Quality Care for Every Child

At our recent Facebook LIVE event, Dr Terence Tan, Consultant Paediatrician and Neonatologist of Kinder Clinic Pte Ltd, and Rita Francis, Senior Parentcraft Counsellor at Mount Alvernia Hospital, fielded questions on paediatric care and parentcraft. The well-attended event was hosted by local content creator and entrepreneur Melissa Koh and sponsored by Mead Johnson Nutrition. It was the perfect opportunity for parents, especially first-time ones, to reach out for up-to-date information on caring for their little ones from pregnancy to the first week of life and beyond. Here are some of the questions they asked, along with the answers provided by our expert speakers. (Some have been edited for clarity and length.)

Q: At what age should babies be vaccinated and are there any side-effects that parents should look out for?
A: The principle is always to give vaccines in a timely way. Some infections tend to attack kids at an early age, and others when they are older. Certain vaccines are also more effective when they are younger, and others when they are older and their immune systems are more mature. Our National Childhood Immunisation Schedule (NCIS)* lists all compulsory and recommended vaccines from birth to about 18 to 24 months*.

By and large, most of these vaccines have been used for decades, so they are generally thought to be very safe.

Though every vaccine is slightly different, there are common side-effects like fever, irritability and soreness around the injection site. These side-effects can be grouped into minor and major, according to their severity. Some vaccines hardly have any side-effects at all. Before any vaccine is given, the nurse or doctor will always outline the possible side-effects.

Q: When should parents schedule their first appointment with a paediatrician?
A: Usually we want to see babies in the outpatient clinic at the end of the first week of life. We want to ensure that their jaundice level is not too high and that babies are gaining weight. That is also around the time when parents can run into a bit of trouble managing their baby.

Q: What are the risk factors for Sudden Infant Death Syndrome (SIDS)?
A: SIDS is statistically related to prone sleeping positions – or sleeping on the tummy. Because of that, we tell parents to put babies on their backs to sleep. That ‘back to sleep’ strategy has lowered the incidence of SIDS. There is a lower incidence of SIDS in the Far East compared to in the west. Co-sleeping with parents in the same bed also increases the risk.

Q: When a baby has a fever, when should parents take the child to a doctor or hospital?
A: For newborns in the first four to eight weeks of life, a fever is generally deemed to be an urgent matter that requires immediate medical attention. This is because their immune systems are not mature; they don’t yet know how to complain; and because they are very small they can become dehydrated very quickly.

After six months, you can be a little more relaxed about it. There are three major parameters you can use to gauge the seriousness of the condition and when to see a doctor.

One is feeding well vs feeding poorly. When a child is feeding poorly, we know that something is wrong. The second is

sleeping or not sleeping. If something is disturbing a child’s sleep, he or she may be in pain or in discomfort. The third indicator is crankiness.

Some experienced parents are very confident and can manage minor ailments on their own, while first-time parents tend to be more nervous, especially when the baby is very young. If it is a first child, it is better to bring the child to the doctor rather than use guesswork.

Q: When kids fall sick, how do you know whether it is an infection or an allergy?
A: It can be confusing, because the symptoms are often the same – typically a cough and runny nose. It is made even more confusing by the fact that infections can trigger allergies, which makes it very hard to tell.

Fever, the presence of a sore throat, runny nose, sore throat, poor feeding and crankiness usually indicate an infection. On the other hand, the symptoms of allergies tend to come and go and can vary within a day. A child can have a runny nose in the morning, which clears up later in the day, and then the child remains well for the rest of the day and until the next morning. So there are some clues that tell us whether that cough and runny nose is the result of an allergy or an infection. When in doubt, bring the child to see the doctor.

As to whether allergies disappear as kids grow older, the proper term is not so much ‘disappear’ as ‘evolve’. Some babies are born with sensitive skin and have childhood eczema, but the eczema will go away and the child might develop wheezing, then the wheezing will go away and the allergy evolves into a sensitive nose.

Q: Should babies be given plain water?
A: Water is necessary for life, but the recommendation is to give water in the form of milk in the first four to six months of life. The reason for that is twofold. Firstly, babies’ kidneys are not mature enough to handle too much water. The kidneys can end up flushing away the salt and this can be dangerous. Secondly, if you give a lot of water, then the baby cannot take milk because they have limited capacity.

Q: What are the signs of labour?
A: There are three signs of labour. They are: a show, regular contractions, and breaking of the water bag. The three signs are not necessarily in this sequence.If you have a show, there is no urgent need to go to the hospital. The show is a mucus plug at the neck of the uterine that acts as a seal during pregnancy. It is dislodged when labour commences.

Contractions usually start from the back and come down to the tummy. Some ladies are more sensitive and can feel them in the thighs. As contractions become regular, the pain usually intensifies and the intervals between them become shorter. Once you have regular contractions, you should come to the hospital.

When the water bag breaks, it is either a gush or a trickle. If your bag breaks, you should come down to the hospital now. You should take note of two things when the water bag breaks – the colour and the timing. If the colour is greenish, it is not a good sign as it means the baby is distressed and may have passed motion. If it is clear, it is a good sign. The timing is important as there is a safe timeframe from the water bag breaking to the delivery.

Everyone is different. Do not compare notes with your friends. And the signs do not come in any fixed sequence.

Q: Are there any antenatal classes mothers can attend to prepare themselves for labour, delivery, childbirth, care of the newborn and breastfeeding?
A: Yes, there are, and of course most are online now. You can learn so many things from our panel of experts – breathing techniques during labour, nutrition tips during pregnancy, tips for the spouse to be a supportive partner, the best positions for breastfeeding, how you burp and swaddle the baby, common skin conditions and more.

There are so many factors involved in pregnancy and parenting, so it is a good thing to attend these classes. You will definitely benefit from them.

Q: Is breastfeeding painful?
A: Breastfeeding should not be painful. If it is painful, please come and see us and we will guide you through. The latch is so important. If the baby is latched well, it should not be a problem.

First of all, the mother should be relaxed. Have a warm drink to warm up your system, massage your breasts, and assume a good position for breastfeeding.

When baby latches on, it should be a deep latch that forms a vacuum seal. The cheeks should be ballooned out, there should be no dimpling, no dribbling and no clicking sounds, and the lower lips should be flanged out, not in.

If the baby is latched well, the sucking should only be rapid during the first few moments. Then it should be strong and rhythmic.

Once you unlatch the baby, your nipples should look nice and round and there should be no soreness. The anatomy of the baby’s mouth and the breast are made for breastfeeding.

I encourage all mothers to initiate breastfeeding early on. Skin-to-skin contact is very important – it makes the baby feel calm and warm and they will actually crawl to the breast. The baby will reach for the breast because the areola emits an amniotic fluid smell, so newborn babies are naturally drawn to the familiar smell.

Q: How can I ensure that my newborn is getting enough milk?
A: Newborns are sleepy, so sometimes you need to wake them to feed them eight or ten, even twelve times a day. There is no restriction of timing on the breast, and it is important to empty one breast before offering the other. Whatever goes in has to come out.

Watch out for signs of dehydration. The frequency and colour of urine and motions are important. The urine should not be dark or pinkish and bloody – this is a sign of dehydration. The motion should turn from greenish to mustard-yellow colour by around day four.

Make sure your baby looks satisfied and is gaining weight. They should not lose more than 7 percent of body weight in the first week – but it should be a gradual loss, not a drastic sudden loss. By day eight or day ten they should go back to their birth weight, and subsequently gain an increment of 200 grammes each week. By four to six months, they should have doubled their birth weight.

These are signs that show your baby is thriving on your breast milk.

Q: How do you calm newborn babies when they wake up ‘in shock’?
A: A mother’s touch can calm the baby down. I also strongly encourage parents to learn infant massage, because it is a lifelong skill. It will also make the mum feel more relaxed and boost her oxytocin, which will help boost her milk production

Q: How can you get a baby to sleep?
A: Do not over-stimulate the child close to bedtime. Make sure the environment is cosy, and create a routine. The temperature should not be too hot or too cold, with no direct breeze from an overhead fan. Make sure that they are well-fed.

Dr Tan adds: When babies are born, they do not respect night or day. Of course in the womb, there is no night and day. As parents, we need to follow the baby’s clock. By and large, we expect an ‘upside-down’ sleep pattern in the first couple of months of life. There are some things that can interfere with sleep, like acid reflux, asthma and allergies, and you need to watch out for symptoms.

Over the first couple of months of life, the influence of light and dark should regulate the baby’s brain. In the night-time, try not to put the lights on even when the baby is crying and needy. Babies are creatures of habit and they should settle into a routine. Baby massage also definitely helps.

If the mum drinks tea or coffee or stimulant foods, it can enter the breastmilk and make the baby wakeful. Breastfeeding mothers should be mindful of this.

Q: Is it okay to breastfeed while you are pregnant?
A: This is called tandem nursing and it is definitely okay. Once the baby is born, the priority should be the newborn, then the second child. Both can be breastfed at the same time. This can enhance the bonding between the baby and the older child and you, and the older child’s suckling can help release blockages in the breast.

“You only go down this road once with each child. Enjoy the time with your kids. The time slips through your fingers too quickly. Don’t struggle with anything if you are uncertain. Always seek help – there is a lot of help available,” said Dr Tan.

“It is a bliss to be parents. So enjoy the whole process, the milestones and everything. Remember, we are always there if you have any queries or need help. We work as a team – our physical therapists, our dietitians, our paediatricians, our doctors and us. We are there for you,” said Rita.

View the video of the event at

This article is taken from our My Alvernia Magazine Issue #45. Click here to read the issue on our website.