QUESTION 1

My little girl is currently 34 months old and is in full-day childcare. She loves to sing and mimic songs from television programmes but she is not speaking and does not bother to communicate with us. If she wants something, she will just use body language. Her childcare principal said that she might be autistic. Could you please advise?

Serene Lim
 

ANSWER:

Language consists of symbols for storage and exchange of information. Language development usually starts at around a year of age and by 18 months, most toddlers can utter a few simple words. Singing is a form of expressive language. You should check if she understands the words in the songs. Another important point is whether she responds well to language i.e. she understands instructions and points to objects or parts of the body when spoken to. Some features suggestive of autistic spectral disorder include poor eye contact, preference to play alone, not pointing out the objects she wants, fascination with repetitive actions and lack of understanding of verbal cues. As language assessment is a complex process, the information provided here is insufficient. You should bring her for an assessment by a developmental paediatrician and clinical psychologist.

– Dr Low Kah Tzay

QUESTION 2

My 4-yr & 5-yr old daughters have not been having smooth stool for some months now. They will pass every or every other day but, most times, the stool is hard and dark coloured. I have tried making them drink more water and eat more fruits and vegetables but it doesn't seem to help. Plus, they do not like fruits and vegetables much so I always have to play games with them to make them eat. They are also taking Grow milk (vanilla) 3-4 times a day. How can I change their diet to improve the situation?

Kwa Saw Khim
 

ANSWER:

Hard stools are fairly frequent in children. It is not always clear why it occurs. However, if children eat a variety of food, they are less likely to have hard stools. For vegetables, you can consider those which are coloured and usually sweeter in taste. Examples are carrots, tomatos, pumpkins and even mushrooms. Fruits such as apples, pears, grapes, bananas and kiwi fruits are usually more easily accepted by children. Yogurt is also a good food to promote regular bowel movement. They should also drink lots of fluids especially if they tend to be active and sweaty. As for toilet habits, they should be encouraged to completely void their stools before getting off the toilet seat. Some children may quickly come off the seat once the discomfort of the hard stools is relieved. The softer stools which are left behind will become hard by the time they next go to the toilet. If these measures do not help, then your children will need medication to soften their stools.

– Dr Low Kah Tzay

QUESTION 3

My son is 32 months old and I noticed he gets bad breath very often and, within the next 1 to 2 days, starts to fall sick – usually with cough and runny nose. On average, he falls sick once every month. He drinks and eats well and we feed him fruits every day. We do not give him sweets or chocolate and only occasionally some biscuits or tidbits. We have also noticed that he tends to fall sick 1-2 days after we bring him swimming though we only allow him to swim 30 minutes maximum. Can you please advise on the likely causes of the above?

Fiona Ang
 

ANSWER:

Your son may have allergic or perennial rhinitis. The condition may be aggravated by exercise or contact with pool water. The bad breath may be related to mucus in the nostril, sinuses or from the back of his throat. This condition is more likely if he has sneezing or stuffy nose in the morning or sensitive, itchy skin, and/or a family member who has similar problems. He should be encouraged to continue with swimming but he needs to be assessed. Allergic rhinitis can be treated so that his quality of life will be better. An active child should be able to take part in all physical activities without restriction. He should also practice good personal hygiene such as hand-washing.

– Dr Low Kah Tzay