"Wind", "Angin", "风" or Colic ?

When we have a question that has no definite answer, we tend to label it very weirdly. The following condition is a good example:

• An apparently well baby who is easy to be taken care of since birth -- feeding, sleeping, feeding, sleeping....
• He/ she started to appear uneasy after about 3 weeks of life (or anytime within 3 months)
• He/ she tend to cry a lot, difficult to console
• An observant parent may notice this baby seemed to know the timing of crying, classically in the evening but stopped by midnight (when he/ she + parents are already exhausted!)
• The doctor checked the baby thoroughly and reassured the parents that everything is okay (but the parents strongly disagree. THEY are not okay -- they are tired of trying all means to console the baby at home)

Most of the time, the parents and the doctor will find a common ground between them -- the baby passes a lot of flatus. Therefore, the parents (and especially the grandparents) said this is because of the "Wind", "Angin", "风" (the term depends on the language). The doctor, being professionally trained and tends to label medical jargon, agreed with them but labelled the condition as "colic".
So, both parties agreed on the description of the problem but the importance is how to help the baby?
Nobody has the exact idea as no one reall know the cause??!! (that's why the name is so weird.)

There are many postulated, possible causes (but none of them explain all scenarios):

diagram taken from here

There are also many possible treatments (but none is definitely effective and you have to try them one by one):

Feed your baby. A hungry man is an angry man, this saying applies to your little baby as well. If you think your baby may be hungry, try a feeding. Hold your baby as upright as possible, and burp your baby often.

Hold your baby. Cuddling helps some babies. You can also try to use baby sling to relieve your arms. Don't be afraid to pamper your baby at this difficult time.

Keep your baby in motion. When you are holding your baby in your arms or putting baby in a sling, you can provide some movement. They seemed to like movements.

Give some music. You must use your soothing sounds. If this is too difficult, try some music.
Offer a pacifier. For many babies, sucking is a soothing activity. Even if you're breast-feeding, it's OK to offer a pacifier to help your baby calm down.

Soft massage at tummy. You might wonder the baby enjoy massage, like adults.
Give your baby (and yourself) some private time. If everything failed, you should give your baby and yourself some time to rest. Just to make sure your baby in a safe place and come back to see him/ her after 10 - 15 minutes. If needed, ask someone to take over the care for a while.

You may need to mix the methods above from time to time.

The good news is normally this condition spontaneously resolved by 3 months. Nevertheless, the new problem may follow --- the teething.

"Pearls" in the mouth - epithelial pearls

A mother told me she saw two white dots in the baby's mouth. I have a look and found 2 pieces of "pearls" inside. Diagram taken from here for illustration purpose.

This is in fact called epithelial pearls, commonly found in the newborn.They normally disappear by 1-2 months of age and no treament is necessary.

Should we give our baby this vaccine?

For children, there are 2 groups of vaccines:

• The "compulsory vaccines" - This is the basic vaccination programme for every child in Malaysia. Therefore, we can get it free from Klinik Kesihatan (government clinic). Nevertheless, we can also get it from private clinics or hospitals. For the latter, we need to pay.
• The "extra vaccines" -  These are the vaccines not available in the Klinik Kesihatan, and therefore we cannot get them free. However, we can get it from most children clinics and private hospital.

For "compulsory vaccines", we should have no questions whether to give to our children, as this is consistent with the basic healthcare standard of Malaysia. The choice is either to get them from the government clinics or the private clinics/ hospitals.
For "extra vaccines", we should decide whether they are necessary for our babies. To answer this question, I suggest you to consider the following factors:

1. Safety - the vaccines should only have minimal side effects and statistically negligible major side effects. For example, pneumococcal conjugate vaccine had been extensively investigated for its safety profile before and after launching in the market (refer here). The long history of use with no reported major side effects should be an added advantage. After all, we do not want our children to be guinea pigs, right?
2. Effectiveness - the vaccines should be effective and protect the majority of vaccinated people.  The chickenpox vaccine is about 70% to 85% effective at preventing mild infection, and more than 95% effective in preventing moderate to severe forms of the infection (refer here). Some vaccinated children do still get chickenpox but they have very mild disease (typically lesss than 50 spots).
3. Preventing common disease - There is no point to prevent a disease that is not common in Malaysia because the risk of infection is very, very low. For example, we do not need to prevent againt yellow fever (don't worry if you never hear of this term, because it is not reported in Malaysia.) It is a different story if you are travelling to Africa or South America.
4. Preventing serious disease - there are thousands of diseases and it is impossible to prevent each and eveyone of them. However, we should try to prevent the serious diseases. Vaccines are considered to be the most effective way of disease prevention, after clean water! Our government had in the past provide hepatitis B vaccine, and now going to give free HPV vaccines to the 13 years old girls (read here). 
5. Cost - I think we have to be practical in life. Everyone of us has limited budget and resources. We do not need to give all the available vaccines in the world to our baby. We should instead think of the potential benefit of the vaccines. For example, pneumococcal vaccines can cause more serious disease than influenza in general. So, a parent should choose the former over the latter if he dicides to give either one of the vaccines to the baby.

I hope the above principles can help some parents to make an informed choice of their children vaccineation programme.

Vaccines -- Sufferings or Gains ?

The children nowadays receive many vaccines. As a consequence, the parents and babies suffer a lot! The parents' losses are as follows:

• Before the child is in the clinic, the parents are imagining all possible scenarios -- the cry, the shout, the fight.... -- the parents are suffering the fear.
• When the child is in the clinic, the parents have to do much persuasion, reassurance and encouragement. If all these sweet words failed, they would come out with carrot (promise to buy this or that) or stick (threaten to punish them if not obedient).
• After the child is home, the parents watch out for the possibility of fever -- by feeling the child body or forehead every now and then.
• Time loss - sacrifice a weekend or evening in order to bring the child to clinic. If the clinic has a long queue, the waiting may take hours.
• Financial loss - with the escalating cost of living, the parents have to allocate budget for these vaccines. Less holidays and candle light dinners.

The children's losses are as follow:

• The anxiety of anticipation of an injection.
• The pain after receiving the injection.
• If the fever is high, the child may need to miss the school or even PLAY.

With so much suffering, then why the parents bring the children for vaccination? This is because of the gains, as the examples below:

• The eradication of diseases, e.g. smallpox. (We achieved this in 1977, thus the new generation does not need vaccination against smallpox).
• The near eradication of diseases, e.g. tetanus. (As this is not completely eradicated, we still need the vaccine.)
• The reduced incidence of invasive diseases, e.g. invasive pneumococcal disease. (We cannot prevent all diseases, but should try to prevent serious diseases with complications.Simple upper respiratory tract infection does not clear, but lung, blood and brain infection does kill.)
• Less hospitalization e.g. rotavirus vaccines can prevent against hospitalization due to rotavirus gastroenteritis. [In Malaysia, 38% of hospitalizations for diarrhoea in children yonger than 5 years old are caused by rotavirus (Hung LC et al. Int J Infect Dis 2006; 10:470-4)]
• Reduced disease severity, e.g. the children who had been vaccinated with chickenpox vaccine had milder disease (< 50 lesions), should he developed breakthrough chickenpox.
• Less risks of cancer e.g. human papilloma virus vaccines (HPV) can prevent HPV infection, subsequently prevent cervical cancer.
• Less occurence of common diseases e.g. influenza.

So, back to our question: Vaccines -- sufferings or gain?
What is your opinion?

Malaysian Children Resources - Grand Opening

Welcome to Malaysian Children Resources -- a one-stop website for everything related to Malaysian children.
For the time being, I will concentrate on the following areas:

1. Health
2. Education
3. Social

When we look at the cute little faces of the infants, deep into our hearts, we may wonder -- who shall he become? what shall she achieve?
Like wise, what is going to happen to this website? No one has the answer. Nevertheless, I shall nurthure it with tender, loving care.
A journey of a thousand miles began with a single step [Lao-tzu (c 604-c 531 bc]. Let's go!