Chickenpox vaccine -- does it necessary?

A mother planned to bring his child to the children's clinic for chickenpox vaccine, as advised by the paediatrician. However, the grandmother told the mother it is better for the child to have natural chickenpox infection. The mother was confused with two different opinions and asked," what is a better option?"
I agreed with the grandmother partly as a natural chickenpox infection can confer 100% protection againt further infection. In comparison, the current chickenpox vaccine has only 95% efficacy against natural chickenpox infection. Then why the doctor still advised for chickenpox vaccine?

Firstly, the unfornated 5% vaccinated children will have very mild chickenpox infection, less than 50 spots. This is in case they are exposed and infected.

Secondly, we can reduce the risk of chickenpox ionfection that has very untimely occurence e.g. school examination, family trip or during her pregnancy.

Thirdly, the child need to miss school and the mother need to miss work if the child has chickenpox. If there is small infant, pregnant lady or elderly people at home, the isolation issue need to be addressed.

So, I opted chickenpox vaccine.

Malaysian Dietary Guidelines 2010

Malaysians like to eat. This is best illustrated by our daily greeting of "have you eaten?". At the same time, we are suffering from various diseases as a result of inappropraite eating habits. Therefore, this guideline is timely and should serve as our dietary guide.

Key message 1: Eat a variety of foods within your recommended intake
Recommendations
1. Choose your daily food intake from a combination of foods based on the Malaysian Food Pyramid.

2. Choose your daily food intake according to the serving size recommended.
.
Key message 2: Maintain body weight in a healthy range
Recommendations
1. Maintain body weight in a healthy range by balancing calorie intake with physical activity.
2. Weigh yourself regularly, at least once a week.
3. If you are an adult, prevent gradual weight gain over time.
4. If overweight, aim for a slow and steady weight loss.
5. If underweight, increase energy intake as recommended.

Key message 3: Be physically active everyday
Recommendations
1. Be active every day in as many ways as you can.
2. Accumulate at least 30 minutes of moderate intensity physical activity on at least five to six days a week, preferably daily.
3. Participate in activities that increase flexibility, strength, and endurance of the muscles, as frequent as two to three times a week.
4. Limit physical inactivity and sedentary habits.
Overweight/obese
To lose weight, a total of more than 30 minutes a day of moderate intensity physical activity is recommended, whilst approximately 45 to 60 minutes per day of moderate intensity physical activity is required to prevent the transition from overweight to obesity.
For weight control and for preventing weight gain or regain among formerly obese individuals, a total of 60 to 90 minutes a day of moderate intensity activity or lesser amount of vigorous activity is recommended.

Key message 4: Eat adequate amount of rice, other cereal products (preferably whole grain), and tubers
Recommendations
1. Consume at least four servings of cereal foods daily.
2. Choose at least half of your grain products from whole grains.
3. Choose cereal products that are high in fibre, low in fat, sugar and salt.

Key message 5: Eat plenty of fruits and vegetables everyday
Recommendations
1. Eat a variety of fruits everyday.
2. Eat a variety of vegetables everyday.
3. Eat at least five servings of fruits and vegetables everyday.

Key message 6: Consume moderate amounts of fish, meat, poultry, egg, legumes, and nuts
Recommendations
I. Consume fish more frequently, if possible daily.
2. Consume meat, poultry, and egg moderately.
3. Practise healthier cooking methods for fish, meat poultry, and egg dishes.
4. Choose meat and poultry that are low in fat and cholesterol.
5. Consume legumes daily.
6. Include nuts and seeds in weekly diet.

Key message 7: Consume adequate amounts of milk and milk products
Recommendations
1. Consume milk and milk products everyday.
2. Replace sweetened condensed milk and sweetened condensed-filled milk with unsweetened liquid or powdered milk.

Key message 8: Limit intake of foods high in fats and minimise fats and oils in food preparation
Recommendations
1. Limit the intake of unsaturated fats to less than 10% of total daily calorie intake.
2. Increase the intake of unsaturated fats monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA).
3. Limit the intake of foods with high cholesterol.
4. Limit foods containing trans fatty acids (TFAs).
5. Minimise the use of fat in food preparation in order to keep total daily fat intake between 20% to 30% energy.
6. When eating out, choose low-fat foods.

Key message 9: Choose and prepare foods with less salt and sauces
Recommendations
1. Limit salt intake to one teaspoon a day.
2. Reduce consumption of highly salted foods and condiments.

Key message 10: Consume foods and beverages low in sugar
Recommendations
1. Eat foods low in sugar.
2. Drink beverages low in sugar.

Key message 11: Drink plenty of water daily
Recommendations
1. Drink six to eight glasses of plain water daily.
2. Maintain fluid intake from other food sources.
3. Avoid alcoholic beverages.

Key message 12: Practise exclusive breastfeeding from birth until six months and continue to breastfeed until two years of age
Recommendations
1. Prepare for breastfeeding during pregnancy.
2. Initiate breastfeeding within one hour of birth.
3. Breastfeed frequently and on demand.
4. Give only breast milk to baby below six months with no additional fluid or food.
5. Continue to give babies breast milk even if the baby is not with the mother.
6. Introduce complementary foods to baby beginning at six months of age.
7. Lactating mothers should get plenty of rest, adequate food and drink to maintain health.
8. Husbands and family members should provide full support to lactating mothers.

Key message 13: Consume safe and clean foods and beverages
Recommendations
1. Choose safe and clean foods and beverages.
2. Store foods appropriately.
3. Prepare foods hygienically.
4. Cook foods thoroughly.
5. Hold foods appropriately.
6. When eating out, choose safe and clean premises.

Key message 14: Make effective use of nutrition information on food labels
Recommendations
1. Use Nutrition Information Panel (NIP) as a guide in making food choices.
2. Make use of nutrition claims wisely.
3. Educate children on the use of NIP.

States take on Pertussis as Disease Cases Resurge Around the Nation

a

In US, it was reported that pertussis disease has increased recently:

States take on Pertussis as Disease Cases Resurge Around the Nation

Reports of pertussis have reached startling numbers in communities around the nation in recent months, leading to renewed attention to the common infectious disease.
Despite the resurgence, public health workers caution that such outbreaks are not unexpected and should serve as important immunization reminders.

Vaccination is the most effective way of disease prevention, second only to hand washing. Yet, we occasionally take the vaccination lightly as some diseases are rarely reported nowadays. In fact, the vaccination is the tool that help us to fight against smallpox, polio and many others. So, we should adhere to the recommended vaccination schedule to safeguard the best interest of children.

Oral Diosmectite is effective in Children with Acute Watery Diarrhoea

We are in the era of evidence-based medicine. The treatmen to diseases should be based on the best available scientific evidence. I would like to share this clinical study with you for the following reasons:

• This is a study done in Malaysia (and Peru) -- suit to our local context
• This adresses the common childhood problem -- diarrhoea

Oral Diosmectite Reduces Stool Output and Diarrhea Duration in Children With Acute Watery Diarrhea

"These results show that diosmectite significantly decreased stool output in children with acute watery diarrhea, especially those who were rotavirus-positive."

I read the prescription literature and it states "not recommended in childeren below 6 in accordance to Malaysia's Drug Control Authority".
However, the above study involved children from 0 to 36 months old. No adverse side effects were noted. In the past, there are many off-label prescription done for the children among the doctors in Malaysia. With this study results, we can safely administer this drug to the suffering children.
The only problem with this medicine is it has no pleasant taste. You can help your babies by mixing it with a semi-liquid food, broth, stewed, fruit, puree, etc.

Flu Shots OK for People With Egg Allergy

Currently, we recommend Flu shot (influenza vaccine) to all children above 6 months old. This article should be able to reassure the parents whose children has egg allergy:

For years, people with egg allergy were told to avoid the flu vaccine because it contains egg protein and could trigger a reaction, but this advice no longer stands. People with egg allergies can -- and should -- get the flu shot this year, according to a new report by the American Academy of Allergy, Asthma & Immunology.

Why the change?
"We now know with confidence that most people with egg allergy can receive the flu shot without reaction," says the report’s author, James T. Li, MD, PhD, an allergist at the Mayo Clinic in Rochester, Minn.
There is a "detectable, but very low" amount of egg protein in the H1N1 and seasonal flu vaccines, and studies have shown that the majority of people with egg allergy do not have an allergic reaction to the flu shot, he says.
"The number of reactions wasn't zero, but it was low, and most reactions were not serious," Li tells WebMD.
Caution is still advised in certain scenarios. For example, there is still some question on whether people with severe egg allergy can receive the flu shot, he says.

We hope those children with allergy also get to enjoy the benefits of flu shots. 

Constipation

picture

What is constipation? It is difficult to define the normal frequency of bowel opening. However,
the American Academy of Pediatrics (AAP) had outlined normal frequency of bowel movements for children.
In general, the bowel frequency is less than 3 times per week, the stools are usually hard, dry and difficult to eliminate. It can be hard large stool or hard pellet like stools.
How to solve this problem, the AAP has recommended the following "10 commandments" (adapted):

1. Drinking plenty of water can help regulate constipation.
2. Encourage high-fiber fo such as whole-grains, fruits, vegetables and Pedia-Lax Fiber Gummies.
3. Avoid giving your child large amounts of foods which could lead to constipation. Every child is different. Discuss dietary changes with your pediatrician.
4. Help your child set up a regular toilet routine.
5. For the younger child, reward them for attempting to have a bowel movement and for successfully having a bowel movement. (Sticker charts, etc.)
6. Be attuned to your child's body and behavior. For instance, if a younger child exhibits symptoms like clenching buttocks or crossing legs, help them to the bathroom. If your child is soiling his underpants and hiding them in embarrassment, address the issue with your child in a sensitive manner.
7. Discuss your child's feelings with them in an empathetic manner. Children, at every age level, are embarrassed, scared, and maybe even angry about their situation. Make them feel like they are being heard, understood, and helped. Help them feel like they are in control by allowing them to be part of the development of a constipation management plan.
8. Parents should never show anger and frustration about the child's constipation to the child. Nor should the parent be overly obsessed with the child's bowel habits. These could be detrimental to the management of constipation and the well-being of the child.
9. If you notice any of the symptoms listed in "How do I know if my child is constipated?" contact your pediatrician as soon as possible. Do not wait for days to see if it will resolve on its own. The key to good management is recognizing the symptoms and addressing them before the situation worsens.
10. Encourage your child to be physically active. Exercise along with a balanced diet provides the foundation for a healthy, active life.

You may explain the body digestive system to your children with this chart, as a picture is better than a thousand words:
You may keep a fibre diary for your children as well.

Ambulatory Paediatrics

I attended the 32nd Malaysian Paediatric Association congress in Kuala Lumpur from 15 to 17 October 2010. This year theme is Ambulatory Paediatrics. I totally agree with what the President, Professor Zabidi Hussin (please click to view his blog), said:

"... provide expertise within a larger community-based setting... Children are certainly best looked after in their own homes at all times and more so when they are sick."

Some interesting topics include:

• Identifying and Managing Sleep Problems in Infants
• Snoring in Chidren
• Assessment of Nutrition in Children
• Practice and Malpractice in complementary feeding in early childhood
• Nocturnal enuresis
• Food allergy in children

As a children doctor, I strive to give the best possible medical care and as far as possible, to allow children to stay at their home en route to recovery.