Q: My two year-old is shy and struggles to make friends at playgroup. How can I encourage him to be more sociable?
Counselling psychologist/marriage & family therapist Charis Wong says,
A group of little children at playgroup may be too overwhelming as an initial social platform for your shy two-year-old. Children at this age are still learning to make friends, and will usually have only one or two significant friends. So go through your list of friends and find a friend who has a child, about six months to a year older than your child, who can make a “good enough” playmate for him. A “good enough” playmate is a child who is friendly, willing to share toys, takes turns, and plays well with other children. As your child’s primary attachment figure, it is important for you to remain as a secure base for him to explore his world and reach out to other children, and a safe haven for him to return whenever he feels scared or anxious. Therefore, do not abandon him in a strange environment or with a strange person until you are certain he is comfortable being left alone with the playmate and his parent without you. Instead, spend time hanging out with your friend while the children get an opportunity to be comfortable with each other and play together. Your child may initially be clingy and stick to you but be patient and give your child the space to make friends at his own pace. With regular playdates in a familiar environment and with the same “good enough” playmate, your child will eventually learn to make a friend.
Once your child is able to get along well with this playmate, arrange other playdates with other parents, so that your child gets to practice his social skills with other children. When he is good with one-to-one peer interaction, you may want to invite two of his playmates to your house for a threesome playdate. Hopefully, in a few years’ time, your child will be ready to invite all his little playmates over for a party!
Q: I’m 37 and have been trying for a baby for the past 18 months with no luck. What help can I get?
Obstetrician Dr. Choong Kuo Hsiang says,
You and your husband will have to consult a gynaecologist. He will take a detailed medical history from you. This may include some very personal questions regarding your social habits such as drinking, smoking and frequency of intercourse. Then a physical examination will be done to ascertain that both of you are in good health. You will probably get a pelvic ultrasound scan to exclude any gynaecological pathology like fibroids or cysts. Further examination will necessitate a sperm evaluation for the man. Do not worry, they will not ask him to produce a sperm specimen right away. Then, your husband will probably be asked to come back another day, where the collection will be done in discreet conditions. For you, tests will be done to ensure there is no blockage in the Fallopian tubes. This can be done by X-ray or Laparoscopy. If all goes well, you will be put on fertility tablets to increase ovulation which will improve your chances of conception. If this fails, you will probably have to seek the services of a test tube baby doctor (infertility specialist and IVF doctor).
Q:My 10-month old baby was recently hospitalised for high fever and febrile seizure. Will the seizure reoccur in the future and can it cause brain damage?
Consultant paediatrician Dr. Ling Shih Gang says,
Febrile seizure (FS) occurs in 3% of children, usually in children below seven years old. Around 30% of those with first FS will develop recurrence. Two risk factors that may increase the possibility of recurrence include:
• Age below one year at time of first FS and,
• History of FS in parents or siblings.
If no risk factors are present, only 10% of such children will have a recurrence. If one risk factor is present, the incidence increases to 40%-50%. Those with both risk factors have a 70% chance of developing a recurrence. Your child has at least one risk factor (i.e. age less than one year) and therefore is at increased risk of getting a recurrence.
If your child gets a febrile seizure, stay calm, turn him to his side to prevent tongue from obstructing the airway, and wait for the seizure to stop. Seizures usually last less than five minutes. Generally, FS does not cause brain damage. Most studies have not shown any difference in intelligence and cognitive functions between children with and without FS. However, in children with FS, there is a modest increase in risk of epilepsy.
Q: I’m experiencing strong Braxton Hicks. How do I know I’m not in labour?
Midwife Ann Ibrahim says,
Braxton Hicks (BH) contractions actually happen from the time you are six weeks pregnant, but you’re more likely to feel it during the second trimester of pregnancy (about 28 weeks).
BH is thought to aid the flow of fluids and blood through the placenta, and to tone the uterus as the baby grows. It is also said to help in softening the cervix, but not in its dilatation. As pregnancy progresses, BH may become more intense and instead of just being uncomfortable, the sensations may be more painful to some women. The feelings are akin to a painful period and are usually concentrated around the abdomen and lower pelvic areas.
A common term for BH is ‘false’ or ‘practice’ contractions because the sensations mimic true birth contractions, and it also happens at the time when one would expect to be going into labour (late pregnancy). The differences between the two, however, are distinct and definable.
True birthing contractions
|How often do the contractions occur?||Irregular and do not get closer together||May begin irregularly but they increase in frequency and regularity. A pattern is usually established|
|Do they change with movements?||May stop when you walk or rest, or may even stop if you change positions first and then get weaker||Continue despite movements or changing positions|
|How strong are they?||Usually weak and do not get much stronger. They may be strong at first and then get weaker||Steadily increase in strength and pressure|
|Where do you feel the pain?||Usually only felt in the front of the abdomen or pelvic region||Usually start in the lower back and move to the front of the abdomen.|
BH contractions can be triggered when you are dehydrated or have a full bladder. They can also occur after sex, when you or your baby are very active, or there’s an external stimulus such as someone touching your abdomen. To alleviate the symptoms, keep yourself hydrated by drinking good amounts of water (about 10 glasses a day), lie on your left side and relax, practise relaxation and deep breathing and empty your bladder regularly. Continuing sex is alright, as long as it does not become painful.
Lactation expert Rita Rahayu Omar says,
With very much related conditions, causes, symptoms, side effects and treatments, the only way to differentiate them is through feeling and observation. A plugged duct is an area of the breast where milk flow is obstructed. The obstruction may occur at the nipple pore (also known as nipple bleb/milk blister) or further back in the ductal system of breasts. It usually comes on gradually and affects only one breast. A hard lump or distinct wedge-shaped area of engorgement may feel tender, hot, swollen or look reddened. Sometimes there won’t be any obvious lump but instead, a localised tenderness or pain. Typically, a plugged duct will feel more painful before/during a feed and less tender and lumpy afterward. Sometimes a mother may experience a low fever.
Mastitis is an inflammation of the breast that can be caused by an obstruction, infection and/or allergy. Most common in the first two to three weeks but can occur at any stage of lactation, mastitis may come on abruptly, and usually affects only one breast. The symptoms are the same like a plugged duct, but the pain/heat/swelling is usually more intense. There may be red streaks extending outward from the affected area. Typical mastitis symptoms include a fever of 38.5°C or greater chills, flu-like aching, malaise and systemic illness.
|Engorgement or ineffective/inadequate milk removal from latching problems, ineffective suck, tongue-tie, nipple pain, sleepy or distracted baby, oversupply, hurried feedings, limiting baby’s time at the breast, nipple shield use, blocked nipple pore, etc.Infrequent/skipped feedings from scheduled feedings, busy mum, returning to work, pacifier overuse, baby suddenly sleeping longer, supplementing, abrupt weaning etc.Pressure on the duct from tight bra or clothing, fingers, sleeping positions.Inflammation from injury, bacterial/yeast infection or allergy.Stress, fatigue, anemia, weakened immunity||Milk stasis/ restricted milk flow Infection: Sore, cracked or bleeding nipples can offer a point of entry for infection. If the mother has had recurring mastitis, this is a risk factor.Stress, fatigue, anemia, weakened immunity|
Continued breastfeeding during mastitis is safe as the antibodies in the mother’s milk protect the baby from any bacteria. Do not decrease or stop nursing as this increases the risk of complications (including abscess). Temporary weaning is an unnecessary hardship at a time when the mother is not feeling well as it is much more comfortable for the mother to continue breastfeeding. Additionally, mastitis clears up more quickly if mother continues to breastfeed because breast is not allowed to become overly full, lessening the risk of abscess. The treatment for both conditions follows these guiding principles: use heat and gentle massage before nursing, get as much rest as possible and empty breasts frequently and effectively. To reduce pain and inflammation between feedings, use cold compresses.
Q: How much of total weight should I gain during my pregnancy? I’m afraid of piling the extra kilos and would like to go back to my pre-pregnancy weight easily after delivery.
Mothers-to-be tend to perceive that being pregnant means doubling your food intake and giving in to all food cravings. In real, that’s how the extra kilos are gained, making it difficult to lose them after delivery. Expected weight gain for the whole pregnancy depends on your Body Mass Index (BMI) as shown below. The energy requirement for a pregnant woman is also different throughout the trimesters. An extra 360 kcal/day can be attained from consuming additional tuna sandwiches (two slices of bread with margarine spread sparingly) for afternoon tea with a glass of low fat milk/dairy products at night. Avoiding junk food, oily food and high-calorie beverages are the key things to controlling a healthy weight gain throughout your pregnancy. Please consult your dietician if you experience a sudden excessive weight gain or no weight change during your pregnancy to prevent any complications during delivery.
BMI = Body weight (kg) / Height²
*** Height² (meter x meter)
Extra Calories needed (kcal)
| 1st (0 to 3rd month)2nd (4th to 6th month)
3rd (7th to 9th month)
25 – 29.9
| UnderweightNormal Weight
| 12.5 to 18.0 kg11.0 to 16.0 kg
6.8 to 11.0 kg
5.0 to 9.0 kg