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Oct 07

QUESTION – When does one start to worry when baby has not learnt to eat solid food? One member asked this question because her almost 8 months old child did not take to solid food well.

REPLY – The question was forwarded to paediatrician, Dr Cheang Hon Kit of a private hospital in Penang. Below is Dr Cheang’s comments regarding difficulties in eating.

Yes, there is indeed a ‘condition’ with difficulty with swallowing. It has something to do with the swallowing mechanism that is immature/ defective. Muscles around the mouth, tongue and throat have to be well coordinated to get the food to be swallowed. Food especially solids, need to be formed into a lump in the oral cavity and then being pushed to back of the throat. Muscles around the throat (pharynx) then will push further down into the esophagus, the food passage leading to the stomach. Along the esophagus, the muscles will propels the food bolus slowly in a coordinated ‘waves like movement down the stomach. Do you know we can actually swallow even in an upside down position? Ever thought of that?

So, the act of eating is much more complicated than we could imagine. Many things can go wrong and you will have someone having problem in eating/ swallowing. This also applies to elderly persons with stroke, I’m sure you have seen some elderly patients with stroke and saliva just keep drooling. They also have a lot of difficulty with feeding. Back to your question, I think he is probably one of those late starters, where the nerves involved in the swallowing is not so matured yet. I do come across some of these very difficult babies. If the baby is well otherwise and not showing any other signs of neurological abnormalities, I usually advise the mum to wait and try again. If the baby is not putting on weight properly and having other developmental problem, I would strongly advise to have the baby thoroughly assessed by the paeds neuro. Hope that answer your/ her question.

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Oct 03

These few days, the local newspapers in Malaysia has reported about Chikungunya fever. As parents, we are doubly responsible to make sure that our children are not infected. However, how much do you know about Chikungunya fever?

I do not know anything about it. So, I took the initiative to find out from CDC which I guess is one of the more authoritative body in diseases prevention.

Chikungunya fever is a viral disease transmitted to humans by the bite of infected mosquitoes. Chikungunya virus is a member of the genus Alphavirus, in the family Togaviridae. Chikungunya fever is diagnosed based on symptoms, physical findings (e.g., joint swelling), laboratory testing, and the possibility of exposure to infected mosquitoes.

As at July 2008, many of the states in Malaysia reported that people have been infected with Chikungunay fever.

The symptoms are :

Chikungunya virus infection can cause a debilitating illness, most often characterized by fever, headache, fatigue, nausea, vomiting, muscle pain, rash, and joint pain. The term ‘chikungunya’ means ‘that which bends up’ in the Kimakonde language of Mozambique.

Acute chikungunya fever typically lasts a few days to a few weeks, but as with dengue, West Nile fever and other arboviral fevers, some patients have prolonged fatigue lasting several weeks. Additionally, some patients have reported incapacitating joint pain, or arthritis which may last for weeks or months. The prolonged joint pain associated with chikungunya virus is not typical of dengue.

Should pregnant mothers and lactating mothers be worried? Read what CDC said :

Pregnant women can become infected with chikungunya virus during all stages of pregnancy and have symptoms similar to other individuals. Most infections occurring during pregnancy will not result in the virus being transmitted to the fetus. The highest risk for infection of the fetus/child occurs when a woman has virus in her blood (viremic) at the time of delivery. There are also rare reports of first trimester abortions occurring after chikungunya infection. Pregnant women should take precautions to avoid mosquito bites. Products containing DEET can be used in pregnancy without adverse effects. Currently, there is no evidence that the virus is transmitted through breast milk.

What about the prevention?

Chikungunya Prevention
The best way to prevent chikungunya virus infection is to avoid mosquito bites. There is no vaccine or preventive drug currently available. Prevention tips are similar to those for other viral diseases transmitted by mosquitoes, such as dengue or West Nile.

Use insect repellent containing DEET, Picaridin, oil of lemon eucalyptus, or IR3535 on exposed skin. Always follow the directions on the package.
Wear long sleeves and pants (ideally treat clothes with permethrin or another repellent).
Have secure screens on windows and doors to keep mosquitoes out.
Get rid of mosquito sources in your yard by emptying standing water from flower pots, buckets and barrels. Change the water in pet dishes and replace the water in bird baths weekly. Drill holes in tire swings so water drains out. Keep children’s wading pools empty and on their sides when they aren’t being used.
Additionally, a person with chikungunya fever should limit their exposure to mosquito bites to avoid further spreading the infection. The person should use repellents when outdoors exposed to mosquito bites or stay indoors in areas with screens or under a mosquito net.

All information in blockquotes taken from CDC

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Dec 04

What methods of birth control are suitable during breastfeeding, aside from condoms and withdrawal?

There is the injection method: IM depo provera. Others: Implanon, progestogen (pills only). Normal OCP generally will reduce supply and therefore not recommended. – A lady ob-gyn in KL

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