Type 2 diabetes (T2D) was once categorised as a disease that generally attacks those in the older age group. But now, an increasing number of children are suffering from T2D, some of them even as young as 7 years!

What is type 2 diabetes (T2D)?

Diabetes is a chronic disease in which the body is unable to produce, or properly use insulin, a hormone that converts sugar and starches in food into glucose, the body’s main energy source. There are two types of diabetes: type 1 and type 2.

Type 1 diabetes is also known as insulin-dependent diabetes, and occurs when the pancreas produces very little, or no insulin at all. This happens as a result of the body’s defense system attacking the insulin-producing beta cells of the pancreas.

Until recently, type 1 diabetes was the only kind of diabetes found in children.

Type 2 diabetes is a much more common form of the disease, and mostly affects adults after the age of 30. However, T2D has become much more widespread among young children, especially those in developed and developing countries. This form of diabetes occurs when the pancreas does not produce enough insulin to overcome the body’s resistance to insulin.

Some kids/teenagers may develop thick, dark skin around the neck, armpits, groin, between fingers and toes, or on elbows and knees. This is a skin condition known as acanthosis nigricans.

T2D is on the rise

Both genetics and the environment have been found to play major roles in a person developing diabetes. Studies have shown that 75% of children who suffer from T2D have a parent or sibling who suffers from it as well. Yet, there are other factors that put children and adults at a higher risk of developing this chronic disease.

Recent research has shown that more and more young children are overweight and obese. Children nowadays spend too many hours watching television and playing computer games instead of going to the park and enjoying a good old game of football.

Furthermore, children also have a preference towards unhealthy foods such as burgers, nuggets, fries and carbonated drinks. Insufficient physical activity and unhealthy eating habits are all risk factors for diabetes.

In fact, being overweight or obese is one of the major risk factors for T2D, especially when most of the fat is accumulated around the abdominal area!

Alarming statistics

According to a survey done in 2007, Malaysia had the fourth highest number of diabetes cases in Asia, with a figure of 800,000!

There are many health consequences that can result from early on-set of diabetes. Children who have diabetes from young have a higher chance of developing complications, including eye disease and vision problems; kidney disease; heart disease and circulatory problems; nerve damage; and even problems with wound healing.

New studies have also brought to light startling facts; in the long run, diabetes may result in clogged brain blood vessels, which limit cognitive abilities. Furthermore, 30% of children who suffer from diabetes have been found to have lower bone mass, compared with those who did not have diabetes, resulting in weaker bones.

Prevention is the key

Managing diabetes is very important, especially in young children, to avoid future health problems. But, preventing the onset of type 2 diabetes is even better. A proper diet and lifestyle is crucial and children with T2D, or prone to T2D, may need to:

• Eat a healthy diet to achieve normal body weight, while gaining all the essential nutrients needed for growth and development. Some children may need to go on a low-salt/fat diet, especially if they suffer from high blood pressure or have high fat levels.
• Carry out regular physical activity; exercise helps the body to increase its response to insulin and burns off extra calories.

Living with diabetes may be quite a challenge, especially for younger children. However, detecting risk factors can help you prevent your child from developing type 2 diabetes in the first place.

Get your child to change his lifestyle and diet, making sure he is always eating healthy and maintaining a healthy weight for his age. This way, you can help reduce his chances of developing the disease.

Gastroenteritis is caused by irritation and inflammation of the gastrointestinal tract, which often results in diarrhoea, abdominal cramps, nausea, vomiting, and fever. This stomach and intestinal infection can be contagious, and can spread through contact with an infected person, unhygienic practices, and through contaminated objects, food or water. Anyone can contract gastroenteritis. However, it is more common among infants and children under the age of 5.

What causes gastroenteritis?

Gastroenteritis is caused by infection from different types of bacteria and viruses. These infectious agents can come from outside a person’s body, or result from an internal condition. Among the most common types of bacteria causing this infection are:

• Escherichia coli (E.coli) – causes food poisoning, dysentery, traveler’s diarrhoea or colitis.
• Salmonella – can cause typhoid fever or non-typhoidal food-poisoning.
• Shigella – can cause dysentery (inflammation of the large intestine causing bloody diarrhea).
• Campylobacter – from undercooked meat and unpasteurised milk.

Viruses such as Rotavirus, Norovirus, and Adenovirus account for 30 – 40% of gastroenteritis in children. They spread through close contact in daycares and schools. Each of these organisms causes a person to develop slightly different symptoms, but they all share one similarity: acute diarrhoea leading to dehydration.

According to the World Health Organisation, diarrhoeal disease is the second leading cause of death worldwide in children under the age of five and is responsible for killing 1.5 million children every year. Unlike bacterial infections, which are treatable with antibiotics, viral infections do not respond to antibiotics and add to the global statistics of child fatalities, especially in under-developed countries.

Know your viruses

It is important to know which infectious viruses are causing your child to run to the washroom every few hours so that immediate action can be taken to control and prevent the spread of this infection.

1. Rotavirus

   Rotavirus, which resembles a wheel when looked under an electron microscope, is the most common and potentially lethal virus that primarily infects infants and young children. Symptoms such as fever, nausea, vomiting and watery diarrhoea will appear two days after exposure to this virus, and the symptoms may last up to eight days.

   The virus spreads through the faecal-oral route. The germs from this virus survive for quite a long time on surfaces such as toys or furniture.

   Most children by the age of 5 would have been infected by rotavirus, and the first infection is usually the worst. This is because once a child is exposed to this virus, subsequent exposure to it will have less severe effects as immunity against the virus develops.

   Rotavirus vaccines have played a major role in preventing the spread of this virus in young children. The US Centers for Disease Control and Prevention (CDC) reports that while this viral disease is still a significant public health problem globally, there has been a clear reduction in hospitalisations and deaths of young children following the introduction of the vaccine.

   Dehydration as a result of diarrhoea can be treated through oral rehydration. This means giving your child more fluids in the form of milk or oral rehydrating salt solutions to drink. Children who have been immunised and breastfed also stand a better chance against the rotavirus.

2. Adenovirus

   Adenovirus is mainly linked to respiratory illnesses; however it also causes gastroenteritis, conjunctivitis, and bladder infection. Symptoms from this viral infection range from the common cold to pneumonia and bronchitis. Infants, young children and those with compromised immune systems are more susceptible to the effects of this infection.

   Similar to the Rotavirus, Adenovirus is transmitted through the faecal-oral route, and direct contact with contaminated objects and water. Specifically, it is type 40 and 41 of the Adenovirus that causes gastroenteritis, both in children and adults. Infection from this virus is usually mild and does not require active therapy, only treatment of its symptoms or complications. There is also no specific vaccine or drug to treat this type of viral infection.

3. Norovirus

   Formerly known as the Norwalk-like virus or NLV, Norovirus belongs to a family of gastroenteritis-causing viruses. Infection from this virus normally occurs in closed or crowded environments, such as hospitals, market places or nursing homes. This viral infection occurs in all age groups, but is more common in adults. Symptoms of diarrhoea, abdominal pains and vomiting begin to develop 24 – 48 hours after exposure and could last up to a few days.

   Similar to Rotavirus and Adenovirus, infection from Norovirus is mild and does not require therapy, only treatment of its symptoms or complications. There is also no specific vaccine or drug to treat this type of viral infection. However, this type of viral infection can occur if a person’s immune system is not strong enough to fight it.

Preventing and controlling the spread: The self-care method

In order to reduce the chances of your child contracting gastroenteritis, always practise good hygiene. Hands must be well-washed after using the toilet, and before eating or touching food. Clean and disinfect contaminated surfaces after an episode of vomiting or diarrhoea. Wash all laundry thoroughly. The best prevention method is by vaccinating against the most common viral cause – Rotavirus – even though it cannot prevent infection by the other organisms mentioned above.

However, if your child has already contracted viral gastroenteritis, it is crucial to keep your child well-hydrated. A variety of oral rehydration solutions are available in Malaysia. Avoid giving your child fluids like water or apple juice. Water does not replace lost electrolytes and apple juice could worsen the diarrhoea. Continue to give milk, especially if it is breast milk. Seek immediate medical attention if your child cannot take fluids by mouth or in severe cases of dehydration.

Influenza, more commonly known as the flu, is not to be mistaken with the common cold. The flu is a serious respiratory infection, and can lead to severe complications.

The flu is highly contagious, and influenza outbreaks occur every year. Flu virus strains can change quickly from year to year, which is why immunity towards the virus does not last long, and people can catch the flu many times during their lifetime.

Children are more susceptible compared to adults as they generally have a weaker immune system.

Getting infected

Influenza is easily spread from person to person, mainly through droplets when an infected person coughs, sneezes or even talks. Influenza virus can also spread when an infected person touches a surface or object, and another person touches the object and subsequently touches his mouth.

Common symptoms include:

• Sudden fever;
• Chills and shakes;
• Headaches;
• Muscle aches;
• Extreme fatigue;
• Dry cough and/or sore throat;
• Loss of appetite.

In younger children or newborns, other symptoms may also be present. These include:

• A high fever that can’t be explained, but with no other signs of illness;
• Febrile seizures/convulsions;
• Stomach upset and/or pain, vomiting, diarrhoea;
• Severe leg or back pain due to muscle inflammation.

Did you know that influenza could lead to other health complications as well?

Influenza usually is not the cause of death; instead, it creates a situation that leads to other serious medical conditions such as pneumonia or secondary bacterial infection, which can be fatal.

Reduce the occurrence of influenza!

Influenza viruses can cause major outbreaks in households, schools, and communities. Therefore, the best and most effective way to treat influenza outbreaks is by preventing it in the first place, and that is through vaccination. Because the viruses are constantly changing, the influenza vaccine is regularly updated to make sure it protects against the strains that are currently circulating.

This is the reason why influenza vaccine should be taken every year. The most recent 2010-2011 influenza vaccine protects against three virus strains that are the most common now – influenza A (H3N2 and H1N1) and influenza B.

It is recommended that everyone aged 6 months and older be vaccinated against influenza every year. Children younger than 6 months are at a high risk of serious complications from influenza infection, but because they are too young to receive influenza vaccination, the people who care for them or live around them should be vaccinated to protect these babies.

Don’t fall prey to serious health complications that can be prevented in the first place. Get your children and the whole family vaccinated against influenza every year – it is the safest way to ensure your family is protected against influenza!

Now and then, your child may be prescribed antibiotics by his doctor when he falls ill. But did you know that antibiotics can put you and others at risk if they are not used in the right way? Read on to learn a bit more about antibiotics, and how you should use this group of medications to protect your child's health, and that of your family.

What are antibiotics used for?

Antibiotics are antimicrobial agents. Antibiotics, such as macrolides, penicillin and cephalosporins, are a group of chemicals used to treat infections caused by bacteria and some fungi. Antibiotics work in two ways. They can either kill bacteria, or they inhibit their growth, and thus allows the body's natural defence to overcome them. Antibiotics cannot fight infections caused by viruses. The efficacy of an antibiotic depends on its dose and frequency, and the type of microbes it acts on. Unwanted side effects like fever, nausea, rash, diarrhoea may also occur. Antibiotics can be given orally, intravenously for more serious infections, or topically, as in skin ointments and creams, or eye drops.

Antibiotic resistance

Antibiotics are usually effective in treating bacterial infections. However, globally there have been concerns in recent years about the increasing incidence of antibiotic resistance.

Antibiotic resistance is the ability of bacteria or fungi to resist the action of antibiotics, allowing them to continue to grow even in the presence of antibiotics. Antibiotics become less effective on these resilient pathogens.

As a result, bacteria continue to spread, leading to prolonged illness, serious complications, and even death. To treat resistant cases, doctors may have to prescribe stronger antibiotics or other forms of treatment, which may be more costly and could pose more side effects. In addition, the surviving antibiotic-resistant bacteria can be spread to other people and causes hard-to-treat infections.

What causes antibiotic resistance?

The longer an antibiotic is used, the higher the risk of emergence of antibiotic resistance. Antibiotic resistance is largely associated with the inappropriate use or abuse of antibiotics, as in self-prescription of antibiotics, overuse of antibiotics for prophylaxis or prevention of infections by travellers and antibiotic abuse to promote growth as in animal husbandry.

• When antibiotics are used frequently for the wrong reasons, eg viral infections, the antibiotics will not act on the offending virus. However, microbes which become exposed to antibiotics will develop strategies to overcome it. Subsequently, the antibiotic becomes less effective against the bacteria they are intended to treat, thus contributing to antibiotic resistance.
• Patients not adhering to prescription. If you do not take antibiotics according to the schedule, do not complete the full course or share antibiotic medication, the antibiotic may not wipe out all the bacteria. The surviving bacteria can evolve to acquire antibiotic resistance.

What parents need to know

Here are things you need to know to ensure that antibiotics continue to work effectively for your child when he takes the medication, and also to help prevent creating antibiotic-resistant microorganisms.

• Antibiotics can only be given on a doctor's prescription.
• Adhere to the instructions given, ie complete the full course, and do not take extra or skip doses. Do not stop giving your child medications just because he is feeling better. There are also antibiotics for short course available.
• Antibiotics are prescribed on a case-to-case basis. The medication prescribed for your child is based on the doctor's diagnosis for your child. The antibiotic given to your child should not be shared with other people, even if they seem to experience a similar illness.

Intussusception is an acute condition in which one part of the intestine slides into another ('telescoping'). This causes intestinal obstruction, blocking the passage of food through the intestine.

As a result of the walls of the intestine being pressed together, pressure is created that reduces blood flow to the affected section. If left untreated, lack of blood causes intestinal wall tissue to die.

Tissue death can result in a tear or hole in the intestinal wall, exposing the lining of the abdominal cavity to infections. Significant bleeding and dehydration can also take place very rapidly.

What causes intussusception?

Intussusception can affect both children and adults, but occur most frequently in children ages 6 months-2 years. It affects boys more often than girls.

The cause is unknown for most cases of intussusceptions before the age of 3 years. In children older than 3 years, a triggering factor or 'lead point' may be found in about a quarter of cases. Examples include Meckel's diverticulum, intestinal growths, polyps or blood vessel abnormalities in the intestines. Gastrointestinal infections may also trigger intussusception.

Signs and symptoms

Intussusception usually occurs in previously well and thriving infants. The very first sign of intussusception may be a sudden, loud crying of the baby due to abdominal pain. Baby will pull his knees to his chest when crying. Vomiting occurs soon afterward. The abdominal pain occurs intermittently at more or less regular intervals. In between episodes, the infant may appear well but as time passes, the infant gradually becomes more apathetic.

Other signs and symptoms may include:

• Pallor.
• Abdominal distension.
• Stool mixed with blood and mucus.
• Diarrhoea.
• Fever.
• Dehydration.
• Lethargy.

Intussusception requires immediate medical attention to avoid severe complications or even death. If your child has any of the above symptoms, seek medical help right away.

Treatment

When treated early, the chances of recovery are good. If treatment is delayed, complications may arise and even threaten the lives of infants and young children. Intermittent colicky abdominal pain associated with vomiting in an infant requires close observation and investigation.

When your doctor suspects intussusception, he may order X-ray examinations, enema procedures or ultrasound scans to confirm his suspicions. Once intussusception is confirmed, it is usually treated with an air or barium enema.

During an enema procedure, a small soft tube is inserted into the rectum and air is released into the intestines through the tube. The air travels into the intestines, and the section of bowel with intussusception, if present, will be shown on the X-rays. At the same time, the air pressure pushes back the intestine to its normal position and clears the blockage.

Barium enema works the same way as air enema, except that a barium liquid mixture is used in place of air.

If the procedure is successful, no further treatment is required. However, if an enema fails to correct the problem, or if the intestine has perforated (a hole has developed), the child requires surgery. If necessary, any dead intestinal tissue will also be removed during the surgery.

As intussusception tends to recur soon after treatment, the child usually needs to stay in hospital for 2-3 days until he is able to eat normally and regains normal bowel movements.

Intussusception cannot be prevented. However, with prompt medical care, recovery is almost 100% and complications and death can be averted. Do not delay in seeking medical help if your child experiences any of the symptoms mentioned.

Appendicitis is a commonly uttered diagnosis by parents and caregivers alike. It is also one surrounded by myths and fallacies. Very often, one hears parents admonishing their children against eating guava seeds or jumping after meals as they may get appendicitis. What is appendicitis and how can one get it?

The appendix is a small, finger-like pouch; it is attached to a part of the large intestine called the caecum, located at the lower right area of the abdomen. The exact function of the appendix is unclear; however, research has shown that the appendix is involved in some part with the immune functions of the body. Hence, some believe that if the appendix is healthy, it should not be removed and discarded.

Appendicitis literally means inflammation of the appendix. This may occur when the entrance to the appendix is obstructed, resulting in mucus secretion, allowing bacteria that normally live inside the appendix to multiply. This results in inflammation and pain.

If an inflamed appendix is not removed, it may rupture, causing infection to spread throughout the abdomen. If not caught in time, the infection can also spread to the bloodstream and cause severe illness and death.

Some signs to look out for....

In addition to abdominal pain, other symptoms are:

• Loss of appetite.
• Nausea and vomiting.
• Fever.

There are other conditions which may mimic appendicitis. These include:

• Mesenteric adenitis. This is a condition where the lymph nodes in the abdomen are swollen, usually as a result of viral infection
• Inflammatory bowel disease. This includes Crohn's disease and ulcerative colitis.
• Urinary tract infection.

Treating appendicitis

If you suspect your child has appendicitis, take him to the doctor immediately. Your child's abdomen will be examined for signs of pain and tenderness. Blood tests will normally show evidence of infection while a urine test may be performed to rule out urinary tract infection. Sometimes, ultrasound of the abdomen may be ordered to identify the inflamed appendix.

Treatment of appendicitis requires removal of the inflamed appendix. This is a surgical procedure known as appendectomy. Today, this procedure can be done via keyhole surgery, leaving a much smaller scar than before and requiring a shorter hospital stay. Treatment of a ruptured apendix, however, is not so straightforward, as the abdominal cavity requires to be cleaned of pus to prevent further spread of infection. Antibiotics are also required in such cases and the hospital stay is longer.

Can appendicitis be prevented? Probably not. However, there is evidence to suggest that it is less common in those who consume a high fibre diet. Until preventive measures can be ascertained, we owe it to our children to spare them the agony and misery of ruptured appendicitis by detecting them early, thus facilitating early treatment.

Asthma, as with most other diseases, has its fair share of myths and rumours surrounding it. Some people believe that asthma is something you can “grow out” of, while others believe that asthma is contagious, or that eating certain foods can cause asthma to worsen or perhaps even get better. Just because your child suffers from asthma, it does not mean you have to put his life on hold. Proper management and understanding of the condition can help your child live a happy and fulfilling life.

Myth 1

Asthma is not that serious and deaths from asthma are rare.

Asthma can indeed be fatal; according to the World Health Organisation (WHO), annual worldwide deaths from asthma is estimated to be at 250,000. One-third of all children who die from asthma were diagnosed with only a mild form of the disease. One of the ways of identifying if a patient is at a higher risk of death is when he or she is taking a lot of puffs from their reliever inhaler daily, even requiring two or more inhalers a month.

Myth 2

Children who have asthma eventually grow out of it.

Around 50% of children suffering from asthma show improvement in symptoms, which include tightness of chest, breathlessness, coughing and wheezing, as they grow older. In some children, these symptoms may even completely disappear, though others with severe or persistent asthma often remain the same, even as adults. However, even when symptoms disappear completely, they may return later on in life, especially if they smoke, acquire infections, or in some people, when they exercise.

Myth 3

You can cure asthma.

Many parents around the world have turned to alternative or complementary treatments like homeopathy, yoga, ayurveda, herbal therapy and even acupuncture in an attempt to cure asthma. These treatments only provide short-term relief and there is no research or evidence that proves their efficacy. The best medication remains your inhalation treatment, which enables total control of your asthma. Although you may not suffer from a lot of asthma symptoms, it does not mean that your asthma has gone away. Once you have asthma, you will always have asthma.

Myth 4

Eliminating wheat and milk from the diet helps asthma.

Eating certain foods does not cause asthma, though it is possible that asthmatics may develop food allergies at some point of their lives. Eliminating foods like wheat, milk and eggs only help if your child suffers allergies when eating those foods. Asthmatics sometimes wheeze after drinking cold drinks, like cold milk, because they inhale the cool, dry air while it is being drunk. Cold, dry air can irritate hypersensitive lungs, causing the muscles around the bronchial tubes to constrict, becoming even narrower, and results in wheezing, coughing or breathing difficulties.

Myth 5

You cannot play sports or exercise if you suffer from asthma.

As long as your child is taking his medication regularly, there is no reason for him not to play sports and other outdoor games. Playing games in conditions that are dry and cold may aggravate asthma in some children, causing wheezing or breathlessness to occur. Some sports have been found to be good for asthmatics, such as swimming and sprinting. Sprinting does not involve continuous running, allowing your child to take breaks in between.

Myth 6

Exposure to animals and dust will desensitise you to them.

There are many different triggers for asthma attacks, among them animal dander and dust. Ongoing exposure causes symptoms like wheezing, coughing and shortness of breath to worsen, instead of desensitising your child to them. Restricting pets from entering bedrooms and other common areas, consistent bathing of the animal, as well as frequent vacuuming of the carpets and cleaning of the furniture can help in relieving these symptoms.

Most deaths from asthma are preventable and can easily be avoided with proper control. It is a chronic, life-long disease that should not be neglected even when there are no symptoms, or if your child is feeling well. Understand asthma as a whole, learn your child's triggers, and always consult the doctor before making any changes to a treatment plan.

Pneumococcal diseases are infections caused by the bacterium Streptococcus pneumoniae, also known as pneumococcus. It can attack various parts of the body, including the brain, lungs and ears, causing serious illnesses in adults and children. There are more than 90 known pneumococcal types, with 10 most common ones that cause 62% of invasive diseases all over the world.

What does pneumococcus cause?

Pneumococci can cause several diseases. There are generally two types of pneumococcal diseases: Invasive diseases and non-invasive diseases.

Invasive diseases are more serious and cause diseases within a major organ, or the blood, including:

Pneumococcal pneumonia

• Most common pneumococcal invasive disease.
• May start off with fever followed by chills, cough, shortness of breath, rapid breathing, chest pains, and tiredness
• If not treated, pneumococcus can spread to other parts of the body including the middle ear, nervous system and even the blood.

Bacteraemia (blood infection)

• A serious complication that occurs when the bacteria spreads and infects the blood.
• If not treated it may affect the functions of major organs leading to kidney failure, heart failure and eventually lead to septic shock Septic shock results in multi-organ dysfunction or failure and can be life-threatening!

Meningitis (inflammation of the meninges lining the brain and spinal cord)

• An extremely serious condition whereby the meninges are inflamed.
• Persons affected often show symptoms such as severe headache, vomiting, high fever, stiff neck, sensitivity to light, confusion and sleepiness.
• If untreated, more complications arise such as seizures, increasing drowsiness and coma.
• Long term complications include permanent neurological damage eg hearing loss, speech impairment, learning disabilities, blindness, cerebral palsy and epilepsy.
• Meningitis has one of the highest fatality rates, with most cases affecting children under the age of 1 year.

Both bacteraemia and meningitis are deadly diseases that can kill within hours, and babies and toddlers fall into the high-risk groups of contracting these diseases!

Non-invasive diseases on the other hand, occur outside major organs and the blood. These include:

Otitis media (infection of the middle ear)

• A person may experience ear pain, difficulty sleeping, difficulty hearing or responding to sounds, loss of balance, headache, fever and fluid or pus leaking from the ear.
• Frequent otitis media may result in serious complications such as impaired hearing, delayed speech development, and spread of the infection to nearby organs such as the brain.

Sinusitis (inflammation of the sinuses)

• A person may experience headache, facial tenderness, pressure, pain, fever, cloudy and discoloured nasal drainage, a feeling of nasal stuffiness, sore throat or cough.
• Undiagnosed or untreated sinusitis may lead to eye socket infection, which may cause a person to lose the ability to move the eye and blindness.

Though these diseases are less severe compared to bacteraemia and meningitis, they can still cause serious complications if not treated appropriately.

Prevent it!

Although pneumococcal diseases can be treated with antibiotics, chances are that it may be already too late and most fatal cases of invasive pneumococcal diseases could have actually been prevented with vaccination. Vaccination is recommended for everyone, as pneumococcal disease can affect anyone at any age. However, there are certain groups of people who are at a higher risk of getting the disease, such as:

• Adults aged 65 years and above.
• Children aged 2-24 months, especially those with chronic diasese of the lung (except asthma), heart, kidney or liver.
• Those with immune systems weakened by conditions such as cancer or HIV infection.
• Those without a functioning spleen eg after removal in Thalassaemia or trauma.

There are two types of vaccines against pneumococcal disease: A polysaccharide vaccine and a conjugate vaccine. The pneumococcal conjugate vaccine is recommended for children aged 2-24 months (upto age 8 years), while the polysaccharide vaccine is used after 2 years of age.

Vaccination is a major means of preventing many diseases, hence avoiding unnecessary illness, disability and even death. Parents may worry about side effects that may occur from vaccination, which are often few and minor in nature. Vaccination remains the best guard against diseases that have the potential to kill or even disable millions of children and adults for life. You have the option to avoid fatalities and serious complications; power up against pneumococcus today!

Do you think that chickenpox is a harmless childhood disease that occurs only once in a lifetime? Although this viral disease most frequently affects children between the ages of 6 and 10 years, as an adult, you can also contract this disease, especially if you have never had it in the past, or in some cases, when it comes back again a second time.

Chickenpox in adulthood

Many of us get chickenpox during childhood, and our body develops a life-long immunity against the virus after that, which makes it rare for chickenpox to strike twice.

Chickenpox tends to be more serious when it occurs in adulthood. There are more blisters, and the resulting scars can be more severe. Though rare, adult chickenpox can be complicated by serious conditions, such as pneumonia, and can even be fatal. In fact, compared to children aged 1-4 years, adults have a 25 times greater risk of dying from chickenpox. About 21% of Malaysian adults aged 21-40 years have never been exposed to chickenpox and are susceptible.

The varicella-zoster virus (VZV) strikes again!

Chickenpox is caused by the varicella-zoster virus (VZV). Although the body develops immunity towards VZV after the first encounter, it doesn't mean that the virus is eliminated from your body. The virus remains dormant (inactive), in the nerve cells near the spinal cord, long after you have recovered from the disease during your childhood.

VZV can become active again many years later in adulthood. When the virus re-emerges, usually triggered by stress or a weakened immune system, it travels along the nerves to the surface of the skin. This time, it causes the development of a painful skin rash, known as shingles (also known as herpes zoster). There can also be lingering painful post-herpetic neuralgia after disappearance of rash.

How dangerous is shingles?

Shingles usually appears only on one area of the body. Although it is generally not dangerous, it is more painful than normal chickenpox. The disease may only last 2-3 weeks, but it often causes nerve pain that lingers on for months after the rash is gone. Unlike chickenpox, shingles is less infectious as it is not airborne, and you won't catch the virus if a person with shingles breathes or coughs near you.

VZV infections can still be transmitted to vulnerable individuals (ie not exposed to chickenpox, not been vaccinated) through contact with the blisters of an infected person, and cause chickenpox. On the other hand, you won't get shingles from someone with chickenpox.

Those who are more likely to get shingles are usually above 50 years old, as the risk of getting shingles increases with age. People with certain medical conditions that impair the immune system (eg cancer, HIV) or take medications that suppress the immune system (like prolonged steroids or chemotherapy) are also at greater risk for shingles.

Prevent the spread

Regardless of the form of the disease, chickenpox or shingles, the diseasecausing virus is very infectious, and can be passed on from adults to children, or vice versa. As long as your body doesn't have the defence built against the virus, you are at risk.

The best way to prevent chickenpox is through vaccination with the varicella vaccine. A vaccinated child will be protected from catching the disease from the people around him, sparing him unnecessary discomfort and suffering. Chickenpox vaccination in adults helps by lessening the severity of the symptoms and risks of complications, as well as reducing the risks of passing the disease to unprotected children and adults. Two doses of the vaccine is given at least 4 weeks apart.

In Malaysia, a combination vaccine containing varicella vaccine, together with the mandatory measles-mumpsrubella (MMR) vaccines for childhood immunisation, is currently available. While chickenpox vaccination is optional (not mandatory), the fourcomponent combination vaccine is able to provide children protection against four illnesses, all conveniently and safely in one shot.

Stop the spread, get vaccinated today; talk to your doctor for more information on chickenpox and the varicella vaccine.

Biliary atresia (BA) is a serious disease that occurs worldwide and affects 1 in 8000 to 15000 newborn infants, causing interruption to bile flow that can lead to serious health problems.

The roles of bile

Bile is the liquid produced by the liver to aid digestion and absorption of fats and fatsoluble vitamins in the small intestine. Bile also helps to carry bilirubin from the liver to intestines for excretion.

Normal and healthy bile ducts – inside and outside the liver – allow bile to flow from the liver to the gallbladder for storage, before it is excreted into the intestine to carry out its functions.

However, when a baby has BA, the bile ducts are absent or damaged and blocked. Impaired bile flow leads to liver damage, affecting many vital body functions at the same time. It can be fatal if not treated.

The causes of BA are still unknown, but it is believed to be caused by multiple factors. What is known so far is that BA is not an inherited disease, and it rarely occurs more than once in the same family. It also has nothing to do with medications taken by women during pregnancy.

Signs to watch out

The very first sign of biliary atresia is jaundice (a yellow discolouration of the skin and the whites of the eyes). Other common signs of BA include pale-coloured stools and dark urine. In “postnatal” BA, the infants are usually born at term with an appropriate weight. On the other hand, infants with the “foetal” form of BA are more likely to be underweight. Parents should be aware that jaundice can also occur in many healthy newborns during the first few days of life. This harmless physiological jaundice usually clears within 2 weeks. In BA, however, infants will experience prolonged jaundice and have pale stools.

If BA is suspected, the infant is usually referred to a centre where there are paediatric specialists and paediatric surgeons with experience in diagnosing and treating the condition.

Treatment for BA

Biliary atresia is a condition that cannot be treated with medication. The only first-line treatment to improve bile flow and reduce jaundice is a surgical procedure called the Kasai portoenterostomy. Prior to the development of this procedure, death from BA was almost 100%.

Nutritional needs in BA

Nutrition can be a problem in a child with BA. Due to inadequate or absence of bile in the intestine, digestion and absorption of fats and certain vitamins can be significantly hampered. Children with BA also have faster metabolism than healthy children, so they require more calories.

If your child has BA, you can take these steps to ensure that his nutritional needs are not compromised:

• Seek the advice of your paediatrician and dietician.
• Feed him a well-balanced diet.
• Offer him three regular meals a day and light snacks in between meals.
• Supplement his diet with vitamins, eg vitamins A, D, E and K.
• Medium-chain triglyceride (MCT) oil may be added to his foods and drinks to give him more calories and help him grow. Compared to other types of fats, MCT are more easily digested without bile.

Influenza virus infection, sometimes called “the flu”, is a highly contagious viral infection that causes generalised symptoms such as fever, headache and muscle aches as well as nasal congestion, sore throat, runny nose and cough. In the past, people living in tropical and subtropical countries considered influenza to be a problem only in western countries with colder climates.

However, influenza surveillance systems in Malaysia and neighbouring countries consistently show that influenza is an important cause of illness in children. Since 1997, when a deadly strain of influenza normally found in birds (A/H5N1) surfaced in people in East Asia, governments have improved and expanded influenza surveillance. In addition to identifying new strains of the virus that can cause serious global outbreaks known as pandemics, these surveillance systems have provided valuable information on who gets influenza and during what time of the year most infections occur. In Malaysia, influenza infections occur throughout the year with peak activity between the months of May-June and August-September. This knowledge can help public health officials and your doctor make better decisions to both prevent influenza through vaccination and to treat influenza infection in certain children who are at high risk for serious complications.

Understanding the basics

The widespread belief that influenza is neither common nor severe is something that has to change. Influenza viruses constantly circulate around the world, causing many millions of illnesses and significant economic losses, mainly in terms of missed work and school days and millions of clinic visits. At unpredictable intervals, a new strain of influenza virus may emerge to which most people have no immunity. This leads to a global epidemic known as a pandemic. This is what happened in 2009 when the H1N1 influenza virus emerged. As of August 2010, more than 214 countries have been affected by the H1N1 pandemic influenza strain with over 18,449 reported deaths. In Malaysia alone, up to May 2010, there have been 14,772 confirmed H1N1 cases with 87 deaths.

Good hygiene practices such as frequent hand washing, covering one’s mouth when sneezing and coughing, and staying home when feeling ill, can help to reduce the spread of influenza. In reality however, these behaviours are difficult to consistently practice, especially with children and in crowded conditions. By far the most effective method to prevent influenza infection is annual vaccination.

Sneezing around

The reason influenza is so highly contagious is because it can easily spread from person to person, mainly by droplets made when an infected person coughs, sneezes or even talks. These airborne droplets can infect those who breathe them in. The influenza virus may also spread when a person touches a contaminated surface or object.

It is quite possible for you to pass on influenza before even realising you have it, as humans are able to infect others beginning one day before their symptoms show. They can continue to infect other people for up to 5 days after they become sick and they start to show symptoms. Children infected with influenza often have gastrointestinal symptoms such as nausea, vomiting and diarrhoea as well.

Keeping the problem at bay

Left uncontrolled, influenza virus often causes explosive outbreaks in households, schools and communities. Vaccination is the most important step you can take to prevent influenza infection. Because the viruses are constantly changing, influenza vaccine is regularly updated to make sure it protects against the strains that are currently circulating. There is also the northern strain and southern strain, referring to the outbreaks during the winters in the two hemisphere. This is the reason why influenza vaccine should be taken annually. The most recent 2010-2011 influenza vaccine protects against three virus strains – influenza A (H3N2 and H1N1) and influenza B – that are the most common at this point of time.

Did you know that influenza infection could also lead to other serious medical complications?

Dying from influenzarelated diseases

Influenza is usually not the cause of death; instead, it leads to other serious medical conditions such as pneumonia, which can be fatal. For example, an estimated 36, 413 influenza pneumonia cases were admitted to hospitals in Thailand during 2005-2008 and 322 people died. About half of these cases were children 15 years and younger as well as adults aged 50 and above. Influenza may seem like a minor illness; but serious complications following an influenza infection may prove to be fatal.

After the 2009 pandemic

According to the World Health Organization (WHO), the influenza A (H1N1) has now reached its postpandemic period, which means that not only has the H1N1 virus spread to all countries, many people from all age groups have also developed some immunity to the virus. Furthermore, in recent months there have been no large outbreaks occurring in countries with colder climates. However, this does not mean you can let down your guard; it is still important to reduce the risks of getting influenza as the H1N1 virus, as well as other influenza virus strains, continue to circulate in Malaysia and around the world.

Protect yourself and your family now!

It is recommended that everyone aged 6 months and older be vaccinated against influenza every year. Children younger than 6 months are at high risk of serious complications from influenza infection, but because they are too young to receive influenza vaccination, the people who care for them or live around them, should be vaccinated to protect these babies.

There are also others who fall in the high-risk groups and should be given priority to receive influenza vaccination. They include:

• People with chronic respiratory conditions like asthma and other heart and lung diseases
• Pregnant women.
• Adults aged 65 years and older.
• Children less than 5 years old, especially those below 2 years.
• Morbidly obese people.
• Adults caring for babies and children such as daycare operators and nurses.

It is important to protect yourself and your family by getting a headstart on the influenza virus. Lead a healthy and clean lifestyle and make sure you get the whole family vaccinated against influenza every year: the best and safest way to ensure that your family is protected against influenza. Influenza virus affects Malaysian children throughout the year. Do your part to protect your children and stop its spread.

Have you heard of someone complaining about their asthma? Or perhaps seen a person breathing in using an inhaler. Although asthma is not uncommon, it still remains one of the mysteries of modern medicine. It has no single cause and does not have a cure up till today. Children are prone to developing asthma if a family member has it, as it is hereditary among families – every child has a 6% chance of developing asthma, which increases to 30% if one parent is asthmatic and 70% if both parents have it.

In general, asthma is a condition whereby the airways to the lungs are temporarily narrowed or blocked, resulting in symptoms such as coughing, wheezing, shortness of breath and chest tightness. Patients suffering from asthma often describe the attacks as breathing through a straw in your mouth while pinching your nose closed!

Does your child have asthma?

Seeing your child suddenly gasping for breath is a scary experience for parents, especially since children are more prone to asthma attacks because their airways are narrower than those of adults. All asthma attacks require immediate attention and medical treatment, but parents can learn to recognise early warning signs of an attack, such as:

• Coughing. Sometimes, coughing can be the only symptom to an asthma attack. If your child is coughing frequently, especially at night and with no illness to cause it, it may be a sign of an asthma attack coming on. Furthermore, if your child has been having a persistent cough for 2 weeks or more, without any apparent reason, then it is highly probable that he may be suffering from asthma.
• Breathing. If your child is having a hard time breathing, listen closely to him, as this may be a sign of an oncoming asthma attack. Listen for any wheezing, loud and fast breathing and watch if he breathes with his nostrils flared, or if he tries to clear his throat often. A child who has asthma also often has a wheezing sound even when breathing normally.
• Be observant. Check if your child shows other physical symptoms such as vomiting, sweating and pale skin, as these are signs of a possible asthma attack. Your child may also complain of feeling tight or uncomfortable in his chest.

Triggering asthma

Asthma is most often inherited from a family member, however children can also develop asthma from exposure to environmental factors, which is known as allergic asthma. Triggers that lead to asthma attacks vary in different individuals and it is important that you know what causes the asthma in your child.

In some children, their asthma symptoms become worse when they breathe in irritants like cigarette smoke, polluted air or odours, paint fumes and aerosol sprays. These substances can easily irritate the upper airways and lower airways causing children to wheeze, cough, and have runny nose or watery eyes. Asthma can also sometimes be triggered by the climate; exposure to cold or even very hot air, can cause an asthma attack in your child.

Avoid those nasty irritants!

The best thing to do for children who have asthma is to try to avoid the triggers that cause them. But sometimes, these triggers – like cats, colds or pollen – can’t be avoided and that’s when medication is needed to manage the asthma. In children with mild intermittent symptoms which is day time symptoms less than a week and nocturnal symptoms less than twice a month and well in between episodes does not require long term medication. He uses asthma medication only when their asthma flares-up. This is known as rescue or reliever medicine (Bronchodilators such as short acting beta agonists (SABA) and anticholinergics) because it works rapidly to open up the airways for the child to breathe.

In children who are symptomatic with daytime symptoms more than once a week and night symptoms more than twice a month and having asthma exacerbations affecting sleep and activity more than once a month will need longterm treatment, which is a preventive medication in the form of inhaled corticosteroids. These medications need to be taken daily to suppress inflammation and prevent flaresup from occurring. If they remain symptomatic despite on inhaled corticosteroids provided the child is compliant to the inhaler, a controller medication will be added in the form of long-acting B2 agonist or anti-leukotrienes. However it is important that these children who are on long term therapy to be follow- up by a doctor regularly to assess his symptoms and asthma control as well to adjust the medication dose regularly.

Asthma medication is most often dispensed through an inhaler, which is held up to the mouth and pressed to release a mist into the lungs when breathed in. Children are not encouraged to use inhaler by using this technique, as this require coordination. Children need a vent with a facemask or mouthpiece. This medication relaxes the airways, making it easier for the child to breathe. Inhalation therapy is a muchpreferred route of medication compared with oral medicine, as inhaled medicine is directly delivered to the lungs with little, or no side effects.

Prevention is the key

Medication does play an important role in managing asthma; however, the best way to control asthma is still through prevention. Here are some things in which you could do to help keep your child’s environment free from potential asthma irritants.

• Always keep your house free from dust or pet fur by vacuuming the carpets and mats around the house. Discourage dust mites – clean the bed sheets and curtains regularly, soaking them in hot water first before washing. Try to keep certain rooms pet-free and make sure that your pets are bathed often to reduce the occurrence of dander.
• If weather or air pollutants triggers asthma, you may need to limit your child to playing indoors when the weather is bad or if the air is especially polluted.
• Don’t allow smoking in the house at all costs! Smoking is bad for the lungs even for normal persons, and can especially aggravate the symptoms in those suffering from asthma. Keep your child away from smokers in and outside the house.

Having a child who suffers from asthma isn’t easy for the whole family. However, life can be almost normal with proper precautions and management. Many children grow out of asthma as they grow older, or have less severe attacks. Doctors believe that as a child gets older, his airways widen and make it easier for the air to get in and out, thus reducing the frequency of getting asthma attacks. In the mean time, treat asthma seriously and always make sure that your child’s medications are on hand. Uncontrolled asthma can lead to more severe attacks, which may result in death if not given proper emergency treatment immediately.

Jaundice refers to a yellowish discoloration of the whites of the eyes (sclerae), skin, and mucous membranes. When this occurs in the first month of life, it is called neonatal jaundice. Jaundice occurs in 50-60% of babies within their first week and it is so common that parents often overlook the dangers or complications that may arise.

Common Jaundice in Babies

When old red blood cells are broken down, bilirubin is generated and released into the blood stream. This bilirubin is carried to the liver where it is processed and then removed from the body through stools. Thus, if there is increased breakdown of red blood cells or if the liver is not capable of processing the bilirubin, jaundice ensues.

Before birth, bilirubin is passed through the placenta to be processed and removed by the mother. Just after the baby is born, his liver takes over the job, but this may take a bit of adjusting to and therefore the levels of bilirubin are always higher in newborn babies. The high levels of bilirubin cause the skin to carry a yellowish tinge, which usually appears and peaks between day 2 and day 4 and clears within two weeks. This is known as physiological jaundice. It is the most common cause of neonatal jaundice and is usually harmless to your baby.

Dangerous Jaundice: Pathological Jaundice

Some cases of jaundice are potentially fatal. Pathological jaundice is the rapid onset of jaundice within the first 24 hours of a baby’s life and is caused by excessive breakdown of red blood cells. This in turn, leads to a rapid elevation of the bilirubin level, as the baby’s liver is unable to process the bilirubin fast enough.

The breakdown of red blood cells is excessive and can be caused by various factors such as infections in newborns, incompatibility of mother’s and baby’s Rhesus blood group or a deficiency of a metabolic enzyme (glucose-6-phosphate dehydrogenase) for red blood cell metabolism. In more serious cases, seizures or changes in muscle tone may occur and if not treated immediately, permanent brain damage or even death can occur. Hence, it is very important to seek medical advice early when your baby has jaundice.

Reducing the Jaundice Level

There are various ways that your doctor may use to reduce jaundice such as:

• Phototherapy, which consists of a special light that can break down bilirubin in the skin, so that it can be easily excreted in bile or urine.
• Exchange transfusion, which is a process whereby the baby’s blood is repeatedly withdrawn in small amounts and replaced with a donor’s blood.

A Sign of Obstructive Liver Disease

When baby’s stools are paler than normal, sometimes completely white, it can be a sign of serious underlying medical conditions. These conditions can cause partial or complete obstruction of the biliary tract, which are the ducts that connect the liver to the gut. Examples include viral hepatitis, an inflammation of the liver caused by viruses, and extrahepatic biliary atresia, which is the absence of the bile ducts between the liver and gut.

What to Look Out for?

If your baby is experiencing any of the following symptoms, bring him to the doctor immediately:

• Colour of the stools. Baby’s stools are pale white, grey or pale yellow while the colour of his urine is dark.
• Extensive yellow skin. Skin becomes more yellow, starting from the face and eyes, continuing to the chest, stomach and eventually legs.
• Lethargy. Baby is listless, sickly and lethargic.
• Duration of jaundice. Jaundice that lasts more than three weeks.
• Weight loss. Poor feeding and loss of weight, or does not gain weight.
• Seizures. Baby is irritable and fitting.

Do not take for granted that jaundice is something so common that it does not require much medical attention. Instead, pay close attention to the different symptoms of jaundice that your baby may show. It may be a sign of a more serious underlying medical condition.

“Your daughter has your beautiful eyes!” or “Your son has his dad’s charming smile!” These compliments usually make parents feel proud. However, besides physical attributes, parents can also pass on certain health conditions to their children. These traits or health conditions are passed down to your child through genes. Although some are indeed hereditary, other diseases may result from a combination of gene(s) and the environment (multifactorial). The latter may remain dormant until triggered by specific events or environmental factors, thereby affecting the child’s health and wellbeing.

While you cannot change the genes of your child, you can protect him if you are aware of the risk that he is facing. Learn about the possible signs and symptoms so that you can detect them early, and take actions to prevent or lessen the symptom severity.

Common Multifactorial Conditions

Allergies
Your child is more vulnerable to developing allergic conditions even if only one of you has an allergy. However, your child may not be sensitive to the same things as you are.
Watch out for: Runny, stuffy or itchy nose, sneezing, itchy ears and throat, itchy eyes, rashes, and hives.
Do: Keep an eye on the foods your child eats and the things he comes into contact with. If any of the allergic symptoms appear, bring your child to the doctor. Also try to identify the triggers (eg foods, animal fur, mould, dust mites) and practise measures to avoid it.

Eczema (dermatitis)
A family history of eczema or other allergic conditions predisposes your child to this condition.
Watch out for: Dry and itchy skin, red and rough patches on cheeks, insides of the elbows, knees and ankles, forearms, scalp and neck.
Do: Avoid possible triggers, such as cold and dry environments, soaps, highly allergenic foods (eg eggs) and stress. Have your child examined by the doctor for appropriate diagnosis and treatment. Take precautions to prevent flare-ups.

Vision problems
These include nearsightedness, colour blindness, and lazy eye.
Watch out for: Headaches, squints or tearing when reading or watching TV, crossed or deviated eyes, habitually turns the head to look at objects, trouble distinguishing between red and green colours and colours that contain these hues.
Do: Have your child’s vision checked by an ophthalmologist if he has any of these symptoms. Start to schedule his annual eye examinations by the age of one year to detect potential vision problems early.

Migraines
Migraines usually start to show up around the age of 8 years old, but may be sooner in some children.
Watch out for: Throbbing pain in the forehead, temples or around the eyes, nausea or vomiting, and sensitivity to light and sound.
Do: Identify the triggers, such as fatigue and certain foods (eg cheese, chocolate, caffeine), and help him to avoid them. Headaches in children can be relieved by sleeping or taking pain relief medications. However, it is still important to see a doctor to ensure no serious underlying illness is present.

Irritable bowel syndrome (IBS)
If you have IBS, your child will be more likely to develop IBS than their friends whose parents do not have it.
Watch out for: Frequent abdominal cramps, bloating, alternating bouts of constipation and diarrhoea, colic (in infants).
Do: IBS can usually be managed with simple lifestyle modifications, such as avoiding food triggers (eg caffeine, chocolate) and reducing stress. To exclude any serious underlying digestive disorder, have your child examined by a paediatric gastroenterologist.

Worm infection is a very common problem, especially among children. It occurs as children tend to put things into their mouths and are less likely to wash their hands. Though it can be treated easily, complications such as malnutrition and bowel obstruction may arise if left untreated.

There are different types of intestinal worms such as roundworms, hookworms and tapeworms. The most common parasitic worm infection is by pinworms, also known as threadworms. Threadworms are small, around 2-13mm long, thin and white in colour. They infect the intestines, and are most common in children, though anyone can get it.

The Lifecycle

When a child is infected with threadworms, the female worms come out at night to lay their eggs around the anus. If he scratches the area, the eggs are transferred onto his hands and fingernails. Objects are then infected upon contact such as toys and toothbrushes. The eggs, surviving up to two weeks, are ingested when another person puts a contaminated object into his mouth. The eggs enter the body and hatch in the intestines, starting the cycle all over again.

Does Your Child have Worms?

Threadworms are not always easily identifiable. Do look out for these signs and symptoms:

• Itching of the anus, and in girls (even the vagina), especially at night.
• Adult worms can sometimes be seen in stools – thin, white, cotton threads.
• Presence of worms around the anus after the child is asleep.
• Reduced appetite, restlessness and irritability.

Harmful or Otherwise?

Threadworms are usually not harmful, often causing itchiness and discomfort around the anus. But if left untreated, it may cause further complications. As parasites, the worms make it difficult for the body to absorb vital nutrients, which then leads to problems in cognitive and physical development, vitamin A and iron deficiency, anaemia and other malnutrition problems. Heavy worm infestation may also cause mild abdominal pains while young girls may suffer from vaginal discharge and problems with passing urine should the worms lay eggs in their vagina or urethra.

Diagnosis and Treatment

Threadworms are usually detected with the “tape test” – a piece of clear tape is patted on the skin around the anus to collect the eggs and confirmed via microscope. All family members will be treated, regardless if they show symptoms or not, to avoid possible infection. Medication such as the chewable Mebendazole tablet is taken to kill the worms in the intestines. This is followed by hygiene measures to prevent infection and re-infection.

Keeping the Worms Away…

Preventing the infection from spreading takes a few simple steps and hygienic practises.

• Clean all nightclothes, underwear and bedding after treatment.
• Ensure you child washes his hands before meals and after using the restroom.
• Keep his fingernails short.
• Stop him from biting his nails and scratching his anal area.
• Make sure your child wears a clean pair of underwear every day.
• Bathe him in the morning to reduce egg contamination.

Dehydration occurs as a result of insufficient fluids, either from lack of intake or excessive losses. Infants and young children are at greater risk due to their higher body surface area. They also have less water in their system compared to adults.

The body loses water and minerals through perspiration, urination and passage of stools. Under normal circumstances, these losses are balanced by oral fluid intake. However, certain conditions can cause excessive water loss. A large amount of water and electrolytes can be lost rapidly if the child has severe diarrhoea. This may be exacerbated by concomitant vomiting. Excessive sweating due to excessive heat may also lead to dehydration.

Dehydration Sign & Symptoms

Dehydration can be divided into three stages. Mild dehydration has very little indication. However, children and infants may progress to moderate and severe stages rapidly.

Treatment of Dehydration

Dehydration is treated through fluid and electrolyte replacement, which can be achieved through oral intake or intravenous drip in severe cases.

Fluids such as plain water and juices can be frequently given for fluid replenishment, whereas breastfed infants should continue breastfeeding. Oral rehydration salts are also useful in replacing both fluids and electrolytes. For solid food, rice porridge has been found to reduce the duration of diarrhoea. Banana, a source of potassium, is needed as low levels of potassium (lost in stool and vomit) cause muscle weakness, and, in severe cases, irregular heart rhythm.

You can continue with your child’s regular formula milk. But if the diarrhoea is due to lactose intolerance, your child’s paediatrician may advise to switch to a lactose-free formula until his symptoms resolve.

If the ill child refuses to take his regular drink, let him suck on ice chips; it’s fun and provides him fluids. Avoid giving drinks containing caffeine or high sugar content. Caffeine is a diuretic, causing urination and further fluid loss. Sugar acts as a mild laxative and may increase bowel movement.

Make sure your child drinks plenty of water daily, Encourage him to drink at the first signs of illnesses, eg vomiting and diarrhoea. DO NOT wait for signs of dehydration. If there are any worrying signs or symptoms, or if his condition does not improve after 3-4 days, see the doctor immediately.

Food poisoning happens when there is inflammation of the stomach and/or intestines caused by eating contaminated foods. Usually symptoms present themselves within 2-24 hours after eating. Depending on the severity, sufferers of food poisoning may also experience fever and chills, bloody stools, and dehydration. Although food poisoning is usually a common and mild illness, it can sometimes be deadly, especially in children.

Infectious Bacteria are to Blame

Food poisoning is usually due to either toxic agents or infectious agents. Toxic agents are pesticides on fruits and vegetables, improperly prepared exotic foods (such as shellfish), or poisonous mushrooms.

Most food poisoning cases in Malaysia, however, are caused by eating food contaminated with infectious agents. This means that the food contains harmful viruses, bacteria, and parasites, which releases poison that causes inflammation of the intestinal lining. E. coli, Salmonella, Shigella and Staphylococci are common infectious bacteria that cause food poisoning.

Hygiene Keeps Contamination at Bay

Poor sanitation and improper food preparation are usually to blame for food contamination. Food handlers should practise personal hygiene and ensure the food preparation area is clean. Food should also be properly stored and kept at appropriate temperatures. Make it a habit to practise the good food preparation tips below:

1. Prepare food with care
   • Wash all fruits and vegetables thoroughly.
   • Do not prepare foods with bare hands if you have wounds.
   • For raw and cooked foods, separate utensils (knives/ cutting boards) should be used.
   • Defrost foods completely before cooking. Thaw food under clean running water.
   • Cook foods (meat, poultry, egg and seafood) thoroughly.
   • Reheat cooked food thoroughly. Bring foods like soups and stews to boil.
   
   
2. Serve food well
   • Serve cooked foods as soon as possible in clean crockery.
   • Never leave cooked food at room temperature for more than two hours.
   
   
3. Store food properly
   • Separate raw food from cooked food in different packages when storing them in the refrigerator.
   • Avoid giving leftover cooked food that has been prepared more than two days ago.
   

When to See the Doctor

Food poisoning should not be taken lightly as severe diarrhoea and vomiting can cause dehydration, which is very dangerous especially if it happens in young children. Consult a doctor if your child :

• Experiences symptoms at a very young age (2 years and below)
• Has nausea, vomiting, or diarrhoea lasting for more than two days.
• Experiences fever, chills, or bloody stools.
• Cannot keep any liquids down.
• Has other immune-related disease or illness.
• Has slurred speech, muscle weakness, double vision, or difficulty swallowing.

Managing Food Poisoning

If your child is suffering from mild food poisoning, in which he experiences short episodes of vomiting and minimal diarrhoea, symptoms will usually go away on its own in two to three days. You can help your child feel better by trying these home care tips:

• Do not feed him solid food until he stops vomiting.
• Offer him water frequently in small amounts to prevent dehydration.
• Once vomiting has stopped, slowly reintroduce easy-to-digest foods (porridge, bread, banana).
• Do not give over-the-counter medicines to stop the diarrhoea.
• Check what your child has eaten over the past 24 hours.
• If in any doubt, seek medical help early.

One of the most joyful experiences in life is when we welcome our baby into this world. At birth, your baby is dependent on you for almost every single aspect of their survival – they cannot walk nor can they talk, however, your baby is able to fully enjoy the nutritional benefits breast milk provides. Why is this so? Compared with other body systems, a baby’s digestive system is mature enough at the time of birth to digest breast milk.

Gut Development

In general, a foetus develops from three different layers of cells to form three main components.

A baby’s intestines start to develop during the 5th week of pregnancy while his digestive system starts to work when he is in the 3rd month of foetal development.

It is best to give only breast milk until your baby is 6 months old; after this, solid foods containing protein, fat, starch, vitamins and minerals can be introduced, as his digestive system is now mature enough to digest more complex foods. Do continue to breastfeed your child while he gradually gets used to eating solid food.

Within Your Baby’s Gut

Bacteria actually play an important role in helping babies achieve a healthy gut. When you start to breastfeed your baby, you introduce several beneficial bacteria such as Bifidobacteria, which are crucial for your baby’s gut health. Over the first few days, both good and bad bacteria increase rapidly to establish a healthy balanced gut microflora. These microflora are important as they help protect your baby against infections and help his immune system to mature. Babies that don’t have the right balance of gut bacteria are more prone to colic and are believed to be at a greater risk of developing allergies and asthma when they grow up.

Breastfed vs. Bottle-fed

Breastfeeding helps your baby achieve optimal growth, development and health. Breast milk is rich in antibodies and studies have shown that breastfed babies have significantly fewer gastrointestinal, ear, urinary and respiratory infections. Breast milk will also encourage the colonisation of good bacteria in a newborn’s gastrointestinal tract.

Bottle-fed babies on the other hand, tend to have far less bifidobacteria in the gut – bacteria that contribute towards the development of healthy gut microflora. Moreover, bifidogenic factors that are found in breast milk help to boost the growth of beneficial bacteria in the gut, which lessens the risk of diarrhoea and other general intestinal illnesses.

The World Health Organisation (WHO) recommends that mothers exclusively breastfeed their babies for at least the first 6 months. However, if possible, both UNICEF and WHO encourage mothers to breastfeed up to two years of age.

Care for Your Child’s Digestive Health

A healthy digestive system is important to ensure that your child gets all the nutrients he needs to grow properly and stay healthy. Food has to be broken down and absorbed properly, as an undernourished child may suffer from improper nutrient breakdown, absorption, and metabolism. If any part of the process goes wrong, your child’s nutritional status is at stake, and when this happens, it may affect his physical as well as cognitive development.

So, if you want your child to grow and stay healthy for many years to come, start taking good care of his little tummy now.

Mouth ulcers are small, round or oval-shaped painful lesions that appear in the mouth. They can occur on the inner side of the cheeks or lips, the edge of the tongue, or at the base of the gums.

Mouth ulcers are generally harmless, but they can be a source of great discomfort for children, especially when it makes eating, drinking, talking and even sleeping difficult. For some, the pain can be so intense that they might refuse to eat, drink or brush their teeth. Some children tend to experience it more often than others.

What You Need to Know about Mouth Ulcers

Some children may be prone to developing recurrent mouth ulcers. This problem sometimes runs in families. The ulcers are usually small (less than 1 cm) with a grey or yellow colour and reddish margin. They may be triggered by trauma such as a cut or abrasion due to accidental biting of the tongue, brushing too hard, the rough edge of a tooth or consuming very hot food and drink. They can also be triggered by stress, eg during school examinations. Deficiencies of vitamins and minerals such as iron, folate and some of the B vitamins may also be associated with the development of these ulcers. Your child may complain of a tingling or burning sensation a day or two before the ulcer appears.

Sometimes, mouth ulcers may be caused by viral infections such as hand, foot and mouth disease or chicken-pox. These types of ulcers may be associated with fever as well as rashes on other parts of the body.

What You Can Do

Normal mouth ulcers usually heal quickly within a week or two without any treatment. However, if your child is greatly disturbed by the stinging soreness, there are things you can do to ease your child’s pain and promote healing of the ulcer.

Food choices

• Avoid feeding foods that are hard, chunky, very hot, salty, spicy or acidic (eg orange juice).
• Feed bland foods (eg yoghurt, custard) that won’t aggravate the pain.
• Make sure he drinks lots of water.

Relieving the pain

• Let him suck on ice.
• Apply pain-relieving oral gel on the affected area.

For quick healing

• Have him rinse his mouth with mild salt solution.
• Encourage him to sleep more.
• Get your child back to his regular eating habits.

Who would have thought that a seasonal flu could turn out to be a more deadly disease? When Damia Bastrisya came down with the flu, Erna Waty Salihuddin, the mother of the child, expected it to be nothing serious. Instead of visiting the doctor, she gave her child leftover medicines that she had at home thinking that it would clear the flu. Erna saw no improvements in Damia’s condition. Within a few days, Damia’s condition went from bad to worse. She was not only coughing, she began developing a fever as well.

“In several hours, her fever worsened. Her body was very hot and weakened dramatically. I knew I had to bring Damia to the hospital when she started vomiting,” said Erna.

“It’s H1N1”

Erna had a hard time digesting the news when the doctor broke the dreaded news to her. “Hearing that your child is infected by the H1N1 virus was really devastating. I felt so helpless. I never expected my own child to be infected by the deadly virus!”

H1N1 is an influenza virus that causes severe illness in people. It was first detected in April 2009 and on June 11, the World Health Organization (WHO) declared it a pandemic as the virus began claiming many lives. Malaysia’s first case occurred on May 15. During the peak period of the virus, several schools and universities were shut down. As of October 30, the death toll in Malaysia remains at 77 and has been stagnant the past months.

In Erna’s case, her child, Damia had definitely shown symptoms of the H1N1 virus infection. The symptoms included fever, cough, headache and fatigue. Some people might experience vomiting and diarrhoea. Young children and the elderly are at a higher risk, especially if they have medical conditions like asthma and heart disease.

Speedy Recovery

Damia was immediately put on an intravenous drip upon admission as she was dehydrated from vomiting. During her 5-day stay at the hospital, she had a steady supply of fluids, an antiviral agent and antibiotics and thankfully, her condition gradually improved.

As for Erna’s entire family, they quarantined themselves in their home for a week, as they did not want the virus to spread. They also wore masks and ensured that they kept themselves hygienic.

After The Ordeal

“Damia was and still is a strong girl. She fought very hard when the H1N1 virus infected her. I am so proud of her,” said Erna, as she smiled at Damia. From the horrific experience, Erna learned that she could not take things for granted.

“I used to think that it (H1N1 infection) won’t happen to my family but it did. We need to be more alert and more considerate of others. If you’re sick, it’s best to stay home. Do not let others get infected. In fact, see your family physician right away. It’s better to be safe than sorry.”

When your child vomits, his stomach contents are forced up his oesophagus and out of his mouth. Vomiting is not a disease, but a symptom. It may sometimes be a sign of an underlying disorder or disease.

You can expect your child to vomit several times during his early years because vomiting is a symptom of common childhood illnesses such as gastroenteritis (due to virus, bacteria or parasite infection in the gastrointestinal tract), upper respiratory infection and food poisoning.

In some cases, vomiting can be a symptom of conditions such as blockage of the digestive tract, urinary tract infections, disruption of the balancing mechanism in the ear, hepatitis and pancreatitis. Increased pressure in the brain, which can be caused by head injury, bleeding in the brain, brain tumour and infections of the brain like meningitis, can also result in vomiting. Persistent vomiting in a child must, therefore, be taken seriously.

When to See the Doctor

Easing your Child’s Distress after a Bout of Vomiting

• Infections

A variety of viruses (e.g. rotavirus), bacteria (e.g. Escherichia coli and Salmonella) and parasites can cause diarrhoea. These germs are mainly picked up through contact with contaminated surfaces, consumption of untreated or contaminated water and unpasteurised milk as well as consumption of contaminated or improperly cooked foods. Cholera caused by a bacteria, Vibro cholerae, also presents with diarrhoea.

• Food Intolerance

Food intolerance happens when the child develops a reaction towards certain ingredients of food. Diarrhoea is usually the most common symptom of food intolerance, although it can be accompanied by other symptoms such as vomiting, skin rashes and wheezing. Cow’s milk, egg white and wheat are examples of food that can cause food intolerance.

• Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is an intestinal disorder that is linked with diarrhoea, abdominal pain, constipation or a combination of these symptoms. Your child’s intestines may be overly sensitive to food and stress if he has IBS.

Beware of Dehydration!

Children who experience diarrhoea are more vulnerable to dehydration, which may be life-threatening if taken lightly. The primary concern is to make sure that your child stays hydrated. Owing to frequent watery bowel movements, he loses significant amounts of water and salts, which can be life threatening, particularly in young children.

Your child may be suffering from dehydration, if he displays any of the following:

• Sunken eyes.
• Sunken fontanelles in a baby.
• Dry, wrinkled skin.
• Little or no tears when crying.
• Reduced urine.
• Lethargy or irritability.
• Fatigue or dizziness.

To prevent the development of dehydration, try taking these steps:

• Give your child plenty of clear liquids to drink in small but frequent amounts.
• Give your child Oral Rehydration Salts (ORS) to replace fluids quickly.
• Feed your child his regular diet if he is not vomiting.
• Avoid giving your child foods that are oily, fried or highly seasoned, for a few days.

Bring your child to the doctor if your child is very young or if he is dehydrated.

Diarrhoea Prevention Tips:

• Practise good hygiene. Ensure that both you and your child wash your hands well and often, especially after using the toilet and before preparing food, and before eating.
• Make sure that you serve your child well-cooked foods and serve food right away after it has been cooked or reheated.
• Wash thoroughly any raw fruits and vegetables that you’re planning to serve your child.
• Be extra cautious when it comes to buying prepared foods from street hawkers.
• Teach your child to avoid drinking water straight from the tap.

REMINDER: The self-administration of anti-diarrhoeal and anti-vomiting drugs is not recommended when it comes to treating diarrhoea in children. See a doctor.

Brush, Brush, Brush Your Teeth…

Brushing can help prevent tooth decay but you need to make sure your child knows how to brush properly. Here are some tips on brushing to maintain his mouth’s cleanliness:

• Brush at least twice a day, after waking up and before going to bed. Plaque build-up speeds up during bedtime due to lower saliva production.

• Teach proper brushing technique. Let him know that brushing only the front teeth will not guarantee a clean mouth. The sides and the back of the teeth are just as important in maintaining the cleanliness of his mouth.

• Don’t rush to brush. Spend at least 3 minutes each time he brushes.

I Don’t Wanna Go!

Dental experts recommend regular check ups at least twice a year, As much as most children (and even adults) dislike going to the dentist, early and regular oral care ensures less (painful) dental visits in the future!

Know Your Child’s Bowel Movements
There is no ‘normal’ frequency of bowel movements. For children, the number of bowel movements changes according to his age and diet. Each child has his or her own pattern of bowel movements. As long as your child is growing well, is energetic, and passes stools easily, the frequency of his bowel movements is not important. However, it is ideal to have a similar pattern of bowel movements every week.

Features that suggest an organic cause are:

• Site of pain. The further the pain is from the center (periumbilical), the more likely the pain is to be organic.
• Sleep disturbance. If the pain is severe enough to wake your child up at night, there is a higher chance that there is an underlying organic disorder.
• Age of child. In general, the younger the child, the higher the chance that there is an organic disease.
• The presence of features such as fever, blood in stools, inflammation (of joints, skin or eyes), weight loss, poor growth, anaemia, jaundice, high blood pressure, abscesses around the anus, recurrent and indolent mouth ulcers.
• Family history. There may be a family history of diseases such as inflammatory bowel disease, peptic ulcer disease or renal disorders.

The pain can affect your child’s growth and development as well as his overall well-being. It can interfere with his school attendance, affect his appetite, sleep, mood and emotions. So, if your child suffers from it, bring him to see the doctor.

Your Child may be Stressed Out!
Studies of recurrent abdominal pain in childhood showed that in over 95% of cases, there are no underlying diseases. This does not mean that the pain is not real, or made up. In cases where medical causes for the pain are not found, it suggests that the pain could be largely caused by stress, anxiety or depression. Studies conducted by University of Malaya Medical Centre show that children aged 9-15 years who experience recent significant lifeevents such as death in the family, change of address, failure in a major school examination or bullying at school, have a higher chance of developing recurrent abdominal pain.

When Your Child’s Stomach Hurts…
You can help your child feel better at home by doing the following:

• Get your child to lie down.
• Spend time listening to your child about anything which may cause him or her to feel anxious or overly stressed.
• Distract your child with interesting activities such as reading or playing toys.
• If your child does not improve, it is advisable to seek medical help early as there are many possible causes of abdominal pain and it is important not to miss an organic cause.

A. First line of defense: Non-specific immunity (innate immunity)

• Skin. A physical barrier, which produces mildly antiseptic sweat and sebum.
• Eyes. Tears wash away dirt and contain an antiseptic substance.
• Mouth. Saliva, a mixture of mucus and enzymes, helps clean the mouth.
• Respiratory tract. Mucus produced here traps organisms and moves them to the throat by tiny hairs called cilia.
• Stomach. Hydrochloric acid in the stomach kills most invading organisms.
• Genital and urinary tracts. ‘Good bacteria’ in these tracts help prevent the growth of harmful organisms.
• Intestines. Mucus protects the lining of intestines from digestive chemicals and harmful organisms.
• Cellular defences. If an invader slips through the barriers above, the immune system reacts by producing white blood cells, other chemicals and proteins to attack and destroy the pathogens. The invaders are sought out and destroyed before they can reproduce. In fact, if they manage to multiply, the immune system responds by increasing in productivity to defeat them.

B. Second line of defense: Specific immunity (acquired immunity)

• Lymphocytes. A type of white blood cell which the main type, T cells and B cells, recognise and eliminate foreign molecules (antigens). This occurs a few days after the exposure of foreign microorganism.
• Antibodies. Proteins produced by B cells destroys microorganisms by binding to the antigens. Only T cells directly attack the invaders.
• Memory T and B cells. Once the microorganism is destroyed, some of the active T and B cells become memory cells. If the body encounters the same microorganism in the future, the second line of defense acts faster.

or more specifically, as “that which bends up”. Chikungunya has effects which persist for a long time or are chronic. In fact, this is one of the main differences between Chikungunya and dengue. Even after the fever has subsided, problems such as joint pains could persist for several months.

Until February 21, 2009, a total of 8920 dengue cases and 23 deaths were reported nationwide since 2009. This is a 158% increase compared to the same period last year – 5646 cases and 10 deaths. The Klang Valley reported majority of the cases while the others occurred mostly in Perak, Johor, Penang and Sarawak. In addition, 883 cases of Chikungunya have also been reported during the same time period this year.

Prevention
Eliminating mosquito breeding areas can be an extremely effective and simple to perform, without resorting to insecticides. Many mosquitoes breed in standing or stagnant water. Ensure that there are no mosquito breeding grounds around your home. Empty water from containers eg flower vases, water coolers, overhead tanks, pails, pet dishes and bird baths. Remove unused plastic pools, old tyres, or buckets; clear clogged gutters and repair leaks around faucets.

Analysis of dengue-related deaths in 2008 showed that 90% of them could have been prevented if patients had sought early treatment. Report any suspected cases to the health authorities for fogging to be carried out in your area.

Any suspected hearing loss should be diagnosed immediately. If the hearing loss is permanent, your child should be aided with hearing devices as early as possible to improve the hearing capability that will allow for optimum speech development, learning and socialization despite the hearing disability.

Signs That Your Child May Be Having Trouble Hearing

Toddlers

• Failure to turn head to direction of call or sound
• For infants, failure to be awakened when loud sound is introduced
• Delayed speech development i.e. failure to develop single words speech by age one and half years
• Showing no interest in being read to or in playing word games
• Habitual yelling or shrieking when communicating or playing
• Greater responsiveness to facial expressions than to speech
• Shyness or withdrawal
• Frequent confusion and puzzlement

Older Children

• Inappropriate responses to questions or other sound stimuli
• A failure to respond to verbal requests
• A seeming inattentiveness

Getting Help
Fortunately, children with some form of hearing loss will still be able to hear, either through ear surgery or the use of properly fitted hearing aids. To effectively gauge the degree of hearing loss and pick the proper aid, you will need to make several visits with the audiologist.

Some commonly used treatments include antibiotics to clear up infection (if it is a temporary case of hearing loss), removal of wax or foreign objects, hearing aids, vibrotactile aids (which translate sounds into vibrations that are felt through the skin), and cochlear implants, which are most effective when used early in life. On top of that, speech therapy is also important for children who experience any type of permanent hearing loss to help them to maximise their communication skills.

Most school systems have programs that help parents teach their child to listen. School-age children may also be enrolled in special classes for the hearing impaired or in regular classrooms with additional speech and tutorial help.

Common Vision Problems
Vision problems normally fall into two categories – those that can be detected immediately and those that take more medical consultation hours to determine. Here are some common ones:

It is important for you to give your child proper eye care, whether or not your child possess a medical eye problem. Please do not wait until it’s too late. After all, the eyes are the windows to the world.

Tiny holes begin to appear on the surface of the enamel. These tiny holes become bigger and bigger until one large hole appears – this is a cavity (also known as early childhood caries). Pain ensues when the erosion goes past the enamel and attacks the dentin. Tooth decay can also lead to inability to eat, infection and fever. If the decayed tooth is extracted, it may lead the remaining baby teeth to “move across” and restrict space for adult teeth to grow. On the other hand, infection from a milk tooth that causes frequent gum abcesses may effect the developing permanent tooth underneath it. Also, once your child has had a cavity, he is at risk of developing more.

GUMS GONE BAD
While a cavity affects the tooth, periodontal disease (gum disease) is a serious bacterial infection that destroys the gums and bone around the roots of the tooth causing the tooth to become loose. You may think that periodontal disease is an adult problem, but it can occur in children in the form of gingivitis (the first stage of periodontal disease), which causes gum tissue to swell, turn red and bleed. If not treated, it will advance to more serious forms of periodontal disease. Gingivitis is almost always the result of poor dental habits. Other causes include nutrient deficiency, particularly vitamin C and certain blood disorders.

3 Steps To Healthy Teeth & Gums

Brush up!
Supervise your child’s brushing daily, before breakfast and before bedtime. (Occasionally brush their teeth for them to ensure effective cleansing)

Eat & drink right
Give your child a varied diet that emphasises foods rich in protein, vitamins, and minerals (especially calcium and phosphorous). Keep sugary snacks (especially the sticky ones) to a minimum and limit the amount of juice your child drinks each day.

Visit the dentist
Schedule a dental examination for your child twice a year even when their teeth are “healthy”. Never terrify your child with horror stories of “Mr Evil the Dentist”.

MAKING PREPARATIONS

• Pack what you need the night before, so that you will not need to rush the next morning.
• Tell your baby what is going to happen, even if she may be too young to understand.
• Try not to leave your baby when he is tired, hungry or sick as this is probably when she is at her most temperamental. Pick a time when she is happiest and most receptive.

AT THE CAREGIVER’S PLACE

• If the caregiver is not a familiar relative, introduce your baby to her and give them some time to get them accustomed to each other.
• Stay with your baby during the first few visits. This gives her a chance to see that the caregiver is someone you trust.
• On the actual day, avoid rushing and never try to sneak off when your baby is not looking.
• Reassure your baby that you will be coming back but avoid prolonged, emotional goodbyes.
• Make sure you give the caregiver specific details of your baby’s sleeping and eating patterns. The consistency in routine will make it easier for baby.

BRUSHING YOUR TODDLER’S TEETH
Brush his teeth for as long as he allows you. He will probably want to brush his teeth himself when he reaches two years. Teach him by standing behind him in front of a mirror. Then show him the correct movements by holding his hands as you brush. Ensure that he does not swallow the tooth paste. Let him rinse and spit out. The fun element here will make him cultivate the teeth brushing habit more readily.

HOW TO BRUSH CORRECTLY

• Top teeth – Brush the teeth downwards and away from the gums. Ensure the brush gets right to the back of your child’s mouth.
• Bottom teeth – Brush the teeth upwards and away from the gums. Ensure the brush gets right to the back of your child’s mouth.
• Biting surfaces – Brush to and fro along the flat tops of the teeth all around the mouth
• Gums – Brush top and bottom gums with a circular motion. Make sure both outside and inside of the gums are covered.

Face fun
To your baby, the most fascinating, aweinspiring thing in the world (at least for now) is none other than mommy’s or daddy’s face. Face-to-face contact allows expressions on your face – from happy to sad, surprised to sneaky. Pull some funny faces and you will be delighted to see your baby trying to imitate you!

Sweet sounds
Your baby’s hearing ability is very welldeveloped, even in infancy. She is able to respond to various noises but the sound that strikes her the most is the sound of your voice. Make it a habit to talk, sing or hum gently to her throughout the day. Your baby will respond to your voice by stopping and listening to you. By about 6 months, she will be able to detect where your voice (or other sounds) are coming from and turn her head towards that direction.

Hanging objects
Your baby sees the world as a fascinating tangle of shapes and colours. She has the ability to focus on and follow slowly moving objects. So, do provide her with objects that will stimulate her visually. But remember to place it out of her reach for safety reasons.

The magic touch
Babies thrive on cuddles, hugs and kisses. Take every opportunity to massage, gently rock, kiss and cuddle your baby.

• DO wipe over and behind your baby’s ears with a warm, moist wash cloth or cotton ball.
• DO consult a paediatrician if you think there’s too much wax build-up in your baby’s ears.
• DON’T wipe inside your baby’s ear.
• DON’T try to remove earwax from your baby’s ears with a cotton bud. When pushed too far, this may rupture his eardrums.
• DON’T put drops into your baby’s ears unless prescribed by the paediatrician.

Cleaning Baby’s Face

• Undress baby down to her nappy, wrap her up snugly in a bath towel and put her on the changing table. Soak some cotton wool in the lukewarm water. Use a fresh piece of cotton wool to wipe each eye from the nose outwards.
  
  
• Use another piece of cotton wool to clean baby’s forehead and cheeks.
  
  
• Wipe over and behind each of baby’s ear. Do not poke it into the actual earhole. Use fresh cotton wool for each ear.
  
  
• Clean baby’s face by wiping around her mouth and nose.
  
  
• With fresh cotton wool, wipe under her chin and in her neck creases.

Cleaning Baby’s Arms, Hands and Tummy

• Remove the towel wrapping baby. Gently lift each arm and wipe the armpit area with fresh cotton wool.
  
  
• Unclench baby’s hands to clean the fingers, between fingers and palm.
  
  
• Wipe baby’s tummy and around her umbilical cord stump. Pat dry with a towel.

Step 1: Lay a clean nappy flat
on a clean surface.

Step 2: Pull the two
bottom corners upwards to
fold the diaper into a rectangle.

Step 4: Flip the diaper over.

Step 5: Pick up the top
layer by the lower right
corner and pull it out to the
left to make a triangle.

Save time at each nappy change!

• After washing and drying each load of nappies, fold them and place liners in position so they’re ready to use

• Keep all your nappy changing necessities in the same place so you don’t have to hunt for them

Washing nappies

You can soak up to 10 nappies at a time in the detergent and bleach solution, provided the last nappy to go in is soaked for at least 30 minutes. Machine-wash them with a mild detergent, rinse well, and sun-dry. Don’t use a fabric softener in the rinse cycle, as this will stay on the cloth and irritate baby’s skin. Avoid harsh detergents and those with added fragrance, conditioners or other chemicals that won’t agree with baby’s skin.

Changing safety

The safest place to change baby’s diaper is the floor, where he can’t roll anywhere and be hurt. If you have back problems or you just prefer to use a changing table, be sure never to leave baby unattended on the table for any length of time.

Step 1: Place baby on
a changing pad or mat
and remove his diaper. If
it’s only wet, put it into the
pail. If it’s soiled with stool,
use a hose to wash the
stool off into the toilet bowl,
then put it in the pail.

Step 2: Dip a cotton wool ball
into water and wipe any faeces
off baby’s buttocks. Clean
baby’s genitals gently, always
wiping from front to back.
Change to a fresh cotton ball
frequently.

Step 4: Place the folded diaper
below baby. Put a diaper liner
in position. Gently lift baby’s
legs by the ankle and slide the
folded diaper underneath him.

Step 5: Bring the tip of the
diaper up between baby’s legs
and hold it in place.

Step 7: Slide your fingers between the
diaper and baby’s tummy and pin or fasten
the layers together. If using a pin, be extra
careful not to prick baby accidentally.

As baby grows, her sleep patterns will change. As a newborn, baby will need about 15 to 18 hours of sleep a day. This is why she nods off to sleep easily, especially after you have breastfed her.

Watch out, however, because she will be awake in 3-4 hours’ time for her next feed. She stomach capacity is small and she gets hungry frequently. So, if she needs to wake up (and wake you up) for a feed, she will!

After baby’s first three months, you will notice that she is sleeping less. However, do not fret as baby has grown up a little and she is starting to be more alert. So, if she tends to be more wakeful at this stage, let her be. Baby might be fascinated by her surroundings and her curiosity will help turn her into the smart child you’ve always wanted.

By the time baby is 8 months old, she will start waking up less during the night. She no longer needs to be fed as often in the night. However, she is still a baby and, at times, will wake up and cry at night.You should see what she wants or needs, and try to lull her back to sleep.

How To Give Baby Better Sleep

Yes, you know very well that your baby needs to sleep. But do you really know how to help your baby get a good sleep? Try out these tips:

1. Ready to sleep
   Get to know the times when baby tends to get sleepy. Before those times, dress her in fresh clothes and diapers. Feed baby 30-60 minutes before you expect her to doze off. Make sure that she is not feeling too hot or too cold.
   
   
2. Sleeping place
   Of course, nothing could be more wonderful than sleeping in your arms. You can lull her to sleep by rocking, cuddling and singing to her. When she starts to enter slumberland, continue to hold her for 10 minutes before gently putting her in her cot. Make sure that the mattress is a fitted one. Do not line the sides of the cot with pillows as her breathing could be obstructed should one press against her face. Use cot bumpers, instead, with ties no more than 6 inches long.
   
   
3. Sleeping positions
   It is recommended for normal healthy babies to sleep on their backs (supine position) than on their tummies.
   
   
4. Proximity
   You and baby should develop a sense of closeness. Nothing beats the feeling of having you sleep by her side. Feeling the warmth of your body can help her have a more pleasant sleep. If baby sleeps in a cot, keep it in your bedroom during her first year at least.

Tub Baths

How often should baby go for a check-up?

The shaded areas in the chart above show when in baby’s first year you should bring him to the clinic for a check-up. Of course, if baby is ill, you need to bring him anyway – don’t wait for his next check-up if he needs medical attention now!

The first check-up

Baby’s first check-up will probably be the first time you and he meet the paediatrician. Relax and treat the paediatrician as a friend who will be helping you to take care of baby’s health throughout his
childhood.

The doctor will measure baby’s weight and length (see below) and ask you some questions about baby’s behaviour and health. Answer them honestly and voice your concerns and doubts if you have any. Asking questions doesn’t mean you’re stupid or a bad parent!

These are some of the questions the doctor may ask you about baby:

• What is baby’s feeding routine?
• Does he pass urine and motion regularly?
• Can he lift his head briefly?
• Is he able to focus on items 8-12 inches away?
• Does he respond to loud or sudden sounds?
• Does he respond to bright lights or sudden flashes of light?

What happens at baby’s check-ups?

• The doctor will take baby’s weight, body length and head circumference measurements – These three measurements combined provide a full picture of whether baby is growing within the normal range. Because the range is quite wide, you shouldn’t worry if baby seems too light or small for his age. If your doctor says he’s healthy and growing well, he probably is.
• The doctor will ask you about baby’s health and behaviour
• As baby gets older, the simple tests the doctor conducts to check his development will change. Don’t be alarmed if he isn’t able to do some of the things the doctor tries to get him to do. Children grow at their own pace, and your child may achieve some developmental milestones more quickly or slowly than other children his age.

Step By Step Guide On Folding And Wearing Diapers.

1. Pull bottom corners upwards to fold diaper into a rectangle.

2. Pull left corners to the right to make a square.

3. Push the bottom edge of the top layer into the middle to make a triangle.

4. Flip diaper over and fold square flap twice towards the centre to form a core.

5. Diaper is ready for use.

6.Lift baby’s legs by the ankles and slide the diaper underneath.
Bring the folded core up between her legs.

7. Fold the right and left flaps over baby’s waist and pull both ends tightly.

8. Slide your fingers between the diaper and baby’s tummy and using a diaper pin,
pin the layers together. Be careful not to accidentally prick her.