PAEDIATRIC CARE

Baby Care

• Holding your baby
  A newborn may not have the ability to control their neck muscles and head. When carrying your baby, gently support his head with one hand, and the other support his body firmly; so that his head does not flop back. When putting the baby down, gently support the head with one hand and the bottom with the other.
• Swaddling
  • Baby should be swaddled or wrapped snugly in a thin cloth/blanket to help him feel soft and secure in the early weeks after birth. Never wrap baby too tightly.
  • In the first few days after birth, swaddling baby day and night may remind baby of being in the womb, making him feel warm and secure.
  • Do not leave your baby swaddled throughout the night as it can interfere with his mobility and normal development.
  • Some mummies find that swaddling the baby at bedtime is an effective way to soothe the baby to sleep. Once the baby is asleep, remove the swaddle.
  • Always place your baby on their back to sleep. The baby being swaddled should not be placed to sleep on his tummy as it may cause suffocation.
  • As soon as the baby grows bigger and stronger and can roll over, stop swaddling him. Swaddling for an extended period may interfere with his mobility and development on his hip joints.
  • It is essential to follow your baby’s cues. Most babies prefer not to be swaddled after six to eight weeks. If the baby resists being swaddled and is constantly freeing himself or rolling over in the cot at night, it may be time to stop swaddling. This development milestone is a good guideline for determining when to stop swaddling the baby.
• Bathing Your Baby
  Giving your baby a daily bath is essential to keeping your baby clean and fresh. Make sure you have all these items within reach, before starting a bath.
  • A plastic basin or bathtub
  • Cotton wool balls or soft face towel
  • Baby bath lotion
  • Baby towel
  • Cloth nappy with liner or disposable nappy
  • Singlet or t-shirt
  • Barrier cream or body lotion
  • A bowl of cool boiled water

  Learn More

• Diaper changing
  • Newborns urinate frequently, so it is important to change your baby’s diaper every two to three hours for the first few months. You can also wait until your baby wakes up before changing the diaper.
  • When changing, choose a flat surface. Standby pre-moistened baby wipes and a clean diaper. Remove the soiled diaper and thoroughly clean your baby’s bottom. During cleaning, carefully hold baby’s legs by the ankles with one hand. Using the moistened baby wipes and wipe from front to back.
  • Your baby may urinate when you are changing the diaper. If your baby is a boy, you can avoid being sprayed with urine by covering his penis loosely with a cloth while cleaning the rest of the diaper area.
  • Make sure you get the size corresponding to your baby’s weight. It is hard to tell which disposable diaper is best for your baby. You will have to try different diapers to decide which suits your baby best.
• Diaper Rash
  Your baby’s skin is thin and delicate. Hence when the skin is exposed to heat and moisture, due to the presence of both pee and poo in the diaper, it is more prone to damage. Furthermore, the pee and poo contain bacteria that can irritate the skin, making it susceptible to diaper rash.
• Sleeping
  It will take a while for newborns to establish a sleep pattern. Their sleep and wake cycles revolves around the 24 hour cycle and they don’t know the difference between day and night. You can help your baby establish a sleep pattern by avoiding stimulation in the night. Keep lights low, no playing or talking with your baby or set a familiar tune for sleep. This will help reinforce that night is for sleeping.
• Crying
  Baby’s only language is crying, it is his primary form of letting you know that he needs help and attention from you. Before you start agonising over the cries, here are some ‘crib’ notes to help you understand what your baby may be saying to you.
  Learn more
• Massage
  Baby massage has physiological and psychological benefits for babies and for their parents.
  There are four main benefits of baby massage:
  • Stimulation – Stimulation of all the senses and all physiological systems of the body.
  • Relaxation – Helps the body to produce ‘calming hormone’ that helps the baby to have deeper sleep and have less stress.
  • Relief – Relief of minor discomfort – wind , colic, constipation, mucus, teething pain etc, making the parents feel empowered to help their baby in a simple way.
  • Interaction – It helps to enhance the parent – baby bonding. Massaging the baby allows the mother to communicate the mother’s love through the nurturing touch. Studies have shown that babies who are cuddled and touched grow up to be calmer and better – adjusted adults.

  At Mount Alvernia Hospital, our team of parentcraft specialists, physiotherapists and dietitians has specially prepared a childbirth education course to help new parents prepare for childbirth and the arrival of their baby. To learn more, click here.

Paediatric Health

The smaller body of an infant or a child is substantially different physiologically from that of an adult. Hence treating children for any medical conditions is not the same as treating a little adult.

• Immunisation
  • This is a simple, safe and effective way of protecting a child from diseases that can cause serious illness and sometimes death.
  • Infections in children can start right from birth. Though there are some antibodies that do cross the placenta to provide some protection, this is usually inadequate and most of the important ones for infants and young children are very low in mothers. Furthermore the immune system in young children does not work as well as in older children and adults, because it is still immature. Therefore, more doses of vaccine are often needed.
  • The protective effect of some immunisations can last up to 30 years while others are required more often. For instance, influenza immunisation is needed annually due to frequent changes to the type of influenza virus circulating in the community. Booster doses are also needed for some vaccines because immunity decreases over time.

  Learn More

• Fever
  • Generally, 37.5 degrees measured from axillary is considered as fever, and 38 degrees from the ears as fever. There are however variations to this guideline depending on the time of day and the activity the child is engaged in before checking the temperature.
  • The common cause of fever is infection such as throat infection, lung infection or tummy infection. Other reasons for fever to occur in new-born babies can be due to poor feeding, leading to dehydration and raised temperature. When they are over wrapped such as by too thick blankets in non-air-conditioned environment can lead to fever too.
  • Metabolic disorders and even cardiac failure that leads to breathing hard can raise temperature too but they are rare.
  • Keep a thermometer at home to help to monitor the temperature even after seeing the doctor and with medications. Put the child in a cool, comfortable environment such as in an air-con room that is set in a comfortable temperature. Don’t blanket the child excessively. Sponging or bath is okay. For sponging, use normal temperature water at the armpit, the groin and so on.
• Diarrhoea
  • Diarrhoea is defined as the frequent passage of loose watery stools. If a baby is breast feeding or given expressed breast milk, the stools are usually loose and watery. Therefore it must be beyond the usual or if there is blood in the stools
  • Diarrhoea is usually caused by an infection which can either be viral or bacterial. Sometimes baby can get a bit of loose stools when they are on antibiotics. Teething does not cause diarrhoea. If they do get diarrhoea when they are teething, it is usually due to a mild infection caused by the child putting things into their mouths
  • Diarrhoea can be accompanied by fever, vomiting and bloody stools. All these are red flags and the child should be reviewed by a doctor. They should be monitored for their fluid intake during the illness.
  • Your child may have a poor appetite when he is having a diarrhoea and may even have tummy pain. Once they poo, the pain may have some relieve but will develop again after a while. Fluids is more important that solids and one should give them small amounts more frequently like 60 to 100ml every half hourly to hourly. The fluids may be in the form of oral rehydrate solutions or isotonic drinks if the child is older. For infants, boiled rice water is a good alternative. Reduce intake of veggies and fruits during the acute episode. Simple foods like porridge and bread is good. Give half portion, more frequently.
  • If your child less than 6mths old, you need to bring him in to see a doctor. For older children, you can observe the child for 1 or 2 days if he is feeding well without fever, vomiting and bloody stools
• Common Skin Problems
  Cradle cap is a dry, flaky, yellowish dandruff-looking, scaly patches over the scalp and sometimes seen over the eyebrows of a baby. It usually starts after a month old and may last for a few weeks or months. It is not itchy and does not disturb the baby.
  • Applying some olive oil or baby oil onto the affected areas for about 10 to 20 minutes (depending on how thick the accumulation is) helps in softening the plaques. Gentle shampooing and massaging the plaques will loosen it and eventually remove the plaques. It is important not to use too much force as this might leave to abrasions. The other thing to note is that the plaques may recur again but will eventually disappear.
  • Pimples or bumps on baby skin usually starts on the cheeks and face of most newborns when they are about 2 to 3 weeks old. It may extend to the forehead, scalp and even around the ears. It may worsen when the baby is hot and fussy or when the skin is irritated by saliva, spit milk or even clothes rubbing over it.
  • Do not apply any creams or use any acne wash over the skin. Just simply wash your baby’s face with cool water will reduce the rashes.
  • Baby Rash is a common skin rash in many newborns that will appear soon after birth. It appears as red patches of various shapes and sizes with tiny white or yellow heads in the centre. It is harmless and resolve within 1 to 2 weeks.
  • The area of the rash moves from place to place till it eventually completely resolves. If the rashes have pus-filled blisters, there might be a skin infection and medical attention is needed. It is best to bring attention to see a doctor if you see this.
  • Atopic eczema or dermatitis is a very common skin condition that often occurs childhood. The skin may be dry, itchy and red. This commonly occurs over the flexural areas such as the neck, elbow, the back of the knees and just about any part of the body may be affected.
  • Avoid scratching and rubbing the skin as this will aggravate the eczema and make the skin redder and more inflamed. This can also lead to breaks and cracks in the skin which can then predispose to bacterial infection. Use gentle soap or soap substitutes. And always moisturize.
• Childhood Obesity Risks
  • Type 2 diabetes. This chronic condition affects the way your child’s body uses sugar (glucose). Obesity and a sedentary lifestyle increase the risk of type 2 diabetes.
  • High cholesterol and high blood pressure. A poor diet can cause your child to develop one or both of these conditions. These factors can contribute to the buildup of plaques in the arteries. These plaques can cause arteries to narrow and harden, which can lead to a heart attack or stroke later in life.
  • Sleep disorders. Obstructive sleep apnea is a potentially serious disorder in which a child’s breathing repeatedly stops and starts during sleep.
  • Asthma – there is a high risk of asthma among overweight Children.
  • Unless the cycle is broken, overweight children become overweight adults

Toddler Nutrition

Toddlers are learning to feed themselves and to eat new foods. They should eat a variety of foods from all of the food groups.

• Healthy food choices
  The My Healthy Plate is a guideline to help you and your child eat a healthy diet.as well as eat a variety of foods. It also encourages the right amount of calories and fat.
  Click on here to learn more.
• Fussy Eaters
  If meal time dramas are a common sight in your household, you are not alone. Getting used to meal times, trying new foods, adjusting to unfamiliar textures and flavours is unsettling for many children, especially toddlers. At the same time, preparing meals that are left uneaten and constantly having to cajole the picky one to take even one bite can be stressful for parents and caregivers.
  Here are some tips to help parents coax fussy eaters
  • Let him be the boss
    Ask your kid what he wants to eat. During your next grocery shopping trip, let him take over the trolley and have a say in picking out new things that he is keen to try. If he chooses it, he will at least take a bite.
  • Make it fun
    Get him involved in the preparation of the food. Have fun together cutting up the vegetables or fruits into different shapes and sizes. Combine different food with bright colours and make the dish “interesting to eat”.
  • Mix it up
    If he shuns the dish once he notices a particular ingredient, try a different way of cooking. Some alternatives include pureeing or mashing and mixing it together with porridge or other types of his favourite food.
  • Encourage, not punish
    – Load up the praises when he eats well or tries out new food. Even if he rejects it for the first time, do not lash out. Instead, try again a week later and do so in small portions.
  • Adopt a routine
    – Kids crave familiarity. Plan regular mealtimes and keep to small but frequent meals with snacks in between to supplement their main diet. Examples of healthy snacks include milk, soy bean milk, cheese, fruits, fruit juices, pudding and yoghurt.
• Preventing Childhood Obesity
  Too little activity and too many calories from food and drinks are the main contributors to childhood obesity.
  • Diet
    Regularly eating high-calorie foods, such as fast foods, baked goods and vending machine snacks, can easily cause your child to gain weight. Candy and desserts also can cause weight gain, and more and more evidence points to sugary drinks, including fruit juices, as culprits in obesity in some people.
  • No Exercise
    Children who don’t exercise much are more likely to gain weight because they don’t burn as many calories. Too much time spent in sedentary activities, such as watching television or playing video games, spending time on electronic devices also contributes to the problem.
  • Environment
    This is true in an environment where physical activity isn’t encouraged coupled with regular consumption of calorific diets or convenience foods (eg crackers, frozen meals etc) could influence children’s choice of food.
  • Stress
    can increase a child’s risk of obesity. Some children overeat to cope with problems or to deal with emotions, such as stress, or to fight boredom.
  • Genetic and hormonal factors
• Constipation
  Constipation may occur when starting solids for your baby as his or her body is learning to digest new foods. Low-fibre foods and not enough fluids also contribute to constipation.
  • Offer more fluid. Water is your best choice, but a little juice mixed with water can help. Some fruit juices, like apple juice and prune juice, are natural laxatives. Start small — offer 30 to 60ml of diluted fruit juice (fruit juice mixed with water) in your baby’s bottle or cup. Limit juice intake though since it can increase the risk of tooth decay and a feeling of fullness.
  • To help keep your child’s stools soft, increase the amount of fluid she drinks. Boost your child’s fiber intake such as fruits and vegetables. You can serve these to your baby alone or mixed into other foods, like baby cereal.
  • Get physical. Movement seems to help improve constipation.
  • Gentle massage to the tummy may also help alleviate constipation.

Weaning

When your baby is six months old, you would have tackled most issues with feeding breast milk or formula milk. Now, it is time to introduce solids to your baby’s diet!

• When is your child ready for weaning?
  Some signs of weaning readiness are when baby:
  • holds his/her head in an upright position.
  • sits upright in a highchair and swallow well
  • chews on his fingers, knuckles, feet, etc
  • is losing the “extrusion reflex”, stops pushing food out of the mouth
  • drools less and is able to move food to the back of the mouth and swallow
  • demands more feedings
  • curious about what you’re eating
• How to start?
  Start with small quantities
  • Add a little of your baby’s usual milk (breast or formula) to mix food
  • Offer one food at a time
  • Allow 3-4 days between the introduction of new foods
  • Establish a routine for weaning
• What to consider when selecting and preparing early foods?
  • Introduce food one at a time and look out for any possible food allergic reaction, such as a rash, swelling of the face, tongue or lip, vomiting or diarrhoea, wheezing or shortness of breath. Common food allergens include seafood, eggs and cow’s milk.
  • Foods should also be prepared in a hygienic manner to prevent food poisoning episodes.
• What are common challenges?
  It is a learning process for both mothers and babies during the weaning process. They include:
  • Acceptance of foods by baby
  • Achieving the right consistency/texture of food prepared by mothers
  • Managing with messy meal times

Learn more about our Weaning Workshop