QUESTION 1

Dear Doctor,

I am a 30 year-old female with a gastric problem. I m trying to shed some 5 kg, and found out the best way to reduce weight is to increase metabolic rate. Is this the most effective way? Is there a way to measure my metabolic rate? I also like to drink Ensure Life. Would you recommend that I drink this everyday for complete nutrition?

Bee Bee

ANSWER:

Dear Bee Bee,

It would be good to know what your present weight and body mass index are to assess how important it is to lose the 5kg that you want. You are correct in that increasing your metabolic rate would help you to shed weight more effectively as you would be burning more calories, but equally important is regulating your calorie intake in terms of the food type and quantity consumed. Both need to go hand in hand.

You can calculate your ‘metabolic rate’ through calculators that you can access on the Internet – Look for the basal metabolic rate (BMR). Increasing metabolic rate is safely done through regular exercise and keeping physically active as well as building muscle.

Food supplements or substitutes like Ensure Life should be used exactly for that purpose. If underweight, the supplements help to gain weight if added to the regular diet. If overweight, the substitutes can replace a higher calorie meal to help the person reduce energy intake. Take care that these are not taken over and above normal meals if your intention is to lose weight!

All the above suggestions should be moderated if you have any medical issues such as gastritis – which may limit your choices of food.

– Dr. Kelvin Tan Eng Kiat

QUESTION 2

Dear Doctor,

My baby girl is turning 1 year. She currently drinks 210ml of Gain IQ 3 times a day. We realised that whenever she moves around, there will be a "clicking" sound around her joints. Is this normal or could it be due to lack of calcium or iron?

Kelly Ng
 

ANSWER:

Dear Kelly,

The "clicking" sound that you are hearing may be normal and may be caused by the cartilage on the joints rubbing over each other. It is normally not related to lack of calcium or iron. If it is isolated to a particular joint only, or if it is significantly loud, do bring her down to your doctor to assess the stability of the joint which may be abnormal and need to be treated.

– Dr Lim Kwang Hsien

QUESTION 3

Dear Doctor,

My 17-month-old daughter only weighs 8.5 kg, putting her at 3rd percentile. She has just been weaned off TBF and is now on formula milk. She drinks around 100ml to 180ml per feed at 4-hour intervals with brown rice porridge for lunch and dinner. Is there something wrong with her diet or could it be other reasons attributing to her low weight? Should I be concerned?

Jenny Goh
 

ANSWER:

Dear Jenny,

You will need to bring your daughter to your paediatrician for a full assessment to ensure that she does not have failure to thrive. Before seeing him/her, there are some useful things that you might like to do. This includes plotting her growth (height and weight) from birth on the growth charts in your health booklet, as well as keeping a food diary for 1-2 weeks.

There are several factors that may suggest that her current weight may be normal. These include:

1. Not being a fussy eater with a good appetite.
2. Has no diarrhoea.
3. Has adequate weight gain (e.g.: if she has always been on the 3rd percentile for height and weight since birth).
4. If you and your husband both have a small frame.

It may be beneficial to see a dietician to help you design an adequate dietary programme with sufficient calories. This might include supplementing her diet with a high calorie complete and balanced formula like PediaSure.

– Dr Lim Kwang Hsien

QUESTION 4

Dear Doctor,

My 6.5-month-old baby girl suddenly decreased her intake of formula milk overnight from 500+ ml to 200 - 300ml per day. She refuses to drink more and will not consume more than the daily dosage of cereal (4 teaspoons). My PD does not detect any illness, but I do not comprehend the sudden change in her level of intake. What can I do?

CY Wong
 

ANSWER:

Dear CY,

This may be a transient phase that your daughter is going through. There are several factors which may contribute to the decrease in milk formula intake. These include:

1. Recent change of milk formula (e.g.: from breast milk to formula milk, or from stage 1 to stage 2 milk).
2. More solids intake, thus less reliance on milk for their daily calorie needs.
3. Exposure and interest in new tastes.
4. Excessive water intake.
5. Too frequent feeds - often a 6-month old child will not want to drink every 3-4 hours anymore.
6. Recent change in milk teet or milk bottle.
7. Recent change in care-giver.
8. Teething.

Continue to offer her 3-4 milk feeds with 2-3 solids a day and allow her to feed as much as she wants. Watch for dehydration and weight loss. If she persistently refuses her feeds, or if there is significant weight loss or dehydration, do bring her to your PD for a follow-up appointment.

– Dr Lim Kwang Hsien

QUESTION 5

Dear Doctor,

My 4-year-old son grinds his teeth in his sleep. What causes such action? How can I stop it? I am worried that his teeth will be damaged through such persistent heavy grinding every night, as I'm a victim of heavy grinding, with almost flat incisors, some which have already split in half.

Tricia Chew
 

ANSWER:

Dear Tricia,

You are not alone - many parents are worried about their kids grinding their teeth. We do not know why it happens but generally it does not cause any long term damage as he would still be having his milk teeth. If this persists, you might like to bring him to your dentist for a dental checkup. Mouth guards are often very difficult to use in children but might be useful once he is older and if there are any signs of damage to his permanent teeth.

– Dr Lim Kwang Hsien

QUESTION 6

Dear Doctor,

My 11-month-old girl experiences rashes which appear like red spotty mosquito bites (could be a few spots together) on her arms and elbows only. Our doctor told me she could have caught a viral infection and administered antibiotic syrup and fucicort cream. However rashes will emerge every now and then. Besides medication, is there any other way to prevent such rashes and also heat rash at her neck area? Please advise what could be the cause of it? I try to keep her clean and let her wear 'airy' clothing. I also wipe her walker since it is in contact with her arms and elbows.

Yiong Ngeok Li (Jennifer)
 

ANSWER:

Dear Jennifer,

Such rashes are either due to an infection, or an irritant/allergy. If it recurs very often, then it is likely due to an irritant/allergy. Some potential causes include :

1. Bathing soap - you might like to consider changing it to a mild soap for allergic skin, or oil-based soap.
2. The washing detergent that you are using for her clothes - consider changing it to a mild detergent and do a double rinse.
3. Sweat - often we see rashes around the folds of the body e.g: neck, elbow, back of knees - consider wiping these often with a gentle cloth and water, and use moisturisers.
4. Contact with an irritant (e.g.: your walker, or maybe even the ground if she is always in a crawling position).

Sometimes medication (e.g.: antibiotic and steroid creams) may be useful to treat severe rashes which do not respond to the above precautions.

Would egg yolk cause allergies?

There are less proteins in egg yolk compared with egg white. However, it can still trigger a severe allergic reaction in some children allergic to eggs. Generally, when introducing eggs into your child's diet, use hard boiled eggs first, and offer the egg yolk first, for a few days. If there is no allergic reaction, then you may progress to offer the egg white. Most parents will introduce eggs after their children turn 1 year of age, to minimise any potential allergic reaction.

– Dr Lim Kwang Hsien