QUESTION 1

Dear Doctor,

My son was delivered on 7th March. As at April 25th, his weight was approximately 5.6kg and his height was 58cm. I would like to know if he is gaining weight too quickly. Please advise on the amount of milk (Formula) to drink per day if the each feeding time is 2.5 hours apart and if feeding should be done routinely. If feeding were to be done on routine, would it be all right if I fed him water before feeding time? Similarly, is it okay to give Gripe Water and/or glucose to the baby? Lastly, is constipation due to formula milk feeding and lack of water?

Png Swee Lin
 

ANSWER:

Dear Swee Lin,

Growth parameters in a 6-week-old baby need to be assessed according to your son's birth weight and length. There are growth charts available in his health booklet which your paediatrician will routinely plot during each of his clinic visits.

Based on his weight, he should be taking roughly 850ml per day. If you are giving him 8 feeds a day (i.e. every 3 hours), he will probably take about 100-120ml in each feed. If you are bottle-feeding, try to train him to feed every 3-4 hours. Of course, you do not need to be too rigid with his schedule, each child is different and you will need to tailor his feeding habits to his daily requirement.

Water is often not necessary in babies below 3 months old. In fact, too much water can be dangerous. Currently, there is no harm in taking Gripe Water. It is believed to help with constipation and colic in children. There are other products that can also help with colic such as Infacol, Dentinox colic drops and Ridwind. However, try not to give too much glucose to your child as he may get used to sweet feeds and start rejecting milk feeds.

There are many reasons as to why a child is constipated (Constipation is defined as infrequent passing of hard stools). Often it is not the milk formula or lack of water that causes constipation. If it persists, do talk to your doctor regarding how to manage his constipation.

– Dr Lim Kwang Hsien

QUESTION 2

Dear Doctor,

My wife and I are having difficulties feeding our baby, Vera, who is just over 3 months old. Every time we feed her, she will cry and attempt to push the bottle away. We have tried changing the milk bottle, the teat and also the milk powder but nothing has worked. The only way to get her to drink is to carry her around the house with the milk bottle. This is a problem as it is difficult to carry the baby, hold the bottle and walk at the same time. Please help.

Jimmy Tan
 

ANSWER:

Dear Jimmy,

It sounds like you are having a hard time feeding Vera. There are several possibilities as to why she is difficult to feed and you will need to work with your paediatrician to make a diagnosis and treat her.

Some of the possible reasons include:

1. Severe colic – this is a condition where your child feels severe discomfort especially after feeding due to spasms of the intestines.
2. Gastroesophageal Reflux Disease – this is a condition where milk moves back up from the stomach causing your child to have heartburn and sometimes vomiting.
3. Cow's milk allergy – this is a condition where the cow's milk protein causes an inflammation in the intestines leading to tummy pain, diarrhoea and occasionally blood in the stools.
4. Lactose intolerance – this is a condition where the body is unable to digest the lactose present in the milk which leads to gas formation in the intestines and diarrhoea.
5. Feed aversion due to overfeeding or feeding too often.

There are other rarer medical problems that may lead to rejection of milk feeds. Your paediatrician may have to conduct some tests if she does not show improvement.

– Dr Lim Kwang Hsien

QUESTION 3

Dear Doctor,

My baby girl, who is 6 months old now, has had redness and swelling at her umbilical area since birth. The spot also has a bad odour to it. I have tried using alcohol swabs to dry the area three times a day, and applying antibiotic powder prescribed by a private paediatrician but to no avail. The doctor could not advise further and only suggested that I continue to apply the swabs and powder. What can I do to relieve her condition?

Lee Lili
 

ANSWER:

Dear Lili,

Persistent umbilical infection needs to be treated with either antibiotic powder, antibiotic creams or oral antibiotics. As she has not responded to antibiotic powder therapy, ask your doctor to do a swab culture to try to identify the germ that is causing the infection. Once isolated, your doctor can tailor her antibiotic treatment according to the germ isolated. If it persists despite correct antibiotic therapy, your doctor will look for other rarer causes that may make her prone to persistent umbilical stump infection.

– Dr Lim Kwang Hsien

QUESTION 4

Dear Doctor,

My son, Lovell, is 3.5 years old. He has had bronchitis since he was 1 and has recently been diagnosed with mild asthma. He was previously prescribed with long-term medication, Singulair, Zaditen, Ventolin and Zyrtec for a period of 3 to 6 months to strengthen his lungs. I have read about the adverse side effects of Singulair such as depression, moodiness, suicidal thoughts, and violence. Please advise if it is still wise to continue consumption. Are there other alternative medication, such as cordyceps, that could help build up my son’s health?

Chee Shwu Pyng
 

ANSWER:

Dear Shwu Pyng,

Asthma is a medical condition where, due to an allergic reaction, a lot of mucous is formed in the lungs leading to severe congestion. During severe attacks, it causes wheezing and breathlessness. In children who are asthmatic, it is important to control their symptoms and prevent asthmatic attacks. This is mainly done by identifying potential allergic triggers and avoiding them, and the use of medications.

Asthmatic medication can generally be divided into two groups. The first group is the "reliever medication" and is used during an asthmatic attack when the child is breathless and wheezing. Ventolin is the most commonly used medication in this group. It works by opening the air passage and allows the child to cough up the mucous and breathe better. Ventolin can be given either as an oral syrup, an intravenous injection, through a nebulizer or using a puffer.

The second group of asthmatic medication is the "preventer medication" which is usually taken over a longer period of time to "prevent" these asthmatic attacks. It is generally used in children who have frequent attacks, persistent background coughing, or very life-threatening asthmatic attacks. Steroid puffers and Singulair fall into this group of medication. They work by reducing the inflammation and thus the mucous production in asthmatic children. Zaditen (ketotifen) is an antihistamine and also falls under this group of medication.

Zyrtec is an anti-histamine which generally has no preventive properties against asthma. It is mainly used to prevent allergic rhinitis (sensitive nose) which is often present in children who are asthmatic.

All medication has potential side effects. Before being sold, all medication must undergo safety trials to determine these potential side effects, and to determine how frequently these side effects may occur. This information is widely available, in the drug packaging, or online at the relevant drug’s website. In the case of Singulair you can find more information at http://www.singulair.com/montelukast_sodium/singulair/consumer/index.jsp.

In Lovell's case, you will need to discuss with your paediatrician how severe his asthma is, based on the frequency and severity of his attacks. If significant, you will need to discuss with your doctor what would be the best way to control his symptoms. This often includes avoidance of potentially allergic triggers and the use of either "reliever" medication during asthmatic attacks, or a combination of "reliever" and "preventive" medication. Do discuss with your doctor the potential side-effects of the different "preventive" medications and use only those which you are comfortable in using for your child.

There are no conclusive studies to validate or refute the use of other natural medication like vitamins or herbs to boost your son's health. They are generally harmless as long as your son is not allergic to them.

– Dr Lim Kwang Hsien

QUESTION 5

Dear Doctor,

Isabella is 9 months old and has difficulty sleeping through the night. She often wakes up in the middle of the night crying. When I offer her milk she takes about 30ml and goes back to sleep but wakes up 1 or 2 hours later. I'm not sure if she is feeling ill or whether it is just hunger that is affecting her sleep. Please tell me how I can keep my baby soundly asleep the entire night.

Karen Lim
 

ANSWER:

Dear Karen,

You have probably read many different methods and theories to train your daughter to sleep through the night. There is no particular method that works for all toddlers. Often, you will have to try numerous methods before succeeding. There are some general guidelines which most parents follow. These include:

1. Keeping to a consistent bedtime routine.
2. Encourage more activities during the day such as playing and singing.
3. Reduce daytime naps if she sleeps excessively in the day.
4. Lie her down on her cot while she is drowsy but awake. This allows her to associate the cot with the process of falling asleep. Allow her time to settle down after lying her down. Some parents will pat her to sleep, others will try singing or stroking her to calm her down.
5. Allow her to self-sooth herself when she wakes up crying. This may involve the use of her pacifier (if she is using one), or sucking on her thumb.

Most toddlers at 9 months can be trained to drop their night feeds. Nutritionally, they should have adequate stores to last them through the night. They often feed only out of habit or comfort.

– Dr Lim Kwang Hsien