First Foods in Babies: How to Wean Your Child

First Foods in Babies: How to Wean Your Child

There is no right way and no right time to wean your baby. The most important point is that the journey is smooth and stress free for both of you, taking one step at a time. Do not worry that the maternal bond may be disrupted if the baby stops breast feeding because there are many other ways to stay close to your baby. Here are some tips to get you ready for the transition.

Image Source: Mother Baby & Child

When should I start weaning my child?

The UK Department of Health recommends that the babies should not be weaned until they are 6 months old while the American Academy of Paediatrics recommends that mothers breastfeed for at least a year.  However, more and more health professionals now agree that introduction of foods other than milk can begin from the age of 17 weeks as the baby’s digestive system is fully matured by then.

How should I wean my child?

There is no right or wrong way to wean a child. You can choose the method to wean when you feel that the time is right to do so. It normally feels quite natural; you will know it.

Baby-led weaning is the easiest way because your child begins to lose interest in breastfeeding which can start from 6 months onwards. By 12 months, most babies may show preference to solid foods. In fact, the more active they are, the faster they wean off breast milk. These are the signs that your baby is ready for solids:

  • Baby is curious and looking at you
  • Baby is interested in what you are eating
  • Baby can hold up the head
  • Baby is drooling

Image Source: New Kids-Center

Mother-led weaning is usually due to mother returning to a busy schedule such as work or other house chores: In this case, it is recommended that you can wean the baby off the breast gradually introducing a combination of bottle feeding breast milk, formula milk and solid food.  It takes time and patience to see how your baby adjust to the change.

It is best to go slow and go in stages. For example, try by skipping a feed and see what happens. You can substitute the feed using pumped breast milk, formula milk or solid foods.  Cow’s milk should only be given if your child is at least 1 year old.

Reducing feedings one at a time over a period of weeks gives your child time to adjust. Your milk supply also diminishes gradually this way, without leaving your breasts engorged or causing mastitis. Shorten nursing time and start by limiting how long your child is on the breast. If your child usually nurses for ten minutes, try five minutes.

What should be the first foods?

There should NOT be any added sugar, salt, nuts or honey for the first 12 months of life.  Start with single flavour food puree such as baby rice, vegetables (such as squash, pumpkin, sweet potatoes and yam) or fruits (such as apples and pears) for a stretch of 3-4 days.  After 4-6 weeks, you can mix these flavours together.

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Basic First Aid Tips for Parents

Basic First Aid Tips for Parents

Every child will definitely experience some falls and minor accidents while growing up. Here are some simple first aid techniques that every parent should know learn in case of emergency.

Open wound with bleeding (usually from cuts)

All wounds will stop bleeding with time as they will form a clot. Clean under running water and then use a clean cloth to press over the wound for a few minutes.  When the bleeding has stopped, apply antiseptic lotion or antibiotic cream and cover with a plaster if the wound is small. Larger or deeper wounds especially if the skin edges are jagged, need to be stitched by a trained doctor to prevent infection and poor healing causing unsightly scars.  If the cut is from a dirty metal object or animal bite, you will need a tetanus injection from your doctor (if you have not been vaccinated before) and antibiotic to prevent skin infection.

Apply antibiotic cream or change the plaster every 2-3 days until fully healed.  Do not pick at the scab as it delays healing.  Try to avoid the sun as the newly formed skin is more sensitive to being sun burn.  If the wound looks red, tender or has pus, see a doctor as soon as possible because this suggests that the wound has infection.

Image Source: The Asian Parents

Swelling or bruise (usually from blunt trauma or from a fall)

Most blunt trauma results in a swelling (due to inflammation) and bruising (if there is internal bleeding). Quickly apply cold compression (using ice cubes wrapped with a clean cloth) around the area to reduce the amount of the swelling and bruising.  Do NOT rub the area as it will make the swelling worse.

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Sprained ligament (usually the ankle, wrist or thumb)

A sprain is an injury to the ligaments which connects and hold the bones in place. It causes pain and swelling very quickly but fortunately, recovers within 1-2 weeks.  Follow the acronym RICE (Rest, Ice, Compression & Elevation). Rest the limb, apply ice pack compression and elevate the affected limb to reduce the swelling.  The ice pack can be applied for 15-20 minutes each time and repeated 4-8 times a day. Most important is NOT to move or weight bear on the leg. If injury looks worrying, go to a hospital emergency department to rule out a fracture by having an X-ray done.

Danger signs of sprains for which you need to see an orthopaedic doctor:

  • Inability to weight bear on the injured leg (or hand) or the joint feels unstable (suggestive of completely torn ligament)
  • A pain directly over the bone of an injured joint (suggestive of fracture)
  • Redness, swelling and hot over the area suggestive of infection

Possible fracture

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  1. For arms, apply an arm sling. You can make one by folding a large piece of clean cloth (such as a sarong or towel) into triangular shape and tie into an arm sling to support the arm.
  2. For legs, reduce movement and avoid weight-bearing on the affected leg. Elevate the leg.

In both cases, take some pain relief such as paracetamol and go to a hospital emergency department as soon as possible.

Burns or scalds

Get the child away from the heat source immediately and put the affected area under cold running water for 10-15 minutes to cool it down. This will prevent deeper and more severe burns. Remove any clothing but do not peel anything that may be stuck to the skin. Seek medical attention if the burnt area is large or deep.

Don’t pop any blisters yourself but let them heal naturally. If the skin breaks, apply an anti-biotic cream and cover the area with a bandage or gauze until it’s healed. Watch for any redness, swelling, tenderness or pus discharge which are all signs of infection.

Seizures

Lay the child down gently onto the floor and clear the surroundings from any hard or sharp objects that may cause injury. Lie the child to one side to allow any vomit or saliva to dribble out and prevent choking. Loosen any clothing around the neck. Do not attempt to put anything inside the mouth as it may cause further injury. Monitor breathing and seek medical attention if it is the first episode of seizure or if the seizure lasts more than 5 minutes.

Choking

Image Source: Active Moms Network

If the child is choking, the first thing you would notice is the child suddenly starts coughing. You may hear wheezing in between the coughs. They may clutch their throat with their hands. They may not be able to speak or cry. If the condition worsens, the child’s lips may turn blue and lose consciousness. If they are coughing, encourage them as it may dislodge the object. Do not leave them alone. You may attempt to remove the object only if you can see it clearly.

There are Basic Life Support (BLS) steps that can be done to help a choking child. These steps are taught during BLS courses along with CPR techniques in accordance with the American Heart Association guidelines.

There are two techniques that can be performed depending on the age of the child and is divided into infants (less than 1 year old) and child (over 1 year old).

Infant technique (back slaps and chest thrusts)

  • Sit down/kneel and place the baby in your lap with the face down and head slightly lowered
  • Hold the head and jaw with your hand while the body rests on your forearm
  • Rest your forearm onto your thigh for support
  • Give 5 back slaps in between the shoulder blades using the heel of your other hand. Do it forceful enough to dislodge the object

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  • If unsuccessful, turn the baby around and hold the back of the head with your other arm and sandwich the baby between your arms. Turn the baby over while ensuring the head and neck is fully supported
  • Now rest the baby onto your forearm, facing up but head slightly lower along your thigh
  • Give 5 chest thrusts at a rate of 1 per second. Push downwards at the lower half of the breast bone, again, forceful enough to dislodge the object
  • If still unsuccessful and baby is still conscious, turnover the baby again and deliver another 5 back slaps
  • Repeat these steps until the object is dislodged

Child technique (Heimlich manoeuvre same as for adults)

Image Source: Mckesson Corporation

  • Stand/kneel behind the child so that you can wrap your arms around their waist.
  • Make a fist with your hand (usually left hand with the thumb enveloped by the other fingers)
  • Place it with the thumb side against the abdomen, at the soft area between the navel and the lower border of the breastbone.
  • Wrap your other hand around your fist.
  • Give a quick, forceful thrust in an inner, upwards direction. Forceful enough to dislodge the object.
  • Repeat these steps until the object is dislodged.

If the above fails, call for help. Dial 999 (or 911) and ask for an ambulance in a composed manner. State your address or location with any obvious landmarks. State what the emergency is and inform if it is an adult or a child. Afterwards, perform CPR while waiting. If there is another person around, tell them to call for an ambulance while you perform CPR. Tell them to get back to you to confirm that they have called the emergency services. If possible, ask them to bring an Automated External Defibrillator (AED) which should be available in major shopping malls or office buildings.

Image Source: Pixabay

Prevention is always better than cure

Children like to explore their surroundings and tend to put small objects (such as marbles or beads) into their mouth, nose or ears. Therefore, ensure their surroundings are free from these objects or else keep them at a higher place where they cannot reach. Always keep your surroundings clean and tidy.

During bottle feeding time, do not leave your baby unattended even for a few seconds. You may get distracted and take longer than anticipated which could raise the possibility of an untoward incident happening. Try not to feed your baby when you are sleepy. Check their solid food for any large or hard food sizes or fish bone before feeding them.

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Dr. Mohd Ridzuan Razak

Dr. Mohd Ridzuan Razak

General Medical Physician

Hand, Foot & Mouth Disease in Children

Hand, Foot & Mouth Disease in Children

Hand foot and mouth disease (HFMD) is typically a common illness among infants and children (up to the age of 10 years) caused by a group of viruses called Enterovirus especially Coxsackie A16 or enterovirus 71. It has become an important public health concern because it is very contagious and can cause large outbreaks among children especially in nursery and schools.

What are the symptoms?

 

The disease is characterised by rapidly ulcerating vesicles (blisters) in the mouth, tongue, palate and on the palms of hand and soles of the feet.  It starts with non-specific symptoms such as fever, sore throat and generally feeling unwell before the blisters develop 1-2 days later.  It can range from being mild or severe with loss of appetite.

How is the virus transmitted?

The most infectious period is the first week of illness and the virus is transmitted by contact with the nasal discharge or saliva, fluids from the blisters and stools of an infected child. As such, it is important that any infected child is kept away from school and other children.  Avoid close contact like sharing toys, pillows, towels or eating utensils and touching objects or surfaces that could have been contaminated by the virus.  Any nursery or school which has an infected child is often advised to close for a short period to allow sterilisation of the school premises and prevent virus spread.

Image Source: Wikipedia

How serious is HFMD?

Majority of the children get a mild illness with no complications. Younger children are at risk of getting weak or dehydrated because they  may refuse to eat or drink due to the painful mouth ulcers. Rare complications occur when the virus (in particular, enterovirus 17 strain) has spread to the brain causing meningitis or encephalitis or to the lung and heart causing pulmonary oedema.

What is the treatment for HFMD?

Bed rest, paracetamol and sponging for fever and keeping the child hydrated is sufficient. Most children recover within 7-10 days without requiring any medication. However, if the child is getting dehydrated or weak, it is better to admit the child to the hospital for intravenous fluids and observation by the doctor. The child should remain away from school for at least 10 days since the onset of the disease or until certified free from disease by the treating doctor.

Statistics of Reported Hand, Foot and Mouth Disease Cases in Malaysia (Source: Kementerian Kesihatan Malaysia)

What are the danger signs of HFMD?

Take your child to see a doctor when the child has the following symptoms:

  • Not taking enough oral feeds or fluids
  • Not passing much urine
  • Persistent high fever (>38oC) more than 48 hours
  • Weak or drowsy or refusing to play
  • Having shallow rapid breathing
  • Irritable or having some jerky movements (fits)

How should a parent look after the infected child?

Let the child stay at home (away from school) and isolate the child away from the other siblings. Do not let them to share beds, pillow, towels, eating utensils and toys.  It is best to have one person looking after the child to ease the discomfort like giving:

  • Paracetamol for fever. Applying a cool towel over the forehead may be comforting
  • Cold treats like Popsicles or milk shakes/smoothies for the sore throat
  • Oral Aids for mouth ulcers
  • Soft diet as it is easier to swallow

Image Source: Pexels

How to prevent the virus from spreading?

Ensure good hygiene by washing your hands after caring for the infected child as well as disinfecting objects or surfaces touched by the child to prevent spreading the virus to other inhabitants in the house.

CHOMEL Antibacterial Range

Dettol Disinfectant Spray Crisp Breeze

Against 24 Disinfection

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Hearing Loss in Your Child: Communication and Assistive Listening Devices

Hearing Loss in Your Child: Communication and Assistive Listening Devices

Communication Decision

One of the most difficult decisions that you might have to make for your child would be the method of communication that he/she would use. The choices vary from the Aural-oral which relies totally on normal spoken language to Sign language that is a language that uses visual hand signs only. Other communication methods that are in between these two choices would include Total Communication and Cued Speech.

No single approach would work with all children. Thus, a thorough discussion with your audiologist and speech language pathologist would help you decide the primary communication method your child would use.

Visits to centers where these particular methods are taught before deciding would also help. A good audiologist would never presume to suggest the best option for your child. Instead, he would provide you with all the information you require to decide the best option for your child and your family.

sign-language

Image Source: Stanford University

Communication method chosen would also bear an important impact on your child’s school placement when he is older. A child with hearing impairment with good amplification and acquisition of speech and language can be considered to be placed in normal schools. Others might be placed in integrated schools while those who use signing as their primary communication mode have the choice of attending special school for hearing impaired children.

 

Assistive Listening Devices (ALD)

assistive-listening-device

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As your child’s needs changes, hearing aids alone might be insufficient for all situations. Devices that are designed for specific needs of a hearing impaired person are often termed as assistive listening devices.

The most popular ALD would be the FM system. This system which usually couples to your child’s hearing aids is important in situations that are noisy and there is a significant distance between the speaker and the hearing impaired person. Examples would be classrooms, meetings and lecture halls.

Although a hearing aid amplifies speech and modern digital hearing aids are capable to reduce some background noise, the challenges of a noisy classroom is more difficult. Imagine a teacher that is standing at the front of the classroom at a distance that is more than the optimum amplification region for the hearing aids.

 

fm-system

Image Source: Phonak

In addition, background noise that is highly speech noise. When the speech signal from the teacher reaches your child’s hearing aids, the loudness is greatly reduced; it is then further degraded by competing background noise. It would be very hard and tiring for your child to continuously pay attention to understand the teacher.

An FM system which consists of a microphone worn by the teacher and a receiver worn by the hearing impaired child ensures that the speech signal is transmitted directly to the child’s hearing aid, thus ensuring no degradation of signal due to noise. FM systems are routinely recommended to school going children to aid their studies.

Other ALD devices would include vibrator alarms that wake up the child in time for school as he would not hear the normal alarms because he does not wear his hearing aids to sleep. More examples would be blinking lights for fire alarms, teletext phones and many others.

 

hearing-aid-child

Image Source: The Indian Express

Hearing loss is a condition that could be managed by you. The important thing to remember is that your child is just as normal as the next child with the only problem being he does not hear sounds as clearly. In every other aspect he has the same potential to be whatever he wants. It is up to parents and professionals to ensure that the impairment does not become a handicap.

As parents, you face the heavy burden of being your child’s teacher, mentor, friend, therapist, advocate and support system. However, you have the assistance from a whole range of professionals, ever improving technologies for amplification and other communication needs as well as the growing knowledge on hearing impairment and ways of managing it.

Download Teleme’s mobile app and consult an Ear, Nose and Throat Surgeon or an Audiologist

 

Dr. Shailendra Sivalingam

Dr. Shailendra Sivalingam

Ear, Nose & Throat Surgeon

 

Mr. Saravanan Selanduray

Mr. Saravanan Selanduray

Audiologist

 

Hearing Loss in Your Child, What to Do Next?

Hearing Loss in Your Child, What to Do Next?

First series of hearing loss in your child: When parents are told that their child has hearing loss, many a times they are lost about what they should do next. What are the management steps that parents should take to help their child?

 

Knowledge is power

There is nothing more important than finding out every detail of the problem that your child has. Feel free to ask your audiologist or doctor, how they test your child and what is the purpose of each test done. Confirm how reliable were the tests done. Next ask the exact nature of the hearing loss as it would be crucial on deciding what the next step would be.

If it is a conductive hearing loss, whereby the problem is either on the outer ear or the middle ear, the problem might be cured by a medical doctor. If it is a sensorineural hearing loss, determine whether it is a permanent hearing loss or is there a chance of a cure.

The audiologist should be able to advice you on this. Remember, you have the right to have a second opinion. You can ask the audiologist to provide you a copy of all the results, a report for records and also reference if a second opinion is sought.

baby-child

Image Source: Singapore Motherhood

You should also find out the sounds that your child could still hear. Contrary to common perception, it is rare for us to find an individual who does not have any hearing at all. In fact, most children with hearing loss have a degree of residual hearing. Knowing the types of sounds your child can hear as well as the level of loudness is important to help him communicate. Even for temporary hearing loss, it is important to know the communication strategies that you would need in order to help your child through this trying period.

 

Hearing Aids

hearing-aid-child

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The Malaysian Association of Speech-Language and Hearing (MASH), the professional association for audiologists and speech language pathologists in it’s guideline states that all children with hearing loss of 25dBHL or more should be considered for hearing aid fitting. Various researches worldwide also indicate that a child who receives optimum amplification and rehabilitation early has the potential of developing speech and language that are similar to children with normal hearing levels.

In most cases of permanent hearing loss, your audiologist would recommend that your child should be fitted with hearing aids to help him/her hear. The first thing that we should know about hearing aids are that they help your child to hear by making sounds louder however they will not cure hearing loss. Your child needs to be trained to hear with the hearing aids as amplification alone is not sufficient to help your child understand sounds and language.

Technology in amplification has been improving tremendously. It is important that you know the difference between the various technologies available before deciding on which hearing aids are the best for your child. Most audiologists would recommend digital hearing aids compared to analogue hearing aids for your child. A complete discussion on the differences and benefits of these technologies would require an entire article. Your audiologist would be more than happy to explain to you about them.

 

ear-diagnosis-child

Image Source: Very Well

Another question that you would be asking yourself would be whether one hearing aid is enough or should you get a pair. For children with hearing loss in both ears, the best benefit would be amplification in both ears. This is to maximize their learning potential as well as to ensure that sounds are as natural as they can be. Wearing a single hearing aid when both ears have hearing loss is similar to using a monocle instead of your spectacles. An adult who has acquired speech and language might be able to cope but a child who is learning would struggle with a single hearing aid.

If your child has severe to profound hearing loss and gets insufficient amplification even from the most powerful hearing aids, then a cochlear implant might be beneficial. Again, please remember that a cochlear implant is a device that helps your child to hear and a lot of rehabilitation needs to be carried out before they could listen and understand speech as well as proceed to speak. This is true with both hearing aids and cochlear implants.

Next up on Health Tips by Teleme, the second series on Hearing Loss in Your Child: Communication and Assistive Listening Devices.

 

Source: The Malaysian Association of Speech-Language and Hearing

Download Teleme’s mobile app and consult an Ear, Nose and Throat Surgeon or an Audiologist

 

Dr. Shailendra

Dr. Shailendra

Ear, Nose & Throat Surgeon

 

Mr. Saravanan Selanduray

Mr. Saravanan Selanduray

Audiologist

 

Hearing and Speech Development in Children

Hearing and Speech Development in Children

The first 3-4 years of life is when the child acquires speech and language skills.  These skills develop best when the child is exposed to world rich in sounds (hearing skills), sights and exposure to the speech and language of their parent and care givers.

What is the difference between voice, speech and language?

1) Voice

This is the sound made from vibration of the vocal folds when air is pushed from the lungs through the larynx (refer to Figure 1).

 

Figure 1: How voice is produced in human

How voice is produced in human

2) Speech

Speech is created by talking to express language and requires coordinated muscle actions of the vocal folds, tongue, lips and jaw.  Speech is controlled by the Broca’s and Wernicke’s area on left side of the brain (refer to Figure 2).

 

Figure 2: The Broca’s (area to express speech) and Wernicke’s (area to understand speech) areas at the left side of the brain control speech by sending signals to the motor cortex (which control the mouth and lips) to articulate the words out loud

speech

3) Language

Language is how people express themselves through speech.

Communication Disorder Red Flags

baby's response to touch and sound

Image source: Stock Unlimited

 Communication is a process of exchanging verbal or non-verbal information between individuals. It involves the receptive (ability to understand) language, expressive (production of words to convey messages) language, speech (sound of a spoken language) and pragmatic language (rules in a spoken language).

Baby respond to voice and playing with doll

Image source: Pixabay

 

Every child may not develop these communication skills at the same time or rate as compared to another child. Every child is unique in his/her development. However, when a child does not acquire certain skills at a certain developmental age, this could be a red flag of a communication disorder.

 

Here are some of the communication disorder red flags to look out for:

If you notice any of these signs, please do not wait to seek help. It is highly recommended that you get your child evaluated by a qualified Speech-Language Therapist or a related professional (ie. Developmental Paediatrician, Clinical Psychologist).

 

References:

American Speech-Language-Hearing AssociationThe Hanen Centre, Jeanne S. Chall, Stages of Reading Development , N.Y.: McGraw-Hill Book Company, 1983.

Download Teleme’s mobile app and consult an Ear, Nose and Throat Surgeon or an Audiologist

 

Dr. Shailendra Sivalingam

Dr. Shailendra Sivalingam

Ear, Nose & Throat Surgeon

 

Mr. Saravanan Selanduray

Mr. Saravanan Selanduray

Audiologist

 

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