic, impulsive and inattentive. Their behaviour can be unpredictable and even inappropriate (such as saying rude comments or behaving too aggressively). People with attention deficit disorder (ADD), without any hyperactivity, are a little less aggressive, but they too suffer from being easily distracted, unable to pay attention to details and losing track of what they are doing. Note that ADD/ADHD can only be diagnosed by a qualified healthcare professional – you cannot simply assume your child has ADD/ADHD! 

Dr Selina also points out that not every child’s learning disability has to stem from a biological condition. It is also possible that the child simply does not enjoy the schoolroom environment, or perhaps he or she is unable to get along with his teachers or other students and therefore, cannot fully pay attention in class.

Getting back on track

“Unfortunately, there are only a few schools in Malaysia that are equipped to manage the many different types of learning difficulties that exist,” says Dr Selina. “There are classes for students with autism or below average intelligence, but slow learners with other causes for their problem will not find such classes beneficial.”

For the parents of those students, a better solution would be to consult a child psychology centre. Here, the child would be assessed to determine the possible causes behind his or her inability to catch up in school, and a suitable programme would be developed just for that child.

For example, many children are found to be dyslexic only after they are screened and assessed by an educational psychologist. Children with dyslexia need special programs tailored for their condition to help them learn; if undiagnosed, most children languish in ordinary classes, unable to keep up. Some are even regarded as “stupid” by their peers and teachers, and sadly, many end up believing this.

Who says dyslexics can’t be brilliant people? Just take a look at the more successful dyslexics out there. Famous dyslexics include:

• The late Fred Epstein, a neurosurgeon who developed many new technologies to operate on cancer.
• Scott Adams, cartoonist and creator of Dilbert, who describes himself as “mildly dyslexic”.
• Steven Spielberg, arguably the most famous director in the world.

In such a programme, the child can learn at his or her own pace, in a manner that the child will enjoy. Dr Selina herself uses various fun learning methods such as play therapy for her young charges. Counselling would be given to help the child cope with emotional issues that may be getting in the way of learning. Parents would also be given guidance and advice on how to continue to support and guide the child at home.

“Given the complex and varied reasons behind a child’s learning difficulty, there is no one-size-fits-all solution,” says Dr Selina. “But with the help of a team of qualified child psychologists, parents can help their child catch up and cope with her studies – and even get her to enjoy learning in the same time!”

[1] http://www.nytimes.com/2006/07/12/nyregion/12epstein.html

[2] http://blog.dilbert.com/post/102892943361/perceptual-super-power

[3] http://articles.latimes.com/2012/sep/25/entertainment/la-et-mn-steven-spielberg-on-unlocking-tremendous-mystery-of-his-dyslexia-20120925

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Words Lim Teck Choon

Dr Sharifah Aida Alhabshi  
Consultant Paediatrician

The word “autism” keeps ringing in your brain. Your voice breaks and you are tired of discussing it with doctors, family members, friends. You are bombarded by conflicting emotions – confusion, anger, grief, shame, worry. You want to hold your child, but your child shrieks and breaks out of your embrace to stare at something in the distance.

It is not pleasant when your child is diagnosed with autism, but it is not the end of the world. It can be, in fact, the beginning of a cherished journey for both parent and child. To illustrate this point, paediatrician Dr Sharifah Aida Alhabshi, who has a special interest in child learning difficulties and child psychology, helps to answer some questions parents may have about raising a child with autism spectrum disorder (ASD).

Question one

What is happening to my child?

The best explanation comes from a study published in 2014 in the Journal of Neuroscience. This study raises the possibility that children with autism spectrum disorder (ASD) can get triggered because their brain experiences some delays (temporal acuity) when processing information sent by their eyes and ears.

Because it takes longer for the child to make sense of the sights and sounds around him or her, it will take more effort to grasp simple concepts and to behave like other children.

Also, Dr Sharifah Aida points out that a child with autism tends to have some increasingly heightened senses compared to other children, while other senses may be delayed or require intervention in order to develop fully. Heightened senses may manifest in various ways that seem extreme to other people. For example, one child will find the soft whirr of a fan to resemble a painful screech in her head, making her scream in discomfort. The rub of the label of a shirt against the nape may cause great discomfort to another child, causing him to try to pull the shirt off.

It is also common for children with ASD to behave in ways that seem to suggest that they are living in their own world. See “The Girl That Makes Herself at Home” for an example of such behaviour.

This doesn’t mean that the child is stupid or mentally handicapped, far from it. With proper intervention sessions and plenty of love and support, a child with autism may learn to adapt to the world like fairly normal people. For children with more severe autism, they will need a little more support, but don’t lose hope – there are still ways to help them grow up to become fairly self-sufficient.

For a good idea of what the world looks and sounds like through the eyes of someone with autism, go to bit.ly/1RQSNNg for a video made by UK’s National Autistic Society.

What Is Autism Spectrum Disorder (ASD)?

It is a set of complex disorders of the brain and nerves. The child usually shows a unique repetitive behaviour, and can experience difficulties with social interaction.

There is a wide range of symptoms, skills and levels of severity, hence the word “spectrum” in the name of this condition. One child may experience only mild autism, while another child may need a little more help before he or she can perform basic daily activities.

What ASD Is Not

It’s not our fault. What we ate or did during the pregnancy did not cause our child to develop ASD.

Dr Sharifah Aida shares that there is no scientific evidence that it can be caused by foods, vaccines and medications. Some researchers speculate that environment may be one of the causes of ASD, but to date no one has found evidence to back up that speculation. There is likely a genetic component to ASD, though.

Therefore, don’t be so hard on ourselves – there is nothing to feel guilty about. Our child needs us. It is time to look to the days ahead, rather than to dwell on matters that we have little to no control over.

Our child is not stupid. Someone with ASD may still learn to interact well with other people, even forming meaningful relationships and holding jobs. Even those with severe ASD can learn to be self-sufficient when they are adults. Therefore, there is no reason to assume the worst for our darling just because he or she has ASD!

Our child is not deliberately naughty. He or she is not deliberately testing our patience or embarrassing us in public. It’s just that our darling’s brain is wired to perceive the world in a different way. Once we can understand what this is like for our child, we will be able to communicate better with him or her.

Autism is not a curable disease. There is currently no specific treatment that can cure autism. While there are medications and supplements out there that claim to do so, Dr Sharifah Aida points out that these claims have not been scientifically proven. Despite a lack of cure, there is still an opportunity for a child with autism to grow up to be a relatively well-adjusted adult, as we shall soon see.

 “I don’t want my thoughts to die with me, I want to have done something. I want to make a positive contribution – know that my life has meaning.” – Mary Temple Grandin, a person with autism who only started speaking when she was three and a half years old, and who went on to become a professor of animal science at Colorado State University.

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Words Hannah May-Lee Wong

Flying for the first time sure is exciting. Soaring thousands of feet above the air, waving goodbye to the tiny houses below, seeing clouds float by and anticipating arriving at a new destination. Yes, it is an exhilarating experience… right up until the little one gets tired, bored, hungry or scared. To curb a possible meltdown, here are a few tips you can use to keep the young ones happy (or calm, at least).  

#1  Snack attack

In preparation for countering those hunger tantrums, come armed with your own nutritious selection of munchies. Pack some whole-grain crackers, small boxes of raisins, cereal, nuts or sandwiches. These wholesome snacks will keep the child’s fingers occupied while filling their tummies. For drinks, besides plain water, you could pack some milk powder to make a comforting warm beverage on board. Just ask the flight attendant for some hot water.

#2  Games and activities

The unfamiliar and confining space of an aeroplane may make some kids uncomfortable. Keeping them engrossed or entertained can help to relax or distract them. Bring along their favourite storybooks and read to them. You could also pack some colouring pencils for drawing or colouring, or workbooks that have puzzles or mazes to solve. Join in the fun and play a few rounds of “I spy with my little eye”. Yet another option is to bring some child-friendly travel version of board games such as tic tac toe, bingo and snakes-and-ladders.

#3  Nap time

When the kids are tired out (and they surely will be after all those tedious check-in processes), take the opportunity to put them down for a nap. Although plane seats aren’t the most conducive to sleep in, make the best of the situation by bringing along a small blanket, a pillow and a favourite soft toy for your child to cuddle up to.

#4  Prepare for take-off (and landing)

With air pressure changes, loud noises and lots of sudden movements going on, take-off and landing can be distressing for the young ones. Keep them calm by holding their hand and getting them to look out the window to take their mind off the scary stuff. As young ears are especially sensitive to pressure change, it could get quite painful for them during the plane’s ascent and descent. Let them sip on some water, suck a lollipop or chew on some dried fruit to reduce ear discomfort.

Have an enjoyable flight!

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Words Hannah May-Lee Wong

The relationship between siblings can be complex. If all goes well, a sibling can be a dependable anchor of family support through the course of your life. They will be there to celebrate with you during special occasions, mourn with you through life’s sorrows and reminisce with you about the good old times growing up – they’re your best and greatest ally. Sadly, that’s not always the case in many families. In contrast, a rivalrous and bitter sibling relationship can feel like an unrelenting thorn in the flesh – a painful reminder of the hurts and trauma of childhood.

Rivalrous relationships between siblings do exist. It can get quite intense and aggressive, and resolving such conflict requires the cooperation of both parties. It is a matter of choice. In some families, the issues resolve, but in many others, they don’t. Psychologist Cathie Wu tells us about the psychosocial aspects of sibling rivalry.  

What causes sibling rivalries?

The psychosocial explanation is that it happens when children, specifically the older child, gets ‘dethroned’ when the younger child is born. This makes the older child feel insecure. A firstborn often feels like there was once a period of security and love. When the rest of the children come along, he or she will get a sense that the love and attention is now divided. Because of that, it is not uncommon to feel insecure, and they start to compete for the attention of parents. It’s usually a competition for perceived scarce resources – they perceive their parents’ love and affection as scarce resources. We use the term “perceived” because the love of a parent isn’t necessarily quantifiable. Other perceived scarce resources could be privileges or material things: they might fight over a toy that they perceive as the only one or the best one. 

Furthermore, parental issues such as playing favourites would exacerbate the rivalry.

Does sibling rivalry occur the same way across ethnic groups?

There isn’t really a difference in sibling rivalries found in Western and Eastern families. But what I sometimes find in Asian societies is that Asian families seem to value harmony more. Asian parents may be very quick to cut in and try to balance the relationship – a move which is not recommended. Among young kids, some competition is natural and quite common.

Even though research is still quite lacking in this area, sibling rivalry can be found across different socio-economic levels and ethnic groups. It tells us that it’s more likely a psychosocial issue rather than a biological issue.

Does personality play a role?

Personality, which is the slightly more biological aspect, does come into play and can affect the situation. If you have children who are very flexible, then they may not have such intense rivalry.

Does age gap affect how siblings get along?

The more similarities children have, the more likely they are to fight. Similarities like gender and a close age gap increase the likelihood of fighting because their developmental stages are more similar. They tend to perceive things the same way and want the same things, and that’s when they vie for attention.

Does birth order affect behaviour and personality?

Yes. A very famous psychologist named Alfred Adler has done extensive research in this area. Findings show that the first child is typically more responsible, independent and nurturing. There’s also an interesting correlation of firstborn children being more likely to hold higher positions in corporations (more leadership positions). But on the flip side, there is a higher likelihood for firstborns to have psychological maladjustments. Because of those years of carrying burdens, responsibilities or expectations, firstborns tend to be people pleasers. They also tend to be more confident.

The middle child is usually a little bit quieter, more patient and seemingly more reserved. They find their place in the middle, and thus it defines their identity.

The youngest child is the baby of the family. Because they grew up in a secure environment, they may feel freer to explore and this is perhaps why they tend to be more risk-taking, life-of-the-party kind of people. They also are more likely to seek attention because they are so used to getting it.

These are some common patterns in relation to birth order, but they aren’t definitive.

Is competition among siblings always a bad thing?

Competition among siblings is not necessarily unhealthy as children can learn and develop through this. They learn social skills, verbal skills, how to adjust their emotions, how to bargain and negotiate. Building all these soft skills in the safe environment of home is often the best way. Mild to moderate types of vying for attention is perfectly normal. That’s how most kids play and learn.

On the other end, if assault or abuse happens, it’s no longer sibling competition or rivalry – it turns into sibling maltreatment and that’s unhealthy. Research has indicated that if an individual shows persistent violence towards family members, he or she is very likely to carry on with it outside of the family. They become bullies. This points to a red flag and the individual should receive help.

How should family members react when siblings get aggressive towards each other? Should they take sides, ignore or intervene?

For mild to moderate cases of sibling rivalry, it is best for parents to first observe as a third party. If the kids are still trying to figure things out between each other in an argument, you may not need to interfere. If you’re too quick to interfere, there may be consequences and it gets tricky. What seems fair and logical in the eyes of an adult or parent may not be so from a child’s point of view. Many times, parents want to interfere immediately to break apart potential fights. But their children can perceive this as the parent taking sides.

If you feel like things are going to get aggressive and physical, interfere in a way that does not point out who is right or who is wrong. Interfere by using ground rules. For example, if the kids are hitting each other in the backseat of the car, instead of saying “don’t hit your brother”, remind them of the ground rules: “in the car, we treat each other nicely” or “there is no beating each other in the car”. When you refer to the ground rules, you are alluding to whoever is breaking the rules. The difference may be subtle, but it can give very different effects.

Can such rivalry carry on into adulthood?

Most of the time, after kids have learnt how to navigate with their social skills, they enter adolescence and their attention shifts from home to school or even outside of school. They will naturally have other things to worry about, so the sibling rivalry gradually lessens.

That said, in some cases, sibling rivalries can carry on. Certain feelings of unfairness, extreme insecurity, inferiority, feeling the need to retaliate by aggression can linger and collect. As a psychologist, I do see many adults that come in for a set of symptoms, some even have clinical symptoms and after some analysis, the issues connect back to the family. 

The competition and rivalry between kids turn into envy as they get older. The vying for parents’ attention evolves into a competition for other forms of scarce resources, perhaps money or prestige. They may start to compare with their siblings and develop feelings of envy.

The prolonged conflict between siblings and even other family members can be unhealthy and can lead to psychological issues such as anxiety, depression or low self-esteem. It is especially a struggle in Asian societies because most people feel the need to put on a façade, pretend to get along during festivities and put on a show for their elderly parents. In the West, individualism may ultimately prevail, and toxic relationships and individuals may be more readily cut out if things cannot be patched up.

How can parents foster a close and strong bond among their children?

This gets tougher the more children you have. My professional advice is to try and develop a quality relationship with each child individually. That way, even if other children come along, it is less perceived as a loss of attention. If a child can see that he or she gets quality time and has a good relationship with the parents, the rivalry is less likely to develop.

Don’t be too quick to interfere and try to prevent potential fights.

To foster close and strong bonds among your children, try to develop a quality relationship with each child individually.

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