Familyties proudly presents Ask The Experts, an informative Q & A column hosted by a panel of specialists.
My 5½ year-old son is still on diapers during the night. Is that normal? At what age should a child go without diapers? What can we do to help him without diapers at night?
Also, how much milk should preschoolers consume daily? There are times where my son drinks only 60-120 ml of Gain Kid a day. Is that enough?
Dear Janet,
A 5-year-old child should be toilet trained and should be sleeping through the night without wetting himself. You might like to start by explaining to him that like all his friends, he should no longer need to wear a diaper at night. Explain to him that you will help him with this process of learning how to wake up at night to pee and not wet his bed. Start by restricting his fluid intake after dinner and ensuring that he pees before he goes to bed. In the first couple of weeks, wake him regularly midway during his sleep (e.g. 1-2 am) to pee, and then put him back to bed. When he wakes up in the morning, get him to pee immediately. Do not punish the occasional accidents; praise the days when he does not wet his bed. If he remains dry in the morning, slowly extend the hour when you wake him up (e.g. 2-3 am then 3-4 am) and eventually till morning.
If he continues to wet his bed, you might like to discuss alternative therapies with your paediatrician. It is important for his self esteem that you teach him to be dry at night by the time he enters Primary 1.
Preschoolers ideally should get 1-2 glasses of milk a day for their daily calcium requirement. You can use alternative dairy products like cheese, yoghurt or milk bread if he does not like to drink milk.
My 4-year-old daughter is suffering from persistent/prolonged cough for 7 months. We've brought her to both western (GP/PD) and TCM clinics but she has not recovered from cough. One GP has diagnosed her condition as sinus bronchitis. I am currently still looking for a specialist. Please advise what else I should do? Thank you!
Dear Cheryl,
You will need to see your paediatrician to determine the reason why she is still coughing. Her persistent cough may be due to an allergic condition such as asthma or allergic rhinitis. Sinus bronchitis generally refers to a persistent infection causing her to cough. Most infections are associated with fever and should resolve within a week. If persistent, some tests such as a chest x-ray, mucous test and blood tests may be necessary to determine the reason why she is still coughing.
When my baby was 2 days old, she knocked her forehead against my collar bone, but there was no visible bruise then. However, I noticed a visible bump on her forehead a month later, which did not subside. She's now 7 months old; the bump, although not obvious, is still visible. Will the bump go away or grow bigger with age? Do we need to seek treatment for this? We read online that it was possible that the first knock she encountered, could have caused some thickening of skin/membrane underneath the surface of the skin, hence the bump.
Dear Grace,
You are indeed right - her head injury at 2 days old may have caused some inflammation or scarring tissue under the skin leading to the persistent bump on her forehead. It may persist for months to years and may subside eventually. It should not be growing bigger - if it is, you might like to get it assessed by your doctor. If it is not too obvious, then you might like to leave it alone as it might eventually resolve. If it is very obvious, you might like to seek an opinion from a plastic surgeon to determine if there is a necessity for surgical intervention.
My son's approaching 11 months and he's been drinking less milk. He drinks about 180ml in the morning, and has porridge for lunch and dinner. He sleeps at 8-9 pm, waking up at midnight for a round of milk feed (max 180ml). Is his milk intake sufficient? I tried changing to different brands of milk formulas but results are the same. How can i help to increase his milk intake? Does he need supplements? His height falls within 50th percentile and weight in 75th percentile - the doctor said he is growing well, but I still feel he should take more milk to aid his growth. I am slowly introducing (30-60ml) milk after his meals in past 2 days.
Dear Pei Chyi,
As an infant grows and starts eating food, his daily nutritional requirements will come from his food and not his milk. The more food he eats, the less milk he will want as his daily calories needs are obtained from his food. This is a natural part of his development as he grows. If your son is eating adequate solids (2-3 times per day), then the current milk intake of 3-4 times per day should be sufficient.
As part of a balanced diet, it is important to ensure that he is getting his daily calcium requirements. Milk is a rich source of calcium and children who drink adequate amount of milk obtain their calcium mainly from milk. For children who do not like to drink milk, you can try offering other forms of dairy produce such as cheese or yoghurt. You can try changing the brand of milk or even try UHT/fresh milk as an alternative for children above 1 year old.
Based on his parameters, your son's growth appears to be normal. Over the next few months, plot his growth along his growth charts. If he is growing well, then do not be too overly worried about his milk intake. It is not how much he eats that matters but rather his rate of growth.
Some warning signs that you will need to bring your son to your doctor urgently are: if he is not growing, if he is refusing both food and milk, and if he is losing weight.
Megen, my second daughter is in Primary 3; she has not been doing well in exams since Primary 1. I've sent her for brain development training programs, tuition classes, and boot camps. This happened after I delivered my third daughter. It happen ever since I had my third daughter, Megen says that we do not love her anymore and she hates her younger sister. She seems lazy, does not put in effort in her tasks, and relies a lot on her elder sister. I tried chatting with her trying to find out what the problem was, but her reply was "I don't know". I am not sure if she is using attention-seeking tactics or indeed has learning difficulties. I want to help her very much but I don't know where to start. Please advice.
Dear Benica,
There appear to be several distinct yet possibly related issues in relation to Megen. These include your concern over her academic performance and behaviours, her feelings of not being loved, and her negative feelings towards her younger sister. Let's address them one at a time.
Firstly, given that she had expressed her feelings of not being loved, you need to respond by reassuring her that your love for her has not diminished at all. It is likely that she had felt neglected upon the arrival of your third child (which is commonly to be expected), and that her need for your attention, acceptance, and love has not been adequately met. Make a conscious effort to spend more time with her, either playing or chatting, with the aim of connecting with her, rather than trying to change her behaviour or improve her studies. Have faith that when her needs are met, her behaviour will naturally improve, for there is no need for her to act up in anyway to gain your attention.
Secondly, create opportunities for her to play with and care for her younger sister. Avoid asking her to 'give in' to the latter, for that will only intensify her jealousy and ill-feelings. Young children also want to feel significant. By encouraging and acknowledging her contributions in helping you care for her younger sister, you will help her feel important and thus, enhance her self-esteem.
Lastly, be mindful that every child has his or her unique abilities and potential. Some children are more academically inclined, and hence, naturally do better in studies without much effort. Some develop their capabilities slower than others. Also, the extent to which she is 'doing well' might be relative to your expectations, the performance of her peers, and her abilities.
Consider examining your expectations (i.e. Is it realistic or reasonable) and if possible, go through her work together so as to uncover the specific aspects of the subjects that she is struggling with. Unless you zoom into the specifics and identify exactly where she needs help, simply sending her to tuition, brain training and boot camps will be of little use. Speak to her teachers and obtain their feedback. They should be able to detect symptoms of learning disabilities and arrange for support if needed. Most primary schools have specialists who are trained to aid pupils with learning disabilities.
In summary, seek first to restore her well-being by meeting her basic needs for parental love and sense of significance. Then, invest time and effort to understand the specific challenges that she faces in her studies so that you could determine the appropriate intervention.
My son is prone to cough and ended up with bronchitis many times. He is afflicted with cough every 1.5 months on average; which we will treat with Ventolin and Flixotide puff. Although we try not to give him antibiotics, we already administered 5 courses of antibiotics this year, and this worries us. We have also tried limiting the amount of 'cold' food, giving him Singulair on a regular basis and brought him to a Chinese physician to regulate his health but we see little improvement. An allergy test was conducted on him earlier but the result was negative. Please advise if there are other reasons for his frequent attacks and if there are any remedies to strengthen his lungs. We do not have a family history of asthma.
Dear Lena,
From the history given, it appears that your child has had several episodes of wheezing often associated with respiratory tract infections. These episodes may have been previously treated as for Bronchial Asthma as evidenced by the use of asthma dedicines like Flixotide, Ventolin and Singulair.
Frequent upper respiratory tract infections (URTI) up to 8-12 episodes a year are common in young school going children. In most children who are otherwise well these infections usually resolve over 3-5 days on average with no complications. In children with an asthmatic tendency, the URTI may provoke an exacerbation of asthma with wheezing or result in a prolonged recovery period manifested commonly as a persistent night cough or activity-related cough. Both Singulair and Flixotide are controller medicines used in asthma and should be used on a continuous basis i.e. months to years; and may not demonstrate effectiveness when used intermittently.
Allergy testing in children with recurrent wheezing is useful in defining possible allergens in the environment which may contribute to airway or nasal symptoms. This test however may be negative in younger children or in children who are sensitised to allergens not tested. A family history of any form of allergic disease i.e. allergic rhinitis, asthma, and eczema or food allergy increases the risk of the child having any of the allergic diseases including bronchial asthma. Not all children with bronchial asthma have a positive family history for asthma. Most infectious triggers for asthma are due to viral infections and antibiotics are generally not needed unless there is a bacterial infection. Food is rarely a trigger for asthma.
Proven strategies for protection of the lungs in this context include:
Young children with recurrent wheezing or persistent cough not responding to treatment may benefit from specialist consultation with a paediatric pulmonologist to confirm possible diagnoses with appropriate tests e.g. lung function tests and to optimise treatment outcomes.
My elder daughter has skin problems - white patches develop around her eyes and sometimes at the neck and legs. We are unsure if it is eczema or fungus infection. Cream was applied to problem spots and I was told to stop application as the doctor said it would take months to heal. My younger girl seems to be losing interest in eating. For e.g. she can drink water from her milk bottle but not milk; she sucks from the bottle for a long time but the milk level remains the same. She is also not eating well.
Dear Letchumy,
White patches around the eyes, neck or legs may be due to fungal infection, pityriasis Alba (eczema), post inflammatory hypo pigmentation, or other less common diseases e.g. virtiligo, genetic diseases. If related to post inflammatory hypopigmentation, the pigmentation may take months to recover. The recovery may be hastened with use of mild steroid creams which should not be used over prolonged periods in sensitive areas e.g. around the eyes. Infection related to fungal infection should respond relatively quickly to anti fungal creams. A specialist consultation with a dermatologist or paediatrician may be necessary if symptoms do not improve or worsen.
Feeding in young children is often a challenge. Feeding problems may range from a child who accepts few foods to a child who is afraid of eating, to an energetic child who rarely seems hungry or a child who shows little interest in eating. The appropriate intervention would depend on type of feeding problem. An adequate well balanced diet is important for optimal growth and development. General advice would include the following:
If your child exhibits persistently poor or disinterest in feeding, it is appropriate to consult your family doctor of paediatrician for further evaluation and advice.