Familyties proudly presents Ask The Experts, an informative Q & A column hosted by a panel of specialists.
Dear Doctor,
My 16-month-old old son is about 7.5 kg and 70 cm tall. His only intake is breast milk and water. He also doesn't like to eat, and only manages to consume a few spoonfuls of rice. He is very small in built and his weight has not increased since the 9th month. He is an active child but I worry that he is not eating enough for his age.
Dear Carol,
Based on his growth charts, your son's height and weight is below the 3rd centile. This means that compared to all 16-month-old boys, he is very small. There are many reasons why he might not be thriving and you will need to bring him to your paediatrician for a full medical assessment. It is possible that his diet is not offering him adequate calories for his growing needs. This can be addressed by seeing a dietitian and trying to design a diet to help him with his catch-up growth. However, it is important to first rule out other medical conditions which can account for his failure to thrive (e.g. hyperthyroidism, metabolic disorders, malabsorption or genetic disorders).
Dear Doctor,
Hello, my son is in Primary 1 and suspected to have ADHD. He currently drinks GROW milk, but friends told me to try organic milk as it may help with his ADHD condition. Does organic milk improve a child's ADHD condition? Please advise. Thank you.
Dear Jojo,
There is no scientific evidence which suggests that organic milk may improve a child's ADHD condition. However, there is no harm in trying organic milk - give yourself a time frame on organic milk to see if it makes a difference. If it does, then do continue to use organic milk. If it does not, then consider reverting back to formula milk, or even use fresh milk. Some hyperactive children may improve by decreasing their daily sugar intake - this includes reducing their sweets, juices and other high sugar content food like chocolate.
What is more important for your son is to confirm the diagnosis of ADHD and seek the necessary established therapy if you have not already done so. This may include medications, together with sessions with a child physiologist and occupational therapist. Attention Deficit Hyperactive Disorder (ADHD) is a medical condition where children have short attention span, causing them to be very active. If he is truly ADHD, he might find it difficult to cope with Primary 1 without the appropriate assistance.
Dear Doctor,
My 5-year-old boy developed rashes around his lips. The GP advised us to apply Vaseline, which we applied for weeks, but the rashes did not go away, and the itch and redness remained. Another GP prescribed steroid cream which worked, but we were told the affected skin will thin out with continuous applications. We stopped applying the cream for a few days but the rashes re-appeared. It only subsided when we re-applied the steroid cream. I am worried about the side effects if we keep using it. Please advise if there is anything else we can do. Thank you!
Dear Ying Leng,
Possible causes for your child's rash could be:
Hi, I have a 10-month-old baby who weighs 7.5kg and is 70cm tall. She seems to have slow weight gain. I have stopped breastfeeding her at 4 months. Since birth, she has not been drinking much milk. Now she is on formula milk. I have changed teats and formula brands but I still could not get her to drink more milk.
I've listed her feeding schedule is as follows:
4am: 2 or 3oz of milk
8am: cereal with chicken
12.30pm: cereal with chicken/fish
3.30pm: 2 or 3oz of milk
6pm: cereal with egg yolk
11pm: 2 or 3 oz of milk
Sometime she only drinks about 1 oz of milk.
She also doesn't like yoghurt and cheese. Please advise me how to get her to drink more. Are there nutritionists I can seek advice from? Also, I heard about Duocal that can help to increase calories in babies. Can I feed this to my baby, or use PediaSure to help her to gain more calories?
Dear Mel Alui,
At 10 months, your baby is around the 25th percentile for length and weight. Many factors affect the growth rate of a young child. These includes birth weight and height, genetic factors, nutrition, ability to feed adequately, energy expenditure through activity and the state of wellness.
It is important for you to track and discuss weight, length and head circumference measurements at every scheduled paediatric visit with your baby's physician. Every baby in Singapore is provided a baby book to monitor growth and developmental milestones. Any deviation from the expected growth percentile will be monitored by the physician and you will be given appropriate advice.
A young infant of 10 months should consume around 750 ml per day. In addition, your child should be introduced to some complementary foods that include the following foods in the right portions:
As the feeding schedule you have provided does not include portions for each of the food items included in the diet, it is not possible to make any conclusion on the adequacy of the feeding plan. It is best to discuss the feeding plan in detail with a paediatric dietitian who can guide both on the right quantity of milk as well as the right portion of each type of food group to include in your little baby's diet.
Paediatric dietitians are available at restructured hospitals that include paediatric departments such as KK Women's and Children's Hospital and National University Hospital. Dietitians who work with paediatricians in private practice can also be contacted through the physician.
Products that increase just the energy content of the diet are to be used with care as they do not deliver all the nutrients your baby needs in proportion to the calories they deliver. These products must be used under the guidance and supervision of the physician and dietitian to ensure that the child grows proportionately – gaining lean body mass as well and not just body fat alone.
PediaSure from Abbott Nutrition is designed to deliver complete and balanced nutrition for children between the ages of 1 – 10 years. It is not an appropriate choice for a 10-month old child. PediaSure has been shown to be of value for children not eating well and who need to catch up on growth. Please discuss with your child's physician if there is an appropriate Abbott product that is energy dense that may suit your child at this stage.
My son is 3 years and 1 months of age, is 96cm tall, and weighs 14.2kg. He refuses milk, even PediaSure Chocolate 6 months ago. He eats 3 meals, some days with tea time snacks like vegetables, fish, meat, fruits, cereals, bread. However, his mealtimes can last 1 – 1.5 hours each. He used to be a chubby, active boy, but has since slimmed down since rejecting milk. He looks small compared to the rest in class. I had no choice but to give him colostrums, calcium, multi-vitamins, DHA tablets, and even brought him to Traditional Chinese Medicine. Is he growing well? Is there any way can help him to put on more weight?
Dear Joy,
Your son at 37 months is around the 50th percentile for length and weight. It is important for you to track and discuss weight, length and head circumference measurements at every scheduled paediatric visit with your child's physician. Every child in Singapore is provided a book to monitor growth and developmental milestones. Any deviation from the expected growth percentile will be monitored by the physician and you will be given appropriate advice.
A child at 37 months should consume a varied diet that includes milk. The Health Promotion Board of Singapore recommends the following diet guidance:
For children, learning to eat takes time – some learn a little faster and others take more time. It is important as parents to continue to offer a wide variety of nutritious food items and allow the child to select how much he can eat. Forcing a child to eat is counterproductive as it makes eating an unpleasant activity for the child. Parents feel much stress through the feeding process as well.
Here are some practical feeding tips that will help you establish good eating habits in your child:
For more feeding tips visit http://www.pickyeating.com.sg/
All this learning will take time. However, kids are programmed by nature to grow at specific periods in the life cycle. When it comes to supplements to support a child's growth and wellness, you should discuss it with your child's paediatrician. Some supplements in the market do not have scientific evidence to support their claims.
As you work towards helping your child eat well and limiting mealtime duration, you may find PediaSure useful in the meanwhile, to help ensure a balanced delivery of all the known nutrients. In addition, it is energy dense and is clinically shown to support catch-up growth.
PediaSure now comes in three flavours – vanilla, chocolate and strawberry. It is available in a convenient ready to drink bottle as well. You can serve it chilled or at room temperature. Click here to view some interesting recipes with PediaSure.