Health concerns? Ask The Expert

QUESTION 1

My second son has constipation since he was a few months old. We've tried several ways to improve his bowel movement, e.g. feeding him with prune juice, celery juice, drinking more water, dilution of milk powder, massaging her stomach, etc. On the advice of a paediatrician, we've also mixed his current milk powder with another type of milk powder, which is supposed to improve his condition. However, his bowel movement has still not improved, which really makes us very worried. Sometimes, he can only pass motion once in five days (which he will cry when passing motion) or a few times in a day. Sometimes, there is also blood when we wipe for him. We hope that we would get some expert advice from you on this matter. Thank you very much.

Immy Wee

ANSWER:

Dear Immy Wee,

The above methods you mentioned are often used to alleviate constipation in growing children. As he is not responding adequately, you might like to discuss his condition again with your paediatrician. There are rare causes of constipation that can only be diagnosed after doing some tests (eg. blood tests, x-rays, rectal biopsy). If all his tests are normal, then your son may be having functional constipation. This is a common condition often seen in children, which will improve as they grow older. The treatment often involves high doses of laxative for a few weeks to allow him to pass out all his hard stools and prevent further bleeding. This is then followed by a maintenance low dose of laxative, which he may need for months to prevent recurrence of his constipation.

– Dr. Lim Kwang Hsien

QUESTION 2

a) I would appreciate it if you could advise me if my 33-month-old girl, who weighs 11.2 kg, and is 91.2cm tall, is underweight? I find it a chore to feed her during mealtimes as I need about an hour to feed her half a bowl of rice. She dislikes eating fish and pork and at one time, she was diagnosed as lacking in iron due to her eating habits. She is taking 3 meals a day but in small quantities, e.g. a piece of bread for breakfast, and half a bowl of rice for both lunch and dinner. She drinks milk 3 times a day (morning, afternoon nap and just before her sleep) and usually about 140ml per bottle. She'll reject any more quantities of milk. Is she drinking below the average quantity recommended? May I know if there's any appetite booster that can enhance her appetite and encourage her to eat more? Thank you.

May Li
 

ANSWER:

Dear May Li,

If you plot your daughter's height and weight on her centile charts (available in her health booklet), her weight lies on the 25th centile and her height is 50th centile. This means that she is within the normal band for height and weight compared to her peers. However, it is also important to measure her rate of growth. This is done by plotting her previous height and weight on the same graph. If she shows adequate weight and height gain (i.e. following the lines on the centile charts), then she is growing adequately.

It sounds like your daughter is a fussy eater. You might like to speak to your paediatrician and design an appropriate approach to deal with her fussy eating habits. This may include planning a proper feeding regime, offering her a variety of food and maybe the use of appetite stimulants, which are usually a mixture of vitamins and lysine. In addition, fussy eating children who are not growing adequately may benefit from some supplementation with high calorie complete formulas like Pediasure. Most 3-year-old children will drink milk 3 times per day.

– Dr. Lim Kwang Hsien

QUESTION 3

My gal is 13 months old now. How do I cultivate her teeth brushing habits and when can I bring her to see a dentist? Thank you for your advice.

Michelle
 

ANSWER:

Dear Michelle,

It is never too early to visit a dentist. Often the first few visits offer a chance to desensitize the child to process of having her teeth checked by a dentist. It is important to find a dentist who is comfortable and gentle when dealing with children. At home, you can start teaching by allowing your daughter to watch you brush your teeth. Slowly, explain to her why you are brushing your teeth. Books and stories about the importance of keeping teeth clean will reinforce this habit. Eventually allow her to brush her own teeth – her first few attempts will not "clean" her teeth very well. Don't be too concerned. You can always wipe her teeth again when she is asleep. Just like self-feeding, brushing teeth is a skill that needs to be learnt with time.

– Dr. Lim Kwang Hsien

QUESTION 4

My son started attending childcare 6 months ago. He has since contracted a cough and running nose regularly. About 2 – 3 weeks ago, I noticed that he tended to cough persistently for 1 – 2 hours in mornings and evenings daily. He is fine at other times of the day. In addition, I noticed that he tends to start coughing after taking fruits like apple. Is there any cause for concern?

Lum Kah Wai
 

ANSWER:

Dear Kah Wai,

It is common for a child who starts attending childcare centres to fall sick frequently in the initial period. This is a natural process for the body to learn how to recognise these viruses and build up its own immune system. If his cough persists, you might like to have him checked by your doctor to ensure that he is not having an infection causing the persistent mucous production. Your doctor may do some tests (e.g. blood tests, mucous test) to rule out any ongoing infections. He might also benefit from some medications to control his cough. Sometimes, his cough is not caused by an infection but by an allergy. Allergies can be either due to environmental factors or food factors. If you notice any potential triggers, you might like to avoid them while your doctor is treating his cough. For example, if you suspect that apples are triggering his cough, try avoiding apples until he recovers. Once his cough recovers, you might like to reintroduce apples to see if it triggers his cough again.

– Dr. Lim Kwang Hsien

QUESTION 5

My 3-month-old baby girl was recently detected with eczema. Her neck, ear lobes, arms & thighs (folded area) gets red & itchy. I have consulted the paediatrition and was prescribed with steroid & aqueous cream. Please advise on how serious is eczema; does it flare up badly? How can I get rid of it or perhaps, make her condition better. What formula I should give her? Thank you!

Faisala
 

ANSWER:

Dear Faisala,

Eczema refers to an allergy of the skin. It is often triggered by food (e.g. milk) or environment (e.g. dust mites). The main treatment of eczema is adequate moisturising of the skin with lotions (eg. aqueous cream). For areas on her skin which have flared up, adding a steroids help alleviate the itch and promotes recovery. Identifying her triggers and avoiding them can help prevent her eczema from flaring up. Eventually, it will get better once she grows up.

The best milk for her is breast milk. If you are unable to breastfeed, you might like to either try soy milk (e.g. Isomil) or Hypoallergenic Milk Formulas.

– Dr. Lim Kwang Hsien

QUESTION 6

My son is 5 years old. Whenever he drinks milk, he tends to have a blocked nose that lasts almost a whole day, and winds up with yellowish mucus that lasts a week, which usually only can be alleviated by consuming antibiotics. After he stopped drinking milk for a few months, his sinus-like symptom does not get worse, other than the occasional nose block in the mornings. Now, I'd like him to get started on milk again, but he refuses to drink. Is it possible for him to get started on milk, without the occurrence of blocked nose or mucus?

Liaw Chew Sien
 

ANSWER:

Dear Chew Sien,

It sounds like your son may have allergic rhinitis or sinusitis which means that his mucous production is caused by an allergy. It may be possible that he may also be allergic to milk as drinking milk worsens his condition. In a 5-year-old boy, most of his nutritional needs come from the food he eats. Thus, it is not essential that you restart him on milk as it does not provide any added value and may aggravate his allergic rhinitis or sinusitis. You may want to consider alternatives such as soymilk, as well as do a skin prick test to identify the potential triggers of his excessive mucous production.

– Dr. Lim Kwang Hsien