QUESTION 1

Dear Doctor,

My daughter is 2 months old. Currently, she refuses to drink water. The only fluid she takes in is formula milk. I’m afraid that this will cause her to have constipation as she experienced difficulty in bowel movement recently. What kind of fluid can I give her in place of water and is it a good idea to dilute her milk to avoid constipation?

Leong Ai Fan
 

ANSWER:

Dear Ai Fan,
The term "constipation" is commonly used in babies. Unlike adults, constipation in babies refers to passing out hard stools on an infrequent basis, and is often asociated with straining. Babies who pass soft mushy stools easily but on an infrequent basis are actually not constipated (some babies may poo only once every 4-5 days).

There are several techniques that you might like to try if your daughter does have problems passing out hard stools. Massaging her tummy and stimulating her to pass motion by bending her knees often work. In a well hydrated infant, supplementing her with water will not improve her constipation. Often, a baby's hydration can be adequately maintained just by drinking milk. On hot days, you may like to try offering your daughter 1-2 oz of water (total) to improve her hydration. Remember to use the appropriate bottle nipple size (normally one size smaller as water flows out faster than milk) to prevent her from choking while drinking water.

Diluting her milk is not a recommended practice and can be dangerous as milk formulas are designed to provide the optimal balance of nutrition and salts to the baby. You might like to try changing her milk formula – some babies' bowel habits improve with different milk Formulas. Fruit juice should not be given to a child under 4 months old.

If constipation persists despite the above measures, do bring your daughter to your doctor for a check up. There are rare medical conditions which may also cause constipation in the infant. Sometimes, you may need a laxative to help your daughter regulate her bowel habits.

– Dr Lim Kwang Hsien

QUESTION 2

Dear Doctor,

My son is 3 years old and has been experiencing difficulty in breathing recently. He doesn’t suffer from a runny nose but snores quite loudly in his sleep. He also gets nose bleeds quite often. My doctor says that this is because he has a sensitive nose. If this is the case, is it necessary for him to see a specialist?

Poh Leng
 

ANSWER:

Dear Poh Leng,
Jalen may have a condition called allergic rhinitis. This is a condition where he is sensitive to something in the environment which irritates his nose leading to frequent nose bleeds, runny nose (especially when he wakes up in the morning) and difficulty breathing. You might want to bring him to your paediatrician or an ear/nose/throat specialist to determine the severity of his condition, as well as check on his snoring problem. If his symptoms are persistent or severe, then your doctor may consider treating him with medication.

– Dr Lim Kwang Hsien

QUESTION 3

Dear Doctor,

My son is 4 and a half years old but weighs only 13kg. His growth is “below average” on the growth chart. He has had a habit of sucking his thumb since he was a baby and has recently started biting his nails. I have tried applying some lotion from the pharmacy to stop this but to no avail. I’ve heard that finger sucking might lead to worms in the stomach which might affect a child’s growth. Is this true and how can I stop this bad habit? I’ve thought of applying chilli to his fingertips but am hesitating.

Sim Chee Wee
 

ANSWER:

Dear Chee Wee,
Ryan has two issues which need to be addressed.

The first is his finger biting habit. This is a common habit in children and sometimes may be a reflection on anxiety of insecurity. It is not associated with worms growing in his stomach... at least not in a developed country like Singapore where hygiene is of a high standard (This myth is often told by parents to "scare" their children to stop biting their nails). There are a few steps that you might like to try to stop him from biting his nails:

1. Address the issue as to why he bites his nails. Observe for precipitating factors (e.g. new environment).

2. Teach him an alternative method to cope with his anxiety or insecurity. For example, instead of biting his nails, try wriggling his fingers instead.

3. Educate him on why he should not bite his nails. A four-year old child is able to rationalise and differentiate right from wrong. You might like to use examples of his favourite characters to show him that biting his nails is a bad habit.

4. Be a good role model – show him that adults and his siblings or friends do not bite their nails.

5. Once he is motivated to stop biting his nails, you can then use reward charts to help motivate him further.

6. Foul tasting solutions and chilli often are best used as reminders for the motivated child and should not be used by themselves as it will appear as punishments which may lead to further anxiety or insecurity.

At the end of the day, biting nails is a harmless habit common in children. The vast majority of these children will stop this habit as they grow older.

The second issue is his poor weight and height gain. You might like to bring him to see your paediatrician to rule out any other medical problems that may contribute to this. He may benefit from seeing a dietician, and some basic blood investigations. If you are worried about worms, a course of deworming medication is harmless and can be administered to him by your doctor.

– Dr Lim Kwang Hsien

QUESTION 4

Dear Doctor,

My daughter is 15 months old and I have been breastfeeding her since she was born. As I am a working mum, my daughter sometimes has to be fed with express breast milk from a bottle. However, two months ago, she started rejecting milk (both breastmilk and formula milk) in either a bottle or a cup. I have tried many different formulas and even yogurt and cheese but nothing has worked. Currently, my daughter only feeds direct from the breast twice a day – in the morning and at night. As my job requires me to travel, there will be days when she will not have any milk at all. Although she is on solid food, I am still worried about her milk intake. Does she have enough? How do I encourage her to drink milk again?

Rachel
 

ANSWER:

Dear Rachel,
The first thing you need to do is to measure Chloe's height and weight and plot it on the growth charts available in her health booklet. If she is growing adequately, then it is very likely that she is getting enough nutrition despite not taking much milk. In fact, at this age, most of her nutrition comes from the solid food she is eating. Milk is but a supplement. Some steps that you might like to try include:

1. Give her freshly pumped breast milk from a bottle to get her used to the idea of drinking from a bottle.

2. Stick to one formula. Changing milk formulas too often might contribute to her refusal to drink milk.

3. Time your milk feeds so that they are not too soon after she has just taken her solids as she might not be hungry yet.

4. Try giving her milk from a cup with a spout, or a bottle with a straw.

It is important to see your doctor for a full assessment if she is not growing well, or if she has signs to suggest cow's milk allergy (e.g. eczema, diarrhoea, bloated tummy) which might contribute to her refusal to drink formula milk.

– Dr Lim Kwang Hsien