QUESTION 1

Dear Doctor,

I have two questions:

1. My 7-month old daughter refuses solids and formula milk and will even go hungry until she gets breast milk. However, my supply has been dwindling even though I have tried drinking more fluid and taking fenugreek. How can I wean her off breast milk?


2. My eldest son is 2½ years old and has problems moving his bowels. We got him to consume more fluids, fruits, vegetables and yoghurt but he still can’t clear his bowels for 5-6 days on end. Even liquid stool softener 3 times a day doesn’t help. In desperation, we have had to use rectal laxatives all the time. He now shivers whenever he sees the pump and it hurts me to see him this way. Are there other ways to regulate his bowel movement?

Mrs Mak

ANSWER:

Dear Mrs Mak,

In reference to your questions:

1. Many mothers face the same problems when trying to wean their toddlers off breastfeeding. Unfortunately, there is no one particular technique that works all the time. Try giving her freshly expressed breast milk and feeding through a bottle. It might also help if someone else feeds her so that she does not “sense” the availability of breastfeeding. You might also like to use a softer or flatter bottle teat (e.g. NUK teat). Be persistent and do not give in. She will eventually drink once she is hungry. Other tricks include timing your feeding time to when she is about to fall asleep. Once you have established bottle-feeding with breast milk, you can progress to feeding formula milk using a bottle. If she is persistently rejecting her formula milk, then you should consider discussing this problem with your paediatrician. Some children may be intolerant or allergic to cow's milk and may need to change formulas.


2. You might like to seek professional help with your son's constipation. Constipation in a 2½ year old child is common and often gets better with diet modifications and use of laxatives during a period of bowel retraining. Try not to use rectal laxatives too often as they can cause emotional trauma and may result in some injuries around the anus, causing pain each time he passes motion. This will worsen his constipation. Often, the treatment of constipation will last for weeks to months. Do discuss it with your paediatrician.

– Dr Lim Kwang Hsien

QUESTION 2

Dear Doctor,

My son, who is turning four soon, started having nosebleeds early this year. This happens about once a month on average. Sometimes, it even happens in the night when he is asleep. Should I be concerned?

Yeo Eng Wah
 

ANSWER:

Dear Eng Wah,

There are many causes of frequent nose bleeding. The most common cause is allergic rhinitis with local trauma. Children with allergic rhinitis often rub or dig their nose due to discomfort from excessive mucous secretions. This leads to injuries on the lining of the nose and causes bleeding. The bleeding often gets better when the allergic rhinitis is treated. If persistent, your doctor will have to rule out other more sinister (but rarer) causes of frequent nose bleeding like bleeding disorders or nasal polyps.

– Dr Lim Kwang Hsien

QUESTION 3

Dear Doctor,

My son, Jiawei, is about 11 months old. Recently, he has become overly attached to me. Whenever I walk out of sight, he will start crying. When we are outside, he won’t even allow his father to carry him. Please advise.

Lynda Soh
 

ANSWER:

Dear Lynda,

Jiawei is going through a stage where he has learnt to recognise faces and is wary of strangers as well as new environments. The reason why he clings to you is because you are his "security blanket". This is very common especially in toddlers around his age, and if he is not often exposed to other children or adults. You need to allow him to slowly build up his confidence in your absence. Try allowing other caregivers to bring him out in your absence (e.g. your husband can bring him for a short walk outside). Praise him when he returns and keep this as a routine for a few weeks. Once he gains more confidence, you can vary the caregivers, lengthen the time of absence, or vary the activities.

– Dr Lim Kwang Hsien

QUESTION 4

Dear Doctor,

My 7-month-old baby doesn’t like to drink milk in the daytime so we mix it with her solid food (cereal or porridge). However, she still chokes and vomits out the food even though it has been mashed. Is this due to a problem with her digestion? She is considered small in size compared to her siblings, which worries me because my second baby recently passed away from brain cancer (medullablastoma).

Agustina
 

ANSWER:

Dear Agustina,

Babies starting on a weaning solid diet may often choke and vomit especially if they are not used to the texture or taste of the food they are eating. Other possible reasons include food allergies or irritants, or swallowing dysfunction. Warning signs to look out for include poor weight gain, rejecting food completely, or persistent vomiting. Do bring her down to your doctor for a full examination if she has any of these warning signs.

– Dr Lim Kwang Hsien