QUESTION 1

Dear Doctor,

Before my first child, I weighed 53kg. I got pregnant shortly after marriage. Within a year of delivering my baby and with the help of a slimming centre, my weight dropped back down to 60kg. I had my second child two years later in 2004, but my weight today still remains at 71kg. I did not go to a slimming centre after my second delivery. The additional weight has caused me medical problems, such as knee and ankle pain, and numbness in both my hands. I desperately need help in losing this excess “baggage”. I have tried walking for exercise because I cannot run, but my knees and ankles still hurt a lot. Exercising is a painful experience. I usually eat two meals a day, and they mainly consist of vegetables as I do not really like eating meat. Please advise me on how I can lose some weight; I am losing confidence in myself. Thank you.

Charlene Tan
 

ANSWER:

Dear Ms Tan,

There are a few additional pieces of information you can give me that would help me advise you better. One would be your height, which would let me calculate your body mass index, or BMI. Another is whether you breastfed your children after each pregnancy, and if so, for how long. It is not unusual for a woman to start each subsequent pregnancy with a higher weight. Going back to your pre-pregnancy weight can take some effort. You might also want to check if you have a thyroid problem. Thyroid problems can develop after delivery, and affect your body's metabolism. The next helpful step you can take would then be to meet up with a dietitian or nutritionist, who can help you evaluate your calorie intake and expenditure to see if you are eating right. If you find that you are unable to walk or run as a form of exercise, then you could look to alternatives such as cycling on a stationary bike or swimming.

I hope that this helps start you off in the right direction!

– Dr Kevin Tan

QUESTION 2

Dear Doctor,

My daughter is seven months old and was fed nothing but breast milk until she was five months old. Is it necessary to supplement her diet with formula milk? Will providing her with semi-solids with the necessary vitamins and minerals suffice? She refuses to drink milk from the bottle and is still unable to use a cup. I usually nurse her directly.

Freda
 

ANSWER:

Dear Freda,

After six months, most of your daughter's nutritional needs come from her semi-solid diet rather than the milk she is drinking. As such, you can continue breastfeeding her without supplementing her diet with formula milk until you decide to wean her off breastfeeding. Babies who are purely breastfed may need to take multivitamin and iron supplements if their solid diet is insufficient. Discuss this matter with your paediatrician before starting her on these supplements.

– Dr Lim Kwang Hsien

QUESTION 3

Dear Doctor,

My son Joel is three and a half years old. I recently found a strand of white hair on his head and discovered a lot of split hairs. Children of his age should not have any white hairs. His height and weight was found to be acceptable during his last medical check up. Please advise me; should I be worried?

Joanne Ang
 

ANSWER:

Dear Joanne,

There are many possible reasons as to why Joel has white hair. Some of these reasons include a lack of certain vitamins and minerals like iron or zinc. If there is a cluster of white hairs, or if it is persistent, do visit your paediatrician or a dermatologist for a full assessment.

– Dr Lim Kwang Hsien

QUESTION 4

Dear Doctor,

Is there a recommended amount of milk that children should take daily? I have a 13-month-old girl and 35-month-old boy. Ever since they started taking solid food, their milk consumption has dropped to about three times a day. I am concerned with whether they are drinking enough milk to meet their recommended daily calcium intake.

Janet
 

ANSWER:

Dear Janet,

A 13-month-old girl will generally take three to four milk feeds a day; a 35-month-old boy will take three milk feeds a day. However, this is only a general guideline and depends on how much milk they are taking during each feed, and on how much solids are they eating. Like adults, children require a specific amount of calories a day. Once they start taking solid food, their milk consumption naturally decreases, depending on the amount of solids they are taking. You should be monitoring their growth parameters instead of the number of milk feeds they are taking. If they are growing well, then do not be too concerned about their milk intake.

Calcium requirements in a child vary during different stages of their growth. Here is a rough guide: A toddler between the ages of one to three years needs two glasses of milk a day, if milk is his only source of calcium. A preschooler between the ages of four to eight years needs three glasses of milk a day. Aside from milk, there are many other sources of calcium such as fish, dairy products like cheese and yoghurt, and vegetables like spinach and broccoli.

– Dr Lim Kwang Hsien

QUESTION 5

Dear Doctor,

My nine month old daughter has refused to drink water since I first gave her water at the age of four months. To prevent her from getting dehydrated and constipated, I have been adding about 20 ml of water to her milk each time. I wonder if she would have gotten used to drinking water had I started giving her water earlier. I am very persistent in trying to get her to drink water; I have tried using bottles, spoons and cups, but each attempt has been a failure. I worry now that as she grows up, she will require more solid than milk intake. I also worry that she will have to consume more water over what I have already been adding into her milk. If I feed her rice, will she have to drink more water since rice is dry? She refuses to drink water even when I give her cereal and porridge.

Serene Teo Lay Chin
 

ANSWER:

Dear Serene,

I believe the concept of giving babies water originates from Asian culture. Medically, when we assess if a child is adequately hydrated, we look at the amount of fluid the child is taking and do not differentiate between milk and water. On hot days, you might want to provide more hydration by feeding your baby more milk. Generally, it is not a good idea to dilute the milk just to get more water into the body. In fact, it can be dangerous as formula milk is designed to mimic breast milk and thus should not be diluted unnecessarily. Once your baby starts on her solids, you may offer her additional fluids apart from milk in other forms if she does not like the taste of water. These include porridge, cereal, soup, juice, glucose water or other sweetened drinks like Ribena, honey water or barley. Most children will eventually learn to drink plain water as they grow older. Do not be too persistent if your daughter does not like water now as she may develop an aversion towards drinking it later.

– Dr Lim Kwang Hsien

QUESTION 6

Dear Doctor,

My baby boy is four months old. He is now fed Dumex Mamil Gold milk formula, but I plan on switching to Abbott milk powder. Can you please advise me on how I should choose the type of milk powder for him? For example, would Isomil or Similac formula suit him better? The consistency of my baby's poo is still not solid, and he has quite a lot of phlegm. It this normal, or should I be worried?

John Chua
 

ANSWER:

Dear John,

Similac is a cow's milk formula and Isomil is a soy based milk formula. You might want to consider Isomil if your son has an allergy to cow's milk, or if he is lactose intolerant. Do not only look at the consistency of his poo, but also at the frequency of his bowel movements. If he has persistent loose stools many times a day, please see your paediatrician to ensure that he does not have any medical problems. Having a lot of phlegm can be normal, but it can sometimes also be an indication that he has an allergy or an ongoing infection. Again, do see your paediatrician if this symptom persists.

– Dr Lim Kwang Hsien