Question 3

Dear Doctor,

My gal is 13 months old now. How do I cultivate her teeth brushing habits and when can I bring her to see a dentist? Thank you for your advice.

Michelle

Answer:

Dear Michelle,

It is never too early to visit a dentist. Often the first few visits offer a chance to desensitize the child to process of having her teeth checked by a dentist. It is important to find a dentist who is comfortable and gentle when dealing with children. At home, you can start teaching by allowing your daughter to watch you brush your teeth. Slowly, explain to her why you are brushing your teeth. Books and stories about the importance of keeping teeth clean will reinforce this habit. Eventually allow her to brush her own teeth – her first few attempts will not "clean" her teeth very well. Don't be too concerned. You can always wipe her teeth again when she is asleep. Just like self-feeding, brushing teeth is a skill that needs to be learnt with time.

Dr Lim Kwang Hsien

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Question 2

Dear Doctor,

My first child is 2 1/2 years old. Since I started sending her to half-day childcare in May this year, she has been falling sick frequently (e.g. cough, flu & fever). Both her 4 1/2 month old brother and I have been infected and only baby has recovered fully. I'm still breastfeeding and wonder if the medication that I'm taking will affect him.

I'm in dilemma whether to let my daughter continue with childcare. The reason I sent her first place was out of concern that my maid cannot handle both her and her brother while I'm at work. Please give me some advise or suggestions what I should do. In July, my daughter had seizure/fits and was admitted to hospital for 3 days due to high fever. I'm so worried this will occur again.

Patricia Ong

Answer:

Dear Patricia,

It is common for children who have just started to attend child-care to develop upper respiratory tract infections. It then leads to other family members similarly affected, especially their younger siblings and the main care-giver. Breast-feeding is helpful to reduce viral infections in the baby and this seems evident in your baby who has recovered fully. You should continue breast-feeding as long as possible. Whenever you are unwell and need prescription medicine, always inform your doctor that you are still breast-feeding so that she will prescribe the appropriate medication.

Parents are always in a dilemma regarding day care for their children especially at the initial period when their children come down with various infections. You have to review your situation and make a decision. You may be comforted to know that as your daughter grows older, she will invariably have fewer infections. Some suggestions to reduce infections would be to teach your daughter hygiene: wash her hands before food and regularly and not touch her mouth, nose or eyes with her hands; use disposable tissues to clean her mouth and nose; bathe and change clothes after returning home from school. She should have adequate rest, and fruits and vegetables. If she is unwell even with slight symptoms, she should stay at home and rest. This is to allow her body to recuperate and not be exposed to further stress. You may also discuss with your paediatrician regarding additional measures such as vaccinations. Young children do get febrile fits if they develop a high fever. If she had a previous episode of febrile fit, she is at a slightly higher risk to develop another febrile fit with the next episode of fever. This risk remains till she is about 6 years old. You should always keep a ready supply of fever medication. Whenever your daughter develops a fever, you should give her the fever medication and apply tepid sponging. You should bring her to see a doctor to ascertain the cause of the fever and treat where necessary.

Dr Low Kah Tzay

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Question 1

Dear Doctor,

My daughter is fully on breast milk. She has been waking up about twice every night for milk since day 1. Could it be because breast milk is not filling enough? Should I substitute her last feed with powder milk? How do I train her to sleep through the night?

Lim Hui Li

Answer:

Dear Hui Li,

First of all I want to congratulate you for being so successful in breastfeeding your daughter. Breast milk is easily digestible and it is normal for her to wake up twice in the night to feed. I would strongly recommend you to continue total breastfeeding until she is at least 6 months old. When you feel ready to wean, you can start substituting breast milk with formula milk. They tend to be more filling. However, every child's sleep pattern differs. I wish I had some tricks up my sleeve for you. Sigh! My own child did not sleep through the night till she was 3 years old. Sometimes you cannot rush things. It will come naturally.

Dr Mary Yang

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Question 6

Dear Doctor,

My little girl now is about 9 months old but she still doesn't take much milk and her weight is only about 7kg. What can I do?

Grace Ong

Answer:

Dear Grace,

She is about 10th percentile. Her weight has to be considered in the context of her height as well as her parents' heights. A 9-month old child should still drink milk 3 to 4 times daily as she is still growing. You can try feeding her with a training cup or using a straw. Otherwise, you can increase her dairy intake by adding milk to her cereals as well as cheese and baby yoghurt to her diet. Other calcium rich foods are tofu, meat and fish.

Dr Low Kah Tzay

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Question 1

Dear Doctor,

I was totally breastfeeding during my maternity leave. Now that I need to go to back to work, I have to leave my son with my mother-in-law. But he refuses to drink from the bottle, not even water.

That means when I am at work, he doesn't drink milk at all. Luckily, I work half a day. So, I will rush back to feed him.

When he refuses to drink, he will cry and cry.... or should I say scream till he gets sore throat. Now, he has cough and phlegm from his older siblings, making things worse.

How can I get him to drink from bottle? I have tried 2 types of teats but that didn't work either. Help me please.

Angela

Answer:

Dear Angela,

This is a fairly common situation encountered by mothers who exclusively breastfeed their babies. It is recommended that once breastfeeding is well established for 4-6 weeks, the baby can be given a bottle of expressed breast milk or water a day to allow him to get used to the bottle. Apart from trying to bottle feed him using latex teats (which are softer), you and the other caregivers can try to use a spoon or cup to feed him. However, until he gets used to it, expect this to be a messy process. If the situation persists for the next one month, you may have to consider starting him on weaning cereals using your expressed breast milk.

Dr Low Kah Tzay

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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

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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

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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

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