Constipation occurs when a child does not go to toilet to defecate regularly resulting in difficult or painful bowel opening (pooping). The peak incidence of constipation is between 2-4 years of age when parents start to toilet train their children.  Around half the kids experience constipation at least once during childhood!

The frequency of defecation depends on the child’s age; beginning with around 4 times a day during neonatal and infant period but gradually decreasing to twice daily during early years of age and once daily by the age of 4 years when children are able to achieve anal sphincter control.

Symptoms of constipation

  • difficulty or pain in defecation
  • hard dry stools (see stool chart below)
  • irregular bowel movements
  • abdominal pain or distention (bloated)
  • bleeding when it causes an anal tear or fissure
  • pain during defecation causes the child to withhold the stool even more thereby setting up a vicious cycle of stool retention

Stool Consistency is best described using the Bristol Stool Chart

Source: Wikipedia

Contributory factors to constipation

  • Low fibre diet (not enough fruits and vegetables)
  • Insufficient fluid intake (see below)
  • Poor quality diet (too much junk food)
  • Being overweight
  • Sedentary lifestyle (not enough exercise)
  • Psychological factors (such as stress or anxiety)
  • Family history
  • Organic bowel disorder


Image Source: YMCA Harrisburg

Prevention is the best option and you can follow the following principles:

  • Increase fluid intake
  • Increase dietary fibre and avoid fatty, sugary or starchy foods
  • Increase sorbitol in the diet (apple, prune or pear juice)
  • Encourage your child to exercise (avoid being sedentary)
  • Develop a regular meal schedule
  • Get the child to have regular bathroom breaks

Recommended fluid intake (including fluid in food and drinks)

The table below is just a guide and more may be required if the child is active and sweats a lot.

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Vaccines work by introducing a weakened or dead form of either the bacteria or virus (known as the antigen). This vaccine encourages the body to create antibodies against this antigen so that when the person is exposed to the infection, the body is able to fight the infection quickly without being affected too severely by the illness. In short, vaccines prepares the body to fight the disease in case the person gets infected in the future.

Source: M Klingensmith

Although there may be some side effects during the vaccination, the benefits outweigh them. In 2018, it was reported that in Malaysia, there were:

  • 6 deaths from measles (none of them receive vaccination)
  • 5 deaths from diphtheria (4 of them did not receive vaccination)
  • 22 deaths from pertussis (19 of them did not receive vaccination)

Reference: Star News Malaysia 22 Jan 2019

Do read the link below on how a lecturer had ‘wished his parents had him vaccinated’ as a baby but instead contracted polio at the age of 18 months and lost his ability to walk properly since then.

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Most kidney disorders are caused by patients with poorly controlled diabetes or hypertension.  As such, it is important to eat a healthy diet which is low in salt and fat (to reduce the risk of high blood pressure) and low in sugar (to reduce risk of diabetes).

Do also refer to our health articles on Diet for Hypertension and Diet for Diabetes if you also have hypertension or diabetes.

When you have kidney damage or on dialysis, the kidneys will have difficulty removing waste and fluid from your body. A good diet will help provide energy for your daily tasks, maintain a healthy weight, prevent muscle-mass loss and slow down the progression of kidney disease.

Image Source: Live Strong

A kidney-friendly diet refers to eating the right amount of protein, phosphorous, calcium and potassium as well as drinking appropriate amount of fluids to control the build-up of waste and fluids in your body. You need to discuss with your doctor or dietitian on how to limit the amount of:

  • sodium in foods and drinks
  • protein in your diet
  • high-phosphorus foods
  • canned foods or fruits (best to avoid)
  • liquid to prevent fluid build-up in your body which cause ankle swelling


Image Source: Whatwolf (Freepik)

When you have kidney disease, you may not be getting enough minerals or vitamins in the food groups you are eating.  Vitamins which are useful for patients with kidney disorders include:

a) Vitamin B Complex. Vitamin B6, B12 and folic acid work together with iron to prevent anaemia. The other vitamin B components such as thiamine, riboflavin, pantothenic acid and niacin help your body convert foods into energy more efficiently.

b) Iron. Iron works with Vitamin B complex to prevent anaemia.

c) Vitamin D & Calcium. Vitamin D and Calcium help to maintain bone density and bone strength.


Phosphorus is a mineral which works together with calcium and vitamin D for the development and maintenance of your bones.  Excess phosphorus in the blood results in calcium being pulled out of your bones making them weak and susceptible to fractures.  The normal phosphorus level in adults should be between 2.5 to 4.5 mg/dl.

Image Source: Huffpost Australia

Phosphorus is naturally found in protein rich foods such as meat, fish, poultry, dairy products, fish, legumes and nuts. Phosphorus found in animal foods is absorbed more easily by our body compared to those found in plant foods. Besides that, phosphorus is also used as additives in processed foods, canned foods and beverages. Phosphorus from food additives is completely absorbed by our body hence avoiding it can help lower your intake of phosphorus. It is usually listed on the food packaging at the ingredient labels as ‘phosphorus’ or you may look for words with ‘PHOS’.


Potassium is a mineral which is essential in maintaining regular heart beat and muscle function. Abnormal potassium levels can cause irregular heart beat or even heart attack and muscle cramps. The recommended intake for normal adults is between 3,500 to 4,500 mg per day. A potassium restricted diet is around 2,000 mg per day. 

What is a safe potassium level in the blood?

Potassium in foods

Listed below are some good practices to help reduce potassium in your diet:

  • Chopping & slicing foods into smaller pieces, soaking them in a large volume of water for a 1 – 2 hours in several changes of water and straining the vegetables to discard the water before cooking, can leach potassium into water.
  • When using canned vegetables or fruits, drain away the brine or syrup
  • Peel off the skin from fruits
  • Do not take the gravy from vegetable dishes or soup
  • Use whole spices rather than ground spices
  • Avoid herbal and traditional remedies (ginseng roots, banana stem, akar kayu and others)

Haemodialysis patients

If you are on haemodialysis, do discuss with your doctor or dietician because you may also need to:

  • add protein to your diet because hemodialysis removes protein
  • choose foods with the right amount of potassium
  • take vitamins made for people with kidney failure
  • find healthy ways to add calories to your diet because you may experience reduced appetite


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This is the recommended vaccination schedule for children in Malaysia. Do share this article with your friends with young children to keep as reference and useful reminder.

Explanation Notes

  • Bacillus Calmette–Guérin (BCG), vaccine that gives protection against tuberculosis
  • DTaP is the combination of diphtheria(D), tetanus(T) and accelullar pertussis (aP)
  • DT is a booster dose which protects against diphtheria (D) and tetanus (T)
  • Hib is Haemophilus Influenza type B
  • MMR is the combination of Measles(M), Mumps(M) and Rubella(R)
  • MR vaccine provides protection against Measles (M) and Rubella (R). MR Dose 2 at 7 years old
  • JE is vaccine against Japanese Encephalitis (This vaccine is only provided in Sarawak)
  • HPV is Human Papilloma This vaccine is provided only for girls aged 13 years. Dose 2 is given 6 months after dose 1

This an additional list of vaccines which you can discuss with your doctor about the suitability for your child:


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Fertility problems are not the best dinner conversations because they involve intimate issues behind closed doors. That is exactly why you can feel free to speak to your fertility specialist about what is really troubling you as a couple, because he/she would be able to talk to you frankly about making babies, with or without sex.

But to get the correct answers, it helps to ask the right questions. Here are answers to some of the most embarrassing questions every couple wants to know – but may be too shy to ask!

Image Source: Getty Images

1. Is position xyz more effective in getting pregnant?

Unfortunately not. There is no scientific evidence that any particular sexual position can improve pregnancy. There is, however, a link between frequency of intercourse and chances of pregnancy. Higher frequency relates to a higher probability of pregnancy.

2. My husband always gets erections, so how can he be sterile? Can I get pregnant if I do not achieve orgasm?

Having an erection does not indicate that the semen ejaculated contains viable and healthy sperm that is necessary for conception. Chances of pregnancy increase when the sperm count is high and sperm motility (energy levels) is good. With good sperm, a woman will still get pregnant without an orgasm, as they will travel up the uterus for fertilisation to happen.

Image Source: 123RF

3. I had a sexually-transmitted disease in my younger days before marriage. Can it cause infertility?

Yes, certain STIs such as chlamydia and gonorrhea result in Pelvic Inflammatory Disease (PID), which causes pelvic, ovarian, and or/fallopian tube damage if left untreated. Untreated Chlamydia may also cause permanent male sterility by spreading to the testicles.

Human Papillomavirus (HPV), a sexually-transmitted disease that is the main cause of cervical cancer, does not affect fertility directly, but its ensuing treatment has a lasting impact on your reproductive health.

The problem with STIs is that they often have no symptoms and can lie undetected for many years. As such, safe sex is important not only to avoid STIs but also to protect your fertility.

4. For IVF treatment, can my partner collect sperm specimen with oral sex?

It is not advisable as the sperm collected may get contaminated with the bacteria and enzymes from saliva that will impact sperm quality.

Image Source: Getty Images

5. What can be done if my partner has trouble collecting his sperm specimen?

The collection room is equipped with magazines and a television screen with the appropriate content to assist him get ‘warmed up’. However, there have been cases where the sperm cannot be collected on the day of the embryo transfer because the partner is under too much pressure. If there are concerns that this may happen, it would be advisable to seek your doctor’s advice in advance. In rare cases, eggs collected will be frozen if no sperm obtained from male partner.

6. Is it normal to get heavy vaginal discharge during IVF treatment?

Vaginal discharge may be heavier than usual due to the hormones that are being taken as part of IVF treatment. However, seek your doctor’s advice if the discharge smells bad or you experience discomfort or itching, as that could indicate an infection.

Image Source: Ostomy Connection

7. If I had an abortion before, must I inform the doctor? I don’t want my partner to know.

This is a critical piece of information to be shared with your doctor, as a previously successful pregnancy is a factor the doctor needs to know to plan your treatment protocol. Speak to the doctor privately, and indicate that the information should be kept confidential.

8. Can we have sex during the course of IVF treatment?

Research on this has been inconclusive. Some studies state that semen helps increase pregnancy rates by improving embryo implantation. Other studies caution against vaginal intercourse for at least two weeks after embryo transfer to avoid potential infections or complications from orgasms. From experience, we know that most couples would prefer to abstain to be on the safer side, considering how much time, emotion and finances have been invested into an IVF treatment.

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Dr. Agilan Arjunan

Dr. Agilan Arjunan

Obstetrician & Gynaecologist (infertility)



Image Source: Pixabay

Psst.. check out our pick on top 5 healthiest new year’s resolution.

With 2018 coming to an end, making too many new year’s resolutions might be difficult to accomplish. Try to focus on simple and healthy resolutions. Pretty sure you can achieve at least one resolution from the list below, now go for it!

Image Source: Stock Unlimited

1. Lose weight

This resolution tops everyone’s list every year. Are you guilty of it too? Now that the holiday season will be over soon, it’s time to eat clean after a month-long of binge eating with family and friends. Party is over! Time to hit the gym.

Learn more on ‘How much should we exercise daily’ here and ‘Part 1 of what is your body type and how to lose weight’ here and ‘Part 2 of what is your body type and how to lose weight’ here. 

Image Source: Fit Girl Code

2. Drink more water

Cut down on caffeine, alcohol or unhealthy fizzy drinks. It’s important to stay hydrated throughout the day and you’ll see major improvement on your skin! It’s recommended to drink at least eight 8-ounce glasses which is equal to 2 litres.

Learn more about healthy eating ‘Let nutrition determine the way you age’ here and ‘Bad calories, good calories – know the difference’ here.

Image Source: Next Avenue

3. Quit Smoking

This resolution was in your list last year? Try again and never fear to fail! Identify your triggers and patterns to overcome it. If you tend to smoke due to peer pressure or social circle (it’s hard to avoid when your family, friends or co-workers smoke as well), let them know that you can’t join them for smoking break session anymore. Try to go for healthier routines such as taking a break with non-smokers or go for a short gym session during your break.

Image Source: The Balance

4. Volunteering

Volunteering benefits yourself and others. You’ll get the feel good factor and increased happiness by helping other people. You can also meet new friends and create an opportunity for a social change. Besides meeting new people, you’ll also get to learn new skills or info from volunteering work.

Learn more about ‘Healthy Aging’ here.

Image Source: Fotolia

5. Travel

Be it a short trip or a long trip, try to plan for a trip twice a year. It doesn’t have to be an expensive, luxury trip. Discovering new places or countries can be exciting and intriguing. A trip is always something you’ll look forward to everyday and you’ll feel refreshed and rejuvenated after a trip!

Learn more about ‘Healthcare checklist before you travel abroad’ here.