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Child and family health in Singapore: An A to G guide

By: Verne Maree

With year-round summer weather, world-class schools, home help and a host of recreational activities for all ages, Singapore can be a kind of heaven for families. But heaven can swiftly turn into hell when illness strikes, wherever in the world you find yourself.

We are living in the tropics, after all. As I write this, two members of our editorial team are woman-down with the dreaded dengue, and a good 50 percent of us – including me – have fallen prey to the virus at some stage. Katie and Rachael are just two more to be added to the 13,208 cases recorded by the MOH in the first half of this year. Children, on the other hand, are more susceptible to hand, foot and mouth disease, which notched up 13,938 victims in the same period.


There's a GP to fit everyone's needs and beliefs here in Singers
There’s a GP to fit everyone’s needs and beliefs here in Singers


The good news? This little island is blessed with some of the best and most medically advanced health care that money can buy.

Every family needs a GP, of course, and there are thousands to choose from. To find one with an approach – both medical and cultural – that gels with your needs and beliefs, personal referral is generally the way to go.

But the health care you choose for yourself and your family doesn’t have to start and end with conventional GPs, dentists and specialists, however essential they are to us. Not only more familiar modalities such as nutritional medicine, osteopathy and homeopathy are readily accessible, but perhaps less-known ones such as TCM (Chinese Traditional Medicine), too. There’s a wealth of healing out there.

Here’s some advice on some family-related health issues – from A for asthma to G for gestational diabetes mellitus.


Inhalers can be life-savers during sudden, serious asthma attacks
Inhalers can be life-savers during sudden, serious asthma attacks


A is for Asthma
Little can be more distressing than the wheezing of a child who is struggling for breath. An osteopath like David Tio, from Osteopathic Treatment Centre, recognises the important role of anti-inflammatory medication and broncho-dilators in the treatment of asthma, especially in acute attacks, while working in conjunction with other health care practitioners with the long-term aim of decreasing the patient’s dependence on medication.

How can babies and children benefit from osteopathy?
A key principle of osteopathy is that structure governs function, and we know that many health issues faced by babies and children today might be due to imperfections in their body structure. Many of these imperfections arise in babies that do not undergo natural childbirth, where the contractions of the vagina help form the child’s muscular-skeletal structure.

In osteopathic hospitals across Europe and the US, babies receive their first osteopathic check up and treatment the moment they are born. This is to minimise subsequent health problems, not only asthma-related but also feeding and sleeping difficulties, colic, reflux, eczema and even autism.

How does cranial osteopathy help babies?
This key treatment involves making very fine adjustments to the skull and spine, which affect the parasympathetic nervous system and hence, functions like breathing and digestion. All the osteopaths at Osteopathic Treatment Centre are well-versed in this technique. In fact, some were directly trained by Dr John Upledger, who developed cranial osteopathy. No child is too young for osteopathic treatment, which is gentle and safe.

How can osteopathy help relieve asthma?
It helps by working on all aspects of the breathing mechanism, including the ribs, the spine, the diaphragm and other muscles of breathing. It also works on the nerve control of the chest as well as blood and fluid supply to the bronchi and lungs. Osteopathy can also play an important preventative role in the care of someone who is suffering from asthma.

Osteopaths recognise that the functions of the human body are inherently linked and can affect each other. With this in mind, the osteopath gently works with the body structure, to enhance and improve the mechanics of breathing by:

• freeing restrictions of the chest and ribs
• relaxing the respiratory muscles
• improving lymphatic draining from the lungs and air passages
• enhancing blood supply to the chest region

Other areas of management include the formulation of an individual exercise programme – with emphasis on breathing exercises – and the avoidance of aggravating factors. We also provide advice on diet, posture, lifestyle and first aid measures during an attack.


Staring at the needle like it's no big deal...what a champ!
Staring at the needle like it’s no big deal…what a champ!


B is for Blood
Blood tests may be required for all manner of ailments. While no one particularly enjoys the experience, for a child – especially a sick child – the idea of drawing of blood via a sharp needle, not to mention the associated pain, can be frankly terrifying.

According to Dr Gary Keong Kean Seng of Nichii International Clinic, one of the commonest reasons for doing a blood test is to assess the cause and severity of an infection in a child with fever. Occasionally, a test for electrolytes like sodium can help assess the severity of dehydration in a child with a diarrhoeal illness.

Nichii International Clinic has its own in-house phlebotomy (blood-taking) service, with doctors and nurses trained to take blood on the premises. For a harried parent with a sick child, not having to make the trip to the separate clinic or lab is a boon.

The doctor agrees that it is always a challenge to obtain a blood sample from a child. “Not only is the child afraid of pain from the needle prick,” he explains, “but an unfamiliar environment – particularly if it’s the child’s first visit to the clinic – is enough to cause significant anxiety and distress.”

“It’s helpful to first establish rapport with the child and to communicate in a calm and gentle manner,” says Dr Keong. “In the case of an older child, an explanation of the procedure and the reassurance of minimal discomfort is important to allay any fears.” A more anxious child may also benefit from the application of a local anaesthetic cream, typically applied 20 minutes before blood-taking.

Does the relatively smaller size of a child’s blood vessels present a challenge? “Yes,” he replies. “Hence the need for medical personnel like ours who are experienced with little ones.”

“It’s both satisfying and rewarding to treat ill children, restore their health and see them laugh and play again,” says Dr Keong. “Another important part of our job is to manage their parents’ concerns and expectations, and to restore calm and order to what can often be a stressful situation.”

Scared of the needle? Six ways to help your child get through it:

• Tell the truth, but keep it simple.
• Don’t tell them too far in advance.
• Explain that it will help him or her get better.
• Use your iPad, a favourite story or a song to distract from the imminent prick.
• A hysterical child may be best left in the medical team’s care. Step outside, or withdraw to a corner while maintaining eye contact.
• Comfort and give your child a treat, be it a lollipop or the promise of a favourite toy or activity.


Heat rash flaring up? Applying moisturiser can help sooth your little darlings
Heat rash flaring up? Applying moisturiser can help sooth your little darlings


C is for Childhood Skin Disorders
It’s almost impossible to stop a child from scratching a worrisome itch – which, of course, only aggravates the problem, leading to infections (like impetigo) and even scarring. Dermatologist Dr Lim Kar Seng of The Dermatology Practice answers a few questions.

What are some of the more common childhood skin conditions that you see?
In babies, that would be heat rash. Usually presenting as red spots over the neck, back or even face, they often resolve on their own after a day or two. Occasionally, we also see food allergies manifesting as rashes – usually from the age of one, when the baby’s diet starts expanding.

In children of primary school age, we are more likely to see skin infections such as viral warts or molluscum. These are transmitted via physical contact, probably at school. And for adolescents, acne represents the biggest skin issue.

What can parents do at home? When is it time to take a rash to a doctor, and how do you treat the various childhood skin conditions?
For a heat rash, I’d recommend keeping the baby cool; applying moisturiser might help, too. However, for a rash that’s persistent or very recurrent – flaring up every week, say – then do see a doctor, as it may be more than a simple heat rash.

Viral warts should be treated as soon as possible, before they spread to other areas or even to the child’s siblings and friends. Unfortunately, it can take a long time to get rid of persistent warts, even with medical treatment. For molluscums that are not actively spreading, I would advise leaving them alone and monitoring them for any change, as they often go away on their own. If you note a rapid increase in the size and number of spots, do seek medical attention, because they can spread like wildfire.

Tell us about impetigo.
Caused by excessive scratching, impetigo is a bacterial skin infection that is quite common in kids between the ages of two and 10. They present with a weepy rash with yellowish discharge or crusts. Left untreated, it can spread to the other areas of the body. If the affected area is localised and superficial, treatment with a good antibacterial wash and topical preparations would suffice. However, should the infection be deeper or more widespread, then one would require oral antibiotics.


All he wants for Christmas is his two front teeth
All he wants for Christmas is his two front teeth


D is for Dental
Many an adult has an unreasonable fear of dental treatment, often brought on by a traumatic childhood experience. (Those brain-piercing drills were enough to put one off forever.) Thanks to today’s high-tech, painless treatments, your child doesn’t have to suffer in this way. Healthily functioning teeth and a lovely smile should be everyone’s birthright, believes Dr Thean Tsin Piao of Aesthete Smilestudio, and instilling good dental habits at an early age is vital.

Parents should start bringing their child to the dentist from the age of two, he says, for regular check-ups and cleaning. Depending on need, the kinds of treatments he provides to youngsters include everything from the extraction of baby teeth to fillings, fissure sealants, root canal treatment and even orthodontics.

Dr Thean agrees that there can be special challenges in treating a child, especially one who doesn’t want to sit in one place, or already has a fear of dentistry.

“Fear of dentistry exists in both children and adults,” he says. “In these cases, good bonding, communication and trust are important in order to get the necessary treatment done. And when I’m dealing with a little one, having good parenting skills helps me to get him or her to cooperate during the process.”

As part of Aesthete Smilestudio’s Total Senses Concept, he adds, the clinic does not look, smell, feel or taste like the traditional dental clinic. Pleasant, comfortable and painless treatment is a key goal, together with an emphasis on good preventive dentistry. The clinic is powered by state-of-the art technology.

Whatever age you may be, he stresses, do go for regular checking and cleaning. Good preventive dentistry is affordable and painless. Delaying early preventive dentistry often leads to a need for advanced dental treatment that can be costly and painful – both in terms of the treatment experience and on the pocket, too!


All clear in these ears
All clear in these ears


E is for Ear Infections
Ever heard of “Singapore ear”? (No, neither had we.) Ear infections are common in moist, humid environments, says ENT specialist Dr Jeeve Kanagalingam of The ENT Practice. Let’s find out more.

The most common cause of ear pain is an infection.
This could either be a middle ear infection (acute otitis media) or an ear canal infection (acute otitis externa). Sometimes, mainly in adults and only very rarely in children, ear pain may be caused by a problem elsewhere. This “referred” pain can be caused by dental infections, inflammation of the jaw joint or arthritis of the neck.

What are the signs of ear infection in a child?
Middle ear infections cause sudden pain, causing the child to wake up during the night, crying in distress. They may run a fever, and may tug at their ear. Ear canal infections, on the other hand, tend to come on gradually. There is usually a visible foul smelling discharge from the ear, and the ear lobe may be red and painful when touched.

Middle ear infections are common, and most children have a couple of infections in early childhood. Often, they follow on from a common cold, and are bacterial. Some are so mild that they may even go unnoticed!

Ear canal infections (otitis externa) can be caused by swimming – particularly long periods in the water during a beach holiday – and may be due to bacteria or fungi. Fungal ear infections are often intensely itchy and may continue for many weeks. Common in the tropics, this infection is often called “Singapore ear”!

To treat middle ear infections that are not associated with a high fever, recent research suggests that a good painkiller such as Ibuprofen may be most helpful. Antibiotics are often not necessary, except in children under the age of two, or in severe cases. Ear canal infections are best treated with antibiotic eardrops and keeping the ear as dry as possible. In severe cases, you may need to consult an ENT surgeon and have your ear canal cleaned of discharge and debris.

Temporary hearing loss may follow a middle ear infection.
If you think your child’s hearing seems poor several weeks after an infection has passed, do consult your family doctor. Glue ear (otitis media with effusion) is common in preschool children and can lead to speech and language delay.


A good family GP can make all the difference
A good family GP can make all the difference


F is for Family Practice
Dr Charyu Narayan, who trained in paediatrics and neonatology in the UK, is now part of the international team of GPs at CHI Health.

As a family doctor, how different is your workload in Singapore, compared with the UK?Interestingly, it has changed from mainly chronic disease management in the UK to seeing more acute illness here, both in adults and children. Viral illnesses – coughs, colds and gastroenteritis – constitute the majority of issues at our clinic.  Other common illnesses are hand, foot and mouth disease (HFMD) in younger children, and skin infections.

Children, including newborns, are seen for developmental checks, concerns from parents and for routine as well as travel vaccinations. A high fever in kids raises concern about dengue and chikungunya – both mosquito-borne illnesses found in Singapore. With in-house testing available at CHI, we are able to speed up diagnosis and management.

Influenza circulates all year round and as families travel frequently, it can be imported from their place of travel, as can typhoid and malaria.

On another note, I also frequently come across psychological issues and anxiety depression in children and adolescents. The stress of moving away from the home country, adjustment to new schools and a new culture may be responsible for these conditions becoming manifest. I must mention seeing a spectrum of eating disorders in teenage girls, too.

Which other childhood ailments that you see are associated with living in the tropics?
Mycoplasma infection deserves a mention and presents with a cough, mild fever and fatigue lasting longer than a usual cold. Some people are able to fight off the infection without medication but I see children in whom the infection causes missed school days and low levels of energy. This group may need a course of antibiotics and follow up if they have a lung infection.

Parasitic infections and bacterial gastroenteritis cases linked to food hygiene and sanitation are often seen following holiday travel in the Subcontinent.

The absence of a winter in Singapore is a plus for asthmatic children whose symptoms are worse in cold weather, but I’ve observed that haze pollution triggers breathing problems in children. Dust mites – a common allergen here – are also a trigger.

What attracted you to paediatrics and neonatology in the first place?
It’s a unique branch of medicine that requires interaction with the child and the family. Even though it’s heartbreaking to see children suffer, it’s also great to see them bounce back after illness – and amazing to see them grow and develop over the years.

As physical and psychological health are so closely interwoven, a good rapport with one’s paediatric patients can make all the difference in making them better. As a GP seeing children in a private practice like CHI, I have more continuity and contact with them than I would have as a hospital doctor, and I find that personally satisfying.


Keeping close watch on the baby bump
Keeping close watch on the baby bump


G is for Gestational Diabetes
A diagnosis of gestational diabetes mellitus (GDM) is one of the last things a pregnant woman wants to hear, and it affects a surprising 18 percent of pregnancies. Fortunately, says endocrinologist Dr Foo Joo Pin of Specialist Endocrine Clinic, the outcome for both mother and child can be good, as long as the mother works closely with her endocrinologist to achieve and maintain good glucose control. Early diagnosis and active intervention are key!

What is GDM and what causes it?
GDM is defined as any degree of glucose intolerance that either starts or is first recognised during pregnancy. It happens because pregnancy-related hormonal changes cause the body to develop resistance to insulin, causing blood sugar levels to rise. If the body is unable to produce more insulin to overcome the resistance, the resistance will progressively worsen over the course of the pregnancy.

How is it picked up?
This is a silent disorder that can only be detected via an oral glucose tolerance test. Your gynaecologist may recommend you to do the screening test, on the basis of your risk factors for diabetes. That said, many women who develop gestational diabetes have no evident risk factors. In fact, US authorities have recommended that all pregnant women be screened for gestational diabetes.

What are the risks to mother and baby?
Left untreated, in can result in serious complications. GDM in early pregnancy can cause birth deformities in major organs such as the heart and central nervous system, and a higher risk of miscarriage. It also causes excessive growth of the baby, increasing the risk of birth trauma.

Who might be more susceptible to GDM?
If you’re overweight prior to becoming pregnant, or have a history of pre-diabetes, or a family history of diabetes, or previously gave birth to a big baby or a stillborn baby, your chances are higher.

How is it treated?
Treating GDM involves dietary and lifestyle intervention. Very often, though, insulin is required to control the blood sugars to optimal levels. Many women have a fear of injecting insulin, but they shouldn’t – modern insulin therapy can be really easy, convenient and pain-free nowadays.