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Kids health: We ask experts about some common childhood challenges

Just when did parenting become so complicated? While I was growing up, doctor’s visits were for chickenpox, measles, whooping cough and the odd broken bone; you either ate your Brussels sprouts for dinner or for breakfast, grey and cold; and you saw the dentist when aspirin didn’t take away the toothache.

As for nutritionists, physiotherapists, dermatologists and specialist dental professionals, they weren’t much of a feature. Itchy rash? Mother will kiss it better. Sore tooth? Hold her down in the chair, fill it with amalgam or pull it out. Sore ankle? Yay, I can skip PE.

In this Information Age, though – and with the prevailing wisdom of the school mothers’ grapevine – it would be difficult for a parent to be so a blithely laissez-faire. And fortunately for us here in Singapore, we have quick and easy access to some of the best medical minds and facilities in the world.

I’ve asked a panel of four Singapore-based healthcare professionals – Dr Sundus Hussain-Morgan from Complete Healthcare International (CHI), Dr Thean Tsin Piao from Aesthete Smilestudio, Dr Lim Kar Seng from The Dermatology Practice and Dr Tan Ken Jin from OrthoSports Orthopaedic Surgery & Sports Medicine  – for their views on some of the most pressing health challenges that parents face.


#1 Getting Them to Eat – the problem of the picky eater

Every second family has a picky eater, and it can be a real worry. Dr Sundus Hussain-Morgan tackles the issue of what the ideal diet is, explains how and why children may resist it, and – most importantly – provides some helpful suggestions to overcome the problem.

So, you’ve cooked a delicious meal for your child, only to have it examined, sniffed at and then rejected? If so then you are not alone – 20 to 50 percent of children are described as picky eaters by their parents.

The ideal diet for children is one that balances high energy with a nutrient content that is required for growth and development. Children may start resisting as they are presented with new foods and different mealtime expectations. Often, this is a temporary problem that can be resolved by making a few changes.

1. Be sensitive to your child’s appetite

We often overestimate how much a child needs to eat. Children know how much they need, so forcing them to eat when they are not hungry, or to finish what’s on their plate, may create anxiety about food and mealtimes. Serve smaller portions and give your child an opportunity to ask for more.

2. Stick to a routine

Try to serve meals and snacks at about the same time each day. Children have smaller stomachs, so a schedule of three meals with two snacks is usually ideal.

3. Introducing new foods

You may need to offer a new food between ten and fifteen times before your child decides to try it. So be patient, and talk about the food’s colour, texture and shape rather than the taste.

4. Be creative and make it fun

Use cookie cutters to cut food into different shapes. Serve brightly coloured foods. Serve vegetables with tasty dips.

5. Bulk up meals with vegetables and fruit

Add grated vegetables to the ingredients for spaghetti Bolognese, stews and casseroles, add thinly sliced vegetables to cheese and ham pizza, and top cereals and yoghurts with fruit.

6. Do not offer dessert as a reward

Together with withholding dessert, this will make desserts seem like the best thing in the world. Offer dessert perhaps a couple of times a week, and fruit at other times.

7. Involve your child

Take your child to the supermarket and let them choose fruit and vegetables. Encourage them to help you in the kitchen.

8. Be a good role model

Eat balanced and healthy meals together with your child.

9. Avoid distractions

Meals should be eaten at the dining-room table and not in front of the TV, so that your child focuses on the food.

10. Mealtime etiquette

Encourage your child to remain at the table during mealtimes, even if he or she doesn’t eat, but keep mealtimes about 20 to 30 minutes long. If he or she doesn’t eat, don’t offer alternative foods; that will only encourage pickiness.

Note: If an eating problem persists or you are concerned about your child’s growth, do seek advice from your GP or from a dietician.

Complete Healthcare International (CHI)
45 Rochester Park
6776 2288 | chi-health.com.sg


#2 Keeping Tabs on Teeth – childhood dentistry is vital

Good nutrition is simply not going to happen in children who don’t have healthily functioning teeth. Resident Tooth Fairy Dr Thean Tsin Piao answers a few questions on how to make sure they do.

How important is the dentist’s role in the early childhood years?

Vitally important, especially with regard to the normal development of teeth and jaws. Firstly, it’s our duty to provide a positive dental experience that will encourage the child to develop trust in the dentist, a positive attitude and appropriate behaviour towards dental care. Secondly, we teach and reinforce dental hygiene as part of preventive dentistry. And thirdly, we monitor any disease, such as cavities, and keep an eye on the sequence of tooth eruption.

At what age should a child’s first dental check-up take place – and how often after that?

Any time from 18 months to two years is a good age for the first dental experience. Ideally, the first appointment should involve observing either a parent or an older sibling having a check-up; later, at home, the parent should talk about it with the child. Soon after that, make a short appointment for the child’s first dental experience, which should be a positive one. Thereafter, schedule six-monthly appointments, or as advised by your dentist.

What are the milestones for early dental development?

* At six months, you should see the eruption of lower baby teeth. By 12 months it’s usual to have about six baby teeth on each jaw, and by 24 months about ten on each jaw. Teething can be accompanied by pain, fever and diarrhoea.

* Around six years of age, the permanent lower central incisors erupt, and their baby counterparts are lost. (The baby teeth may need to be extracted if the permanent teeth erupt either behind or in front of them.) The first permanent lower molar also erupts around this time, and we may recommend fissure sealant to prevent cavities.

* Once all permanent teeth have erupted, usually by age 12, we check the alignment of the teeth and recommend orthodontic treatment if necessary.

Some children – and adults, too! – are afraid of dentistry, sometimes because of an unpleasant experience. How do you ensure a positive experience?

To start with, it has to be pain-free. Prevention is of course the best approach, and good oral hygiene goes a long way towards preventing cavities and gum disease in the first place. If dental treatment does become necessary, local anaesthesia does the trick; even general anaesthesia is available, for advanced dental treatments.

Why are regular check-ups important?

They’re an opportunity to diagnose early decay, gum disease or mal-alignment of teeth that causes poor bite, difficult in cleaning, and a less than aesthetically pleasing smile. Remember that early disease can be symptomless; pain is often only felt at a later stage of the disease.

Aesthete Smilestudio
24 Raffles Place
#02-04 Clifford Centre
6438 3811 | aesthetesmilestudio.com



#3 Saving Their Skins – things you’ve been itching to know!

As our biggest organ – doing a great job of keeping the outside out and our insides in – human skin has multiple protective, regulatory and other important functions. Being relatively fragile, though, especially in the case of younger children, skin is also vulnerable to infection and a whole lot more. Dermatologist Dr Lim Kar Seng tells us about the childhood skin complaints he sees and treats.

What are the commonest conditions?

Viral skin infections such as warts and verrucas (plantar warts), and also molluscum. Colloquially called water warts, molluscum is a cousin of the wart that’s easily spread through water; it looks like clusters of small pimples. In our hot and humid environment, children get them from swimming pools, play schools and so on. They’re hard to avoid – good hygiene helps, but children do come into contact with one another.

How do you treat them?

To treat warts and verrucas, we physically destroy them with liquid nitrogen. Molluscum blisters are more delicate, so we can just prick them out; but for children we tend instead to apply “betel juice”, so called because it’s derived from a beetle toxin. This liquefies the blister, which then scabs up and drops off.

What else do you often see?

Bacterial infections are commonplace: small, crusty sores that develop from a small scratch in the playground, for example. They’ll generally resolve at home with ordinary antiseptic; but if they don’t resolve, or they start to spread, we’ll prescribe a topical cream, or even oral antibiotics if necessary.

How common is eczema in Singapore?

Very common indeed. Patches of skin become rough and inflamed with blisters that can cause severe itching and bleeding, and anything from a third to half of all schoolchildren here have it at some stage. Eczema can be very distressing, as it’s hard to stop a child scratching – especially a younger child.

Why do you think it’s so common here?

It may have something to do with our over-sterile environment – one can be too clean! One theory is that when children aren’t exposed to allergens while they’re young, they don’t develop the necessary degree of tolerance; and so, when they are exposed, they become overwhelmed. To treat eczema, we advise keeping the skin well moisturised; we may also do allergy tests to identify the allergen with a view to avoiding it. Luckily, most children outgrow the condition.

The Dermatology Practice – Skin Hair Allergy Laser
38 Irrawaddy Road
#07-60/61/62 Mount Elizabeth Novena Hospital
6694 3290 | thedermatologypractice.com



#4 Surviving the Sports Field – getting through adolescence with bones intact

Unlike those of us who spent our teenage years curled up with a large bag of cheese and onion crisps and a library book, many children (so I’m told) become increasingly active during adolescence. Dr Tan Ken Jin tell us more about what makes them vulnerable to foot and ankle injuries, and the Orthosports approach to treating them.

During adolescence, many teenagers enjoy multiple sports and may also begin to play at a competitive level. So, it’s no surprise that they tend to experience foot and ankle issues. Frequent problems include bunion pain, ankle ligament and cartilage injuries, arch pain related to flat feet or high arched feet, and heel bone or Achilles tendon pain.

Because this is also a period of rapid bone growth, injuries and fractures to the growth plates around the foot and ankle can also occur – either from an acute injury, or from chronic stress and overload.

Common sports that put more stress on the foot and ankle include rugby, basketball, athletics, dancing and racquet sports. Each sport exerts different demands on the lower extremities, and calls for various combinations of agility, balance and strength in different regions of the foot and ankle are needed. This can result in different injuries associated with each sport, and each may require a different treatment approach.

Our treatment approach at Orthosports is individualised to each adolescent. After making an accurate diagnosis, we take into account the specific needs of each person and the demands of his or her sport.

Therapy focuses heavily on rehabilitation and biomechanics. In selected cases, surgical treatment may be needed for an optimal outcome, and this is always carefully discussed and planned with both the adolescent and his or her parents. Some of the procedures our doctors specialise in include minimally invasive ankle ligament repair, adolescent bunion correction and minimally invasive flat-foot correction.

In each case, we’ll offer the most effective treatment options, maximising the benefit and minimising any downtime.

OrthoSports Orthopaedic Surgery & Sports Medicine
38 Irrawaddy Road
#10-41 Mount Elizabeth Novena Specialist Centre
6734 8168 | footandankledoctor.com.sg

By Verne Maree