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.
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
According to Dr Yong Junina, young babies with dengue may not show specific symptoms—they may not even exhibit fever.
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.
Also, a child’s condition may worsen quickly if left untreated.
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
“Older children may still experience difficulties in communicating their conditions to their parents,” Dr Yong Junina shares.
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.
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
Dr Yong Junina tells us that young children are more likely to develop severe dengue and related complications, such as dengue shock syndrome.
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!
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.
“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
“There is no preventive method that is 100% effective,” says Dr Yong Junina. Hence, it is important for parents to practice vigilance.
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.
Keep windows closed at dawn and dusk, as these moments are when the Aedes mosquitoes are more active, and sleep with long-sleeved clothing.
Use mosquito repellents. There is a wide range of products available, including chemical-free products infused with lemongrass.
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.
Parent Nur Suhana sharing her personal experience caring for her child Shafiq Rizqi who was born premature, and her experience in dealing with the RSV infection.
Parent Nursyahirah shared the challenges in caring for her child Wan Nur Afeeya who was born prematurely at 25 weeks.
Wan Nur Afeeya who was born prematurely at 25 weeks, was infected with RSV this year.
Norazleena Yaha, founder of Pertubuhan Kumpulan Sokongan Ibu Bapa Dan Bayi Pramatang Malaysia (BPM) spoke about how the organisation help parents access the available financial support to purchase the vaccines.
Associate Professor Dr. Adli Ali, Head of Immunology and Rheumatology Services, UKM Children's Specialist Hospital
Associate Professor Dr Choo Yao Mun, Consultant Neonatologist and Paediatrician, University of Malaya Medical Centre
Azrul Abdul Khalib, Founder and Chief Executive Officer of the Galen Centre for Health and Social Policy
On 15 June 2023, the IMFeD for Growth programme inaugurated June as Growth Watch Month.
Growth Watch Month was jointly launched by the Malaysian Paediatric Association (MPA)—which also helmed the IMFeD for Growth programme—in partnership with the Malaysian Medical Association, the Malaysian Family Medicine Specialists’ Association, the Malaysian Association of Kindergartens, and the Malaysian Association of Registered Early Child Care and Development.
FEATURED EXPERT PROFESSOR DR LEE WAY SEAH
Senior Consultant Paediatric Gastroenterologist and Hepatologist
Chairman of IMFeD for Growth Programme
WHAT THE GROWTH WATCH MONTH MEANS TO PARENTS
According to Professor Dr Lee Way Seah, Chairman of the IMFeD for Growth programme:
Growth Watch Month is largely dedicated to identifying children and adolescents that are either stunted or at risk of stunting.
The IMFeD for Growth programme organizers will organize avenues and activities that will provide advice to parents of these children and adolescents, so that they can avail themselves to appropriate nutritional interventions and support that can get their children’s growth back on track.
Professor Lee stresses that optimal growth can only be achieved when certain fundamentals are present, namely:
Good feeding practices
Optimal nutrition
Adequate physical activity that are appropriate for age
Regular growth monitoring from young
Thus, he encourages parents of children between 1 and 17 years old to bring their children to an appropriate healthcare professional for growth check.
IS STUNTED GROWTH REALLY THAT A BIG DEAL?
The statistics from the 2022 National Health and Morbidity Survey indicates that there is a cause for concern.
21.2% or 1 out of 5 children have stunted growth by the age of 5.
6.8% of adolescents have stunted growth, falling behind 15 to 20% from their potential adult height.
Additionally, IMFeD for Growth reveals the key results of its screening campaigns from 2018 to 2021, which suggests that a considerable number of children between 1 to 5 years old are at risk of stunting or have stunted growth.
Click for a larger, clearer version. Image courtesy of IMFeD for Growth.
Professor Lee says that this stunting problem needs to be addressed before the number of children at risk of or are affected by stunted growth increases.
FEATURED EXPERT DR SELVA KUMAR SIVAPUNNIAM
Consultant Paediatric Nephrologist
President of the Malaysian Paediatric Association (MPA)
WHAT PARENTS CAN LOOK FORWARD TO IN GROWTH WATCH MONTH
Dr Selva Kumar Sivapunniam, the President of the Malaysian Paediatric Association (MPA) shares that the IMFeD for Growth programme will work with all relevant stakeholders to conduct educational activities geared at parents and their children.
Parents as well as other caregivers can look forward to media write-ups and interviews.
Parents Forums (June 25 onward)
From June 25 onward, IMFeD for Growth will host a series of Parents Forums, to be broadcast live over Zoom (click on the link to register), the MPA Facebook page, and their YouTube channel. All links open in new tabs.
Topics covered are:
Feeding, Nutrition and Growth for Tiny Tots (June 25)
Helping Children Shine in School
Nurturing Growth Through the Teenage Years
Parenting Tips for Healthy Children
Annual Screening Campaign (August to November 2023)
Dr Selva shares that the IMFeD For Growth Annual Screening Campaign happening from August to November 2023 in all IMFeD clinics.
Interested parents can click here to view the list of participating clinics in Malaysia (link opens in a new tab).
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.
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.
FEATURED EXPERT PROFESSOR DR MUHAMMAD YAZID JALALUDIN
Senior Consultant Paediatrician and Paediatric Endocrinologist
UM Specialist Centre
Most babies seem small when they first come into the world, but for some, they truly are smaller when compared to their fellow babies-in-arms.
This condition is known medically as small for gestational age (SGA for short).
Gestational age, by the way, is the length of time a baby spends growing in their mother’s womb.
Small for gestational age babies that weigh below 2,500 g at birth are additionally considered to have low birth weight.
SMALL FOR GESTATIONAL AGE CAN BE MEASURED AND DETECTED AFTER A BABY IS BORN
After a mother has given birth in a hospital or clinic, nurses will clean the newborn and giving them a quick check for any abnormalities. The nurses will also measure the length and head circumference of the baby as well as weigh.
These measurements inform healthcare professionals whether or not a baby is small for their gestational age.
POSSIBLE CAUSES OF SMALL FOR GESTATIONAL AGE
Pregnant women should go for their antenatal check-ups to monitor for and manage any problems that might result in a small for gestational age baby
The mother’s health during pregnancy
Presence of infections or medical conditions such as heart disease, uncontrolled diabetes, thyroid disease, or high blood pressure
Drinking alcohol or smoking
Poor nutrition during pregnancy
The mother’s age
The risk of having a small for gestational age baby is significantly higher for women aged 30 and above that have never given birth before, as well as all women aged 40 and above, compared to women in their 20s.
The mother’s height
Women that are short are at risk because their smaller wombs and shorter birth canals influence the growth of their foetus.
Family history
Interestingly, research has shown that the risk of having a small for gestational age baby can be influenced as far back as two generations.
If the pregnant woman and/or her own mother were small for gestational age babies, the foetus has a higher chance of being born small for gestational age.
Issues with the placenta during pregnancy
Placental insufficiency, which happens when the blood vessels in the uterus that are supposed to transform into the blood vessels of the placenta do not change as they should, can lead to placental infarction
Placental infarction sees the disruption of the blood supply to the placenta, resulting in the death of placental cells, placental abruption (the placenta partially or completely separates from the uterus before childbirth), and structural abnormalities of the placenta
All these conditions cause the foetus to receive insufficient nutrients and oxygen from their mother, thus affecting their growth
Chromosomal or genetic abnormalities
These abnormalities include those that give rise to Down syndrome and congenital abnormalities such as structural defects of the heart, kidneys, lungs, or intestines.
Other possible causes
Catching an infection while in the womb or being part of a multiple pregnancy (twins, triplets, etc) can also negatively affect a foetus’s growth.
SMALL FOR GESTATIONAL AGE COMPLICATIONS AFTER DELIVERY
As they have only small amounts of fat or energy stored away, they may have a low body temperature at birth. This can result in hypothermia, where the body loses heat faster than it can produce it. If this condition is prolonged, the baby can die as their heart and brain cannot function well at these sub-optimal temperatures.
The lack of fat and glycogen stored in a small for gestational age baby’s liver can cause hypoglycaemia, where they have low blood sugar levels that are unable to match their body’s needs. This can cause the baby to have seizures and/or brain damage. If the hypoglycaemia is prolonged, the baby may die or develop long-term neurodevelopmental deficits, including cerebral palsy.
As they are deprived of sufficient nutrients in the womb, small for gestational age babies become ‘programmed’ to hoard whatever nutrients and calories they receive. This means that after birth, they can very easily put on weight if their caloric intake is not carefully monitored. Thus, these babies are prone to obesity and its associated conditions (diabetes, high blood pressure, high cholesterol, osteoarthritis, heart disease, etc). This “programming” lasts throughout their lifetime.
Their growth rate can influence when they achieve puberty. Small for gestational age babies that catch up in their growth very quickly might experience early puberty. On the other hand, if they are slow in growing, their puberty might be delayed.
Persistent short stature.
SMALL FOR GESTATIONAL AGE, FORTUNATELY, CAN BE MANAGED
Generally speaking, small for gestational age babies should be able to catch up in their growth within the first six months to two years of their life with good nutrition.
In fact, 85% of these babies achieve normal height and weight for their age and gender by two years of age.
Some children require a longer time and there is still some leeway until the age of five to allow them to catch up in growth to their peers.
However, by five years of age, 8-10% of small for gestational age babies would still be smaller than normal, and this is the time that parents and doctors need to start discussing treatments for the child.
Growth hormone therapy
The main treatment for small for gestational age babies that do not manage to catch up in growth by the time they are four to five years old
Will enable them to achieve their optimal final height as adults, through improving muscle and bone growth
Helps increase the breakdown of fats, to address the tendency of small for gestational age babies to accumulate fat and become obese
Good nutrition
Nutrition plays a critical role in the first two years of life in promoting a child’s growth
Their diet must be carefully monitored as they are prone to becoming overweight; on the other hand, when they are not fed enough, they might become stunted
Parents need to do a careful balancing act when it comes to feeding their small for gestational age baby
Regular physical activity
As the child grows, parents also need to encourage and allow their child to be active
Doing so will prevent excessive weight gain and help stimulate the natural production of serotonin and growth hormone to help the child grow
Such physical activity must be vigorous enough that the child’s heartbeat increases and they sweat.
Proper sleep
It is critical that children are asleep at the latest by 9 pm, as the peak time for the body to produce its natural growth hormones is between 10 pm to 12 am.
Sleeping later, as many Malaysian children tend to do, will cause them to miss this critical period of growth hormone secretion.
FEATURED EXPERT DR CHOO KOK KUAN
Consultant Paediatrician and Paediatric Cardiologist
Subang Jaya Medical Centre
The most common heart disease among children is known as congenital heart defects.
This condition occurs when the heart or the blood vessels near the heart do not develop normally before birth.
HOW COMMON IS THIS CONDITION?
According to our Ministry of Health, the incidence of congenital heart defects among children is about 8 to 10 per 1,000 live births.
With an average of 500,000 deliveries in Malaysia each year, the number of children born with congenital heart defects is about 5,000 a year, of which two-thirds will require surgical intervention.
THE CAUSES & RISK FACTORS
Most congenital heart defects have no known cause.
They may sometimes run in families.
Some congenital heart defects may be associated with genetic disorders, such as Down syndrome, Turner syndrome, Williams syndrome, etc.
Some children have a higher risk of developing congenital heart defects if the mother has diabetes or rubella, or has taken certain medications such as anti-epileptic drugs, during pregnancy.
DETECTION OF CONGENITAL HEART DEFECTS
Sometimes a heart defect can be diagnosed before a baby is born.
However, defects are usually identified days or even months after birth, when symptoms become obvious.
Less serious congenital heart defects may not show any noticeable signs or symptoms, so they may only be diagnosed later in childhood.
It is also possible to have a heart defect and show no symptoms at all.
POSSIBLE SIGNS THAT A BABY OR YOUNG CHILD MAY HAVE CONGENITAL HEART DEFECTS
Rapid breathing
Bluish discolouration commonly noticed around the lips, fingernails, palms of the hands, and soles of the feet
Shortness of breath during feeding, leading to poor weight gain
Poor growth
Recurrent lung infection
WILL A CHILD WITH CONGENITAL HEART DEFECTS BE OKAY?
As a result of medical advancements, the outlook for congenital heart diseases is increasingly positive.
Most children with this condition reach their adulthood.
In fact, children with simple conditions may lead completely normal lives, while those with more complex conditions usually face more challenges that can nevertheless be addressed with the right measures in place.
6 THINGS THAT EVERY PARENT OF CHILDREN WITH CONGENITAL HEART DEFECTS SHOULD KNOW AND DO
Heart medications can be very strong and dangerous if not given correctly. Parents must understand how much medicine to give and how to give it. If the child takes a blood thinner, parents must have clear instructions on how to give this medicine safely.
Ensure the child eats well and receives adequate nutrition. They often tire when eating, so they eat less and may not get enough calories.
Prevention of infections is crucial. Although an infection in the heart (endocarditis) is uncommon, children with heart defects have a greater risk of developing this. Good dental hygiene goes a long way toward preventing endocarditis by reducing the risk of tooth or gum infection. Parents can get more information from cardiologist about the latest guidelines on antimicrobial prophylaxis against infective endocarditis. These children must also get all the recommended vaccinations.
Most children with a congenital heart defect can be physically active without restrictions. In fact, children are encouraged to be physically active to keep their hearts fit and to avoid obesity, unless they have a few specific heart conditions.
Emotional support will help children who may have self-esteem issues because of how they look. They may have scars from surgery, and they may be smaller, or have limits on how active they can be.
As children transition to adulthood, parents can gradually teach them about their heart defect and guide them in how to care for their own health without being overly protective.
FEATURED EXPERT DR LEE ONN LOY
Paediatrician
Mahkota Medical Centre
WHAT IS RESPIRATORY SYNCYTIAL VIRUS?
Respiratory syncytial virus (RSV for short) is a common respiratory virus that usually causes mild flu-like symptoms, except in infants and elderly people.
There are two sub types of RSV, RSV-A and RSV-B, which co-circulate during the same season with alternating predominance.
However, we do not test for sub types in Malaysia, mainly because we do not have seasonal weather and there is no difference in disease severity between the two sub types.
WHO ARE MOST AT RISK WHEN IT COMES TO GETTING INFECTED?
Children are more prone to be infected due to their immature immune systems and first exposure to the virus.
They are often exposed to and infected with RSV outside the home such as in daycare centres or school.
WHO ARE MOST AT RISK OF DEVELOPING SEVERE COMPLICATIONS?
People who are at higher risk of severe RSV disease are:
Prematurely born infants
Children with congenital heart disease or chronic lung disease such asasthma
Children with compromised or weakened immune systems either due to medical conditions or medical treatments
Adults with compromised immune systems
Elderly people with existing health problems or co-morbidities
HOW DO I KNOW IF I MAY HAVE CAUGHT RSV?
Symptoms of RSV are just like those of normal flu, such as:
Fever
Cough
Decreased appetite
Lethargy
Wheezing and difficulty in breathing
Consult a doctor if you or a family member show these symptoms.
HOW IS RSV TREATED?
There is no ‘one size fits all’ treatment for RSV.
We usually treat it with paracetamol and antihistamines.
If a child catches the virus, the doctor will monitor the child to ensure that they are eating and drinking well.
When there is no improvements seen, and when one becomes lethargic and develops wheezing and breathlessness, they should be admitted for fluid infusion, regular nebuliser therapy, and oxygen when necessary.
WHAT CAN PARENTS DO TO PROTECT THEIR CHILDREN FROM RSV?
Firstly, we should know how RSV can spread. Common ways of transmission are:
When an infected person coughs or sneezes, and the virus droplets find their way into your eyes, nose, or mouth
When you touch a surface that has the virus on it like doorknobs, and then touch your face before washing your hands
When you have direct contact with an infected person, such as kissing the face of a child with RSV
There are a few things parents can do to protect their children against RSV such as:
Keeping them away from close contact with sick people
Teach them and encourage them to wash their hands often with soap and water for at least 20 seconds
Teach them to avoid touching their face with unwashed hands
Don’t send your unwell kid to school or centres, and limit the time children spend in child care centres during outbreaks if possible
CAN ONE DEVELOP RSV, FLU, AND COVID-19 ALL AT THE SAME TIME?
Yes, but this is not common. Should it happen, though, the complications are going to be very severe with a high risk of death!
Hence, people should go for influenza vaccinations yearly, especially during the COVID-19 pandemic.
The survey is now closed. All parties involved would like to express their gratitude to everyone that participated in the study.
FEATURED EXPERT ASSOCIATE PROFESSOR DR ERWIN J KHOO
Consultant Paediatrician & Head of Paediatrics Department
International Medical University (IMU)
IT CAN BE CHALLENGING FOR A PARENT TO DETERMINE FACTS FROM FICTION WHEN IT COMES TO NEWS ON SOCIAL MEDIA
Netizens who are vaccine hesitant have an alarming footprint on social media. In a vicious cycle, their hesitance is likely to be fueled by health (mis)information obtained from a variety of sources, including news media such as the Internet and social media platforms.
As access to technology has improved, social media has attained global penetration. In contrast to traditional media, social media allow individuals to rapidly create and share content globally without editorial oversight. Users may self-select content streams, contributing to ideological isolation. As such, there are considerable public health concerns.
These worries may be magnified in the face of the ongoing COVID-19 pandemic. As the development and subsequent deployment of more vaccines are expected to play a critical role in downstream emerging pandemic control efforts, social media will remain a powerful tool. Most concerning is how (mis)information and (un)substantiated reports on its platforms will threaten to erode public confidence even well before the release of any scientific evidence.
It is not readily evident why social media is so disproportionately successful in promoting vaccine hesitancy as opposed to uptake. Social media users may represent a skewed population sample with baseline misperceptions regarding the benefits and side effects of vaccination whilst simultaneously lacking familiarity with the consequences of vaccine-preventable disease. Moreover, when evaluating the risks and benefits of vaccination in general, the risks may be overestimated and may seem more immediate, and tangible as compared to the more abstract potential benefits of disease prevention.
IF YOU ARE A PARENT WITH A CHILD UNDER 18, PLEASE SPEND 15 MINUTES TO HELP US BETTER UNDERSTAND THE SITUATION
SOcial MEdia on HesitAncy in Vaccine E-survey or in short, SOMEHAVE, is a multinational collaborative study between International Medical University (IMU), the Singapore’s National University Health System (NUHS), National University of Malaysia (UKM) and Universiti Malaya (UM)
The study uses unidentified e-survey for parents with the aim of seeking the impact of social media on vaccine hesitancy.
For the English survey form, please click here (link opens in a new tab).
For the Bahasa Malaysia version, please click here (link also opens in a new tab).
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