Breathing Better

“Respiratory illnesses account for more than 50 per cent of clinic consultations and about 35 per cent of hospital admissions. It is also one of the leading causes of death in children under the age of 5 years in Malaysia, along with infectious diseases, injuries, congenital disorders and neurological problems,” says Dr Salehuddin Samsudin, Consultant Paediatrician and Neonatologist at the Sime Darby Medical Centre ParkCity. 

The most vulnerable are children less than 6 months old, premature infants and the immune compromised. According to Dr Salehuddin, asthma and upper and lower respiratory tract infections are the main respiratory diseases that are seen in paediatrics. Asthma affects about 10 to 15 per cent of children and is the commonest chronic respiratory illness in childhood. Although asthma may present at a very early age, it is very difficult to make an accurate diagnosis in children under the age of 5 years. This is because there are many other respiratory illnesses that can mimic asthma in this age group such as bronchiolitis, viral pneumonia or mycoplasma pneumonia. A strong family history of allergies, eczema and asthma makes the diagnosis more likely. Children with asthma have recurrent reversible narrowing of their lower airways. They usually have sudden breathlessness, coughing or wheeze, which is often worse at night or with exercise.

Dr Salehuddin says that asthma is often treated with bronchodilators (medications that relax the bronchial muscles) in the more severe episodes but in many recurrent cases a good preventive strategy is to use inhaled steroids. “Compliance with treatment and regular contact with your paediatrician is important to ensure the symptoms remain under control. It is also essential to avoid any known triggers such as house dust mites, pollen and cigarette smoke.”

The most important intervention is for the parent to stop smoking. He adds that even if parents smoke outside the house, there will be enough smoke particles on them and their clothing to trigger an attack in susceptible children. “Upper respiratory tract infections such as middle ear infection, tonsillitis and pharyngitis (throat infections) are mostly caused by viral infections.

However, there are bacterial organisms such as streptococcus that normally live in one’s nose and throat, which could also invade and cause ear and throat infections. Other more virulent organisms can also be passed on from one person to another via direct contact or droplets,” explains Dr Salehuddin.

Lower respiratory (usually below the trachea) or chest infections on the other hand, can be severe but are less common than upper respiratory tract infections. The same organisms that cause upper respiratory tract infections can also cause lower respiratory tract infections. Pneumonia, bronchiolitis and whooping cough are sometimes preventable by taking the necessary vaccinations.

“Parents should look out for symptoms of high fever, productive or wet cough with fast and increased work of breathing which usually accompanies chest infections,” advises Dr Salehuddin.

A careful clinical examination will usually show that the child has rapid breathing with increased respiratory effort, a crackling noise when listened with a stethoscope or reduced air entry, which could be a sign of fluid collection or a collapsed lung. A chest X-ray would be able to confirm the diagnosis safely even in very small babies. 

“Treatment is usually with oral or intravenous antibiotics and oxygen or respiratory support in more severe cases. There is no evidence that cough medications can alter the natural progression of the disease although it is often used to improve the coughing symptoms,” he says.

Although respiratory illnesses in children can get severe at times, identifying signs and symptoms early on and seeking immediate treatment will help keep the illnesses at bay.

This article was contributed to Tab A Doctor by,
Dr Salehuddin Samsudin, Consultant Paediatrician and Neonatologist, Ramsay Sime Darby Health Care, ParkCity Medical Centre

Common Myths of New Motherhood

As if you needed another challenge on top of learning to be a mom and getting to know your baby, there are a bunch of myths about new babies in circulation. By ridding yourself of some erroneous bits of information, you can streamline your life and make your days and nights more pleasant.

Myth: Babies Should Sleep Through the Night

Lack of sleep is an oft-cited reason to dislike the first months of new motherhood. Sleeping like you did prior to pregnancy is not going to happen for a while. However, there are a couple of key things to remember about nighttime sleep when you're a new mom.

For one thing, no one actually sleeps deeply through the night. If you look at what sleep researchers have known for years, the truth is that everyone passes through different cycles of sleep each night. These are periods of both light and deep sleep. Many adults have minor waking episodes at night. When your baby wakes you up with crying, it might not be much different from those experiences.

Second, in many cases, it is dangerous for babies to sleep through the night. This is because a baby has a tiny belly that cannot hold enough food to get her through the night. By waking to feed, even in small amounts, babies get what they need to survive and thrive. In the beginning, most babies wake up two or three times each night. By three months of age, this has gradually decreased for most families, though it is not uncommon to have a baby who is still waking up once a night even at nearly nine months of age.

Additionally, waking to feed your baby a few times a night gives you the opportunity to meet some of her other needs. This might include changing a dirty diaper or moving your little one into a better sleeping position. Some mothers are also anxious about sleep periods that last too long, so night waking can ease these worries.

Myth: You Will Get Skinny Right Away

You will probably be sad to know that you'll most likely wear maternity clothes home from the hospital. Though you lose a lot of weight when your baby is born, you may also suffer from some swelling, particularly if you have intravenous therapy in labor or postpartum. You will have stretched your abdominal skin, which will take a while to return to its original shape. Remember, it took you nine months to put on the weight, so you can't expect to lose it overnight. However, you will see the most dramatic changes during the first six weeks after birth.

The good news is that breastfeeding can burn up to 1,500 calories a day. It also taps stores of maternal fat that were established in your body specifically for breastfeeding during pregnancy. This makes breastfeeding the natural way to shed unwanted pregnancy pounds.

Myth: The First Six Weeks After Birth Are Unbearable

Surely you have heard this one. Everyone says those first six weeks of little sleep, endless feedings, a sore body, and other physical issues will nearly kill you. Truthfully, many women actually find the first six weeks interesting and pleasant. Many of the sweetest moments you will share with your baby come during late-night feedings and other supposedly "terrible" moments. Don't expect the first six weeks postpartum to be miserable; you may end up pleasantly surprised to find these few weeks go more smoothly than you thought.

Myth: After the First Few Days You Should Feel Like Your Old Self Again

Giving birth is hard work. You will likely feel drained from pregnancy and birth for weeks to come. You'll probably also be a bit overwhelmed by the task of shaping your parenting theories, not to mention tired from a few sleepless nights. While the physical issues are normal and simply take time to heal, your new role as a mother will take the place of certain other activities you enjoyed as your "old self."

It will take at least six weeks for the majority of the physical healing process to occur. During this period of time, your uterus will shrink back down to its prepregnancy size. You will lose the majority of your weight, though it will take additional work to strengthen and tone your muscles. Your hormones will start to level out, and your body will heal any wounds incurred during the birth process.