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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

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Early newborn/infancy period D3 D14 Neonatal Jaundice 1 4 mths Infant colic 1 6 mths GORD (reflux) Skin allergy - eczema D1D142 mths4 mths6 mths

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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

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MILD, SB ~ 150-200 umol/L MODERATE, SB ~ 200-320 umol/L SEVERE, SB >340umol/L Kramer LI. Advancement of Dermal Icterus in the Jaundiced Newborn. Amer J Dis Child. 1969; 118: 454- 458 KRAMERS RULE

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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

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