1. BABY’S HEALTH AND SAFETY:
OUR TOP PRIORITY
Dr B.A.KHOO
Consultant Paediatrician and Neonatologist
Sunway Medical Centre
21st JULY 2013
GARDEN HOTEL

2. What is our objective?
• Healthy mother and pregnancy
• Healthy baby
• Happy family

3. 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

4. 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

5. Early newborn/infancy period
D3 – D14
Neonatal
Jaundice
1 – 4 mths
Infant colic
1 – 6 mths
GORD (reflux)
Skin allergy
- eczema
D1 D14 2 mths 4 mths 6 mths

6. 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

7. 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

8. 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

9. 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

10. G6PD deficiency

11. Abdominal colic

12. 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..

13. 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..

14. 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)

15. 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

16. 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”

17. 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)

18. Monitor their growth parameters
** Beware of under-nutrition but AVOID obesity

19. 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 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

20. NUTRIENTS FOR BRAIN DEVELOPMENT
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.
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
communication
synthesis 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

21. 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.

22. 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)

23. Development milestone

24. 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.

25. 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.

26. 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!!!

27. 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

28. 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

29. 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

30. 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

31. Prevention is better than cure

32. Smallpox
1950
DTP
1960
BCG
1961
Polio
1972
Measles
1982
Rubella
1986
Hepatitis B
1989
MMR & Hib
2002
1950
1960
1970
1980
1990
2000
VACCINATION
Year
Vaccine Type

33. Compulsory vaccines in Malaysia

34. 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

35. 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

37. 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.

38. 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%.

39. 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

40. 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.

41. 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

42. 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

43. Skin Care – Allergy

45. RISK OF ATOPY

46. 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

47. 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