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BABY’S HEALTH AND SAFETY:OUR TOP PRIORITY Dr B.A.KHOOConsultant Paediatrician and Neonatologist Sunway Medical Centre21st JULY 2013GARDEN HOTEL
What is our objective?Healthy mother and pregnancyHealthy babyHappy family
BABY’S HEALTHCAREPhysical health(growth and development)Mental health (IQ vs. EQ etc..)Social and behavioral healthCommunication skills healthy baby joyful/smart children holistic, wise and caring adult
Tips for healthy babyGood start – healthy mother – pregnancyGood nutrition – pre and postnatalEffective stress coping mechanismGood immune system – vaccination, personal hygiene, healthy diet, etc..Safe environment to learn and exploreSafe sleeping position Early education and stimulation – audiovisual, music, communication etc..Loving and caring family
Early newborn/infancy period D3 – D14Neonatal Jaundice1 – 4 mthsInfant colic1 – 6 mthsGORD (reflux)Skin allergy - eczemaD1 D14 2 mths 4 mths 6 mths
Neonatal JaundicePhysiological jaundice (First 1 week of life)Very common Self limiting but sometime need phototherapyBreastfeeding jaundice (First few days of life)Due to inadequate breast feeding dehydrationAdvise to persevere with BF +/- supplementation
Neonatal JaundiceProlonged jaundice (After 14 days of life)Need to exclude other conditions (e.g UTI, hypothyroidism, liver problem etc..) Warning sign – “pale stool and tea-colored urine”If all tests were normal, it is most likely due to breastmilk jaundice – harmless and BF should be continued
MILD, SB ~ 150-200 umol/L MODERATE, SB ~ 200-320 umol/LSEVERE, SB >340umol/LKramer LI. Advancement of Dermal Icterus in the Jaundiced Newborn. Amer J Dis Child. 1969; 118: 454-458KRAMER’S RULE
G6PD deficiencyX-linked recessive red cell enzyme deficiency.Asian babies (~ 3-3.5% in Malaysia)Sex distribution: Males – affectedFemale – carrier Can cause sudden and severe RBC breakdown when exposed to oxidative agents mother father25%carrier XX XY XX XY 25% affectedXXXY
Abdominal colicCause ?unknownBelief to be due to “wind/gas” in the bowelsNormally self limiting by 3-4 months of ageMay consider anti-colic drops if severeProbiotics may helpWarning signs: persistent vomiting(greenish), mucousy/blood stain stool, abdominal distension, refuse feeding, lethargic and unwell looking etc..
Gastroesophageal refluxMild regurgitation is very commonNormally self limiting by 3-6mths of ageObserve if weight gain within acceptable rangeSolutions: Feeding technique, position, smaller amount but more frequent feedsIf severe, may consider thickened feeds +/- anti-reflux medicationsWarning signs: Forceful/projectile vomiting, feeds hungrily after vomiting, yellowish/greenish vomitus, poor weight gain, unwell looking, abdominal distension and not passing flatus/stool etc..
Other problemsStuffy nose and noisy breathing Seawater nasal spray is very safeDo not give sedative antihistaminePhlegm soundGenerally self limitingCTM (herbs, pearl powder etc…) – not recommendedHiccupsHarmlessSelf limiting Do not give excessive water(esp for infant < 6mths)
How to ensure my baby is thriving well and safe?First 6 months Good nutrition – breastfeeding is the BEST Safe environment and surroundingSleeping position – back to the BACK Do not use “sarong” – prone to accident and chocking +/- suffocation
How to optimize your child’s growth and development? Good nutritionBrEaST feeding – BEST nutrition (must make sure mother takes balance/healthy diet) “All nutrients are essential for growth and brain development and there is no single nutrient that should be particularly emphasized as providing your child with well balanced diet”
Benefits of breastfeedingBoth to baby and motherOffer perfect nutrition to your babyProtein, fat, CHO, minerals, vitamins etc..Easy to digest (lipase, amylase and lisozyme)Hormones for growth and development (prolactin, prostaglandins, insulin, thyroid stimulating hormone, thyroxine and growth hormone)Anti-allergenic agents Strengthen immune systemColostrum – contain leucocytes, antibodies (IgG &IgA)Promotes healthy gut systemLactoferrin – increase iron absorption and inhibit the growth of bacteria (e.g. E coli) in the bowelPrebiotics and probiotics (e.g. lactobacillus, bifidobacterium)
Monitor their growth parameters** Beware of under-nutrition but AVOID obesity
Evidence based medicine on breast feeding and breast milk
Nutrients for brain development
Food sources for brain nutrients
When to introduce solid food?~ 4-6mths of ageTiming and types of food?6-9 mths – cereal, porridge, bread, fruits, meat, chicken and vegetables.12-24mths – fish, eggs and all the above> 24mths – honey, sea foods and all the above>5 yrs – peanuts (risk of choking and aspirated into the lungs if being introduce early)
Development milestone4 Important areas:Gross motor skill – ability to move around their environment from rolling over to crawling, walking, running, climbing, cycling etc.Vision and Fine motor skill – ability to use hand-visual coordination to complete certain tasks for e.g. stacking the cubes, threading the beads, feeding himself/herself, writing, drawing etc.Hearing and speech – ability to communicate with his/her surrounding through spoken words or language.Social and behavioral skill – ability to interact with his or her peers, siblings and parents and maturity in handling social needs such as toilet train, social mannerism etc.
What every parent should know regarding their child’s development?Every milestone had its range of normality.Give some time for your child to acquire the skills as some children achieve certain milestone later than the other. It is important to know the range of normality in order to detect the abnormality.Children should be given enough time for them to perform under non-stressful environment or expectation.
What every parent should know regarding their child’s development?Every child is different and unique. Your child will develop and grow at his own pace. As long as he or she makes forward progress in his/her milestone, just sit back and enjoy seeing him/her grows. What's most important to track is that the child is making forward progress in all 4 domains of development.As a parent, you know your child well. Your first instinct is often reliable. Talk to your paediatrician or bring your child for developmental assessment if you are concern about your child being delay or different from other kids. Don’t wait!!!
Ways to enhance your child’s developmental skills? Gross MotorProvide safe environment for learning and exploring - No sharp edges or cornerAvoid the use of bouncer or walker as it is more prone to accident and injury. By putting babies on the flat surface will also encourage them to explore their body more naturally.Vision and Fine MotorEncourage touching different textures at an early ageEncourage stacking the cubes/blocks and playing with clay + pegsEncourage them to dig, paint, sweep, pour and thread beads
Ways to enhance your child’s developmental skills?Hearing and SpeechLook into your baby’s eyes and talk to him/herRead story book aloud to your child dailyRead nursery rhymes and sing nursery songsName the objects surrounding the houseIntroduce flash card or picture bookLet your children see you read daily and they will follow
Ways to enhance your child’s developmental skills?Social and behavioral skillCreate a positive body contact such as hugging and kissingEncourage your children to share toys among one another and with their friendsTeach them learn to wait for their turnBuild his/her self confident – allow him/her to help in your daily choresLet kids figure things out themselves – allow them to decideLet your child respond by himself and avoid the urge to speak for him
Good immune systemVaccination the most cost effective method in combating infection A good doctor/parents – detect early and treat early A “not so good” doctor/parents – detect late, resuscitate and treat the complications An excellent doctor/parents – prevent the disease “chinese proverbs” Prebiotic and probiotic – enhance immune system, healthy GIT system + digestion
Prevention is better than cure
Smallpox1950Polio1972MMR & Hib2002VACCINATIONYearVaccine Type
Compulsory vaccines in Malaysia
Optional Vaccines in Malaysia
IMMUNISATION SCHEDULE (SMC)
Pneumococcal Pneumococcal – bacteria that are commonly found in the throat and nasal cavity of young children. There are about 100 types of pneumococci, of which about 7-15 types are most important.
Pneumococcal Pneumococcal infection can causemiddle ear infection (otitis media), lungs infection (pneumonia)brain infection (meningitis)blood stream infection (septicaemia). Pneumonia, meningitis and septicaemia are serious life-threatening infections with mortality rate about 30%.
Pneumococcal vaccine Prevent against pneumococcal infectionPCV(pneumococcal conjugate vaccine) – recommended for all children < 5 years old4 doses regimes for infant < 6mths.1 dose of PCV for children >2 years old
RotavirusRotavirus – the commonest virus that causes diarrhea in children. Rotarivus is discharged by the billions from the infected stools of a patient and may contaminate garments, toys, bedding, food and in fact everything that is in contact with the patient. Hence, it is difficult to prevent transmission of the virus despite strict hygiene.
RotavirusThe disease will present as fever, diarrhea, vomiting and abdominal pain which may lead to severe dehydration and can cause death(n=440,000). Parashar UD et al, Emerg Infect Dis 2003;9(5):565–572
Rotavirus vaccine Prevent against rotavirus infection1st, 2nd or 3rd dose to be given 1-2mths apart1st dose should not be administered after the age of 6mths
Skin Care – Allergy
RISK OF ATOPY
How to prevent allergy?Identify high risk infants – avoid the allergens during antenatal and from birthAllergy prevention strategies: Exclusively breastfeedingHypoallergenic (HA) formula – partially hydrolyzed formula shorter protein chain less allergenicProbiotics
Take home messagehealthy baby joyful/smart children holistic, wise and caring adult Safe sleeping position and environmentEnsure healthy gut and immune systemBreast feeding, Balance nutrition good personal hygiene VaccinationAllergy preventionPre/probioticsCaring and loving family is essential
THANK YOU !!!