BABY’S HEALTH AND SAFETY:OUR TOP PRIORITY

Dr B.A.KHOOConsultant Paediatrician and Neonatologist

Sunway Medical Centre

21st JULY 2013GARDEN HOTEL

What is our objective?

• Healthy mother and pregnancy

• Healthy baby

• Happy family

BABY’S 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

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

Early newborn/infancy period

D3 – D14Neonatal Jaundice

1 – 4 mthsInfant colic

1 – 6 mthsGORD (reflux)Skin allergy - eczema

D1 D14 2 mths 4 mths 6 mths

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

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

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

KRAMER’S RULE

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

X X X Y

G6PD deficiency

Abdominal colic

Abdominal colic

• 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..

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..

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)

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

How to optimize your child’s 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”

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)

Monitor their growth parameters

** Beware of under-nutrition but AVOID obesity

Evidence based medicine on breast feeding and breast milk

Evidence Based Medicine Benefits 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 mthsMental skills were compared at 13 mths and 5 years of ageNon breastfed group – score below average at 13 mths At 5 years of age – breastfed group average 8 points higher in IQ

NUTRIENTS FOR BRAIN DEVELOPMENT NUTRIENTS FOR BRAIN DEVELOPMENT

FUNCTIONS

Omega-3, omega-6 Arachidonic acid (AA) DHA (docosahexaenoic acid)

building blocks of the brain cellssynaptogenesis, important in cell membrane function and myelination.

Iron facilitating nerve communication and production of neurotransmitter

Choline improve memory, keep brain cells functioning and assists in nerve transmission

Lutein ability to filter blue light and protect the eyes

Taurine efficient and rapid nerve communicationsynthesis and release of brain neurotransmitters

Zinc protecting brain cells (anti-oxidant properties)

Tryptophan Ensuring good night rest in order for the brain to build and consolidate neural connections

FOOD SOURCES FOR BRAIN NUTRIENTSBRAIN NUTRIENTS FOOD 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

Choline eggs, 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

Taurine eggs, fish, meat, milk, seaweed, clam, squid, octopus, and oyster

Zinc, B-vitamins and folic acid green vegetables, beans, pasta, grapefruits, yogurt, fish and seafood

Tryptophan Turkey, 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.

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)

Development milestone

Development milestone

• 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.

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 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

Ways to enhance your child’s developmental skills?

• Hearing and Speech– Look into your baby’s 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

Ways to enhance your child’s 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

Good immune system

• Vaccination – the most cost effective method in combating infection

A good doctor/parents – detect early and treat earlyA “not so good” doctor/parents – detect late, resuscitate and treat the complicationsAn excellent doctor/parents – prevent the disease

“chinese proverbs”

• Prebiotic and probiotic – enhance immune system, healthy GIT system + digestion

Prevention is better than cure

Smallpox1950

DTP1960

BCG1961

Polio1972

Measles1982

Rubella 1986

Hepatitis B1989

MMR & Hib2002

1950

1960

1970

1980

1990

2000VACCINATION

Year

Vaccine Type

Compulsory vaccines in Malaysia

Optional Vaccines in Malaysia

Vaccine Month

0 1 2 3 4 5 6 12 18+

Pneumococcal Conjugate

Vaccine

Chickenpox Vaccine

Hepatitis A Vaccine

Rotavirus Vaccine

IMMUNISATION SCHEDULE (SMC)

VACCINE Birth 6w-2m 3-4m 5-6m 6-7m 12m 12-15m 18m 19-23m 2-3yr 4-6yr

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

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 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%.

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

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.

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):565–572

Rotavirus vaccine

• Prevent against rotavirus infection• 1st, 2nd or 3rd dose to be given 1-2mths apart• 1st 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 birth

• Allergy prevention strategies: – Exclusively breastfeeding– Hypoallergenic (HA) formula – partially hydrolyzed

formula shorter protein chain less allergenic– Probiotics

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

THANK YOU !!!