Expert Advice for Moms That Are Juggling Breastfeeding and Work

WORDS MAS AMIRAH MOHMAD AZHAR & DR HASLINA ABDUL HAMID

FEATURED EXPERTS

MAS AMIRAH MOHMAD AZHAR
Student of Master’s in Clinical Nutrition
Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)
DR HASLINA ABDUL HAMID
Lecturer and Registered Dietitian Nutritionist
Centre for Community Health Studies (ReaCH)
Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)

Exclusive breastfeeding is recommended for infants from birth until at least 6 months of age.

This is defined as providing an infant with just breast milk—no other foods or liquids.

For the first six months of life, the World Health Organization (WHO) and other health organizations highly advise this practice, as it can contribute to many advantages for both mother and baby.

THE BENEFITS OF BREASTFEEDING

In addition to its balanced nutritional composition, breast milk contains important substances such as immunoglobulin A or Ig A, lactoferrin, cytokines, enzymes, growth factors and leucocytes. These substances provide the baby with protection against infections while also promoting intestinal adaptation and maturation.

Breast milk also contains numerous prebiotic substances such as human milk oligosaccharides (HMO), which support the growth of non-pathogenic probiotic microorganisms, primarily lactobacilli and bifidobacteria, while removing the potentially pathogenic bacteria. This high concentration of HMO is unique to humans, and studies have shown that breastfed infant has a more stable and constant population of oligosaccharides compared with infants fed with formula milk.

Furthermore, the composition of breast milk is unique, as the concentration of both energy and protein in expressed breast milk is highly variable throughout lactation stages, between mothers, and even from the same mother.

Breast milk feeding also has been linked to improved long-term neurocognitive development and cardiovascular health outcomes.

Additionally, numerous studies have demonstrated the effectiveness of breast milk in offering protection even to preterm infants in the Neonatal Intensive Care Unit (NICU).

THE JUGGLE BETWEEN BABY AND BRIEFCASE

For many working mothers, balancing work and breastfeeding can be challenging.

If you’re one of these mothers, you can choose to breastfeed exclusively or partially once you go back to work.

If you choose to exclusively breastfeed, you should express your milk while you’re on your work breaks. You can use this expressed milk to build up a supply for the feeding of your infant by a caregiver while you’re at work or for moments when you face a shortage of breast milk.

TIPS & ADVICE

The following may be useful for working mothers that still wish to breastfeed as well as to support needs of their infants.

Don’t stress yourself out!

While it’s always ideal to aim to complete your breastfeeding journey until 2 years, you and your health matters too.

Studies have shown that the benefits of breast milk on babies are dose-dependent, so the more and the longer you give, the better the beneficial effects are.

With that said, it also means that some breast milk is better than none.

Every drop matter, so while you are trying your best to pump your milk within your capacity, do not be discouraged by the amount. You might get to express more in some days and just a little in other days, and it’s totally fine.

Seek help whenever necessary.

Being a new mother is overwhelming with both love and new responsibilities, so it is very important for you to prioritise your mental and physical well-being.

Also, go for consistent health check-ups and give yourself ample time to rest.

Know your employment policies.

Nowadays, many companies provide reasonable breaks for breastfeeding employees to express breast milk. Certain companies even provide special rooms or areas for pumping the breastmilk, which comes with a refrigerator to store breast milk as well as a wash area. These venues are kept out of sight and away from public or coworker intrusion.

You can request for such an area at your workplace if such a space is not available.

The location to express your breast milk, the number of breaks available for you, and the length of each break likely differ from company to company. You should get a better understanding on your employer’s company’s policy when it comes to expressing breast milk at the workplace. This way, you can incorporate breast milk expression into your work schedule without negatively affecting your work performance or your ability to get enough rest.

You have the right to ask for permission, explain about your timetable routines to express milk, and enquire about any accommodations to improve your ability express milk more conveniently, so don’t hesitate to talk to your supervisor or human resource department.

You can do this early, such as before your delivery date, so that you can transition from your maternity leave to back to work more seamlessly.

Manage your expectations.

Know how much you need to pump, how many sessions you need to spare your time for, and how much breast milk your baby needs.

How much does your baby need? While it is quite difficult to estimate how much a baby receives from direct breastfeeding, Recommended Nutrient Intake for Malaysia 2017 states that:

  • Babies need around 500 to 600 kcal/day during their first year of life.
  • This amount increases to around 900 to 980 kcal/day at the age of 1 to 3 years.

The number of breastfeeding sessions is reduced as the baby ages, but the amount of milk needed by the baby is increased, from 6 to 8 sessions and 60 to 150 ml.

So, the number of pumping sessions and amount of milk needed to be expressed could be tailored to that.

The amount of milk consumed by your baby is usually reduced once you start them on complementary feeding, but they can still be breastfed on demand, with direct breastfeeding done at home.


Estimated daily milk requirements of babies from 0 to 6 months old. Click image for a larger, clearer version.


The recommended nutrient intake for infants from 0 to 3 years old. Click on the image for a larger, clearer version.


Invest in a good breast pump and breast milk storage.

There are many innovations and developments in the design of breast pumps and related accessories.

Hence, before purchasing a breast pump, take time to research by reading reviews or talking to your healthcare about the necessary equipment to meet your breastfeeding needs. You can also opt for trial or rental period to determine whether a breast pump is suitable for you.

Don’t just choose based on design and brand—you must also choose based on your needs also your budget. Local brands are usually more economical while still having comparable good quality to imported brands.

If you have a busy schedule, there are certain brands that offer quiet, wearable, or hands-free option which could accommodate your routine.

You will also need specialised storage bags made specifically to hold breast milk for safe transportation and storage.

  • Look for BPA-free bags that are strong enough to be kept in the freezer or refrigerator.
  • Consider bags with double zipper seal, the ability to stand alone for simple pouring, and a write-on section to record the time and date you expressed the milk.

Also, after each use of the breast pump, you should clean every area that came into contact with your breast milk or breast tissue. It is not always possible to use soap and water, particularly at work when you might not have access to a sink or have limited time. Cleansing wipes prevail for these instances!

Breastfeeding sanitizer spray is another useful consideration for quick or last-minute cleaning.

To make breast pump cleaning easier when you are on the go, make sure the supplies you buy fit compactly inside your pump bag.

Maintain proper hydration.

Have a bottle of water ready every time you pump your breast milk as well as every time you breastfeed your baby.

Water is essential, but it’s especially critical for working breastfeeding moms to stay focused and energised throughout the day.

Studies have shown that consuming more fluids than normal does not result in an increase in milk production. However, drinking too little water can lead to dehydration, which can harm your health and the quality of your breast milk.

Therefore, to ensure that your body is functioning at its best, it is crucial to consume enough fluids as to stay hydrated, which can range from 1.5 to 2.5 litres per day.

Some mothers rely on coffee to stay awake— which makes sense when your baby decided to play at 3 am! —so consuming low to moderate amounts (around 2 to 3 cups per day, or less than 300 mg of caffeine) is still considered acceptable.

Balanced meals are always key!

Recommended Nutrient Intake for Malaysia 2017 recommends that lactating mothers should consume about 2,400 kcal/day in the first 6 months of lactation, which is approximately 500 kcal more than normal adult women (1,800 to 1,900 kcal for a moderately active individual).

For mothers that want to lose some of their pregnancy weight, make sure to have adequate calories and protein according to your needs. Schedule an appointment with a dietitian if you need help to plan your meal.

Make sure to include plenty of fruits and vegetables in your meals as they are a great supply of important vitamins and minerals. Carbohydrates, especially from whole grains, is a great source of energy and fibre that can support the ability to feel full for longer.

Healthy snacking is encouraged in between meals. Go for fruit smoothies, toast, crackers, yogurt, and nuts.

TO SUM THINGS UP

Exclusive breastfeeding is one of the essential components of early childhood nutrition, but every breastfeeding mother’s circumstances are different. Therefore, it’s critical to identify a schedule and strategy that are most effective for you and your baby.

Furthermore, practice self-compassion while you manage this delicate balancing act, and don’t be afraid to seek for help and advice from your loved ones, coworkers, family members, and friends.

An Expert Spills the Bean on Lactose Intolerance & Your Kids

WORDS LIM TECK CHOON

FEATURED EXPERT
DR ONG SIK YONG
Consultant Paediatric Gastroenterologist and Hepatologist
Sunway Medical Centre

According to Dr Ong Sik Yong, lactose intolerance is a common gastrointestinal condition caused by the inability to digest and absorb dietary lactose.


Lactose intolerance is the result of your small intestine not producing enough of an enzyme called lactase. Lactase helps to break down lactose or milk sugars into simple sugars for absorption by your body.


BLAME IT ON DECLINING LEVELS OF LACTASE

Dr Ong shares that newborns can digest about 1 litre of breast milk every day.

However, the enzyme lactase, which digests lactose, usually declines in levels once the child stops breastfeeding, a circumstance known as lactase non-persistence.

“Approximately 70% of the world population are affected by lactase non-persistence, which causes the condition called primary lactose intolerance,” Dr Ong reveals.

He adds that generally a child shows symptoms of primary lactose intolerance after they turn 5. However, some children may exhibit symptoms as early as 2 years old.

CAN ALSO BE DUE TO OTHER GUT ISSUES

In young children, lactose intolerance may also be caused by underlying gut issues such as:

  • Gut infection.
  • Cow’s milk allergy.
  • Celiac disease.
  • Inflammatory bowel disease.

Dr Ong further shares that sometimes a child may temporarily lose the ability to digest lactose during an episode of acute gastroenteritis. Once the child recovers, however, they can continue to consume milk without further issues.

SYMPTOMS OF LACTOSE INTOLERANCE

“Usually, symptoms begin about 30 minutes to two hours after consumption,” says Dr Ong.

He adds that the common symptoms are:

  • Abdominal discomfort.
  • Bloating.
  • Farting.
  • Diarrhoea.
  • Perianal skin irritations with raw lesions surrounding the anus, due to low faecal pH in the child’s stools.
MANAGING THE DIET OF A LACTOSE INTOLERANT CHILD

Dr Ong advises parents to feed dairy products with naturally lower lactose content to children that show signs of lactose intolerance.

“After a period of limiting food with lactose, the child can consume back small amounts of foods and drinks containing lactose,” he adds.

The child’s symptoms should be observed throughout this trial period and over time, the parents or even the child would be able to tell how much of lactose the child can take.

“Besides that, parents can also consider using lactase enzyme, which can be taken by the child prior to consumption of dairy products to reduce unwanted consequences from consuming lactose,” advises Dr Ong.

NUTRITIONAL CONSIDERATION FOR THE LACTOSE-INTOLERANT CHILD

Milk and other various dairy products are a major source of calcium and vitamin D.

“Hence, it is important to make sure children who has limited dairy product intake to have other non-dairy food which are rich in these nutrients, like fish with soft edible bones, such as salmon and sardines, as well as green leafy vegetables. They may also require calcium or vitamin D supplement for their growing bones,” Dr Ong says.

A Physician Explains How You Can Have a Safe and Happy Vacation with the Kids

WORDS LIM TECK CHOON

FEATURED EXPERT
DR NUR ELAYNI BORHAN
Consultant Emergency Physician
Sunway Medical Centre
BEFORE YOU LEAVE THE HOUSE

Make sure that you have at hand essentials such as the following:

  • Paracetamol for fever or pain
  • Oral rehydration solution for dehydration due to diarrhoea
  • Cough and cold medications
  • Inhalers if your children have asthma
  • Antiseptic wipes
  • Band-aids, adhesive tapes, and gauze for wound care
  • Thermometer
  • Your child’s existing medications, if any

“I would also advise to bring some topical medication such as antiseptic cream, mentholated or medicated topical ointment – anything you’re used to, from home,” Dr Nur Elayni Borhan adds. “You know your own children, so bring the things that you know would benefit them. Try to avoid bringing things that are new to them.”

WATCH WHAT YOUR KIDS ARE EATING!

Diarrhoea and vomiting are among the most common illnesses that affect children while they are on holiday.

Dr Elayni advises parents to ensure that their children are taught to follow safe food and water precautions.

Her other tips are:

  • Frequently wash hands to prevent foodborne and waterborne illnesses.
  • If you are breastfeeding your child, continue to breastfeed during the vacation.
  • Make sure that vaccinations for the whole family are up to date, as there is generally a higher risk for most vaccine-preventable diseases when travelling.

If your child—or any other family member—develops diarrhoea, Dr Elayni recommends consuming plenty of fluids.

Oral rehydration solution may be used to prevent dehydration, especially if the child is also vomiting,” she further adds. “If your child appears to be dehydrated and/or has a fever or bloody stools, seek medical attention immediately.”

IF YOUR CHILD HAS AN ALLERGY

Dr Elayni says, “Planning ahead is the key to making your trip safe and enjoyable.”

  • Always stay alert, take every necessary precaution, and carry all essential medications.
  • Bring a medical kit with your child’s medications, including their epinephrine pen. Do this no matter how near or short the trip is.
  • Not everyone can understand English or Bahasa Melayu, so get information about your child’s allergy translated to the native language of your destination. Written information about your child’s allergies, for example, can be very useful when ordering food for your child.
  • Take note of the allergy policies of the airline and at the hotels you will be staying at. Every airline or hotel is different, and they need advance notice to make accommodations.
  • Research restaurants or grocery stores at your destination that would carry products safe for your child.
OTHER USEFUL TIPS
If your child suffers from motion sickness:
  • Keep them hydrated.
  • Let them eat and drink in small amounts regularly instead of having heavy meals.
  • Avoid letting them read or us screen devices while traveling in a vehicle. Instead, encourage them to sleep or engage in conversations with other family members.
If your child experiences uncomfortable pressure in the ear:
  • Encourage them to swallow their saliva. Younger children can breastfeed or suck on a thumb while older children can suck on lozenges or chew gum to equalize the pressure,

General tips for a fun and safe vacation:

  • Bring along your child’s comfort toy or blankie.
  • If your child has an existing chronic condition, consult a doctor before traveling to destinations with different climates and altitudes. You may need to take special precautions, such as dressing your child appropriately for colder destinations and apply sunscreen at hotter destinations.
  • Discourage your children from swimming in non-chlorinated bodies of water (rivers, ponds, lakes, etc), as there is a risk of your child swallowing contaminated water.
  • Pack safe snacks and meals in case there are no appropriate restaurants for your child.
  • Identify important healthcare facilities at your destination. You can also seek advice on available local medical services from hotels or tour company representatives.
  • Include your child in any travel insurance policies bought for the trip, which should include medical repatriation if necessary.

15 Facts & Tips That Moms & Dads Should Know When It Comes to Dengue & Their Kids

WORDS LIM TECK CHOON

FEATURED EXPERT
DR YONG JUNINA FADZIL
Consultant Paediatrician and Paediatric Cardiologist
Klinik Pakar Kanak-Kanak Junina
FOR PARENTS WITH BABIES BELOW 6 MONTHS OF AGE
  1. According to Dr Yong Junina, young babies with dengue may not show specific symptoms—they may not even exhibit fever.
  2. Furthermore, fever is also a symptom of many other childhood illnesses. Thus, even when a child has fever, it can be challenging for a doctor to identify the exact cause of the fever.
  3. Also, a child’s condition may worsen quickly if left untreated.
  4. Hence, Dr Yong Junina advises parents with a child of under 6 months of age to promptly seek medical attention when their child appears unwell.
FOR PARENTS OF SLIGHTLY OLDER CHILDREN
  1. “Older children may still experience difficulties in communicating their conditions to their parents,” Dr Yong Junina shares.
  2. Generally, unwell children tend to consume less fluids, and severe dengue can cause fluid leakage from blood vessels, resulting in reduced urine output. Dehydration, regardless of the cause, can be perilous, especially in young children.
  3. Hence, bring the child to see a doctor promptly when they show such signs of being unwell.
SOME POSSIBLE SIGNS THAT A CHILD MAY HAVE DENGUE
  • Lethargy.
  • Body ache.
  • Pain behind the eyes.
  • Headaches.
  • Parents can check whether their child’s hands and feet feel cold. They can also press on the child’s fingertips to observe how quickly the fingertips regain their normal colour.
HOW DENGUE AMONG YOUNG CHILDREN IS TREATED
  1. Dr Yong Junina tells us that young children are more likely to develop severe dengue and related complications, such as dengue shock syndrome.
  2. Dengue shock syndrome is the result of dengue-causing viruses triggering a chain of reactions that cause one’s blood vessels to leak. Eventually, the person experiences sudden drop in blood pressure, internal bleeding, and even organ failure. This is a serious medical emergency that can lead to death if not treated quickly!
  3. Dr Yong points out that children with severe dengue will need to be admitted into the hospital. There, they will undergo repeated blood tests and possibly be put on drip.
  4. “Throughout all this, parents would need to stay with them, affecting their work and ability to care for the rest of the family,” she says. “Among daily wage earners, the loss of income would be significant.”
PROTECTING YOUR CHILD FROM DENGUE
  1. “There is no preventive method that is 100% effective,” says Dr Yong Junina. Hence, it is important for parents to practice vigilance.
  2. Keep the house free of potential mosquito breeding grounds by ensuring there is no stagnant water.
    • Aedes mosquitoes, the ones responsible for infecting us with dengue, breed in clean water, so make sure pails are covered and use larvicide in any places that water may collect in.
    • Remember to check aquariums and containers of aquatic pets (such as terrapins), receptacles for catching residual water from plants and dishracks, and containers of water-based plants such as money plants and hydroponics.
  3. Keep windows closed at dawn and dusk, as these moments are when the Aedes mosquitoes are more active, and sleep with long-sleeved clothing.
  4. Use mosquito repellents. There is a wide range of products available, including chemical-free products infused with lemongrass.

Are You Aware of Your Child’s Handwashing Habits? Here’s Why You Should Be

WORDS LIM TECK CHOON

FEATURED EXPERT
PROFESSOR EMERITA DR ELIZABETH SCOTT
Chair of the Global Hygiene Council
FIRST, THE BIG CONCERN
  • Infectious diseases are the leading cause of death all over the world.
  • Every year, there are about 525,000 children under 5 that perish from diarrhoea-related diseases.
  • A single emerging infectious disease can cost the global economy anything from USD30–50 billion.
  • There is also the rise of drug-resistant infections to worry about.
WHAT DO OUR CHILDREN HAVE TO DO WITH THIS?

Professor Dr Elizabeth Scott reveals that about 1.8 million children under the age of 5 die each year from diarrhea-related diseases and pneumonia.

However, it does not have to be this way. Professor Dr Scott shares that:

  • Simple handwashing could protect 1 in 3 children from diarrhoea.
  • Likewise, handwashing can shield 1 in 5 children from pneumonia.

Access to handwashing essentials such as soap and water, and hand washing education in schools not only fosters good hygiene habits but can help to improve attendance,” she goes on to explain.

She adds: “Furthermore, early hygiene habits potentially enhance child development in some settings.”

Are you washing your hands correctly? Click for a larger, clearer image.
OUR KIDS AREN’T WASHING THEIR HANDS ENOUGH OR CORRECTLY, THOUGH!

Results of the Global Hygiene Council’s survey on nearly 5,000 parents, primary school teachers
and children aged between 5 and 10 found that:

  • 40% of primary school children are not always using soap when washing their
    hands at school.
  • 27% of primary school children did not learn how to wash their hands at school.
  • Only 37% of parents and teachers know that hands can still contain germs when they are visibly clean.
  • 47% of primary school children believe that if their hands are visibly clean, they will not get sick.
  • 65% of primary school children say they have seen people in their school not wash their hands after going to the toilet.
  • 50% of parents and teachers believe that children’s handwashing habits have little effect on whether they get ill.
OH DEAR, IS THERE ANYTHING THAT CAN BE DONE ABOUT THIS?

The Global Hygiene Council offers the following recommendations, which they call the ‘four pillars of change’:

Pillar 1: Build on lessons learned from the COVID-19 pandemic.

Link lessons learned from the implementation of hygiene practices in previous pandemics (such as handwashing, mask wearing, and surface disinfection) to provide policy guidance for future public health campaigns and infection, prevention and control policies.

Pillar 2: Mainstream AMR-sensitive infection prevention and control tools.

Direct more focus on infection prevention and investment in new antimicrobials, vaccinations, and antimicrobial stewardship. National action plans on antimicrobial resistance should be adapted to include hygiene and Water, Sanitation, and Hygiene (WASH) recommendations for home and community settings.

Pillar 3: Quantify the economic benefits of hygiene.

Consider hygiene education and access to appropriate hygiene facilities as a critical and cost-effective solution for facilitating hygiene behaviour change and protecting against the spread of infectious diseases in schools, at workplaces, and throughout communities.

Pillar 4: Establish strong hygiene habits.

Make public communications campaigns easy to understand and built on evidence-based approaches. Highlight the personal impact that changing hygiene behaviour has on the health of families and communities with respect to reducing the risk of infection.

PROTECTING FUTURE GENERATIONS AGAINST PANDEMICS

To protect against future pandemics, including the threat of antimicrobial resistance, there is a need for greater public awareness of the role of targeted hygiene practices in preventing infections within home and community settings.

Future public health campaigns and infection prevention and control policies should include clear and practical information on evidence-based practices, as well as ensuring adequate access to clean water and hygiene resources to help prevent the spread of infections, including those that are drug resistant.


References:

  1. World Health Organization. (2021, March 10). Diarrhoea. https://www.who.int/health-topics/diarrhoea
  2. McArthur D. B. (2019). Emerging infectious diseases. The nursing clinics of North America, 54(2), 297–311. https://doi.org/10.1016/j.cnur.2019.02.006
  3. Liu, L., Johnson, H. L., Cousens, S., Perin, J., Scott, S., Lawn, J. E., Rudan, I., Campbell, H., Cibulskis, R., Li, M., Mathers, C., Black, R. E., & Child Health Epidemiology Reference Group of WHO and UNICEF (2012). Global, regional, and national causes of child mortality: An updated systematic analysis for 2010 with time trends since 2000. Lancet (London, England), 379(9832), 2151–2161. https://doi.org/10.1016/S0140-6736(12)60560-1
  4. Ejemot, R. I., Ehiri, J. E., Meremikwu, M. M., & Critchley, J. A. (2008). Hand washing for preventing diarrhoea. The Cochrane database of systematic reviews, (1), CD004265. https://doi.org/10.1002/14651858.CD004265.pub2
  5. Aiello, A. E., Coulborn, R. M., Perez, V., & Larson, E. L. (2008). Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis. American journal of public health, 98(8), 1372–1381. https://doi.org/10.2105/AJPH.2007.124610

What Parents Should Know About Heart Conditions in Newborns & Children

WORDS LIM TECK CHOON

FEATURED EXPERT
DR ANG HAK LEE
Consultant Paediatric Cardiologist
Sunway Medical Centre
CONGENITAL HEART DISEASE IS THE MOST FREQUENTLY DIAGNOSED CONGENITAL DISORDER

Congenital disorder is an abnormal condition that is present at birth.

When a child is born with heart disease, therefore, they are said to have congenital heart disease or CHD.

Dr Ang Hak Lee explains to us: “The symptoms of this condition are often silent, but the risk increases significantly when there’s a family history of congenital heart disease.”

He shares that the risk triples if the mother has the condition; if the father has it, the risk doubles.

EARLY DETECTION OF CONGENITAL HEART DISEASE IS CRUCIAL

Dr Ang shares that, should congenital heart disease is not detected soon after birth, the child may not survive the first few years of life.

“One of the significant challenges the healthcare community faces are that symptoms in infants are usually subtle, making it easy to miss,” he says.

POSSIBLE SIGNS OF CONGENITAL HEART DISEASE
  • Feeding difficulties.
  • Poor growth.
  • Low birth weight.
  • Bluish discolouration of the skin and lips.
  • Nail clubbing, which is a deformity of the finger and toe nails—frequently, the nails curve down to look like an upside-down spoon.
  • The baby or child tires easily.

Parents often attribute symptoms of congenital heart disease to those of common illnesses, which can lead to delays in the child getting a proper diagnosis.

Further complicating matters is that not every child with congenital heart disease will show symptoms at birth. Some children only develop symptoms later in their childhood or even during adolescence.

FORTUNATELY, DETECTION METHODS HAVE BECOME MORE ADVANCED & MORE ACCURATE

“One of the major components for early detection a simple bedside test called pulse oximetry,” says Dr Ang.

A pulse oximeter measures blood oxygen levels and pulse. A low level of oxygen saturation could be a sign that you may have certain health conditions.

This test is painless and takes only a few minutes, as a device called pulse oximeter is used to gently clip onto a child’s toe or finger to measure the child’s blood oxygen levels.

“A low oxygen reading can be a sign of critical congenital heart disease,” Dr Ang elaborates.

He adds, “While this method doesn’t replace a complete history and physical examination, it can detect critical heart defects before oxygen levels become too low, especially for newborns with other major congenital disabilities.”

Other non-invasive imaging methods, such as echocardiograms, and advanced screening tools have allowed paediatricians to detect even subtle heart abnormalities. “Amazingly, echocardiography can be used to detect CHD while the baby is still in the mother’s womb!” Dr Ang points out.

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