Updates on Child Nutrition and Health Seminar (Part 3)

This is the continuation of a previous blogpost.

2. 2nd speaker - Prof. Dr. Khor Geok Lin (Dept. of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, UPM) on "Socioeconomic Disparities in Childhood Malnutrition". Prof. Dr. Khor shared about statistics of child hunger, malnutrition, underweight, mortality (death), and obesity. Here are some interesting statistical facts:

• Where child hunger in Asia is concerned, Bangladesh tops the list and surprisingly, Malaysia has the lowest (but Mommy didn't see Singapore in the list at all!).
• Three-fourth of the world's underweight and stunted children in the world actually live in Asia. Being underweight is a high risk for young children. South-east Asia has the highest prevalence of underweight children below 5 years old, and Latin America and Caribbean Islands has the lowest. Within South-east Asia itself, Malaysia has the lowest prevalence of underweight children and Timor Leste the highest.
• In terms of child death before the age of 5 years (in Asia), Singapore has the lowest and Myanmar the highest. China and Malaysia have low prevalence.
• Rural children are twice as likely as urban children to be underweight. In Malaysia, among children below 18 years old, the prevalence of underweight is lowest in both Penang and Selangor (in fact, much lower than the national average), and Sabah is the highest (in fact, much higher than the national average).
• As for the prevalence of overweight children below 18 years old in Malaysia, Selangor, Negeri Sembilan and Melaka are among the highest and Sabah is the lowest.
• It is found that child obesity is more prevalent among the lower socioeconomic group.
• Adequate nutrition before and during pregnancy and the first 6 months of life is critical to a child.
• Among the determinants to reduce child malnutrition, women's education actually contributes the most.
• Prof. Dr. Khor also brought up the issue of health inequality in the Internet. She pointed out the trend that health websites are mostly written at a level understandable to high school up to graduate level readers. Thus, the lower level group is at the most disadvantaged in accessing health information from such websites.

Stay tuned for the gist of the next speakers.

An After-Thought About Juan Or's Condition of Being Underweight

During the most recent visit to the paediatrician for vaccination at 12 months old, the paediatrician found Juan Or to be underweight at 8.1 kg. As such, he recommended Juan Or to be on PediaSure (Abbott Laboratories) for 3 months.

Of course Mommy is baffled as to how Juan Or turns out to be underweight considering that the babysitter gives him 3 or 4 times of milk feeds (ranging from 7 to 9 oz. of milk per feed) per day, and Juan Or is also capable of finishing 2 bowlfuls of porridge (rice bowl size) in a day. And the porridge contains mashed up carrots, some butter or cheese (to fatten him up) and fish meat or ikan bilis stock. Then one day, a quick flash of thought occurred in Mommy that Juan Or's condition of being underweight may be caused by him taking his antibiotic (trimetoprim) on a daily basis. Juan Or has to take trimetoprim daily as a preventive measure of him getting urinary tract infection. Juan Or has this congenital condition called mild bilateral hydronephrosis (laymen's term: mildly dilated kidneys) which makes him susceptible to getting urinary tract infection. And the HUKM peadiatrician mentioned that any infection to his growing kidney is no good because it can cause kidney scarring and along the way will cause the kidney function to deteriorate. Mommy thinks perhaps the antibiotic, taken in long run, has killed many of the natural friendly microorganisms in Juan Or's gut system. And these microorganisms have been known to aid nutrien absorption. So perhaps Juan Or's nutrient absorption is not efficient, that's why he has poor weight gain.

(The antibiotic that Juan Or has to take every day, trimetoprim.)

So on the day the paediatrician recommended PediaSure on Juan Or, Mommy went to buy a 900g tin of PediaSure that is supplemented with FOS and probiotics. Mommy bought is for RM55.90 at Pasar Mini Wah Seng (Jalan Sepadu, off Old Klang Road). Mommy saw The Store selling it for RM60.++ Anyway, Juan Or finished the entire 900 g within 9 days! So Mommy had to go buy PediaSure again. Mommy went to the same shop and this time, the exact same type of PediaSure is sold for RM53.90! So Mommy bought 2 tins straightaway since Juan Or consumes it very fast.

(The PediaSure that the paediatrician recommends Juan Or to take, which Mommy bought for RM55.90, then later for RM53.90 at the same shop.)



After 9 days of consuming PediaSure, Juan Or already showed some results. His cheeks are puffier now and the diameter of his hand looks bigger. Haha....to put it in a light way, Juan Or's extra flesh or fat costs RM55.90!






(A photo of Juan Or a week or so before the visit to the paediatrician. )










(A very recent photo of Juan Or about 9 days after consuming PediaSure. Cheeks are puffier and the diameter of his hands are slightly bigger now. Photo taken at this angle may not reveal such big difference, but the difference is easily seen in real life.)

A Visit to the Paediatrician: Conflicting Parenting Issues Resolved

Today was Juan Or's appointment for the MMR (Measles, mumps and rubella) jab. Of course, before entering the paediatrician's consultation room, the nurse asked to weigh Juan Or's body weight, which turned out to be 8.1 kg - much to Mommy's dismay. Here's a history of Juan Or's body weight records:

Birth: 3.38 kg
1st month: 4.87 kg
2nd month: 6.06 kg
3rd month: 6.59 kg
4th month: 6.80 kg (first sign that Juan Or's body weight gain rate is slowing down already)
5th month: 7.12 kg
6th month: 7.35 kg
7th month: 7.60 kg
1 year (present): 8.10 kg



Finally, we were called into the consultation room and the pediatrician prepared the jab for Juan Or. Then he handed Juan Or a Barney soft toy about almost as big as Juan Or. He asked Juan Or to hug the Barney and then pressed Barney's paw which triggered a music to play. The pediatrician injected Juan Or with no time at all and Mommy was sure Juan Or didn't even realize that he was jabbed. After that, Mommy asked the paediatrician whether Juan Or's body weight gain was alright or not and the paediatrician immediately said,"It's gone case!" "Oh, dear," Mommy thought. So looks like the HUKM's pediatrician's recommendation that Juan Or's solid food be added with butter and cheese did not significantly help to increase Juan Or's body weight. So the present pediatrician recommended that Juan Or's milk be changed to PediaSure (Abbott Laboratories) for 3 months. The paediatrician said that PediaSure is a kind of formula milk that contains higher calories than other normal growing up milk and is meant for catch-up growth. After that, there were a series of questions and answers between Grandpa (who also accompanied Mommy and Juan Or into the consultation room), Mommy and the paediatrician. So Mommy has listed down the questions and answers here for everyone's benefit:


Q: Is it alright to change baby and toddler's milk powder brand?
A: Of course if you are already comfortable with the brand you are using, then might as well stick to it. But from the paediatrician's own experience, he said that his own children had used many brands before (Mommy is not surprised since paediatricians receive all sorts of free sample milk powder from various companies!) to which there was no detrimental effect.


Q: Can bathing at night cause the baby or toddler to get chills?
A: There's no right or wrong answer to it, although traditionally people don't bath babies/toddlers at night for fear of getting chills. The main thing is that if the child can take the night bath without any detrimental effects, then by all means, you can continue to bath the baby at night. But if the child can't take it, then don't.


Q: Is it alright to start disciplining (verbal discipline, not physical punishment) a child from as young as 1 year old?
A: Yes, of course. Recommended is to say with firm tone of voice. If you don't start disciplining now, soon the child is going to go over your head (and shit there!).


Q: At what age is it alright to start using children toothpaste on your child?
A: As long as your child knows how to spit, you can start using it already. The peadiatrician's own children started using it from one-and-a-half years old. The paediatrician also said that even if the child swallowed some of the toothpaste, it's alright. The manufacturer has already put that in mind when formulating the children toothpaste. If the child can't spit yet, then suffice with brushing teeth using a finger-held baby toothbrush and water only.



These questions above (except the toothpaste question) stem from differences in opinions, preferences and practices between Mommy and the In-Laws. Mommy hopes these questions and answers help (in some way or other) fellow readers out there who may experience the same conflicting issues that Mommy is currently facing with the In-Laws.


Finally, we left the clinic after Mommy paid RM70 for the MMR jab. Later in the day, Mommy single-handedly took Juan Or out to a bank in Overseas Union Garden (OUG) to settle some transactions and then headed to a Chinese medicine hall (Pasaraya Wah Seng at Jalan Sepadu, off Old Klang Road) to buy a tin of PediaSure. The PediaSure which is 900 g, vanilla-flavoured and contains FOS and prebiotics, costs RM55.90. From now on, Mommy (with Juan Or around) will do things as single-handedly and as independently as possible - don't want anyone (except Papa) to tag along or accompany Mommy and Juan Or if possible, because it's time to take charge of our own family's life and to take pride in how we manage ourselves and our young family!