Paediatrics

Drinking milk increases the time it takes for a drug to leave the stomach and be absorbed in the small intestine. This is usually not an issue if the drug is supposed to be digested slowly but would be an issue if the drug is supposed to be digested rapidly.

Whole milk increases the delay due to a higher fat content. Non-fat milk has less of an effect. Certain antibiotics, such as tetracyclines and doxycycline, also exhibit reduced rates of absorption if taken together with milk. Both antibiotics are used as anti-malarial drugs in combination with quinine.

Milk also inhibits iron absorption. However, milk remains one of the most readily available sources of calcium; which itself is critical for increasing bone tensile strength and preventing osteoporosis. Overall, the benefits of milk outweigh its nominal inhibition of iron absorption.

Some pills and supplements should thus be taken on an empty stomach to accelerate the absorption process. You should read and follow instructions from your doctor and/or pharmacist to enable the medication to work in the most effective manner.

Contributed by Dr. Lee Bee Wah, eMenders Paediatrician and Clinical Paediatric Immunologist/Allergist.

Mature coconut milk, the expressed juice of grated coconut flesh and water, does have a high proportion of saturated fat and is not particularly considered to be good for your health. However, it contains no cholesterol.

Young coconut water has no fat and is rich in minerals. Its flesh has some fat, but ten times less than that in a mature coconut.

As such, eating the flesh of a young coconut has is not an immediate health hazard, and you should be able to consume it regularly and in moderate amounts without worrying too much.

Fatty coconut products like mature coconut flesh should be consumed in moderation.

Contributed by Dr. Lee Bee Wah, Paediatrician and Clinical Paediatric Immunologist/Allergist.

The BCG vaccination is given to newborn babies to prevent tuberculosis. The usual dose, 0.1 ml intradermally, produces a skin reaction in 3-4 weeks.

There will be a papule that vesiculates and heals with a small scar. The small papule indicates that the vaccination is successful.

Contributed by Dr Chiang See Ping, Paediatrician.

Any pharmacy will sell over the counter medication for treatment of parasites (helminths) in the gut. One popular preparation is Zentel (albendazole). It is 400mg (10ml or 2 tablets) as a single dose for children older than 2 years and adults; and half the dose for children under 2 years.

This will take care of most parasitic worms of the gut round worm, hook worm, pin worm and whip worm. The dosage may vary for other worms.

Contributed by Dr. Lee Bee Wah, Paediatrician and Clinical Paediatric Immunologist/Allergist.

Tempeh is a source of protein and is made from soy. It is safe for consumption by your one-year old as long as he can tackle the chewy consistency of the food. It is arguable if it is better than tofu. It is a traditional fermented food made from soaked and cooked soybeans inoculated with a mold, usually of the genus Rhizopus.

After fermentation has occurred, the soybeans are bound together into a compact cake by dense cottony mycelium. An important function of the mold in the fermentation process is the synthesis of enzymes, which hydrolyze soybean constituents and contribute to the development of a desirable texture, flavor, and aroma of the product. There is no concern about alcohol.

Contributed by Dr. Lee Bee Wah, Paediatrician and Clinical Paediatric Immunologist/Allergist.

Bedwetting is usually associated with some overactivity of the bladder and commonly occurs during childhood. Children are not considered to have this problem unless they are at least 5 years old and still wet the bed at least two times a month. With time and patience, bed-wetting stops in most children.

The exact cause of bedwetting is not known. A child may be a bed-wetter for more than one reason. Bed-wetting often runs in families. Children do not wet the bed because they are naughty or lazy. These are important points for parents to remember–and to stress to their child. Parents should not punish their child for wetting the bed. The child probably has little or no control over the problem. Because of bed-wetting, children can have poor self-esteem. Treating bed-wetting helps these children feel better about themselves. Most children who wet the bed are completely healthy. Urine tests are the only tests they might need. Bed-wetting usually is not a sign of a kidney problem unless the child has other signs, such as wetting during the day or pain with urination. Talk to your paediatrician or family doctor if your child has been dry at night but starts wetting the bed.

Even with no treatment, many children “outgrow” bed-wetting when the control center for micturation matures. To stop bedwetting, there are some treatments that can help. The bed-wetting alarm seems to have the best cure rate. The child wears the alarm at night. When the child begins to wet the bed, the alarm goes off. The child wakes up and gets up to go to the bathroom. For this treatment to work, the alarm may need to be used for 3 or 4 months.

Desmopressin (brand name: DDAVP) is a medicine that is used to treat bed-wetting. It comes in a nose spray or pill. Desmopressin works quickly, but it is expensive. Many children start wetting again when they stop taking the medicine. Sometimes, the bed-wetting alarm and desmopressin can be used together. Minirim is another medication which can be used for treatment of bedwetting. It is taken at night and will stop children from bedwetting at night. It is especially useful if the child is going for an outing.

Whichever treatment is chosen, here is some advice for parents:

1. Be positive–and reassure your child that bed-wetting will stop or be cured with time. Do not punish your child for bed-wetting!
2. Give your child the job of changing the wet bed. A younger child can be asked to take the sheets off the bed. An older child may be asked to do the laundry.
3. Don’t let your child drink water, milk, or other beverages too close to bedtime.
4. Before you go to sleep at night, wake your child up to use the bathroom.
5. Develop a system of rewards, such as stickers for dry nights, to encourage your child.

Contributed by Dr. Lee Bee Wah, Paediatrician and Clinical Paediatric Immunologist/Allergist.