Don't ignore your baby's symptoms. A sick baby is stressful to parents.

Adj Assoc Prof Yeo Cheo Lian, Senior Consultant from the Department of Neonatal and Developmental Medicine at Singapore General Hospital, gives detailed answers to your questions.

Question by melody1512

Hi!

How do you know that your toddler of 2years is not overeating which may cause them to become overweight or result in vomitting?

Thanks!

Answered by Clin A/Prof Yeo Cheo Lian Head & Senior Consultant Department of Neonatal and Development Medicine Singapore General Hospital

Your concern is valid. It’s obvious that eating too much can make people fat. More kids are developing diabetes at an early age and are overweight. However, do not assume that if your child is overweight, they must be overeating. A child who eats to satisfy their hunger is not overeating. Eating beyond the point that they feel full or drinking large amounts of juice, or fruit-flavoured drinks is overeating.

If your child eats or drinks food and beverages between meal and snack times, or if they eat a lot of candy, potato chips, high-fat baked goods or fried foods, this could also lead to excess weight.

Help your child learn to eat normally to keep a healthy weight as he or she grows by:

• Offering small portions. Let the child ask for more.
• Allow enough time. This may give your child a chance to feel full.
• Take food away when your child stops eating.
• Avoid extremes of withholding food when your child is hungry. Offer a small snack.

Question by eujiny93

Hi

My daughter in law works overseas and doesnt have proper nutrition as both she and my son works in the day and are too tired to cook dinner. If any cooking is done, its usually frozen food put in the oven. How will this affect the foetus. She does take folic acid and calcium. She also had early stage bleeding twice and is now due July. I will be visiting during her confinement. Please advise what I can do for both mother and baby to ensure both are healthy and well.

Thank you
Lisa

Answered by Clin A/Prof Yeo Cheo Lian Head & Senior Consultant Department of Neonatal and Development Medicine Singapore General Hospital

Hi Lisa, you are right. Food can affect the health of a pregnant woman and that of her baby’s. Fresh fruits, vegetables and lean meats are solid nutritional bets, but there are also healthy versions of frozen dinners too. Certain food which may result in food-borne illness in a pregnant woman or have possible adverse effects on the baby’s developing nervous system should be avoided.

Foods to avoid during pregnancy include:

• Seafood high in mercury (eg swordfish, shark, ling mackerel)
• Raw, undercooked or contaminated seafood
• Undercooked meat, poultry and eggs
• Unpasteurized foods, juices
• Unwashed fruits, vegetables
• Excessive quantity of liver
• Excessive caffeine
• Herbal tea, alcohol

Folic acid and calcium prescribed by her obstetricians helps. The early stage bleeding experienced is unlikely to be related to her dietary habits. She should consult her obstetricians at the earliest possible if bleeding recurs. After giving birth an adequate diet is especially important to help ensure the mother’s health and to supply her with the energy necessary to care for her new baby. A postpartum woman’s diet should replace nutrients lost during pregnancy and include nutrients needed to maintain her body and to facilitate breastfeeding. The chart summaries the range and amount of food required by woman during confinement:

Remember to drink plenty of liquids. Drink to satisfy her thirst, but be sure to drink six to 10 glasses of liquid everyday Avoid serving:

• fad weight reduction diets,
• harmful substances (such as alcohol, tobacco and drugs)
• excessive intake of fat, salt, caffeine, sugar, and artificial sweeteners.

With the physical and emotional support showered by you and family, your daughter will transit readily into her new role and enjoy motherhood.

Question by vaskuna

Hi Doc!

I have a set of preterm (26 weeks) twins who r now turning two. They have been in n out of hospital for bronchitis. They are always treated with ventolin MDI in hospital. I want to know if or should they be put on a preventer long term. And would it affect them in the long run as both of them have got cardiac conditions ASD and PDA subsequently.

Thank You!

Answered by Clin A/Prof Yeo Cheo Lian Head & Senior Consultant Department of Neonatal and Development Medicine Singapore General Hospital

It is a fact that preterm kids are at risk for respiratory ailment in early childhood. In most children, the use of timely appropriate vaccination against common childhood infections and with appropriate physical growth, the frequency of these respiratory illness decreases with age.

Frequent relapses of respiratory illness affect child’s eating habit and may contribute to poorer weight gain and affects lung healing as well as acquisition of developmental skills. Medications are available to improve the control of respiratory symptoms.

It is relevant for you to discuss the benefits and side effects of medications with your family physicians or Paediatricians. Understanding the pros and cons of medications and the natural history of respiratory illness of ex-preterm kids will allow you to make a concerted decision on the use of medication to control your child’s respiratory conditions.

Question by meiyun11

Hi, I have two questions to ask regarding my 5 mth old baby:

1. My baby has a red patch on the back of her neck which the doctor diagnosed it as a birthmark and said 90% will fade. Is there anything which I can do to make the birthmark go away?
2. She has yellow discharge from her left eye daily. One doctor diagnosed it as eye infection and one said it is blocked tear duct. Is there anything which I can do to minimize the discharge? Her red eye has no such problem.
3. She has dry circular patch of skin on her elbows and thighs as in . What can I do to help her recover from the dry skin? It looks something like this (http://i44.photobucket.com/albums/f6/drxxchula/What%20IS%20IT/SDC10643.jpg)
4. She is turning 6 mths old next month and I plan to feed her solid food. What are the issues which I need to consider before giving her solid food given her skin condition and eye discharge? Thanks a lot for your advice in advance!

Regards,
Mei Yun

Answered by Clin A/Prof Yeo Cheo Lian Head & Senior Consultant Department of Neonatal and Development Medicine Singapore General Hospital

1. From your description, these patches are most likely collection of fine blood vessels in the layer of the skin. It is a congenital capillary malformation present in 25%-50% of newborns and also termed as stork bite marks. Stork bites on the back of the neck usually do not go away. No treatment is needed. If a stork bite lasts longer than 3 years, it may be removed using laser surgery to improve the person's appearance.
2. Absence of eye swelling and pain suggest that it is unlikely an eye infection. One third of newborn babies have a blocked tear duct at birth. For most children born with a blocked tear duct, there is only a small membrane blocking the opening, which opens spontaneously as the infant grows. Usually the membrane opens by 10 to 12 months of age and spontaneous remission occurs in 95 percent of cases by age 1.

3. The following may be considered while waiting for spontaneous resolution:

   • Keep the eye clean
   • Massage the lacrimal sac In cases where tearing persist, surgical intervention may be considered to open the lacrimal duct and improve drainage of tears. It is recommended that you visit your Paediatricain or an ophthalmologist if problem persist.
4. Sorry, cannot comment as pictures cannot be accessed.

Question by varsha

Hi, My daughter is turning 4 yrs old in June. She is overweight with weight of 35kg and her height is 110 - 115cm. She doesnt's eat much but eats chocolates & ice cream regularly.

I realise she gets tired easily and yesterday while runnig about with her cousins, all of a sudden, she coughed & coughed and she started jumping like as if she couldn't breathe., and then there was some milk which came out of her nostrils. I am worried. What should I do. Is there any medications for her to stop gaining weight.

Pls help.
Varsha

Answered by Clin A/Prof Yeo Cheo Lian Head & Senior Consultant Department of Neonatal and Development Medicine Singapore General Hospital

Dear Varsha, Excessive weight gain and less than desirable pattern of growth may be secondary to:

• Eating more calories than he or she expends
• Too much fat in the diet
• Too much sugar in the diet
• Family genetics
• Hormonal disorder

It is recommended that you consult your family physician or paediatrician to ensure that there is no medical reasons for her weight gain. Following exclusion of medical risk factors, majority of children can achieve healthy, long-term weight loss by changing a few daily habits and getting involved in more physical activities.

Some simple changes that improve a child's chances of maintaining a healthy weight include:

• Choosing snack foods that are fresh and unprocessed, such as fruits, vegetables, and whole grains. Unhealthy snack foods include processed, high-fat, high-sodium, or high-sugar foods, such as candy, chips, processed cheese and meat products, or bread products that are made with refined white flour.
• Encouraging children to drink more water, and limit the consumption of sweetened beverages of any kind including fruit juice
• Discouraging eating while distracted and/or "on the go" including while watching television, in the car, or playing video games
• Limiting how often the family eats fast food - even "healthy" options on fast food menus are often high in fat, sugar, sodium, and calories.
• Encourage physical activities by limiting the amount of time your child spends in front of the television and computer. Play a good role model by being physically active.

The episode of spitting of milk is possibly the result of increased intra-abdominal pressure related to severe coughing. Milk can spill from the nostril with a severe bout of cough. Medication is reserved for extraordinary situations in children more than 12 years old. There is no safe medication to stop weight gain in children.

Question by cann71

Hi Doc,

My son has been suffering from cough since March until now, he has yet to recover. We have been sending him to see GP and was given medication and anti-biotic for the phlegm.

He will be turning 4 years old in November and is now in childcare centre.

Would appreciate if you could advise whether i should send him to pediatrician for further examination of his condition? Does inhaler helps?

Many thanks.

Answered by Clin A/Prof Yeo Cheo Lian Head & Senior Consultant Department of Neonatal and Development Medicine Singapore General Hospital

There are many reasons for prolonged cough. Treatment recommendation varies depending on causative factors. There is room for better control of his respiratory symptoms, hence certainly relevant for child to be assessed by your regular family physician or a paediatrician to establish cause and advice on use of inhaler and other preventive measures.

Question by crystal76

my boy is 11 months old. before this, he is already banging his head onto the wall before sleep. during daytime, he will also rock to & fro to bang onto the body of the person who is carrying him. he will do that when he is in the stroller too.

my husband is afraid that his brain is affected due to the few falls he suffered previously when he is still a baby. or is he having sleep disorder?

i read that it may be due to attention seeking & by stopping him, will reinforce the behaviour. however, will it affect his brain development or his health in any way?

Answered by Clin A/Prof Yeo Cheo Lian Head & Senior Consultant Department of Neonatal and Development Medicine Singapore General Hospital

The rhythmic behaviour described is unusual of an infant. It is unlikely for an infant to demonstrate attention seeking behaviour by rocking and banging themselves against surfaces.

Ear ache, headache and neuro-developmental deviant are some conditions that may account for behaviour observed. It is highly recommended that you consult your family physician or a developmental paediatrician to exclude and establish the significance of the behaviour observed.

Question by skyblue_01

Hi Doc,

My baby is 10 weeks old. I am currently bottle-feeding her mainly with my expressed breastmilk and supplementing with formula milk (Enfalac).

Since her 8th weeks, she has been feeding 135ml every 3 hourly and she has regularly finished the amount given without trouble. However, the past few days, she has been vomitting sticky milk-like fluid shortly after her feed and she sound like she has lots of phlegm.

Also, she used to poo twice a day at noon and in the evening. However, the same past few days, her poo is at various times throughout the day (up to 6 times a day) and at smaller amount each time. Is this change normal? I understand that babies at 10 weeks should be poo-ing less but mine seems to be poo-ing more often.

Please advice on the vomitting/phlegm as well as the frequency and amount of poo. Also, should I take her to a GP or a PD to solve the phlegm and vomitting problem?

Thank you.

Regards,
May

Answered by Clin A/Prof Yeo Cheo Lian Head & Senior Consultant Department of Neonatal and Development Medicine Singapore General Hospital

Formula milk is higher in calories than full cream fresh milk and this is not necessarily a good thing. The extra calories are usually from sugar and fat, not from any added 'special nutrients' The typical caloric requirement for a toddler is 1000-1200 kcal/day and the majority of this should be coming from solid food. Infants are ready for cow’s milk when they are more than 1 year old.

Cow's milk is a convenient source of calcium, protein, fats, vitamin D, etc. However, calcium requirement of a toddler is easily met f your child gets the recommended two servings of dairy foods every day. A serving of 125 grams of cheese or 2 cups of yoghurt a day ensures that her calcium requirement is met. However, it is important to ensure that she is served a healthy well-balanced meal comprising of adequate portion of grains, vegetables, fruits and meat/fish.

Question by inner_peace

Hello Doctor,

My baby has had periods of milk strike since she was younger. During the milk strike period, she will cry whenever we feed her and refuse to swallow. Is this normal and should I stop feeding her milk? Her stats are as follow:

1. She is currently 1 year old.
2. She is at 97th percentile for her height and 90th percentile for her weight.
3. She sleeps less than 10 hours a day, which is below the norm for her age at 1 year old.
4. She does not have reflux or phlegmn or wind problems.
5. She has already teethed and has no problems with her solids, though she is a fussy eater.

By putting her in her sarong for her feeding (captive), we are eventually able to force her to swallow her milk, but the first 5 minutes while she is crying and with milk leaking all over her mouth is not a pleasant experience. I have relegated the feeding to her grandmother as I can't bear to go through with this.

Answered by Clin A/Prof Yeo Cheo Lian Head & Senior Consultant Department of Neonatal and Development Medicine Singapore General Hospital

Some kids don’t like milk and your child appears to be one of them. With her age at a year old and with her preference for solids, it is reasonable to ensure that she is served a well-balanced meal of solids comprising of grains, vegetables, fruits and meat/fish. Children at 1-11/2 years of age are ready for transition to cup feeding with cow’s milk.

A serving of 2 cups of milk or yogurt or 125 grams of cheese is sufficient to meet the calcium required at her age.

Avoid force feeding. Feeding experience that frustrates you irritates her equally and can result in negative caloric balance if she spends energy struggling and crying over a feed. Force feeding a child who is crying or in a semi-awake state increases the risk for aspiration of feeds into her lungs, resulting in acute breathing difficulty.​

Ref: U11