QUESTION 4

My baby is 13 months old. He was feeding well, eating porridge, cereals and fruits but recently, his eating habits have started to deterioriate. He is taking a long time to swallow his food, even pureed ones. Before, he could chew and swallow pieces of fruit. But now, he sometimes gags and vomits. He also doesn't eat as much. He is active and doesn't look unwell. Why is he regressing? Is he getting fussy with food or is it part of a developmental process?

Yap Yin Fong
 

ANSWER:

Dear Yin Fong,

Calen’s behaviour may be normal. Try varying both his food as well as its texture. Go back to the basic foods that he likes. Also try feeding him solids before letting him drink his milk. You might like to visit a dietician for some advice.

It is important to ensure that Calen’s other developmental milestones are appropriate, and that he does not gag or vomit when he drinks fluids.

He will need further evaluation by your paediatrician if he has other regressive milestones.

– Dr Lim Kwang Hsien

QUESTION 5

My boy is 5 years old and is currently in K1. He likes going to school and has never complained. However, he was unwell last week and was absent from school for 4 days. Thereafter, he has refused to go to school. We have tried talking to him but he cries and creates a big fuss, sometimes refusing to even change into his uniform. We are running out of ideas on how to deal with him. Can you please advise? Thanks.

YL
 

ANSWER:

Dear YL,

You will need to speak to Justin’s teacher regarding his school refusal behaviour. Sometimes there may be an underlying reason why he refuses to go to school. Try working with his teacher on identifying these reasons. His teacher will also be able to help him reintroduce school to his daily routine. You might like to try:

• Spending some time with him in school for the first couple of days
• Starting with half-day school initially
• Be firm by not succumbing to his tantrums when faced with school
• At the same time, ensure he does not feel ‘abandoned’ in school by promising him that you will pick him up after school, and not break this promise by picking him up promptly
• Praise the work he does in school
• Work with his teachers to provide a sense of security in school. Sometimes allowing one teacher he likes to act as a surrogate ‘guardian’ might be useful

– Dr Lim Kwang Hsien

QUESTION 6

Dear Dr Kelvin Tan, I would like to know the risk and preparation of getting pregnant for diabetes carrier. What are likly to be the outcome of the process during the pregnancy? I had a pre-mature baby of 24 weeks with 540gm birth weight. Is being a diabetes patient the cause of this prematurity?

Joanne Yap
 

ANSWER:

Dear Joanne,

I take it that by 'diabetes carrier', you mean that the person has diabetes. It is always said that no woman with diabetes should enter into pregnancy without prior planning. We call this 'pre-conception planning' in medical terms. This would involve both you and your doctor (diabetes specialist) discussing and attaining good blood sugar control prior to conception. This might mean going on to insulin injections even before pregnancy if you were on oral tablets previously. You need also understand that the pregnancy blood sugar targets are much stricted that the pre-pregnancy targets. Only when you are ready and your doctor agrees, should you start trying for a baby

Unfortunately there is 'good' and 'bad' regarding having diabetes in pregnancy. On the one hand, poorly controlled diabetes can affect the baby's development in terms of miscarriages and congenital malformations. Poor blood sugar control leads to big babies which make for difficult delivery and poor maturation of the babies' lungs. On the bright side, good sugar control from pre-conception can reduce all these complications to that similar to non-diabetic pregnancies.

It is really difficult to say if diabetes was the main cause for your baby's premature delivery and this is best discussed with your own OBGYN

I hope that the above information motivates you to control your diabetes perfectly whilst planning for another baby !

– Dr Kelvin Tan