BABYS HEALTH AND SAFETY: OUR TOP PRIORITY Dr B.A.KHOO
Consultant Paediatrician and Neonatologist Sunway Medical Centre 21
st JULY 2013 GARDEN HOTEL
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What is our objective? Healthy mother and pregnancy Healthy
baby Happy family
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BABYS HEALTHCARE Physical health(growth and development) Mental
health (IQ vs. EQ etc..) Social and behavioral health Communication
skills healthy baby joyful/smart children holistic, wise and caring
adult
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Tips for healthy baby Good start healthy mother pregnancy Good
nutrition pre and postnatal Effective stress coping mechanism Good
immune system vaccination, personal hygiene, healthy diet, etc..
Safe environment to learn and explore Safe sleeping position Early
education and stimulation audiovisual, music, communication etc..
Loving and caring family
Neonatal Jaundice Physiological jaundice (First 1 week of life)
Very common Self limiting but sometime need phototherapy
Breastfeeding jaundice (First few days of life) Due to inadequate
breast feeding dehydration Advise to persevere with BF +/-
supplementation
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Neonatal Jaundice Prolonged 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
G6PD deficiency X-linked recessive red cell enzyme deficiency.
Asian babies (~ 3-3.5% in Malaysia) Sex distribution: Males
affected Female carrier Can cause sudden and severe RBC breakdown
when exposed to oxidative agents mother father 25% carrier XX XY XX
XY 25% affected XXXY
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G6PD deficiency
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Abdominal colic
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Cause ?unknown Belief to be due to wind/gas in the bowels
Normally self limiting by 3-4 months of age May consider anti-colic
drops if severe Probiotics may help Warning signs: persistent
vomiting(greenish), mucousy/blood stain stool, abdominal
distension, refuse feeding, lethargic and unwell looking etc..
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Gastroesophageal reflux Mild regurgitation is very common
Normally self limiting by 3-6mths of age Observe if weight gain
within acceptable range Solutions: Feeding technique, position,
smaller amount but more frequent feeds If severe, may consider
thickened feeds +/- anti-reflux medications Warning signs:
Forceful/projectile vomiting, feeds hungrily after vomiting,
yellowish/greenish vomitus, poor weight gain, unwell looking,
abdominal distension and not passing flatus/stool etc..
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Other problems Stuffy nose and noisy breathing Seawater nasal
spray is very safe Do not give sedative antihistamine Phlegm sound
Generally self limiting CTM (herbs, pearl powder etc) not
recommended Hiccups Harmless Self limiting Do not give excessive
water(esp for infant < 6mths)
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How to ensure my baby is thriving well and safe? First 6 months
Good nutrition breastfeeding is the BEST Safe environment and
surrounding Sleeping position back to the BACK Do not use sarong
prone to accident and chocking +/- suffocation
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How to optimize your childs growth and development? Good
nutrition BrEaST 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
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Benefits of breastfeeding Both to baby and mother Offer perfect
nutrition to your baby Protein, 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 system Colostrum contain leucocytes,
antibodies (IgG &IgA) Promotes healthy gut system Lactoferrin
increase iron absorption and inhibit the growth of bacteria (e.g. E
coli) in the bowel Prebiotics and probiotics (e.g. lactobacillus,
bifidobacterium)
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Monitor their growth parameters ** Beware of under-nutrition
but AVOID obesity
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Evidence based medicine on breast feeding and breast milk
Evidence Based MedicineBenefits of breastfeeding and breast milk
American Journal of Clinical Nutrition, October 1999 BF > 3.2 IQ
points Maternal bonding > 2.1 IQ points Enhanced cognitive
development seen in as early as 6 months of age and sustained
through until 15 years of age. Archives of Disease in Childhood
2001;85:183-188 345 children breastfed for 3 vs > 6 mths Mental
skills were compared at 13 mths and 5 years of age Non breastfed
group score below average at 13 mths At 5 years of age breastfed
group average 8 points higher in IQ
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NUTRIENTS FOR BRAIN DEVELOPMENT FUNCTIONS Omega-3, omega-6
Arachidonic acid (AA) DHA (docosahexaenoic acid) building blocks of
the brain cells synaptogenesis, important in cell membrane function
and myelination. Ironfacilitating nerve communication and
production of neurotransmitter Cholineimprove memory, keep brain
cells functioning and assists in nerve transmission Luteinability
to filter blue light and protect the eyes Taurineefficient and
rapid nerve communication synthesis and release of brain
neurotransmitters Zincprotecting brain cells (anti-oxidant
properties) TryptophanEnsuring good night rest in order for the
brain to build and consolidate neural connections
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FOOD SOURCES FOR BRAIN NUTRIENTS BRAIN NUTRIENTSFOOD SOURCES
Omega-3 fatty acids (Alpha-linolenic acid (ALA). Omega-6 fatty
acids (Linoleic acid - LA). breast milk, tuna, salmon, sardines,
mackerel, cod liver oil, flax seeds, eggs, meat, dairy products,
chia seeds, walnuts, sea vegetables, and green leafy vegetables,
cold-pressed sunflower, safflower, corn, sesame oils and black
currant seed oils. Iron Clams, pork Liver, oysters, chicken Liver,
mussels, beef liver, beef, shrimp, sardines, turkey Cholineeggs,
fish, legumes (soybeans), grains (wheat), nuts (peanuts), organ
meats, lean meat, and vegetables Lutein (carotenoids class of
yellow to red pigments found especially in fruits and vegetables)
spinach, corn and egg yolks, peppers, tomatoes, carrots, sweet
potatoes, corn, beans, peas, peaches, oranges, papayas, apricots
and mangoes Taurineeggs, fish, meat, milk, seaweed, clam, squid,
octopus, and oyster Zinc, B-vitamins and folic acidgreen
vegetables, beans, pasta, grapefruits, yogurt, fish and seafood
TryptophanTurkey, chicken, beef, brown rice, nuts, fish, milk eggs,
cheese, fruits and vegetables. Antioxidants eg: beta-carotene,
taurine, vitamin C, Vitamin E and zinc, monosaturated oleic acid
Strawberries, apricots, red cabbage, spinach, sunflower seeds and
walnuts, olive oil, oils from almonds, pecans, macadamias, peanuts,
and avocados.
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When to introduce solid food? ~ 4-6mths of age Timing 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)
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Development milestone
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4 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.
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What every parent should know regarding their childs
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.
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What every parent should know regarding their childs
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. Dont wait!!!
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Ways to enhance your childs developmental skills? Gross Motor
Provide safe environment for learning and exploring - No sharp
edges or corner Avoid 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 Motor Encourage touching different textures at an
early age Encourage stacking the cubes/blocks and playing with clay
+ pegs Encourage them to dig, paint, sweep, pour and thread
beads
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Ways to enhance your childs developmental skills? Hearing and
Speech Look into your babys eyes and talk to him/her Read story
book aloud to your child daily Read nursery rhymes and sing nursery
songs Name the objects surrounding the house Introduce flash card
or picture book Let your children see you read daily and they will
follow
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Ways to enhance your childs developmental skills? Social and
behavioral skill Create a positive body contact such as hugging and
kissing Encourage your children to share toys among one another and
with their friends Teach them learn to wait for their turn Build
his/her self confident allow him/her to help in your daily chores
Let kids figure things out themselves allow them to decide Let your
child respond by himself and avoid the urge to speak for him
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Good immune system Vaccination 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
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Prevention is better than cure
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Smallpox 1950 DTP1960 BCG1961 Polio1972 Measles1982 Rubella1986
Hepatitis B 1989 MMR & Hib 2002 1950 1960 1970 1980 1990 2000
VACCINATION Year Vaccine Type
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Compulsory vaccines in Malaysia
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Optional Vaccines in Malaysia VaccineMonth 01234561218+
Pneumococcal Conjugate Vaccine Chickenpox Vaccine Hepatitis A
Vaccine Rotavirus Vaccine
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IMMUNISATION SCHEDULE (SMC)
VACCINEBirth6w-2m3-4m5-6m6-7m12m12-15m18m19-23m2-3yr4-6yr BCG Hep B
DTaP/IPV HiB Rotavirus PneumoC Influenza (2nd dose to be given 1
month later then yearly) MMR Chicken pox Hep A (2 doses)
MeningoC
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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.
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Pneumococcal Pneumococcal infection can cause middle 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%.
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Pneumococcal vaccine Prevent against pneumococcal infection
PCV(pneumococcal conjugate vaccine) recommended for all children
< 5 years old 4 doses regimes for infant < 6mths. 1 dose of
PCV for children >2 years old
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Rotavirus Rotavirus 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.
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Rotavirus The 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):565572
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Rotavirus vaccine Prevent against rotavirus infection 1 st, 2
nd or 3 rd dose to be given 1-2mths apart 1 st dose should not be
administered after the age of 6mths
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Skin Care Allergy
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RISK OF ATOPY
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How to prevent allergy? Identify high risk infants avoid the
allergens during antenatal and from birth Allergy prevention
strategies: Exclusively breastfeeding Hypoallergenic (HA) formula
partially hydrolyzed formula shorter protein chain less allergenic
Probiotics
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Take home message healthy baby joyful/smart children holistic,
wise and caring adult Safe sleeping position and environment Ensure
healthy gut and immune system Breast feeding, Balance nutrition
good personal hygiene Vaccination Allergy prevention Pre/probiotics
Caring and loving family is essential