Oral ulcers refers to the little sores that come up inside the mouth, on the tongue or on the gums. There are many causes of oral ulcers in toddlers and young children, but they usually occur following some trauma to the mouth such as:
Oral ulcers can also happen when children feel tired or stressed or if is a family history of recurrent oral ulcers.
Infections are another major cause of oral ulcers in children. Common viral infections include hand-foot-and-mouth disease (HFMD), chickenpox, and herpes gingivostomatitis (otherwise known as cold sore). If an infection is the cause, symptoms such as fever, malaise, or rashes may accompany in some cases.
Dr Tan Zhen Han, Paediatrician, SBCC Baby & Child Clinic said: “Although rare, mouth ulcers can sometimes with associated with an underlying medical condition, in which there may be recurrent mouth ulcers together with other associated features. Some of these conditions include vitamin deficiencies (For example, Iron, vitamin B12, folate, vitamin C, zinc, magnesium), impaired immune system, and gastrointestinal tract disease.”
Preventive measures
A good oral hygiene practice is extremely important. Be sure your child uses a toothbrush with soft bristles, and brushes gently, and do take them to visit the dentist regularly.
If your child has a habit of sucking their thumbs, remember to cut their nails regularly. For younger children, watch out for toys or objects with sharp edges that your child may put into their mouth
Similarly, having a good hand hygiene is equally important. Parents and teachers should start teaching children regular hand washing at home and in school from young as this can help reduce the spread of infections such as HFMD.
When to visit a doctor?
You should bring your child to the doctor if:
Treatment for oral ulcers
If your child is in significant pain, your doctor may prescribe a topical local anaesthetic (washes, gels, drops or sprays). Such forms of remedy may provide some short term symptomatic relief, which also help improve oral intake.
Give your child small frequent sips of water every now and then as this will help to prevent dehydration.
What can parents do to help the child ease the discomfort?
Dr Tan Zhen Han
Paediatrician
SBCC Baby & Child Clinic
MBBS (S’pore), MRCPCH (UK), FAMS (Paediatrics)
This article is brought to you by Healthway Medical.
This is very normal, and entirely understandable. When the baby is folded up tightly in the womb, the leg bones become a little curved. Those bones are still soft and growing while the baby is inside the womb. Even when a baby is first born, those little legs are still rather soft as the bones finish setting into their strong and healthy form. They remain a little curved throughout the infant weeks, but when they begin to walk and bear weight on their legs, the legs naturally straighten.
When a child first begins to walk, he or she might look like a bow-legged baby, even if they aren’t. That’s because when a child first learns to walk, they are very careful about where they place their feet. They have to keep their balance, and that’s hard to do. Therefore, they bend their knees to help them balance and support their body weight. This can make them appear bow-legged when they walk. Don’t worry about this at all, as it is perfectly normal.
Only get worried if the bones seem to be curved unequally, or if the curves are extreme, or if the curving seems to get worse over time. If your baby seems to be in pain when he or she tries to walk, or refuses to try to walk at all, then that might make you wonder if a bow-legged baby is actually experiencing more trouble than you thought.
How Long Does It Last?
A bow-legged baby might look that way for several months after they begin to walk. Over time, the legs will straighten and the baby will walk with a more erect posture. The bones will appear to lengthen and straighten as this happens. For some babies this takes only a few months, and for others it might take up to a year or more. As long as your baby is walking normally and doesn’t seem to be in pain, things are probably fine.
What might happen next is just the opposite–a problem called knock-knees. When a child has knock-knees, it means their knees touch when they walk or run. Their lower legs angle out. This is usually noticed between three and six years of age. But just as with bow-legged problems, the knock-knees tend to go away as the child gets older.
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When To See A Doctor
In most cases, your child is probably completely normal, and the problem with being bow-legged will sort itself out in short order. If you are worried about it, take your child to the doctor and let the physician watch the baby walk across the room. If there is any cause for concern, the doctor will spot it.
These are the time when you should call your healthcare provider about your child’s legs:
As always, if you are worried about the way your baby is walking, check with the doctor!
Article adapted from New Kids Center
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If you are planning to travel to another country with your kids, being familiar with the risks of travel helps to keep them stay safe and healthy. This may include getting prior travel advice, vaccines or certain medications – even if the destination is not considered exotic.
For example, United States is experiencing a first time high number of measles cases since 1996; many areas of developed countries in Europe reported large outbreaks of measles, meningococcal infection and pertussis and there were many who suffered serious complications from seasonal influenza in Hong Kong last year.
Children are exposed to similar health risks as adults but the consequences can be much more serious. A previous study of almost 1840 children in the US who returned from various international destinations showed that of the 86% who developed illnesses upon return; diarrheal syndrome was the most common, followed by skin disorders from animal, insect bites or parasites, fever syndromes caused by viral infections, typhoid fever, dengue, malaria, as well as respiratory tract infections.
Protecting children involves updating routine childhood vaccines and giving appropriate travel specific vaccines. There may be recommended vaccinations for your destination and it may take 4 to 6 weeks before travel to complete them. Some vaccines can be given earlier or with an accelerated schedule. The vaccines you need would depend on where you are going.
Travel-specific vaccines to consider include:
Hepatitis A
Hepatitis A is one of the most common vaccine-preventable infections acquired during travel that is spread through contaminated food and water. It is usually mild in babies and young children but in some older children above 5 years old and in adults, symptoms like fatigue, loss of appetite, abdominal pain, diarrhoea, and jaundice can be prolonged. It can last up to 2 months or longer and it even rarely lead to severe liver damage.
Hepatitis A vaccine is safe and effective. 2 doses, at least 6 months apart, are required for long-term protection.
Typhoid
Typhoid fever is caused by the bacteria, Salmonella Typhi, that is spread through contaminated food and water. It can cause high fevers, fatigue, headache, stomach pains and occasionally a rash.
It may result in low blood pressure (shock) and potentially death. An inactivated (killed) vaccine is available for prevention of infection. One dose at least 2 weeks before travel would provide protection for 2 years.
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Influenza
Most people recover from Influenza "the flu" within a few days to 2 weeks. Young children below 5 years and those with chronic medical conditions for example, asthma, are at higher risk from flu complications that may lead to hospitalisation and even death.
Children less than 9 years old having influenza vaccine for the first time requires 2 doses at least one month apart and protection starts 2 weeks after the series is completed. Annual influenza vaccination is recommended for young children from 6 to 59 months old and those with chronic medical conditions.
Meningococcal
Meningococcal infection caused by the bacteria, Neisseria meningitidis (particularly Serogroups A, B, C, W, and Y) leads to bloodstream infection and meningitis (infection of the lining of the brain) and is spread through close contact.
Young children are at increased risk of infection. Meningococcal vaccination is a requirement to enter Saudi Arabia for the Umrah or Hajj pilgrimage. The vaccine is also recommended for travel to areas where there are increased numbers of reported cases or outbreaks.
Meningococcal ACWY vaccines can help prevent meningococcal disease caused by serogroups A, C, W, and Y. A different meningococcal vaccine is available to help protect against serogroup B. Your doctor would be able to advise on the number and timing of doses and the need for additional booster according to your child's age.
Japanese Encephalitis
Japanese encephalitis (JE) virus is spread through a bite of an infected mosquito, and is common in rural parts of Asia. It causes encephalitis (brain infection) and can lead to death, with a rate of 1 in 4 affected people, or even long-term neurological disability.
This vaccine is recommended for travellers with prolonged stay of more than a month in rural areas, activities like trips to rural farms and extensive outdoor exposure, during the high transmission season and shorter stays in areas with an ongoing outbreak.
There are 2 types of JE vaccines available and your doctor would advise on suitability according to your child’s age.
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Yellow Fever
Yellow fever virus is spread through a bite of an infected mosquito. It can lead to liver, kidney, and multiple organ failure, as well as death in up to half of infected people. Vaccination is required under international health regulations for travel to certain countries like Africa, and Central or South America.
It can only be administered at certified centres and you will be issued an "International Certificate of Vaccination or Prophylaxis" (yellow card). Only infants older than 9 months through 59 years of age can receive the vaccine, which contains a live, weakened virus. 1 dose confers long-term protection.
Rabies
Rabies is more common in children than in adults because children tend to like playing with animals. Human get rabies through bites of an infected animal; typically wild animals like bats, stray dogs, foxes, racoons and other mammals. Human rabies leads to severe brain infection and is almost always fatal.
If your trip is considered as high risk for rabies exposure, you can consider getting vaccines before travel (“pre-exposure” vaccinations) which consists of a 3-dose vaccine series over a period of 3 to 4 weeks. In the event of a bite and possible rabies virus exposure, treatment (”post-exposure”) would depend on whether you had received rabies vaccines prior to your travel.
Malaria
Children who are travelling to countries where malaria is a possibility should take drugs to prevent malaria. There are currently no vaccines available against malaria.
You may consult your paediatrician or a doctor trained in travel medicine who will review your itinerary carefully and discuss individualised risk assessment based on travel style (backpacking versus hotel), regions you will be visiting (urban vs rural) and the time of year (seasonality can influence exposure to mosquito-borne infections e.g. Japanese encephalitis) to determine if the recommended vaccines or prevention measures are really necessary for your trip.
A reliable source of information on travel would be https://wwwnc.cdc.gov/travel
This article was provided by the Singapore Medical Group.
By Dr Mas Suhaila Isa, Paediatrician, MBBS, MRCPCH (UK)
Kids Clinic @ Mount Alvernia – www.kidsclinic.sg
Chinese Pediatric Massage, more commonly referred to as paediatric tuina, is not just a helpful aid in treating common ailments in babies and young children, but it is useful as a preventive measure too. Find out more about this unique form of external therapy that is thought to have originated and practised in China for at least 700 years.
Traditional Chinese Medicine (TCM) is fast catching on as a highly effective treatment in paediatric care, and its therapeutic methods include tuina, acupuncture, moxibustion, cupping, ear-seeds, guasha (skin scraping) and plum-blossom needling. In particular, parents of younger children are turning to paediatric tuina, viewing this as a more proactive method to reinforce the constitution of weak and sickly children. Among practitioners, tuina is also generally the preferred method as it can be applied on children from birth to about 4-6 years of age.
Increasingly, “prevention rather than cure” is becoming the first line of defence for concerned parents who would rather improve the existing health of their child as opposed to starting treatment only as and when symptoms develop. For parents seeking alternative solutions to conventional western medicine, paediatric tuina is also considered safer with less side effects, as it can reduce the amount of conventional drugs children are required to take; antibiotics for example.
So what exactly is paediatric tuina? Generally, it is a form of external therapy that is applied to stimulate specific acupuncture areas on the body, in order to treat and prevent ailments common in young children. However, unlike acupuncture, massage techniques are used instead of needles to influence and regulate the flow of qi (circulating life force) within the body, strengthen the immune system, and even help mental development.
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How Tuina Can Help
“According to Chinese medical theory, children correspond to the rising of yang energy within the yin. A characteristic of their energy is its volatility, which means rapid changes in the state of their health,” says Dr Elisa Rossi, MD, an acupuncturist and licensed psychotherapist.
“They get sick very easily, yet respond to treatment just as quickly. When they are ill, it is often possible to balance their energetic systems using small and gentle interventions. Chinese medicine thus helps accomplish this very effectively,” continues Dr Rossi.
TCM practitioners note that many paediatric ailments such as constipation, poor sleep, agitation, rashes, cough, catarrh or asthma arise due to “accumulations” that revolve around overindulgence, especially food. Food accumulation does not refer to acute indigestion however; but rather an excess that comes from eating food of the wrong quality, quantity and frequency. As a result, this excess can adversely affect the body’s qi, stools, emotions, and so on, hence creating blockages which will then need to be released. Accumulation also easily transforms into heat within the body, which is also the cause of “heaty” conditions such as the build-up of phlegm.
Without being too invasive, paediatric tuina is thus able to free accumulations and expel the body’s excess heat while also reinforcing qi. “We see big changes in treating children who are tired, whining, clinging, have poor appetite, lack of energy or get sick often,” highlights Dr Rossi, who, since 2005, has also run Xiaoxiao Clinic, a paediatric centre that specialises in treating children using tuina and acupuncture techniques.
“We can also do a lot for babies who wake up many times during the night, for toddlers who are agitated, angry or stubborn, or older children who are hyperactive, with dif?culties in concentrating and staying still. Some other paediatric problems that are easy to treat include acute abdominal pain in infants, constipation, diarrhoea, and nocturnal enuresis; other issues such as eczema or asthma take longer to cure, but Chinese medicine is still a good choice for them.”
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Tuina – An At-Home Possibility
“Paediatric tuna is signi?cantly different from tuina for adults,” says Dr Rossi. “It requires specialist training because of the speci?c features of children’s physio-pathology, symptoms and diagnosis. On the other hand, because it uses only a few, relatively simple, main techniques, it can be learnt fairly easily. Basic sequences can also be taught to parents.”
Tuina treatment for children is generally a sequence of 8-10 massage techniques (fa), mainly pushing (tui) and kneading (rou) along specific lines or points. Each fa is usually done for 1-2 minutes, with the child either lying down or sitting in the lap of the parent. Traditionally on the hand and forearm points, the right side is used for girls, the left for boys, with other points/lines used bilaterally.
Parents or caregivers can apply a simple sequence of tuina techniques to be applied once a day at home or more often if the child is having a more serious ailment such as fever. The order does not matter, but the techniques should be applied together and can even be done while the baby is sleeping or feeding. The stimulations should also be “neither too light to obtain an effect, nor too heavy, unpleasant or harmful,” advises Dr Rossi.
Because of tuina’s popularity, some parents are also opting to attend courses conducted by certified therapists, to learn more about techniques and how to administer these to their children at home. In fact, most practitioners actually encourage the extension of the treatment beyond the confines of the clinic, particularly if parents notice that their child is under any kind of stress, or if the child seems less energetic or exhibits an imbalance of energy.
Besides basic tuina techniques that may be designed according to the needs of the individual child, parents are also advised how to modify their child’s diet and daily habits. Once parents get familiar with administering therapy to their child, the treatment is reinforced, and they are also empowered with improved self-confidence in understanding their child’s health and temperament. Overall, a better child-parent relationship is further fostered in the long haul as the power of touch is extremely beneficial for closer bonding.
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Scarring can happen at any age in life, when the skin cells that are regenerated are usually of lesser quality than the original cells. While scars cannot be permanently erased without a trace, they can be lightened or have their appearance improved. Parents can choose from DIY home remedies to anti-scar treatments made specifically and specially for kids!
Not every child will emerge unscathed during their early years in the school of hard knocks (otherwise known as life!). Some of their experiences will no doubt be fuelled by their developing motor skills (learning to walk and run), curiosity (exploring their surroundings, discovering cause-and-effect) and the natural need to get active (during vigorous playtimes).
In light of all this, it’s therefore natural for children to sustain bumps, scrapes, cuts and other lesions along the way. These injuries or wounds arise as a result of any activity or condition that adversely affects the skin’s surface: these can include rough-and-tumble play; insect bites from playing outdoors; minor mishaps and more severe accidents (the latter with minimal frequency, hopefully); or childhood ailments such as chickenpox or hand, foot and mouth disease.
Almost all these activities pose a certain degree of risk which simply cannot be avoided, as growing up is all part and parcel of life. Even the most careful and cautious of parents and children will soon have to come to terms and acknowledge this inevitability.
Risk is not necessarily a bad thing, however. It prompts children to be more acutely aware of their surroundings, practise making sound decisions and gradually instils greater independence and self-confidence. Eventually, they’ll also come to know that after the hurting, comes the healing.
Scar Outcomes
A scar may be defined as the mark left on exposed skin after it has been damaged. As a natural process the skin tries to heal itself. In order to repair itself, the skin produces a new tissue which results in a scar. If many layers of the skin are damaged, the scar will be deeper and more visible. The lighter scars may fade away with time.
The colour, size, shape and even texture are the aesthetic benchmarks that usually determine whether or not of a scar is hardly noticeable to the eye or distressingly obvious. The eventual appearance of the scar is affected by the severity of the injury or wound, and the degree of scarring will also depend on the depth and width of the wound or incision and the location. Healing is usually affected by:
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Alternative Methods
While genetics and skin pigmentation are beyond our control when it comes to scarring prognosis, infection of the wound site can be prevented, in order to relieve the side effects of wound infection. Scarring is one among the main after effects of wound problems. Proper care and treatment will thus help greatly in relieving side effects due to wound infection.
When turning to home remedies for curing wounds, avoiding and preventing irritation should be a top priority. Parents can begin by supplementing their children’s diets with more vitamin E foods such as sunflower seeds, pine nuts, almonds, dried apricots and cooked spinach. Intake of vitamin E-rich foods can help brighten skin and reduce the risk of permanent scarring. Application of diluted apple cider vinegar, honey or turmeric powder directly onto wounds is also effective for promoting natural healing as these ingredients have antiseptic properties to prevent bacterial infection.
What if, however, your child is already on the road to recovery but all evidence points to the early formation of a scar? And how about the treatment of existing and older scars?
Just like in wound treatment, some parents might prefer trying natural home remedies first, to alleviate the appearance of scars. The pros of such treatments are that the ingredients are usually easy obtained, economical and don’t have chemical-causing side-effects. The cons are that improvements may take a longer period of time to manifest (that is, if they do occur at all!), so you may need lots of patience and perseverance before you do see results.
Try:
1. Lemon: Lemon juice is known as natural bleach. As bleach lightens the colour so does the juice of lemon, which can be squeezed out and applied on scars.
2. Banana: Apply ripe banana pulp on scars. Leave for 10 minutes and then wash off.
3. Honey: Apply honey directly on the scars. Do this regularly.
4. Oils: You can opt to use lavender, tea tree, almond, olive or coconut oil. Simply add a few drops undiluted on some cotton wool or massage onto scars directly.
5. Vegetables: The juice from a cucumber or tomato can be massaged into scars, or cut a few slices and rub them gently one by one over the affected areas.
Whatever scar remedy or solution that you choose for your young ones’ delicate skin, parents, remember these three golden rules:
1. Practise due diligence by beginning the line of treatment early and consistently stick to it!
2. Boost your child’s natural immunity by keeping them well-hydrated, serving them at least two servings of fruit and two servings of vegetables a day, and ensure that they have a good night’s sleep to recharge and regenerate
3. If the wound is still fresh, always keep the injury site clean and dry; refrain from picking at the scab until the new skin beneath has fully formed
Life’s Lessons
It’s natural for parents to fuss and fret whenever their little ones suffer any degree of physical injury. It’s equally natural that healing will, and does, happen, eventually. More importantly, by attempting to reduce the appearance of their kids’ scars with their best intentions and efforts, parents are helping to minimise the emotional impact that physical reminders of injuries and even traumatic events may have on their children.
During the healing process, parents should also continue reassuring their kids that they will always be loved and precious, whatever their appearance, scars and warts and all! If all else fails, encourage your kids to wear their “battle scars” as unique badges of pride! After all, the school of hard knocks will always cheer on and champion every individual who grows in courage and resilience as they pass through its doors.
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Allergies in older children can be treated with vitamins, over-the-counter products and even DIY home remedies. Here are some suggestions for the latter that are worth a try.
From peanuts to milk, there are a great many allergies that can plague a child in their early years. Even though most childhood allergies fade over time, usually disappearing altogether by the time the child reaches puberty, there are still many years in which parents must be overly cautious about what their children come into contact with.
Genetically, however, it must be noted that allergies cannot be inherited; rather, the likelihood of developing an allergy increases if there is a family history. If both parents have allergies, their offspring has a 50-70% chance of being allergy prone. In fact, even if both parents were allergy-free, a child would still have an around 15% chance of developing an allergy. In the end most allergies can be treated with medications or very simply by avoiding the substance or situation that your children are allergic to. Either way, allergies can range from uncomfortable to deadly so finding out what your child is allergic to and addressing it accordingly is important not only to safeguard their health but the overall quality of their lives.
This is because some allergies manifest themselves in conditions that can really be uncomfortable (and even unsightly!) such as atopic dermatitis. Also known as childhood eczema, this is a common ailment that affects two out of every 10 children. Usually, the symptoms affect small or large distinctly confined areas of the skin and include: dryness and roughness, redness, itching, small papules and small blisters filled with fluid.
Childhood eczema can have occasional flare-ups, with episodes before the age of 5 usually resolving within months. While the worst of the symptoms will subside by the time your child is 5 or 6 years old, relapses can still occur, with recurrent itching and dry, red patches.
Parents can manage their child’s eczema with creams, ointments, lotions or cleansers, but these products should be non-steroidal for younger children’s sensitive and delicate skin. One option is Ezerra’s treatment range that offers a 3-step solution of Treat-Moisturise-Cleanse. Its two active ingredients include a naturally-derived agent that works like an anti-histamine to deter itch, redness and inflammation. The other ingredient, saccharide isomerate, helps retain moisture to soothe and protect skin.
Interestingly, the main cause for eczema remains unclear – and there is no cure for it either. Parents who suspect allergy or irritation from specific substances can try to minimise their child’s exposure to the causing agent, or avoid it totally if possible.
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Typically, the environmental substances which react with the immune system are medically known as allergens, of which there are three main types: inhalants (particles in the air); ingestants (food or medicine); and contactants (chemicals which the skin comes into contact with).
Natural therapies may minimise the occurrence of allergies and help soothe symptoms which are usually uncomfortable for even the most tolerant child. Try these remedies for some relief:
To boost immunity, coughs and colds:
For skin allergies:
As a good all-rounder:
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Wage war against the common cold and other viruses with these combat-and-conquer strategies.
There are more than 200 viruses that have been identified as being responsible for the numerous varieties of cold and influenza around the world. Besides the common cold, cough, viral fever and other viral infections such as stomach flu are other ailments that can plague children with weaker immune systems or who already suffer from allergic disorders. The number of cold infection cases usually spikes during the rainy season. However, kids who are placed in regular childcare may also be more prone to catching the common cold throughout the year as they are exposed more frequently to the presence of other children, who may or may not be ill with a virus-borne infection too.
The most common virus, which accounts for about a third of all infections, is the rhinovirus. The common cold, which is the most frequent of all viral infections, is caused by the rhinovirus that enters the body through the mouth or nose, and which goes on to infect the upper respiratory tract. The common cold is contagious as it is caught mainly by inhaling in the air which bears droplets sprayed by the infected person when he or she coughs, sneezes or talks. The common cold virus can also spread through hand to hand contact or sharing articles belonging to the infected person.
The symptoms of the common cold and influenza are similar and include a runny or blocked nose, sore throat, headache, watery eyes, and a cough. Influenza sufferers however, tend to run a fever and have general aches and pains in muscles and joints.
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As parents, it can be distressing to see and hear your child sneezing and coughing frequently, or experiencing discomfort because of accumulated mucous or phlegm that are clogging their airways. Unfortunately, conventional medicine has no cure for the rhinovirus, and neither will antibiotics help if the infection is caused by a virus instead of bacteria. Fortunately, a viral infection is self-limiting, which means the illness will normally run its course before literally burning out. Until then, you can help relieve the worst of your child’s symptoms with any of these countermeasures:
* Immunped Syrup is available at the KKH and NUH pharmacies; private paediatric specialist clinics as well as general practitioners.
Useful to Note
1. Most non-prescription cough-cold remedies contain a combination of ingredients to relieve multiple symptoms. These combination products often contain antipyretics (to reduce fever) and analgesics (which relieve minor aches, pains, and headaches).
2. A decongestant is usually prescribed for clogged up phlegm or mucous while an antihistamine is more helpful for a runny nose, excessive sneezing and even relieving a rash or itch.
3. Although zinc and vitamin C are useful in easing the worst symptoms of the common cold, consuming large amounts of both over long periods can result in diarrhoea, nausea and stomach cramps.
4. For zinc to be especially beneficial in reducing the duration and severity of the common cold, any supplement is recommended to be taken within 24 hours of the onset of symptoms.
Waging war doesn’t mean being aggressive or on the attack all the time – it also means arming yourself with defensive tactics and coping strategies to outwit and outsmart the enemy: the year-round Hand, Foot and Mouth Disease viral infection.
First-time parents or parents whose kids have never fallen ill with HFMD before may understandably be filled with excessive fear at every ominous-sounding headline that mentions the disease. So acute is their awareness that in Singapore, most parents of young children are very likely familiar with the acronym without any need for clarification.
What’s more, you’ll also likely be met with a variety of reactions from them when discussing the subject, ranging from worry and anxiety to getting all flustered and even physically recoiling, as if there’s a sudden change in the air.
And there’s good cause for concern: HFMD, a.k.a Hand, Foot and Mouth disease, was at its highest levels in early May, exceeding more than 1,000 weekly reported cases since the last major outbreak in October 2013.
HFMD is caused by the enterovirus family of viruses, which is responsible for a wide range of infections in children. These viruses live in the intestinal tract, the more common ones being the Coxsackie A and Enterovirus (EV71). While HFMD is endemic in Singapore (meaning it occurs regularly, and all year-round), it certainly isn’t a new illness, nor confined to just our shorelines. In fact, the World Health Organisation recorded approximately 2.5 million cases in China, Japan, Singapore, Vietnam and Hong Kong in 2015.
Why Parents Fear HFMD
I recall being a new mother when the worst HFMD epidemic hit in the year 2000, which claimed the lives of seven children after they developed complications caused by the more dangerous EV71 virus. The severity of the situation led to HFMD becoming a legally notifiable disease in October 2000.
It was 2004 when my then 4-year-old son fell ill with HFMD, but it could not have come at a worse time, when paranoia of transmittable diseases was still high. A year ago, there had been nationwide panic during the SARS outbreak. For the past few years, the public had indeed been inundated with images of face masks and hand sanitisers and messages in the media stressing the importance of personal hygiene and such. It was only natural that my heart dropped to the pit of my stomach when I saw those dreaded red spots appear on my son’s hands and feet…. A parent, no matter how well-informed, is sometimes unable to plug their worst worries nor control their imaginations from running rampant towards worst-case scenarios.
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So believe me, I know the fear first-hand, and how real and raw it feels:
It’s Highly Contagious!
An infected person can transmit the virus when in direct contact with other individuals through nasal discharge, saliva, faeces, or fluid from ulcers, rashes or blisters. There’s also the risk of getting infected simply by touching unsanitised items used by the HFMD patient.
It’s Who It Infects Especially!
While both adults and children can get infected, children under the age of five are the most susceptible. The Ministry of Health has noted that two-thirds of HFMD cases in Singapore are below the age of five. According to Yearbook of Statistics, Singapore (2015), the total enrolment in childcare centres is 92,932; for kindergartens, there are 68,999 registered children. Children are usually in close proximity with one another in these facilities, sharing common areas, toys, stationery and other items, so just one sick kid could end up infecting a wider pool.
My Kid(s) Can’t Go To School!
Once your child has been diagnosed with HFMD, he must remain at home and not be allowed to go to school as he will be contagious throughout the length of his illness. For working parents, this could prove complicated as they will now have to juggle their job responsibilities with taking care of their child (parents with more than one child may also have to isolate him/her from the healthy siblings). They may have to work out an arrangement between themselves, their employers and their extended families and decide on the number of days to take leave.
It Can’t Be Treated Directly!
There are no vaccinations nor specific antiviral drugs to treat HFMD, nor does it respond to antibiotics since it is a viral infection. What’s more, a second episode of HFMD can never be ruled out as it could be caused from a different strain of enterovirus.
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What Parents Should Do
The reality is that, just like the common cold, HFMD is a viral malady that is omnipresent and seasonal. Note: Singapore recorded its first outbreak of the illness in 1970, so we’ve been living with the virus for nearly half-a-century now (and likely, more!).
On hindsight, it’s therefore best not to become too alarmed, even after your child has been confirmed with HFMD. Reassure yourself that HFMD really isn’t as scary as it seems to be. Most medical professionals describe the illness as “usually mild and self-limiting”, which means that even without treatment, it will typically run its course by days 7-10.
Remember, if your child falls ill, refrain from overreacting or panicking! Here’s what you can do to get hands-on and proactive.
Look out for Symptoms
On average, HFMD symptoms will show up 3-7 days after the infection, which is known as the incubation period. The usual symptoms include:
Some virus carriers are even asymptomatic (meaning they won’t show any symptoms), while others do not exhibit all of the usual symptoms. For example, when my son had HFMD, the rashes on his hands and feet were not overly bothersome; he did not have mouth ulcers and was able to eat normally; and his energy levels also seemed normal.
However, if you notice any deterioration of your child’s condition and worsening of any of his symptoms, seek medical advice as soon as you can. The EV71 virus strain, in particular, can cause complications and inflammation of the heart and brain, though this is rare. In any case, keep a watchful eye over your recovering child.
Currently, there is no clear evidence that enterovirus infections, including HFMD, during pregnancy can adversely affect mother or baby. There is the risk that a mother may pass the virus on to her baby if she was infected shortly before the birth or have symptoms during the delivery. Most babies will recover without need for serious medical intervention. Newborns infected during the first two weeks of life may need to be monitored more closely as their immunities are still vulnerable; however, the risk of developing severe illness is again uncommon.
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Offer First Line of Care
Once you suspect that your child is unwell, bring him promptly to a doctor. Medicine will usually be prescribed to treat the symptoms, such as paracetamol for fever and pain management; as well as topical treatments for the ulcers and rashes. To relieve sore throats, parents can try using Betadine’s Sore Throat Spray or Gargle & Mouthwash, both products of which have proven anti-virus effectiveness against EV71 and Coxsackie A16, two strains commonly known to cause HFMD.
Caregivers should keep the patient hydrated with plenty of bedrest, and let their immune system do the rest to fight off the infection. Feed your little one a soft diet and avoid spicy, salty foods, citrus fruits and soda drinks as he slowly regains his appetite. Just do your utmost to ensure your young patient is kept comfortable and hopefully occupied as he recovers!
Help Break the Chain of Transmission
Unfortunately, a child who has gotten HFMD before is not prevented from catching it again, although he can develop immunity against specific strains. This is actually good news as a child who’s already gotten infected once in a current outbreak season will rarely fall ill twice from the same strain. While older children over the age of 10 as well as adults can catch HFMD, their symptoms are usually milder unless they have weakened immunity systems.
Because the patient is usually most contagious during the first week of catching the illness, most medical professionals advise keeping your children at home and away from school or other public places if they are infected with HFMD (for up to 10 days. The virus, however, can remain in the faeces of a sick child for up to 12 weeks and in the saliva for up to 4 weeks.
That’s why it’s so important to practise good basic hygiene until it becomes the norm, rather than an exception during outbreak seasons or when a family member takes ill. For something that offers more protection than soap and water, families can use Betadine Skin Cleanser, a disinfectant hand wash and skin cleanser with active ingredient povidone-iodine. Like the brand’s Throat Spray and Gargle & Mouthwash, the product is highly effective in combating the two leading strains of the HFMD virus. No-rinse hand sanitisers are another convenient option too, but ensure that it contains at least 60% alcohol for it to be an effective germ-killer.
If any of your kids are sick with HFMD, it’s also advised to disinfect surfaces and items which they may have previously come into contact with or touched. Wash and wipe down with soap and water before proceeding to disinfection with a solution of 1 tablespoon bleach to 4 cups of water. Alternatively, you can buy disinfectant sprays and solutions off the shelf as well.
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What Lies Ahead?
In the current war against HFMD, scientists at Beijing Vigoo Biological have developed an as-yet released vaccine against EV71, a common strain of enterovirus that has also been previously linked to more serious outbreaks resulting in sporadic fatalities. Researchers said that while the vaccine provided 90% protection against EV71-associated HFMD, it should also be noted that other viruses can also cause the illness. Since there was no evidence that the vaccine offered cross-protection against other strains apart from EV71, even if it were to be rolled out eventually, its limitations would thus have only a “minimal impact on reducing the overall number of cases of the disease,” Reuters reported.
It may seem disheartening that even with the emergence of this ground-breaking vaccine, eliminating HFMD once and for all seems highly unlikely – especially as there are more than 70 different strains of enterovirus! In light of this reality, what we as parents can do is to work together with the community to minimise the spread of the illness during an outbreak by practising good hygiene habits, and keeping vigilant to break the chain of transmission by being aware of the signs and symptoms in affected individuals, and isolating those who are infected away from their healthy peers.
Note This!
The Ministry of Health provides regular updates on the HFMD situation locally at: www.moh.gov.sg/content/moh_web/home/diseases_and_conditions/h/hand_foot_mouth_disease.html
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While young children may not be mindful enough to take care of their eyes, parents can play a key role in being aware of preventative and treatment options to safeguard their vision.
The stats are staggering: according to the Health Promotion Board, in Singapore, 1 in 2 children will develop myopia by the time they are 12.
Myopia, which means near sightedness, is the most common visual problem for children. Most children start out with good eyesight; however, the environment children frequently find themselves in alters their visual acuity quite dramatically.
Does my Child Need Glasses?
If your child is displaying tell-tale signs that points towards vision impairment, the first thing to do would be to consult your local optometrist and have your child’s eyes checked before deciding on whether or not glasses or any other forms of vision correction is needed, advises Titus Wu, master of optometry (M.Optom), fellow in the International Academy of Orthokeratology (FIAO), optometrist and orthokeratologist at Titus Eye Care.
The most common vision issue for children in Singapore is myopia, with about half of all school going children aged seven to 16 being affected. This is also the age where myopia progression is the highest.
There are signs that parents can simply observe from a child’s daily habits to assess whether the child has myopia. A few common behaviours such as squinting, closing one eye to see, sitting close to the TV or lowering his head while reading a book are symptoms of myopia.
According to Wu, most of the time, symptoms of vision impairment can be picked up from daily behaviour when you spend time with your child. However, sometimes they might go unnoticed and young children generally do not let their parents know when they are experiencing eye problems.
Having an eye examination conducted by an optometrist is the best way to find out if your child needs glasses or other forms of vision control.
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Vision Control
Glasses only correct symptoms of vision impairment, explains Wu. They do not control myopia progression or improve the condition over time. This is why glasses need to be changed regularly, about once a year or so, to keep up with deteriorating eyesight.
One method that has been proven to be one of the most effective ways to reduce myopia progression is Orthokeratology (or Ortho-k). The best way to describe it is “braces for the eyes”, where the child wears a specially designed pair of corneal moulds during sleep and is able to see clearly after removing them the next morning, without the need for glasses or contact lenses. Studies have shown that it can reduce progression of myopia by 50 to 100 per cent. This is especially effective during the school-going years where myopia progresses the most.
Naturally, the main concern of these lenses will be the risk of infection. Therefore, it is important to go to a practitioner who specialises in Orthokeratology to ensure that the lenses are fitted well so that the eyes are healthy and the myopia is well controlled.
Basically, while there is no cure for myopia, there are ways to control it and reduce the discomfort of wearing glasses throughout the day.
Going for an Eye Exam
Exactly how often should kids have an eye examination? Well, it depends on the age and daily activities that your child engages in.
In Singapore, the Health Promotion Board conducts vision checks in pre-schoolers from five years of age as well as in primary school. However, if there are no problems, a yearly check is quite sufficient.
With that said, can vision screening or a paediatrician exam substitute for a comprehensive eye examination? Well, not really. A comprehensive eye examination, however, not only checks for vision, alignment, refractive error, but also involves dilating the eye to check form “front to back” to look for any structural abnormalities, explains Dr Inez Wong, senior consultant ophthalmologist, director of Paediatric Ophthalmology & Strabismus Service, Eagle Eye Centre and also visiting consultant, National University Hospital Singapore.
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The Causes of Myopia
“If you’re wondering why kids get myopia, the role of “nature versus nurture” has long been debated. Genetics certainly play a part. If one parent is short-sighted, there is 60 per cent chance that a child will become short-sighted, and it goes up to 80 per cent if both parents are affected,” explains Dr Wong.
However, the role of the environment is now increasingly recognised as an important factor. The relative lack of sunlight and outdoor activity has been shown in large studies to contribute to the development of myopia.
Kids in Singapore have a higher prevalence of myopia than those in Australia for example, who spend a lot more time outdoors, even correcting for other confounding factors such as the amount of near work. We encourage children to spend 11-14 hours a week outdoors during daylight hours.
As for environmental factors, we know that near work is associated with myopia progression. The ones who start having myopia early – in kindergarten – are mostly the ones who love to read. So it appears that myopia can be attributed to a combination of genes, too much near work, and too little sunlight exposure, says Dr Wong. In general, taking a break from near work after 30 to 40 minutes helps to avoid eye discomfort from eye strain.
The Truth About Screen Time
Is watching TV linked to near sightedness? It all depends on the amount of time the child spends watching TV and how much it affects the other aspects of his life. For example, if a child watches an hour of TV and then spends the rest of the day outdoors, then it will have no influence on the development of myopia. The light emanating from the TV, or the act of watching images on a screen, does not influence the development of myopia in itself. However, explains Dr Por Yong Ming, consultant eye surgeon, Mount Elizabeth Novena Hospital, if the child spends the whole day in front of the TV, neglects to spend time in the sun, then watching TV would be linked to near sightedness.
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Controlling the Progression of Near Sightedness
Apart from good eye care habits, several studies have now shown evidence that an eye drop called atropine can slow down the rate of progression of myopia, explains Dr Por. There are also many published studies which show evidence that Ortho-K lenses may have an effect on slowing the progression of myopia. Ortho-K/CRT is one among many different options for the correction of myopia, advises Dr Por. Like each method, it has its pros and cons. Ortho-K works best in people with myopia. Patients and practitioners have to be disciplined in lens care practices. Ortho-K does not permanently alter the corneal shape, so there is a regression of effect once the lenses are not worn for a period of time. With high spectacle powers sometimes this regression can be apparent during the course of a day. As parents we know that having good vision is one of our most treasured assets. We should not wait until serious problems beset our children's eyes or even our own before we begin to take care of them. Let’s make a start now to take better care of our eyes.
About the Author
Titus Wu (???) – Bsc.Optom (USA), M.Optom (Aust), FIAO
Titus graduated as an Optometrist in Singapore before completing his Bachelor degree in Optometry from Salus University (USA). He then went on to further his education and was awarded a Masters of Optometry from University of New South Wales (Aust). He was largely involved in advanced contact lens studies, advanced clinical optometry, ocular therapeutics and dry eye management. He also completed a preceptorship in LV Prasad, Hyderabad – India, one of the busiest eye institutes worldwide, where he concentrated on anterior and posterior eye complications, as well as advanced specialty contact lenses to treat cornea diseases. Titus is an Associate Lecturer at Ngee Ann Polytechnic, guiding and supervising final year Optometry students with their clinical skills. Titus is also a member of the American Academy of Orthokeratology and Myopia Control (AAOMC), International Academy of Orthokeratology (IAO), Scleral Lens Education Society (SLS) and Singapore Optometric Association (SOA). His expertise in Orthokeratology allowed him to obtain his Fellowship from the International Academy of Orthokeratology (FIAO). Orthokeratologists who have successfully attained the rank of FIAO have demonstrated a commitment to excellence in the field of Orthokeratology. His area of clinical interests includes myopia control for children and cornea and vision rehabilitation. He has since devoted his practice to the field of specialty contact lenses and primary eye care.
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