Experts Explain Why Thumb Sucking Can Be a Damaging Habit for Children Over 5

WORDS DR NIK MUKHRIZ NIK MUSTAPHA & DR MOHD AMIR MUKHSIN ZURIN ADNAN

FEATURED EXPERTS

DR NIK MUKHRIZ NIK MUSTAPHA
Lecturer and Specialist Orthodontist
Centre of Paediatric Dentistry and Orthodontic Studies Faculty of Dentistry
Universiti Teknologi MARA (UiTM)
DR MOHD AMIR MUKHSIN ZURIN ADNAN
Lecturer and Specialist Orthodontist
Centre of Paediatric Dentistry and Orthodontic Studies Faculty of Dentistry
Universiti Teknologi MARA (UiTM)
5 QUICK FACTS ABOUT THUMB SUCKING
  1. Thumb-sucking—a repetitive behaviour of sucking the thumb—is one of the behaviours referred collectively as non-nutritive sucking habits (NNSH).
  2. This behaviour has the potential to adversely affect the dentition, occlusion, and facial structures.
  3. It is prevalent among young children, particularly girls, and its occurrence tends to decrease with age. Approximately 70% to 80% of children exhibited this habit before the age of 5, with the incidence reducing to 12.1% and 1.9% beyond the age of 7 and 12, respectively.
  4. Interestingly, a higher percentage of mothers with thumb-sucking children had received some college education in comparison to mothers of children that don’t have this habit.
  5. It was also reported that the prevalence of thumb-sucking was least common among children that had favourable breastfeeding opportunities.
THUMB-SUCKING COMFORTS & SOOTHES INFANTS

The thumb-sucking reflex is one of the first sophisticated patterns of behaviour in infants, appearing around the 29th week of age.

Such reflex is considered normal, harmless, and comforting.

It helps infants to fall asleep easier as well as provide a sense of comfort, happiness, and security when they feel distressed.

COMMON FACTORS, EMOTIONS & SITUATIONS ASSOCIATED WITH A BABY’S THUMB-SUCKING HABIT
  • Fatigue.
  • Boredom.
  • Hunger.
  • Anger.
  • Fear.
  • Excitement.
  • Tooth eruption.
  • Insufficient sense of satisfaction.
  • Physical and emotional stress.
WHAT STARTED OUT AS AN EMOTIONAL COPING MECHANISM CAN BECOME A HABIT WHEN THE CHILD IS OLDER

Because thumb-sucking is a comforting coping mechanism, a child may eventually develop a strong attachment to this habit that persists at an older age.

This is the point at which problems begin to arise.

There is a direct link between the destructive effects of thumb-sucking habit and the intensity, frequency, and duration of the habit.

Having the habit for a short period will not leave much of an impact on the child.

However, continuous thumb sucking more than 6 hours daily often lead to the development of significant destructive outcomes.

Abnormal Pattern of Teeth Formation

The constant pressure and sucking motion exerted by the thumb on the teeth may interfere with a child’s normal path of tooth eruption and cause teeth to shift unnaturally. The position of the thumb within the oral cavity determines the pattern of the deformity.

A study has indicated that the incidence of tooth misalignment (malocclusion) is 3 times higher among children that exhibit thumb-sucking behaviour and other unhealthy oral habits, compared to those who do not have any such habits.

Asymmetrical Open Bite

The child’s front upper and bottom teeth do not come in contact when biting. This is usually worse on the side that the digit is sucked.

In turn, this may interfere in biting, speech, and to some extent, prevent closing of the lips.

Asymmetrical Facial Appearance

The narrowing of the palate associated with strong buccal musculature contraction and low position of the tongue can lead to the development of a posterior crossbite.

This can potentially impede the establishment of a proper bite and cause the jawbone to shift to one side, resulting in an asymmetrical facial appearance.

Increased Overjet

The tongue may push the upper front teeth forward, resulting in a ‘sticking out’ appearance while the lower front teeth is backward. The combination of these movements will result in an increased horizontal gap between the upper front and lower front teeth, a condition referred to as increased overjet.

Children with an increased overjet usually are at a greater risk of dental trauma due to the prominence of the teeth.

Speech Difficulties

Pronouncing certain words using tip of the tongue may be difficult, often with the child developing a lisp.

Skin Problems

Prolonged thumb sucking can cause skin irritation, cracked skin, and callus formation along the thumb.

Fingernail infection and eczema of the thumb may also develop.

WHEN SHOULD PARENTS BE CONCERNED ABOUT THEIR CHILD’S THUMB SUCKING?

The American Dental Association recommends intervening before a child turns 4 or, at the latest, by the time the permanent front teeth are about to erupt at the age of 5.

If the habit continues into the mixed dentition stage, past the age of 6, problems with the position of teeth might occur.

These problems can still self-correct and the child experience normal tooth growth if the habit is stopped by the age of 7.

After this age, the positions of the child’s teeth become more established and self-correction is less likely to occur. Complex orthodontic treatment is needed at this stage.

Hence, parents should aim to help their child stop the habit as early as possible, such as during preschool.

HOW TO WEAN YOUR CHILD OFF THUMB SUCKING
Psychological or Behavioural Approaches

Identify triggers. Determine the situations or times that would most likely drive your child to suck their thumb. By identifying these triggers, you can redirect their attention or provide them with alternative forms of comfort.

Positive reinforcement. Celebrate your child’s thumb-free moments. Consider setting up a reward system like a sticker chart that allows your child to visualize their progress and earn treats for sustained periods without thumb-sucking.

Communicate. Engage your child in age-appropriate discussions about thumb-sucking. Help them understand why they need to stop, while at the same time addressing any of their anxieties that lead them to suck their thumb.

Use visual reminders such as a band-aid on their thumb or a colourful bracelet on their wrist as a visual cue to remind them not to suck their thumb.

Distraction and substitution. Help your child find alternative ways to comfort themselves or keep their hands busy. Offer items like a soft toy, a soothing blanket, or even a stress ball. Keeping their hands occupied can divert attention away from thumb-sucking.

Seek professional help. If your child’s the thumb-sucking habit persists despite your efforts, consider consulting a child psychologist or counsellor. They can help identify any underlying emotional or psychological issues contributing to the habit and provide appropriate guidance.

Non-orthodontic Strategies

Thumb guards are devices that fit over the thumb and make thumb-sucking less enjoyable.

Other forms of physical barriers that can be used include bandages and gloves, but parents will have to monitor the child as these barriers can be easily removed by the child.

Taste-based deterrents. Apply bitter-tasting products to the child’s thumb as an immediate and often effective deterrent.

Orthodontic Strategies

Palatal crib is a dental appliance attached to the upper teeth. It prevents the thumb from comfortably resting against the roof of the mouth. Dentists often recommend the use of this appliance if the child’s thumb-sucking habit is causing dental issues.

Bluegrass appliance is designed to redirect thumb-sucking behaviour. It includes a roller or bead that the child can play with using their tongue, instead of sucking their thumb. Over time, this can help break the habit.

Quad-helix with crib attachment is recommended for more severe dental complications arising from prolonged thumb-sucking. This device corrects dental misalignments while curbing the thumb-sucking habit.

Experts & Parents Come Together to Raise Awareness of Respiratory Syncytial Virus

WORDS LIM TECK CHOON

On 4 September 2023, the Pertubuhan Kumpulan Sokongan Ibu Bapa Dan Bayi Pramatang Malaysia (BPM) and the Galen Centre for Health and Social Policy partnered to organize a media roundtable called Taking a Closer Look at RSV.

RSV is short for respiratory syncytial virus, one of the most prevalent viruses that infect the respiratory system of mostly children below 3.

FEATURED EXPERT
ASSOCIATE PROFESSOR DR ADLI ALI

Head of Clinical Immunology
UKM Children’s Specialist Hospital

“RSV is a disease that has been around for a long time, yet the number of cases is still high. The actual burden of the disease is not known from the economic impact on the healthcare system which includes admission costs, utilization of respiratory supports, as well the economic and social impact on the family of patients. Therefore, prevention is very important in addressing the further progression of the disease in the country.”

FEATURED EXPERT
AZRUL ABDUL KHALIB
Founder and Chief Executive Officer
Galen Centre for Health and Social Policy

“With the varied guidelines on prevention, we need to prioritize and respond with more urgency to RSV which can have a life-long impact. Parents, caregivers and the community at large need to understand the severity of the disease, how it can affect the future of our nation and what can be done to address them immediately.”

Azrul also called for more streamlined guidelines for RSV prevention and to ensure the channels for parents to seek support and financial aid for their children are made more accessible.

Furthermore, increased availability of preventive options would help reduce mortality and save children’s lives.

 

Does Height Matter for Girls? A Paediatric Endocrinologist Weighs In

WORDS ASSOCIATE PROFESSOR DR AZRIYANTI ANUAR ZAINI

FEATURED EXPERT
ASSOCIATE PROFESSOR DR AZRIYANTI ANUAR ZAINI
Consultant Paediatrician and Paediatric Endocrinologist
Department of Paediatrics
Faculty of Medicine
University Malaya

Many people are under the impression that it is alright for girls to be short or petite.

While being a few centimetres shorter than the norm may not have much of an effect on a girl or woman, being abnormally short or stunted could have serious psychosocial consequences.

THE RAMMIFICATIONS OF ABNORMAL GROWTH

Mental repercussions. Girls that are too short may face bullying and discrimination, especially among their peers, or they themselves may constantly compare themselves negatively to their normal-height friends.

This can result in psychological distress, low self-esteem, and social isolation.

Discrimination. As they grow up and enter the workforce, this can also translate into discrimination at the workplace, with many studies revealing that shorter people tend to earn less and be viewed as less powerful or influential.

Childbirth issues. Shorter women tend to have smaller pelvises, which may result in difficulties during childbirth. Indeed, research indicates that shorter women tend to have shorter pregnancies, smaller babies and a higher risk of needing a caesarean section.

Practical consequences. Examples include needing a booster seat or car modifications in order to drive and being unable to reach higher items on supermarket shelves or grasp the hanging strap on public transport.

IS YOUR DAUGHTER ABNORMALLY SHORT?

The expected height for a girl or woman is assessed according to their age, population and parents’ heights.

In Malaysia, we use the World Health Organization (WHO) length/height-for-age growth charts to measure the growth of children from birth to the age of 19.

You can get these charts at the WHO website (link opens in a new tab). Note that there are different charts for different sexes and age range, so pick the right one for your child!

A girl whose height is shorter than the average by 10 cm or more on the age-appropriate growth chart should be considered a red flag, and they should be brought to see a doctor as soon as possible.

WHY DO SOME CHILDREN EXPERIENCE STUNTED GROWTH?

Stunting is defined as having a height that was more than two standard deviations from the average height, while risk of stunting was having a height that was between one and two standard deviations from the average.

A nationwide study led by Universiti Malaya, involving over 15,300 children, found that 16.1% of Malaysian children aged 1 to 5 were stunted, while a further 20% were at risk of stunting.

The most common general cause for stunting in Malaysia is malnutrition. This can range from poor nutritional intake due to a low-quality and/or low-quantity diet, to poor behaviour towards nutrition such as slow or picky eating.

Children with a chronic disease, such as congenital heart disease, respiratory illnesses, cancer, or malabsorption disorders, can also suffer from stunting due to factors related to their disease.

In addition, babies born at term and small-for-gestational-age (SGA)–usually less than 2.5kg–can also be abnormally short. Although they may be otherwise healthy, small-for-gestational-age babies that do not catch up in growth by their fourth or fifth birthday are at risk of being stunted.

More specific causes for stunting include hormonal conditions, such as growth hormone deficiency, and genetic conditions such as Turner’s syndrome in girls.

WHAT PARENTS SHOULD PAY ATTENTION TO WHEN IT COMES TO THEIR CHILDREN’S GROWTH

Nutrition. Good nutrition can make a big difference in a child’s growth. It is, in fact, the main driver of linear growth during the first 5 years of life. Even if a child has a hormonal deficiency or genetic condition that causes stunting, ensuring that they receive good nutrition in the early years can go a long way in helping them achieve an optimum height.

Sleep. Many Malaysian children have an unfortunate tendency to go to bed late before having to wake up early in the morning to go to school. Growth hormone tends to be released during the deep, uninterrupted periods of sleep in the middle of the night. Therefore, children who have shorter amounts of such undisturbed sleep may have their growth compromised.

Physical activity. Lastly is our children’s increasingly sedentary lifestyle, which was particularly exacerbated during the movement control order over the last two years. The lack of exercise and tendency to just sit and play with electronic gadgets have a negative effect on a child’s growth. Research has shown that not only is the risk of obesity increased with such a lifestyle, but the child’s growth is also jeopardized.

CAN ABNORMAL GROWTH BE TREATED?

There are definitely ways to treat and manage girls who are abnormally short, but the key influencing factor is the age at which they are diagnosed and when treatment can be commence.

This is because there is only a small window of opportunity to help these girls achieve their maximum potential height.

Despite most parents noticing their daughter’s unusual shortness, many of them only tend to bring their daughter to see the doctor when she fails to have her period by her early teens (primary amenorrhoea).

This is because there is a myth that girls only start their growth spurt after menarche, or their first period. However, the fact is that menarche marks the last stage of puberty. By this time, there is only potential for another 3 to 5cm of growth!

So, while we can still treat such girls, the window of opportunity to help them achieve a more normal height is much more limited.

Ideally, girls with short stature should be referred to a paediatric endocrinologist by the ages of 7 to 10.

This would allow sufficient time for diagnosis, monitoring and treatment.

IN CONCLUSION

It is very important that parents monitor their child’s growth and development.

There are many simple ways parents can keep track of their child’s height at home, including annual measurements—tip: use a cereal box, which has a nice 90⁰ angle, rather than a bendable ruler or paperback book—and digital tools such as apps.

Experts Talk About How to Best Care for and Feed a Child with Autism

WORDS AINUL SYAFIQAH MOHD AZAHARI & DR NUR HANA HAMZAID

FEATURED EXPERTS

AINUL SYAFIQAH MOHD AZAHARI
Nutritionist and Student of Master’s in Clinical Nutrition
Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)
DR NUR HANA HAMZAID
Senior Lecturer
Center for Rehabilitation & Special Needs Studies (iCaRehab)
Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)

Autism spectrum disorder (ASD), also known as autism, is a developmental disability caused by neurodevelopmental disorders that affect how the brain functions and alter the development of the nervous system.

As a result, someone with autism typically experiences difficulties in their social, cognitive, and emotional functioning.

Among the main characteristics of people with autism are significant social communication and behavioural challenges that can be seen as early as when they are 18 months old.

Additionally, people with autism would also exhibit a high degree of repetitive behavioural patterns.

AUTISM CAN GIVE RISE OF PROBLEMS AFFECTING THE CHILD’S GASTROINTESTINAL SYSTEM

These problems, called gastrointestinal issues (GI), are common among with children with autism.

A 2019 review of 13 studies found out that 80% of children with autism experience gastrointestinal issues.

These children typically experience:

  • Constipation
  • Diarrhoea
  • Abdominal bloating
  • Abdominal pain

The same review also found out that there is an association between poor gut health and the children’s behavioural response, due to the impaired function of the gut and disruptions to the population of bacteria in the gut (the gut microbiome).

ISSUES IN THE GUT CAN CAUSE THE CHILD WITH AUTISM TO ACCEPT ONLY A SMALL SELECTION OF FOODS 

The affected gut-brain axis results in neurological imbalance that gives rise to the child’s tendency toward repetitive behaviour and sensitivity.

This repetitive behaviour can restrict the variety of foods accepted by the child, or food selectivity, based on their taste and sensory requirements. A hypersensitive child with autism, for instance, usually prefer foods with less texture and milder tastes, while a hyposensitive child with autism—one with lower-than-normal sensitivity to sensory input—may prefer instead foods with more textures and stronger tastes.

THESE ISSUES CAN PUT A CHILD WITH AUTISM AT RISK OF NUTRITIONAL DEFICIENCY

Food selectivity as well as gut issues in children with autism can put their nutritional status at stake. Here are some common issues related to this.

Reduced absorption efficiency of nutrients in the gut during digestion

This is due to abnormalities in gut functions.

Reduced digestion of carbohydrates

Some studies mentioned that children with autism lack the enzymes needed for a better carbohydrate digestion.

Preference for carbohydrate-rich and often sweet foods

One 2004 study found out that children with autism prefer foods high in carbohydrates, which are generally sweet, while commonly rejecting foods that are bitter and sour.  High consumption of carbohydrate-rich foods can impact the child’s glucose tolerance and sensitivity, which over time would lead to overweight and obesity, diabetes, and dental caries.

Food selectivity keeps children with autism from obtaining the types and amounts of nutrients to meet their daily nutritional intake

Rejection of certain tastes and food textures may restrict the child from obtaining essential micronutrients such as vitamin D, vitamin B12, vitamin C, calcium, and zinc.

The child may also have a lower consumption of dairy products.

Furthermore, parents of some children with autism put these children under dietary restrictions protocols, such as casein- and/or gluten-free diets. However, to date there is no evidence that these dietary restrictions can improve the child’s behavioural and gastrointestinal issues. On the other hand, it is likely that such dietary restrictions only further narrow the window of opportunity for proper nutrient intake.

HOW TO PROVIDE OPTIMAL NUTRITION & CARE TO A CHILD WITH AUTISM

Providing optimal care to a child with autism involves a multidisciplinary team, which comprises of paediatricians, psychiatrists, occupational therapists, speech-language therapists, dietitians, and social workers.

  • The paediatrician and psychiatrists work to recognize the early symptoms of and conduct assessments for autism.
  • Occupational therapists evaluate the current developmental levels of emotional self- regulation and participation in social interactions.
  • Speech-language therapists provide interventions to help the child improve their communication skills.
  • Dietitians consult with carer or the child themselves to understand the child’s dietary and eating behaviours, in order to identify the child’s food aversion and/or nutritional deficiencies and to advise the child’s carers on how to best manage these issues.
  • Social workers link parents and families with agencies and autism-related community programmes.
HOW PARENTS CAN MANAGE THE FOOD SELECTIVITY OF A CHILD WITH AUTISM
Explore various food textures and tastes 
  • A hyposensitive child requires more triggers in order to stimulate their senses, so offer crunchy and chewy foods with strong aromas. Use herbs and spices, instead of salt and sugar, to enhance the flavours of these foods.
  •  For hypersensitive children, introduce softer, mushier foods with less intense flavours such as porridge, yoghurt, and mashed foods. Parents and caregivers should also incorporate desensitization techniques into playtime and other activities with these children outside of eating time.
Roleplay with the child during mealtimes

For example, pretend to be a cook or feed the child’s favourite toy. You can also use the foods that your child likes and accepts to spin a story about other foods that your child may also enjoy.

Such imaginative games can help switch on the child’s imaginative skills, make mealtimes for enjoyable, and reduce the child’s reluctance to eat.

Food challenge

For example, if your child accepts a certain sauces, dips, or gravy, try dipping new foods into them to get your child to try these foods.

Food chaining

Food chaining helps to encourage a child with food selectivity to try new foods.

If your child like apple sauce, for example, you can try introducing the apple fruit into their meals.

Food chaining involves trial and error, and parents/caregivers may experience some degree of frustration when the child rejects the new foods that are introduced into their meals.

However, be patient and don’t give up! Perseverance and consistency are essential when it comes to success in helping a child with autism to adopt healthier eating habits.


References:

  1. Lefter, R., Ciobica, A., Timofte, D., Stanciu, C., & Trifan, A. (2019). A descriptive review on the prevalence of gastrointestinal disturbances and their multiple associations in autism spectrum disorder. Medicina (Kaunas, Lithuania)56(1), 11. https://doi.org/10.3390/medicina56010011
  2. Narzisi, A., Masi, G., & Grossi, E. (2021). Nutrition and autism spectrum disorder: Between false myths and real research-based opportunities. Nutrients13(6), 2068. https://doi.org/10.3390/nu13062068
  3. Schreck, K. A., Williams, K., & Smith, A. F. (2004). A comparison of eating behaviors between children with and without autism. Journal of autism and developmental disorders34(4), 433–438. https://doi.org/10.1023/b:jadd.0000037419.78531.86
  4. Williams, B. L., Hornig, M., Buie, T., Bauman, M. L., Cho Paik, M., Wick, I., Bennett, A., Jabado, O., Hirschberg, D. L., & Lipkin, W. I. (2011). Impaired carbohydrate digestion and transport and mucosal dysbiosis in the intestines of children with autism and gastrointestinal disturbances. PloS one6(9), e24585. https://doi.org/10.1371/journal.pone.0024585
  5. Zeidan, J., Fombonne, E., Scorah, J., Ibrahim, A., Durkin, M. S., Saxena, S., Yusuf, A., Shih, A., & Elsabbagh, M. (2022). Global prevalence of autism: A systematic review update. Autism research : official journal of the International Society for Autism Research15(5), 778–790. https://doi.org/10.1002/aur.2696

Here’s EVERYTHING That Mom and Dad Should Know About Hand, Foot & Mouth Disease

WORDS LIM TECK CHOON

FEATURED EXPERT
ASSOCIATE PROFESSOR DR ERWIN J KHOO
Consultant Paediatrician and Head of Paediatrics Department
International Medical University (IMU)
WHY KIDS ARE VULNERABLE TO HAND, FOOT, AND MOUTH DISEASE

It’s hard to avoid hand, foot, and mouth disease recently, as it’s either affecting children in the country or appearing in the news.

Simply put, young kids are at risk of catching this disease because they are active, mobile, and curious.

According to Associate Professor Dr Erwin Khoo, toddlers tend to have a messy habit of touching and putting everything they come across into their mouths. This puts them at risk of the disease.

THE CULPRITS RESPONSIBLE FOR THE DISEASE

That will be viruses, the most common ones being Coxsackie A16 and Enterovirus 71.

According to Dr Erwin:

  • These viruses can be found in the respiratory tract and faeces, as well as in the fluid-filled blisters that form on the hands and feet of someone with hand, foot, and mouth disease.
  • The usual incubation period—the time period from infection to the first appearances of symptoms— is between 3 and 7 days, but it can also be and can go up to 2 weeks.
  • The virus can remain contagious for several days, even when it’s on hard surfaces.
  • As a result, the virus can spread easily amongst those in close contact with the infected child. One can also catch the virus from touching toys, eating utensils, and other objects that had been handled by the infected child.
  • One can also catch the virus from not properly washing their hands after performing routine childcare tasks on the infected child, such as changing diapers.
COMMON SYMPTOMS OF HAND, FOOT, AND MOUTH DISEASE
  • Fever
  • Sores around the mouth
  • Rashes
Rashes on the feet. Click for larger, clearer image.

Widespread rashes across the body are commonly seen on children with this disease, which may lead some people to confuse it with chickenpox.

Dr Erwin shares that unlike chickenpox, however, the rashes of a child with hand, foot, and mouth disease typically form at the hands and feet (hence the name of the disease) as well as sometimes on the knees, elbows, and buttocks.

IT CAN ALSO AFFECT ADULTS

This disease commonly affects children under the age of 6, but adults can also get infected and develop the disease.

Research has suggested that adults usually experience milder symptoms when compared to children.

Hence, it is possible for adults to pass the virus on to children under their care.

ONE CAN GET THIS DISEASE MORE THAN ONCE

Dr Erwin explains that this is because there are different strains of viruses that cause this disease. Because of this, any immunity developed by the body after an infection is only temporary.

HOW IS HAND, FOOT, AND MOUTH DISEASE TREATED?

“There is no cure or specific treatment for this disease,” Dr Erwin shares.

Currently, treatment revolves around managing the symptoms and making the child as comfortable as possible.

Dr Erwin points out that the disease typically goes away on its own between 7 and 10 days.

OKAY, BUT CAN WE PREVENT THE DISEASE FROM AFFECTING US OR OUR CHILDREN, THEN?

Unfortunately, we currently have no means to fully prevent hand, foot, and mouth disease from happening to us or our children.

SOMEONE AT HOME HAS THIS DISEASE. WHAT SHOULD WE DO?

Dr Erwin advises the following:

  • Be extra careful and limit contact with the infected individual.
  • Practice good hand hygiene. Wash or disinfect hands regularly, especially after caring for an infected child. It’s also good to wipe down common areas, such as the living and dining areas, as well as commonly handled objects such as toys, doorknobs, etc with disinfectant.
  • Don’t share food and eating utensils.
  • Avoid touching the eyes or nose.

Do the above up to 10 days after the infected individual started showing symptoms.

If your child is confirmed by a doctor to have hand, foot, and mouth disease, it is prudent to have the child stay at home to avoid passing the infection on to others.

WHAT CAN PARENTS DO TO HELP PROVIDE THE BEST TLC TO A CHILD WITH HAND, FOOT, AND MOUTH DISEASE?

Dr Erwin advises the following:

  • The paediatrician will prescribe appropriate medications for fever, pain relief, and reduction of inflammation of mouth ulcers. Parents wishing to use medications outside of the doctor’s prescription should consult the paediatrician first.
  • Give the child easy-to-swallow foods, such as soups and porridges.
  • Have the child drink plenty of fluids to avoid getting dehydrated. Offer them their favourite drinks or juices.
  • For painful mouth ulcers, consider using cold treats such as ice cream, jelly, and yoghurt to provide soothing pain relief. Parents can also consider alcohol-free mouth rinses and oral gels for the child.
  • Have the child shower or bathe regularly, as this will help soothe their sores. Avoid using harsh soaps and body scrubs on the child, as these may irritate their skin further.
  • Afterward, apply a towel gently to dry the child, to avoid breaking the blisters on the child’s skin. harsh soaps and scrubs that further irritate the skin.
  • If the child’s sleeping area has air-conditioning, switch it off at night. This is because air conditioning can create a dry environment that will reduce the child’s saliva production. This can cause the child’s mouth ulcers to hurt more.
  • If cooling is needed, such as due to hot weather, a humidifier or even just leaving a bowl of water in the room can prevent an excessively dry environment from forming.
  • If the child can’t sleep or rest due to pain, consult the paediatrician about the use of a pain reliever at night.

Dr Erwin points out that there are many “home remedies” being passed around, such as using coarse salts or enzyme water on a child with this disease. There is no evidence that such “remedies” actually work, and in most cases, they only irritate the skin and cause more pain and discomfort!

WHAT ABOUT COMPLICATIONS? ARE THERE ANY?

Usually, plenty of rest at home can help a child with hand, foot, and mouse disease recover, with over-the-counter treatments sufficient to relieve symptoms such as fever, rashes, and/or red spots.

However, in some cases, painful ulcers in the mouth can prevent a child from eating, drinking, and swallowing normally.

“This can lead to dehydration. Serious cases of dehydration require medical attention,” Dr Erwin states.

To keep an eye out for signs of dehydration, parents can do the following:

Take note of poor urine output, dry mouth, and lack of tears when they cry.

These are possible signs of severe dehydration.

Seek immediate medical attention when your child experiences the following:
  • Rapid breathing
  • Disorientation
  • Drowsiness
  • Giddiness
  • Stiff neck
  • Seizures
  • Fever for more than 3 days
  • Not eating and drinking
IT MAY SEEM OVERWHELMING WHEN YOUR CHILD HAS HAND, FOOT, AND MOUTH DISEASE, BUT TAKE A DEEP BREATH

Dr Erwin encourages parents to take a different outlook.

“If you can arrange to take some time off from work, maybe with a doctor’s letter for your employer, just stay home and spend this time with your kids. It is easy to overlook how quickly they grow up!” he says.

Great News! Now More Children Are Eligible for Free Pneumococcal Vaccination!

WORDS LIM TECK CHOON

In conjunction with World Immunization Week from 24 to 30 April, the Ministry of Health held a National Immunisation Day 2023 on 31 May 2023.

The event was a collaboration between various divisions in the Ministry of Health’s Public Health Programme and Immunise4Life (link opens in a new tab).

THE BIG CATCH-UP

The theme of National Immunisation Day this year is ‘Tingkatkan liputan, kurangkan keciciran’ or ‘The Big Catch-up’.

Dr Zaliha Mustafa, our Minister of Health, revealed that this theme is in line with the expansion of Malaysia’s free pneumococcal vaccination programme to those born between 2018 and 2019. This expansion will commence from June 1.

Pneumococcal vaccine was included in the National Immunisation Programme (link opens in new tab) to initially cover children born from January 1 in 2020.

With this expansion, our Ministry of Health hopes to target 70% or 700,000 of the 1 million children aged 4 to 5 under the two-year programme.

“The nationwide pneumococcal vaccination programme will start on June 1 until May 31 next year and it will involve the ministry’s primary healthcare facilities,” she explained.

Interested parents can set an appointment for their children’s vaccination using the MySejahtera app.

WHY KIDS SHOULD GET THE PNEUMOCOCCAL VACCINE

Pneumococcal disease, an infection caused by bacteria called Streptococcus pneumoniae is contagious and may cause severe illness, so early diagnosis and treatment is important.

Children 2 years old or younger are vulnerable to such infection.

Hence, these children are also at risk of developing serious, potentially life-threatening complications such as:

  • Pneumonia, which is the infection and inflammation of the air sacs in our lungs
  • Ear infections
  • Meningitis, which is the inflammation of a membrane called meninges in the spinal cord and brain
  • Bacteraemia, or infection of the bloodstream
Pneumococcal pneumonia is a lung infection caused by the bacteria responsible for pneumococcal disease. Click on the image for a larger, clearer version.

Once the bacteria infect the bloodstream, they can find their way to parts of the body that are normally sterile, such as the peritoneum—that’s the membrane lining our abdominal cavity—as well as our joints and heart. This can lead to many more invasive diseases, such as peritonitis, arthritis, and endocarditis (inflammation of the inner layer of the heart) respectively.

Hence, parents with children that are eligible for the free vaccination should consider taking advantage of the expansion of Malaysia’s free pneumococcal vaccine programme. They can consult a doctor should they have any doubts and concerns about the vaccine.

Doctors Answer Parents’ Burning Questions About Eczema and Children

WORDS LIM TECK CHOON

FEATURED EXPERT
DR MELANIE MAJAHAM
Consultant Paediatrician
Sunway Medical Centre Velocity

WHY DOES MY CHILD HAVE ECZEMA?
Dr Melanie Majaham explains that:

  • Eczema usually happens in a child that already has a tendency for dry skin.
  • The child’s skin becomes inflamed and very itchy when they are exposed to triggers such as chemicals, sweat and heat.
  • Red, dry, itchy patches form on the skin as a result of the inflammation.
  • Because of the itch, the child will constantly scratch their skin, which can lead to further damage to the skin. Blisters, oozing, crusting, and sores are some possible consequences from the constant scratching.
  • Such damaged skin leaves the child vulnerable to bacterial, viral and fungal infections.
HOW IS ECZEMA TREATED?

Dr Melanie says that treatment options will depend on which phase the eczema is in.

Active flare-ups
  • In active flare-ups, the child may need steroid-based creams to reduce the inflammation and break the itch cycle. These steroid creams are safe and will not cause long-term complications when used correctly over a short duration.
  • If the skin is infected, antibiotics and antiviral medications may be needed. Parents should be reassured that steroid creams prescribed correctly and in short duration will not lead to long term complications.
Subacute or chronic case (the skin is merely dry; no active inflammation present)
  • Maintenance therapy is important to prevent flare-ups.
  • Such therapy include intensive moisturizer creams that are free from fragrance and certain chemicals.
  • The child will also need to bathe with soap-free solutions to prevent excessive drying of the skin.
  • While bathing, make sure the water is not too warm. Dr Melanie nots that water that is too warm tend to worsen one’s eczema.
  • Wet skin should be pat dried gently with a towel.
FEATURED EXPERT
DR JUANI HAYYAN ABDUL KARAF
Consultant Ear, Nose & Throat (ENT) and Head & Neck Surgeon
Sunway Medical Centre Velocity
WILL IMMUNOTHERAPY HELP MY CHILD?

Dr Juani Hayyan Abdul Karaf explains that immunotherapy—in the form of shots—is available to treat allergies, but this is specific for certain allergens such as house dust mites.

WILL MY CHILD CONTINUE TO HAVE ECZEMA WHEN THEY ARE AN ADULT?

Children with eczema can develop food allergy, allergic rhinitis, and asthma—a natural progression from infancy to adulthood known as the atopic march.

Dr Juani shares that the atopic march happens when children continue to develop inter-related allergies into childhood that can begin with eczema.

“It can start with a skin condition as it’s the first body barrier that can be breached. The body’s response can continue and manifest later as food allergies, allergic rhinitis, and asthma,” she elaborates.

More than 50% of children with eczema develop asthma later in life, with a further 33% developing food allergies, as well as an increased risk of developing allergic rhinitis .

CLOSING ADVICE FROM THE EXPERTS
  • “Parents should ensure the child is kept cool as heat can aggravate eczema,” Dr Melanie points out. “Constant round-the-clock moisturizing also does wonders in keeping the child comfortable.”
  • Dr Melanie also discourages the use of antiseptic soaps, as these soaps are harsh and can worsen eczema. “Some parents think eczema is caused by poor hygiene and tend to use antiseptic soaps. However, the more appropriate bathing solution would be something soap-free and fragrance-free and rich in emollients.”
  • Dr Juani advises parents to encourage their child to exercise regularly and spend time outdoors to soak up vitamin D.

A Dentist Sets the Record Straight on How Kids Can Have Healthy Teeth

WORDS LIM TECK CHOON

FEATURED EXPERT
DR YOGESWARI SIVAPRAGASAM
Senior Lecturer and Consultant in Paediatric Dentistry
School of Dentistry
International Medical University (IMU)
Tip 1
START EARLY—CLEAN YOUR BABY’S GUMS AT LEAST TWICE A DAY

“It is easy to overlook oral care in babies – after all, they won’t have teeth till months later!” says Dr Yogeswari Sivapragasam,

  • Get a clean, damp washcloth.
  • Use the washcloth to gently wipe clean your baby’s gums.
  • Also gently clean the front of your baby’s tongue.

You should do this after every breastfeeding.

“Besides that, parents should also get advice from healthcare practitioners, such as a nurse advisor at community clinics or paediatricians, on how to care for their child’s oral health from birth, which includes what to do when their teeth first appear,” Dr Yogeswari further advises.

Tip 2
DELAY ADDING SALT & SUGAR INTO YOUR KID’S DIET

Dr Yogeswari advises us to hold back the introduction of added salt and sugar into their child’s diet.

This is because getting your child hooked early on sweet or salty foods can increase their risk of dental problems as well as chronic health conditions (obesity, type 2 diabetes, etc) later in life.

Instead, let your child develop a liking for naturally unsweetened and unsalted foods.

Tip 3
TAKE YOUR KID TO THE DENTIST REGULARLY & MAKE THESE VISITS AS FUN AS POSSIBLE

Children should receive their first dental check-up when they are 1 year old.

“Remember this: first birthday, first dental check-up!” says Dr Yogeswari.

After the first dental visit, you are advised to bring your kid to the dentist every 6 months.

“While it is unlikely that they will have any dental problems at this young age, this will help young children have a positive experience rather than associate dental visits with pain and fear,” Dr Yogeswari further adds. “Regular visits will help to normalize the experience of visiting a dentist and will go a long way towards preventive care.”

Of course, regular visits to the dentist will also help to detect early any potential problems with your kid’s oral health and tooth development, and allow the dentist to address these problems without further delay.

Tip 4
KEEP AN EYE OUT FOR UNUSUAL CHANGES IN BEHAVIOUR

Your child sometimes refuses certain foods or refuses to brush their teeth. “While this may be easily explained as the child being fussy or picky, there could be another reason behind it,” says Dr Yogeswari.

For example, your child may have developed cavities or gum disease, and the constant pain and discomfort may cause them to refuse foods that need to be chewed.

“This may inadvertently lead them to avoid whole foods such as apples and chicken,” Dr Yogeswari elaborates, “and choose softer foods instead, many of which are processed and contain higher levels of salt, sugar and fat. Over time, this may lead to nutritional deficiencies or chronic conditions that can affect a child’s health into adulthood.”

The constant pain can also cause irritability and affect their ability to concentrate during lessons in school.

“In addition, poor oral health can also affect a child’s self-esteem if they are teased due to the appearance of their stained or rotten teeth. This may cause them to avoid social activities or become withdrawn,” Dr Yogeswari adds.

As such, be alert and check for possible dental problems if your child suddenly appears to be unwilling to chew or becomes irritable without any apparent cause.

A Cancer Expert Explains What You Should Know About Wilms Tumour

WORDS LIM TECK CHOON

FEATURED EXPERT
DR ENI JURAIDA ABDUL RAHMAN
Consultant Paediatrician, Paediatric Haematologist, and Paediatric Oncologist
Sunway Medical Centre

Wilms tumour is the most common type of kidney cancer affecting children, usually those that are under 5 years old,” says Dr Eni Juraida Abdul Rahman.

FACTS ABOUT WILMS TUMOUR
  • It is also called Wilms’ tumor or nephroblastoma. The name Wilms came from Max Wilms, a German surgeon that first described this cancer.
  • The tumour is the result of mutations of genetic materials in kidney cells, which typically occur after birth.
  • Usually only one kidney is affected, but in 5% to 7% of cases, it can be found in both kidneys.
WHAT CAUSES WILM TUMOUR?

Just like with most cancers, we still haven’t found the exact causes for this cancer.

However, Dr Eni Juraida points out that there are certain genetic disorders that can increase a child’s risk of developing Wilms tumour, such as:

  • Aniridia, or the abnormal development of the iris of the eye due to genetic mutation, usually along chromosome 11 that led to deleted genes and hence missing genetic information.
  • Hemihypertrophy or hemihyperplasia, a condition in which one side of the body or a part of one side of the body is larger than the other in an extent that is greater than what is considered normal.

“Patients with WAGR syndrome have a 45% to 60% chance of developing Wilms tumour,” says Dr Eni Juraida.  WAGR stands for: Wilms tumour, aniridia, genitourinary malformation, and range of developmental delays.

SYMPTOMS TO WATCH OUT FOR IN A CHILD
  • Painless swelling in the abdomen, occasionally noted by parents while bathing the child; the tumour may cause discomfort
  • Haematuria, or blood in urine
  • Hypertension or high blood pressure
  • Fever
  • Unusual loss of appetite, resulting in weight loss
  • Pain in the abdomen
  • Generally feeling unwell
  • Cough and shortness of breath
HOW IS WILMS TUMOUR TREATED?

Treatment options will depend on the stage of the tumour.

Surgery

The mainstay treatment, usually done upfront for stage I and II tumours and sometimes delayed for stage III, is a surgical procedure called nephrectomy. This surgery removes the affected kidney and hence the tumour from the child’s body.

In the rare cases when tumours are present in both kidneys, partial nephrectomy removing only the parts affected by the tumour will be performed to preserve as much of the kidneys as possible.

Chemotherapy

“Chemotherapy are medications that are given to kill cancer cells,” Dr Eni Juraida explains.

For stage I and II tumours, these medications can be given after a nephrectomy, to kill off any remaining cancer cells.

However, stage III tumours are much larger in size compared to stage I and II ones, and chemotherapy will be prescribed before a surgery to first shrink the tumour. This will allow the surgery to be carried out more safely.

Radiotherapy

This may be prescribed in some cases, usually for tumours that has spread to other organs such as the lungs or are not completely resolved via chemotherapy.

CAN WE HELP PREVENT THE DEVELOPMENT OF WILMS TUMOUR IN OUR CHILD?

“Since we don’t know the cause, it is difficult to have any preventive measure,” Dr Eni Juraida points out.

However, for children with WAGR syndrome, having them undergo a surveillance ultrasound of the abdomen on a periodic basis—such as every 6 months—can help detect Wilms tumour.

Food for All: Modifying Food Texture for People With Dysphagia

WORDS AINUL SYAFIQAH MOHD AZAHARI & DR NURUL HUDA RAZALLI

FEATURED EXPERTS
AINUL SYAFIQAH MOHD AZAHARI
Nutritionist and Student of Master Clinical Nutrition
Faculty of Health Sciences
Universiti Kebangsaan Malaysia
DR NURUL HUDA RAZALLI
Dietetic Programme
Centre for Healthy Ageing and Wellness (H-CARE)
Faculty of Health Sciences
Universiti Kebangsaan Malaysia

DYSPHAGIA: IT MEANS DIFFICULTIES IN SWALLOWING FOODS & LIQUIDS

  • Dysphagia comes from  Greek word ‘dys’, which means difficulties, and ‘phagia’, which means swallowing.
  • Medically, dysphagia is a term for swallowing difficulties. Someone with dysphagia takes more time and effort to move food or liquid from their mouth down to their stomach.
  • Episodes of dysphagia can be intermittent or progressive.
IT IS A SYMPTOM FOR MANY MEDICAL CONDITIONS
  • In adults, dysphagia is very common in adult that has a history of stroke, dementia, Alzheimer’s disease, neck cancers, and gastroesophageal reflux disease (GERD).
  • It could also be present in children with attention deficit hyperactivity disorder (ADHD), autism, Down syndrome, and cerebral palsy.
  • Dysphagia can also be a sign that there are some issues with the many nerves and muscles that are involved in swallowing activities.
YOU MAY HAVE DYSPHAGIA IF YOU EXPERIENCE THE FOLLOWING
  • Persistent drooling of saliva
  • Coughing or choking when eating or drinking
  • Bringing food back up, sometimes through the nose
  • Feeling as though food is stuck in your throat or chest
  • Being unable to chew food properly
PEOPLE WITH DYSPHAGIA FACE ISSUES THAT CAN JEOPARDIZE THEIR HEALTH & WELL-BEING

Choking and lung infection

Individuals with dysphagia are susceptible to choking. Due to difficulties in swallowing normally, consumed foods or liquids can accidentally enter the airway into the lungs. This could result in aspiration pneumonia, often known as a lung infection and can be fatal.

Poor nutrition intake
  • The prevalence of malnutrition among people with dysphagia is reported to be anywhere between 3% and 29%, which is quite a high number.
  • Malnutrition leaves people with dysphagia more vulnerable to diseases, should they not receive enough essential nutrients for optimal body function.
  • Muscle wasting, underweight, and stunting could be other issues that arise. Hence, people with dysphagia needs to be aware of any weight loss, hair loss, feeling of coldness, and fatigue as these are the early symptoms of malnutrition.
Loss of appetite and fear of mealtimes
  • People with dysphagia often lose their appetite in conjunction with their reduced swallowing ability.
  • They might develop some degree of “laziness” when it comes to drinking more often, which may lead to dehydration.
  • Because their eating experiences can be difficult, uncomfortable, and unpleasant, they may develop anxiety during mealtimes.
Inability to talk fluently
  • Dysphagia can hinder one’s ability to talk fluently and, combined with difficulties in eating, may cause the affected person to experience low self-esteem and lead to self-isolation.
  • The decrease in social engagement will give a negative impact in the person’s quality of life.
  • Thus, social support from their carer, family members, and close friends are crucial. A little extra kindness and help will give a huge impact in their life and sometimes even touch their heart.
Proper nutrition management for people with dysphagia involves providing adequate nutrients through modification of food texture and fluid consistency.

We need to also keep an eye out for symptoms of dehydration such as dry mouth or tongue, thirst, headache, and lethargy. 

Also, be alert to any unexplained weight loss, hair loss, feeling of coldness and fatigue—these could be early symptoms of malnutrition.

IF YOU ARE WORRIED THAT YOU OR SOMEONE CLOSE TO YOU HAVE DYSPHAGIA

Consult a speech language pathologist, a healthcare professional trained to diagnose dysphagia, for a proper diagnosis.

People with dysphagia can consult with dietitians for their nutritional concerns or if they want to assess their nutritional adequacy.

TIPS FOR INDIVIDUALS WITH DYSPHAGIA TO ACHIEVE GOOD NUTRITION

Understand the extent of one’s dysphagia

Discuss with the speech language pathologist and other relevant healthcare professionals on the degree of swallowing ability in the person with dysphagia.

Refer to the International Dysphagia Diet Standardization Initiative (IDDSI) Framework

This guideline has seven levels. Flow test, spoon tilt, and fork drips are used as measurement methods to determine each level.

Click to view a larger and clearer image.

Further information can be obtained from the IDDSI website (link opens in a new tab).

Modify foods into certain textures 

For more detailed information on how to modify the textures of various foods, you can refer to this page on the IDDSI website (link opens in a new tab).

  • While modifying the textures of foods into appropriate textures, take into consideration the nutritional content (carbohydrates, protein, fat, as well as vitamin and minerals). Daily meals should provide all the nutrients to improve the person’s nutritional status.
  • Always choose softer food options if texture modification is not possible. For example, choose papaya instead of apple, and ‘soften’ a dish with gravy.
  • Add special thickening powder to watery liquids. This thickening allows for easier swallowing.
Useful tips for eating
  • Have the person with dysphagia sit upright to prevent choking.
  • Have them tilt their heads to prevent liquids from going into their air passage.
  • Encourage the person to take smaller bites, and give enough time to chew the food thoroughly.
  • If small pieces of food or liquid are stuck, have them cough a little.

Dysphagia is a journey of eating experience that may switch an individual’s life 360 degree. Hence support and motivation play an important role in the management of one’s dysphagia.


References:

  1. O’Rourke, F., Vickers, K., Upton, C., & Chan, D. (2014). Swallowing and oropharyngeal dysphagia. Clinical medicine (London, England), 14(2), 196–199. https://doi.org/10.7861/clinmedicine.14-2-196
  2. Shaheen, N. A., Alqahtani, A. A., Assiri, H., Alkhodair, R., & Hussein, M. A. (2018). Public knowledge of dehydration and fluid intake practices: Variation by participants’ characteristics. BMC public health, 18(1), 1346. https://doi.org/10.1186/s12889-018-6252-5
  3. Ueshima, J., Momosaki, R., Shimizu, A., Motokawa, K., Sonoi, M., Shirai, Y., Uno, C., Kokura, Y., Shimizu, M., Nishiyama, A., Moriyama, D., Yamamoto, K., & Sakai, K. (2021). Nutritional assessment in adult patients with dysphagia: A scoping review. Nutrients, 13(3), 778. https://doi.org/10.3390/nu13030778
  4. World Health Organization. (n.d.). Fact sheets – malnutrition. https://www.who.int/news-room/fact-sheets/detail/malnutrition