Saturday, December 26, 2015

Slinky that doesn't work

If you want to get a slinky for your kid. Don't go for the plastic ones because they don't work. If you want, test if first and if the slinky works on the spot, get it. Else, it's a waste of money.
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We got this slinky for our girl and it failed. -

Christmas tree at home in Singapore

We bought a synthetic Xmas tree that looked like the real tree from Carrefour five years ago. Carrefour is no longer in Singapore.
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We also bought ornaments for adorning the shoots and leaves. However, we have never got anything to decorate the apex of our Xmas tree.
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Our first Xmas with the tree was when we had our daughter. She was 1 yo then and couldn't yet appreciate the tree. We had the tree out every Xmas since.
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This year, our girl is going to 4 yo. She was very excited when I got the Xmas tree out. She helped mummy decorated the tree. We had everything except the ornament/star at the apex.
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Getting a decent and beautiful star from shops is easy, we wanted to try something that will be more meaningful. We helped our girl to DIY the star for our Xmas tree.
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She was excited and helped to color the star. When it was placed at the top of the tree, she was so proud of herself. Most importantly, she was ecstatic.
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Here is her work.
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DIY Star for the apex of our Xmas tree

Tuesday, December 22, 2015

Zaini milk chocolate eggs with a 3D collectibles

The product is made in Italy. We got two boxes for S$11 at VivoCity Harbour Front. If you are familiar with "egg surprise" on YouTube, then you will be aware of the craze kids nowadays about egg surprise. 
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Zaini Milk Chocolate Egg Surprise.

Our kid loved it. However the stickers that comes with the car are so small that it was difficult to paste them on the car model. Here is the final outcome of car.
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Front view

Side view

Back view

 Another surprise about this car is that IT GLOWS in the dark. So cool!

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However, if you have less than a year old toddler in the house, remember to keep this car away from him/her because it is a choke hazard.
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Just to share.

Thursday, December 17, 2015

Learn about periods of the day


Morning starts around 5 am and noon takes over at 12 pm. Evening is at 5 pm onward and night is from 9 pm until 5 am on the next day. Twilight is the first light over the horizon. From the East, twilight signify day while on the West, it signify the starting of night.

Periods of the day

Saturday, August 15, 2015

Fruits available in Singapore markets

Fruits available in Singapore markets are as follow (in alphabetical order)
  1. Apple
  2. Avocado
  3. Banana
  4. Blueberry
  5. Buddha’s hand (Citrus medica var. sarcodactylis)
  6. Cempedak (Artocarpus integer)
  7. Cherry
  8. Ciku (Manilkara zapota)
  9. Coconut
  10. Custard apple (Annonaceae spp.)
  11. Dragon fruit (aka Pitaya)
  12. Durian
  13. Grape
  14. Grapefruit
  15. Guava (Jambu batu)
  16. Jackfruit (Nangka)
  17. Kiwi
  18. Lychee
  19. Langsat (Lansium parasiticum)
  20. Lemon
  21. Longan (Dimocarpus longan)
  22. Mandarin orange
  23. Mango
  24. Mangosteen (Manggis)
  25. Melon
  26. Orange
  27. Papaya
  28. Passion fruit
  29. Peach
  30. Pear
  31. Persimmon
  32. Pineapple
  33. Plum
  34. Pomelo (Citrus maxima) is similar to grapefruit
  35. Pomegranate
  36. Rambutan
  37. Red berry
  38. Rose apple (Jambu air)
  39. Salak (Salacca zalacca)
  40. Soursop (Durian Belanda)
  41. Starfruit (Carambola spp.)
  42. Strawberry
  43. Tamarind (Assam Jawa)
  44. Watermelon

Thursday, May 28, 2015

Post cereal expiration (or best before) date

According to Post Food official website, in the FAQ states that due date is in the following format: yymmdd (or 13JN01 means 1st Jan 2013). However, when production/printing is not standardised or updated, you will get confused with the following (see Fig).
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A simple search at Google didn't help to enlighten me about how to read the expiration date. I can't recall when the unopened box was purchased. That complicated the interpretation,  e.g. is the expiration date in 2012 (3 yrs ago! ) or 2015 (just recently).
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My wife suggested we try the cereal and if they are bad, we will know. I didn't want neither her nor me to get poisoning, so I decided to visit the local supermarket to find out.
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At the supermarket, on the box states mmmddyyA## (e.g. SEP122015T01). The alpha numeral (or A##) at the end of the numbering had no informative value to customers and Post Food should just remove/separate them from the best before/expiration date (to avoid confusion).
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Also, Post Food FAQ website need to be updated because the format yymmdd don't apply here.
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Saturday, May 2, 2015

Baby belly button from hernia-like to normal (updated)

Previously I was concern about the protrusion (and collapsed region) observed in our baby's belly button. The pediatrician assured us that our baby's umbilical hernia is normal and will recover after several months. We waited for 2 and a half months and indeed the hernia was less obvious (and the region of collapse had also disappeared).

After 3.5 months, our baby's umbilical hernia disappeared.


What we did during the wait (as according to the doctors and nurses) was to allow our baby to exercise the tummy more.

Helpful exercise
  • We would gently tickle our baby's belly to induce him to contract his stomach muscles.
  • We placed our baby on a rubber mat with the belly facing down so that he can lift up his head and try to kick and move. The main purpose was to train and strengthen his tummy muscle.
It worked! We were worried about persistent hernia but fortunately, it was just normal hernia. For information about persistent hernia, refer to Umbilical hernia by Children Surgery. New hernia service at University Surgical Center, National University Hospital (NUH).



Breakfast for the lil one

I got a sandwich maker/toaster that has a waffle plate to make waffles. I would use the electrical item to make the following.

Waffle recipe can be found here at All Recipes.
 
 The best combination to have with waffles would be peanut butter and strawberry/berries jam. Locally, peanut butter and kaya would be a great combination and added with a slice of cheese would make it super.

Kaya recipe can be found here at Rasa Malaysia.

Our favourite peanut butter must be Peter Pan. We used to buy peanut butter from Skippy, which has comparable taste, but the price was slightly higher than Peter Pan (SGD 1.09 higher). We bought them at NTUC FairPrice. NTUC Fairprice site is a good reference for item price and to compare different brands.

  • Egg sandwich
 Sometimes, I would make sandwiches and the best combo would be egg sandwich or tuna/sardine mayonnaise sandwiches. A way to get a consistent hard boiled egg can be referred to this site (or other types of boiled eggs; Fine Cooking). I used the 8 min hard boiled egg method. Cooling the eggs in iced water and then peeling them under running tap water helps to remove the shells. To prepare egg sandwich, I would mash the egg with a tea spoonful of salted butter. Adding mayonnaise would add extra flavour (but my kid doesn't fancy mayonnaise nor butter). Adding a cheese slice to the mashed egg and then toast them would add a little saltiness to the product (not to mention calcium for stronger bone).

Hard boiled egg by Fine Cooking.



3 months old cries

Our baby used to be all smiles and then suddenly all cries at 3.5 months old. Our concern was that something was wrong. We thought that it could be fever, stomach discomfort, or shoulder dislocation (paranoid me). The first two possibilities were demonstrated to be remote, whereas the latter physical injury was nil. It seemed that our baby is at the stage where he will start teething. Our baby would still break a smile to us, but whenever he is uncomfortable, he will scream and cry out the most dreaded cries that would leave us with cold sweat.

Teething & Symptoms
BabyCenter provides information about baby's teething. Few indications of teething are as follows:
  • Drooling (our baby is doing that)
  • Difficulty sleeping (probably due to teething-associated discomfort)
  • Likes to bite (when we cleaned his gum, he would nip at our fingers; although he hadn't started biting mummy's nipple). Note that mummies would be the first to know when their babies are teething because they will start biting nipples.
  • Cranky (irritated by the discomfort)
  • Refused to be fed (probably due to distraction from the discomfort)
We still haven't observed the last indicator.

Other associated symptoms (though it might be inconsistent) would be:
  • fever (probably due to infection as teething babies likes to stuff things into their mouth, hence predispose them to infections)
  • others (refer to Baby Center)
Means to alleviate symptoms
  • Teether (to soothe the "pain" (it's an itch-cum-pain feeling). A refrigerated, cooling teether could help to alleviate the gum discomfort.
  • If baby is not comfortable with teether, then using a finger and muslin cloth would be a good idea. Rub it gently around the gum and allow baby to bite (slightly painful) whenever he/she has the urge.
  • Apply Bonjela gel to soothe the discomfort.
  • We tried Bo Ying Compound (Chinese medicine) to soothe our first baby's discomfort during teething, but after a scare about contaminant that can be harmful to children (reported not long ago in Hong Kong [FDA report]), we dared not try it anymore (though I believe that Singapore scrutiny on its products is of highest stringency compared to other places).
  • Carry our baby and soothe him/her with comforting voice/lullaby and attention will help to alleviate their fear and anxiety (of the unknown because teething is our baby's first experience and can be frightening).
 When can my baby eat solid (semi-solid)
 Some said we can give our babies at around 4 months old (we preferred to wait until 6 months).

More adventurous means to alleviate teething discomfort (if in doubt, consult pediatrician before trying the following). I have not tried any of the following. Also, make sure the ingredients are safe for children (e.g. be organic with no pesticides)
  • Rubbing the gum with ginger slices, spices, almond (or vanilla) extract, banana, chilled food or plastic utensils, and other solid food (referred to Home Remedies For Life).
  • Home-made teething oil (composed of olive oil, coconut oil, and clove bud essential oil; referred in MommyPotamus).
  • Teething cream (composed of coconut oil, cocoa butter, clove essential oil; Modern Alternative Mama).

Monday, March 30, 2015

Children saving accounts with very low interest rate p.a. in Singapore

We wanted to start a bank saving account for our kid and I searched for reviews pertinent to best interest rate saving accounts.
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In Singapore, saving by adults and children will give near zero interest rate (hence zero motivation to save).
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What I gathered from these reviews (without the latest up-to-date reviews), OCBC is okay in terms of interest rate while DBS/POSB is the lowest.
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When we visited OCBC, we found out that the interest rate for children saving account is at 0.05% per annum (p.a.). That's equivalent earning 4 cent per month for a SGD 1000 deposit.
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There are other plans available, such as those associated with insurance/assurance scheme.
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Alternatively, there is also the arrangement that earns higher interest rate for saving accounts, e.g. zero-withdrawal criteria with minimal monthly deposit of SGD 1000. This arrangement will allow earning of 0.48 % p.a. or 0.88 % p.a. (for child who holds OCBC child development account).
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We opted for the basic saving account that earns the 0.05 % p.a. interest rate.
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Visiting the bank today made me realize that saving in the bank is not a wise decision for saving money for our children's future. I need to find prudent investment options in the near future.

OCBC saving plans.

Rashes

My kid developed eczema and we suspected it was due to contact allergy. The allergen was still an enigma but most probably came from outside the house, e.g. playschool.
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We have visited the clinic twice. The first one was at a polyclinic and the pediatrician prescribed anti-histamine syrup and steroid cream. The thing about steroid cream was that it didn't help alleviate the itch. Our kid scratched and broke the skin. We tried calamine and it was better than steroid cream. Calamine with menthol that gives off cooling sensation is the best. However, doctors would warn against over-usage of calamine because it will dry off the skin and aggravate the eczema. To prevent that from happening, we would also apply moisturizer intermitently.
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It didn't work. After more than three weeks of itchiness, we decided to bring our baby to see a skin doctor (dermatologist). 
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The doctor asked about our history of allergies and came to the conclusion that our kid's eczema is due to genetics. Although he was right, we know that genetics is not the only factor. Environment and habits are also involved in the development of eczema in children and adults.
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A study on urban versus rural suggested that habits, lifestyle and environment play important contribution to discrepancies in rural versus urban susceptibility to eczema or autoimmune disorders.
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We are currently giving our kid another antihistamine oral medication, steroid anti-inflammatory oral medication, and topical steroid creams for body and face (the distinction is due to the potency of steroid, where the face will have lesser steroid content as compared to body cream). Hope this week will see a better improvement.
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There is a great reference about skin rashes and type of rashes with their associated probabilities. Read "Rashes" by AskDrSears.
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For persistent/chronic eczema, I wouldn't suggest using steroid cream long-term because the side-effects are bad for developing kids. I would use calamine for most time and try to reduce steroid usage. I am willing to try traditional chinese medicine (TCM) or Ayurveda approach.
 

Kuih bangkit recipe

Our baby loved kuih bangkit. Unfortunately, lunar new year was over and it was difficult to get find stores selling one. Bengawan Solo has kuih bangkit and I bet it would be very delicious but a little pricey for me. Furthermore, I wanted to learn how to bake kuih bangkit so that I can make some for my kid whenever there is demand in the house.
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There are two main recipes that I consulted.
I followed the latter (Nasi Lemak Lover).
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It wasn't difficult to get tapioca and sago flours from Singapore. I could easily get them from NTUC Fairprice. I used the packed coconut cream and the outcome was okay. I was having difficulty finding the classic mould for kuih bangkit with bunny, tortoise etc., so I simply got one for other purposes and it worked just as well.
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Home made kuih bangkit as according to Nasi Lemak Lover recipe.
 
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The outcome was delicious.


Steroid cream will get into body for adults and children (inevitably)

I have received plenty of reassurance that topical cream with steroid will not cause any problem because the steroid will not get into the body (or at least at a predetermined rate of skin absorption), i.e. steroid will stay on the skin longer while absorption rate is controlled.
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I asked, "what about accidentally ingesting it from fingers or hands"? The same reassurance of negligible amount.
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I asked "what about scratching and breaking the skin"? The same negligible amount.
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However, steroid such as hydrocortisone will be absorbed by the body. It is important to know how much is considered hazardous (or detriment). I hope the clinical or toxicological studies on steroid cream toxicity considered the above accidental means of introducing steroid into the body (e.g. increased "absorption" due to skin tear made by scratching or ingestion by toddlers).
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Our 3 yo toddler got prescribed the following medicines:
  • Elosone 0.1% (w/w) mometasone furoate which is a synthetic corticosteroid with anti-inflammatory, anti-pruritic and vasoconstrictive properties used on face. Precaution includes adrenal suppression more prone in infant and children (I had a look at a similar disorder adrenal insufficiency in children). In children, other complications are Cushing syndrome and probable stunted growth (no study on it thus far).
  • celestroderm/diprocel (aka Betamethasone dipropionate) 5g is a body topical steroid cream.
  • Prelone syrup taken orally. Synthetic steroid with anti-inflammatory and anti-itch effect.
  • Polaramine (aka DEXCHLORPHENIRAMINE MALEATE) taken orally. It is an antihistamine.
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We never felt confortable giving steroid cream but had to give in after seeing how unbearable the itch was. Unfortunately, the steroid cream is not as effective as Calamine solution with menthol (soothing and cooling effect). We are using these two medication alternately and prefer the Calamine over steroid cream.
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As for the oral medication, we are hoping that the anti-histamine will neutralize the histamine produced by the body.
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It's been three weeks now and any sign of recovery would be a relief.
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I hope there is no "urbanized eczema" caused by exposing children to overly clean and sterile environment. After this, we are planning to bring our kids to more outdoor activities with lots of earth, soil, and sand. Physical interaction with leaves, grass, and crawlies will be good. Some gardening will be super.
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References

Monday, March 23, 2015

What to expect in newborn prolonged jaundice

There are many reasons (multifactorial) for newborn baby jaundice. Some are normal events (for Asian babies), whereas in rare cases they are due to insidious reasons.

First week
After given the green light to go home (especially with acceptable jaundice level), baby will still be susceptible to increased bilirubin (biological product that causes jaundice), especially when he/she drinks just mother's milk. There are two main means to remove bilirubin, i.e. urine and stool. If baby's urine is pinkish/reddish, it is an indication of blood/hemoglobin in urine (e.g. hemoglobinuria as experienced by our baby) which can indicate ABO incompatibility (e.g. mother's antibody is attacking baby's blood cells) which is common for parents with different blood type (see below). After discharge from hospital, parents are required to visit polyclinics to monitor their babies' bilirubin level (every two days). The result mostly will show an increase in bilirubin level (if it reaches a threshold, hospitalization and phototherapy will be required). To minimize the chance of going back to hospital, babies should be given sufficient amount of milk for him/her to pass both yellowish urine and stool. Some doctors don't encourage sun-bathing babies (but morning sun should be harmless). Alternatively, getting a portable photo-therapy assembly is good (if ABO incompatibility is suspected; good hospitals will check baby's blood type and compare it with mother's).

ABO incompatible arises when mother, father and resultant baby's blood types.

Second week
After second week when the bilirubin still persist on the high (even after healthy amount of passing urine and stool), it is still normal considering that baby's liver is still not fully functional. Visit to the clinic is still at two days intervals. There is nothing much the doctor can do except prescribe the next visit.

Third week
If the jaundice level is still high. It is time to add milk with formula. Although we wanted fully breast milk, but jaundice and re-visiting the clinic is not permitting that ideal. The best way to beat baby jaundice is to add milk with formula for the day-feeds and fully breast milk during the night-feeds. You will realize that the amount of stool will increase tremendously. Giving our baby fully breast milk at night prevents constipation (milk is mild laxative whereas formula can cause constipation). 

Normally if jaundice is still high, doctor will prescribe liver function test. Our baby has normal liver function.

Subsequently
After introducing formula at 1/3 part of daily feed, our baby's jaundice stabilized. The jaundice still come-and-go but by the look of the skin and white eye, our baby is getting better.

What we wished our hospital provided
  • Blood type test on baby (we had to ask for it)
  • Portable photo-therapy assembly for rent (when required)
  • Step-by-step expectation if jaundice level persisted. Although the hospital encourages fully breast milk for babies, persistent jaundice is an indication that breast milk is not enough and a compromise is needed.
 
 

Good Gift Vouchers


What makes a good gift voucher?

  • Discount should be more than 10 % off listed price. If the gift voucher can't provide an equivalent of 10% discount of the listed price, then it is useless.

I got this voucher with terms & conditions stating "a minimum purchase of 12 packets of Pampers/Merries diapers". There is an ambiguity in the term "packet". If it meant a pack of diapers (e.g. Pampers New Baby Diapers size S 46 diapers cost SGD 18.20), then 12 packs would be SGD 218.40! That would translate to a  3.7 % discount which is not attractive.
 Anyway, there is also Pampers New Baby Diapers (24 pieces) that cost SGD 8.80 per pack. At 12 packs, they cost SGD 105.60 and an SGD 8.00 off would translate to a 7.57% discount. Well, it's still less than 10% discount.

However, if you compare with Dutch Lady promotion of SGD 3.00 off for every SGD 8.00 spent. That translate to 37.5% discount! Way better than the first example. However, practically, I would have to buy approximately SGD 9.00 of Dutch Lady product to qualify for the SGD 3.00 off, which is still better at 33.3% discount.

This is how voucher/promotion supposed to be! At more than 30% discount. Great buy Dutch Lady!
Another good example is Old Town White Coffee SGD 5.00 off for minimum SGD 20.00 spent in the restaurant. That is a 25% discount! Although it's not possible to have exactly a SGD 20.00 bill, the voucher is still better at more than 10% discount.

Old Town White Coffee voucher worth SGD 5.00 for every SGD 20.00 spent (equivalent to 25% discount).

  • Ubiquity to redeem the voucher. If the voucher requires the holder to travel to far region of Singapore just to spent it, then it will not be a favourite.
  • Free-means-free vouchers. Sometime back, a friend received a free facial treatment voucher and went to redeem it. The outlet provided free facial treatment to half of the face (as a comparison for "before-and-after effect" of treatment). However, the other half of the face will require payment! That's a deceitful tactic (even if there is fine prints on it).
  • Reasonable time/duration to redeem voucher.
  • Privacy protection voucher. A voucher that requires filling in personal particulars with name, address, phone number, spouse name, children's name etc. can sometimes be an uncomfortable feeling, especially when we don't know how the personal data will be protected/safe-guarded.i
That is my list of good voucher criteria. I'll add more if I can think of any.

Just to share.

 

Engagrow A plus LeapFrog AlphaPup Learning Playset (worth SGD35)

With minimal spending of SGD200 on participating Enfa A plus products.

  • Enfamama A+ 0.9 kg, 
  • Enfamil A+ Stage 2 0.9/1.8/1.95 kg, 
  • Enfamil A+ Gentlease Stage 2 0.9 kg, , 
  • Enfagrow A+ Stage 3 0.9/1.8/1.95 kg, 
  • Enfagrow A+ Stage 4 0.9/1.8/1.95 kg, 
  • Enfagrow A+ Stage 5 0.9/1.8 g

Send NTUC Fairprice receipts (in single receipt dated 1 Mar to 31 Mar at >SGD200 of participating products) to Mead Johnson Nutrition (S) Pte Ltd by 7th April 2005 (deadline). A redemption slip for collection of LeapFrog free gift will be sent via direct mail (while stock lasts) two weeks after the deadline (expected date would be around 20 Apr 2015).

Redeem LeapFrog AlphaPup Learning playset with Enfagrow purchases (see participating products).
I sent mine and hope to receive the redemption slip soon (after March).

Wednesday, March 18, 2015

Noisy foldable bathroom door wakes baby

Foldable plastic door that you slide to open and close in the bathroom has a "clickable" catch, i.e. spring catch (I called it springy latch). It is used to fasten the foldable door in place and it makes a clicking loud noise that startle my baby.
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Going to the bathroom will have a fail-proof baby-waking effect in our household, especially when our baby sleeps in the master bedroom with a bathroom.
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There are different types of spring catch out there, with some that comes like ball bearing. I think they make clicking sounds too but I'm not sure how subtle these better quality designs are.
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The easiest to fix way would be to do away with the door catch. I removed two of them (bottom and upper ones). These catches will not affect the locking mechanism of the foldable door.
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It is much better now with the catches gone. The only difference to the door is that if you don't lock the door, a strong wind/draft will move the door.

Monday, March 2, 2015

Child height prediction

Sometimes back, I read an article about height prediction for the son or daughter of basketball player Yao Ming and his wife We Li. Note that both are 2.26 m and 1.90 m, respectively. Based on the formula given, e.g. for daughter’s estimated height = (father’s height x 0.923 + mother’s height)/2 produces 1.992 m, whereas for a son’s estimated height = (father’s height + mother’s height) x 1.08/2 produces 2.246 m. The average height of a man is 1.74 m.

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The above calculation is easier than the online version where you have to convert meter or centimetre to foot. In addition, you will have to input the child’s age and weight (in kg or pound). Fortunately, Google can help with the conversion, e.g. typing “180 cm to foot” will produce 5.9 foot.

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Online height predictor

  • BabyCenter height predictor. You will have to produce child’s current age, height (in inches), weight (in pound), and parents’ height. The minimal age of child is 2 yo.

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Sometimes, abnormal growth (gigantism) could be due to benign (or malignant) tumour to the pituitary gland, in which case, there is an over-production of the growth hormone. However, the reverse is true for under-development (hypoplasia) of pituitary gland in which lesser amount of the growth hormone is produced, and thus causes dwarfism. Read more about the treatment for dwarfism (MayoClinic). Growth hormone therapy can be expensive and it is required daily for several years until the targeted height is achieved.

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An example of synthetic growth hormone therapy is Protropin from Genentech. Yearly treatment cost is estimated at USD 20,000 to USD 40,000 or more (as quoted in NYTimes dated 1994). There are other drugs out there nowadays, e.g. Nutropin by Genentech. It is best to consult paediatrician/doctors.

Wednesday, February 18, 2015

Our kid is cautious of height

I wouldn't place it that our girl is acrophobia (fear of height) because she would dare taking a few steps up the slide and no problem with sliding down afterwards. That is a great accomplishment and a no-no for strictly defined acrophobes.
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You see, as she is our first child, we tend to go overboard in protecting her and we inevitably imbued in her certain characteristics, and unfortunately being overly cautious is one of them.
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We are fortunate that she is not a rebellious and negligent kid. That is why she never had any serious boo-boo (injury). However, when a person is unfamiliar with pain, they tend to be  infrequent at attracting pain by being over-cautious.
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It is not healthy to bring up kids to be over-cautious and less daring to try. For her, she was late at picking up many motor skills, e.g. holding on to hand rail with climbing. Such coordination with the hands and legs seemed so challenging to her! I felt bad and sad seeing her immobilised with the fear of falling and deprived of carefree fun.
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Now at almost 3 yo and after several months going to the neighbourhood playground, she had demonstrated great improvements. By encouraging her to try, she had developed several basic motor skills. Her depth perception (part of child's eye development) no longer served as a weakness (inducing acrophobia) but as a needed attribute to scale height and physically interact with her surroundings (e.g. how acrobats catches horizontal bar in midair based on depth perception).
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She had several bruises but that is part of learning to rise up after each fall. As parent, I can only try to minimize the impact and nurse any wounds.
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Note
Our kid climbed up the slide and on the last few steps to the top, she crawled (on four limbs) up to the platform. Once there, she laid down on her belly and slithered (with her belly constantly touching the support/platform) to the edge where the sliding board was located. There, she inched herself up and ended up in a sitting position. Then,  I would give her word of encouragement, two thumbs up and counted to three before she slide down. Sliding down wasn't a problem.
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After several visits, she started from crawl to walking-like-duck, and finally experimented with walking upright. I was excited to see such transformation. I'm waiting for the next phase in which she will run up and zoom down the slide in split seconds. Haha.
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Just to share.

Newborn urine turns reddish brown indicative of hemoglobinuria

What is hemoglobinuria? 
Our red blood cells (RBCs) are composed of hemoglobin (red pigment) that carries oxygen and carbon dioxide in our circulatory system. If there is excess of RBC lysis (or breakdown/turnover), then our blood will have excessive amount of hemoglobin. Hemoglobin will be filtered out from kidney along with urine and because of its colour, the urine will stain reddish to brown.

Why it is pertinent to us?
Our baby had reddish to brown urine during the first postnatal week. The nurse said that it was normal to see reddish diaper stain sometimes and that upon subsequent feeding and passing of water, the stain will go away.

However, that reddish stain later served as an indication of persistent jaundice that we experienced later on. I am blood group B+ while my wife is A+ and our baby is AB+. Fortunately, we requested that our baby's blood group be tested (it was not normal routine for our hospital to test baby's blood group and we had to explicitly ask for it), or else we wouldn't have gotten this important information that facilitated the medical staff to conclude that our baby was having ABO incompatibility (and persistent jaundice).

What is ABO incompatibility?
ABO incompatibility happens when mother's antibody recognizes and attacks baby's blood cells. It seemed that mother's antibody can traverse from the umbilical cord to the baby's blood circulation.

As an example, if mother had no antigen B in her blood cells (i.e. she is A+ or O+), she will have antibody against this antigen. If baby has antigen B on the blood cells (e.g. if baby is B+, AB+), then the maternal antibody will start attacking the baby's blood cells. This causes excessive blood cell loss and increases circulating hemoglobin and its broken-down product, bilirubin.

Update

It has been more than a month and our baby still has jaundice (indicated by higher bilirubin level). We had phototherapy for 3.5 days and it didn't help to reduce baby's jaundice. Liver function was tested normal (indicated by testing the ratio of conjugated vs unconjugated bilirubin; where normal conjugated bilirubin signifies a working liver). Regular visits to polyclinic depletes our wallet but not the jaundice problem. We got to know that some parents just stopped visiting the clinic after the repetitive tests and brief "consultations" informing them numbers ranging from 180 to 210 of bilirubin level. The consultation fee was very high as compared to the price of the test itself (almost10 fold difference!), e.g. SGD 6.00 per test as compared to SGD 45.00 per consultation. My opinion is that there shouldn't be a flat rate of SGD45 for consultation pertaining to reading to parents their babies' bilirubin test results and setting another appointment for further tests!

How I wished there was an over-the-counter test kit for measuring bilirubin at home. Alas, a spectrophotometer is required to test bilirubin and that machine is not cheap to be placed in homes.

Solution
Now, we are advised to mix formula with breast milk for our baby in order to hasten the clearing of his jaundice. Although we wanted to give complete breast milk, but under the current circumstances - breast milk alone had failed to reduce baby's jaundice and thus - we are obligated to get a tin of formula and start giving mixed milk to our baby. Hope this approach will help reduce our baby's jaundice.

Tuesday, February 17, 2015

Jaundice test is expensive for foreign babies in Singapore

The bilirubin test is around SGD 5 to 6. What is expensive for per visit to polyclinics is the consultation fee. Add them up, a visit to the polyclinic for jaundice test is around SGD 50. That's for babies considered as foreigners (without subsidy). Note that the insurance that we got don't cover jaundice too (probably too common).
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Initially, our visit to the clinic was at two days intervals. That's SGD150 per week for two weeks for a total of SGD300. Subsequently, it was three days costing SGD100 per week for two weeks. Then it was once per week costing SGD50 per week. In total for the first month, we forked out SGD450. That did not include being admitted for 3.5 days for phototherapy (both baby and mum, latter for feeding baby). Note that our hospital didn't have portable phototherapy unit to loan parents, unlike other hospitals like KK children hospital.
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The test for the ratio of conjugated vs unconjugated bilirubin (to test for liver function) came back normal. What a relief.
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The last test showed baby's bilirubin started to increase again. My blood pressure too increased after having informed that. What was going on?
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I asked if there was any precedents and the doctor said yes. It seemed that jaundice is likely to happen especially for babies given breast milk (and more frequent for Asians). The doctor advised us to mix formula with breast milk. That would normally clear the jaundice faster. We went home getting a tin of formula and started feeding our baby that. We thought, "So much for fully breast feed".
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We will have to visit the polyclinic again next week. Let's hope for the good response.

Sunday, February 15, 2015

Game: Sorting beans and relativity

Sorting beans and relativity

How this game is played? First, have four types of beans (or more), and then count the number of each type, e.g. Adzuki bean (red in colour) at 5 beans, mung bean (green in colour) at 10 beans, black turtle bean (black) at 15 beans, soy bean (yellow) at 30 beans, or other beans of different shapes and sizes.

Mix these beans together and put in in a plate or a flat surface. Allow your kid to sort out the beans as according to appearance. Once this is done, as him/her to show which cluster has the least beans and which has the most beans.

Adzuki bean (wikipedia)

Mung bean (wikipedia)

Soy bean (Danielstrading.com)

Black turtle bean (wikipedia)







Thursday, February 12, 2015

Strike three and I can't guess why my baby is still crying

Earlier I have written about what to do when my baby starts crying, e.g.
  1. Feeding
  2. Discomfort - (a) need diaper change, (b) trapped air in stomach, (c) flatulence, (d) constipation, (e) colic cries with no discernible reasons, (f) insomnia caused by discomfort, (g) awareness and stress, etc.
 The second reason baby cries is the most challenging aspect to troubleshoot. It is not that the baby will be able to cry out a code for parents to decipher based on a decoder key. I am at my wit's end trying to figure out what is wrong with our baby these few nights.

 The only suspect would be colic (discomfort in the alimentary tract), either failure to burp or having too much gas (could it be due to lactose intolerance?), tummy bloated, constipated, etc. If that is the case, there is nothing I can really do about it.

I tried patting/rubbing baby's back to soothe and induce burping (but that didn't help even after few successful burps), applying medicated oil by rubbing on both palms to make it warm before applying to baby's tummy (to soothe and help baby to pass gas, but that too didn't work), massage the back, placing baby to sleep on the tummy (back facing up), moving back and forth to promote undulating movement to soothe baby to sleep but without success. He keeps on crying... and only stop when he is too exhausted. After which, he will doze off. My wife is worried that such cries are not healthy for baby (and I concur).

The only thing that can really soothe our baby to sleep would be to let him latch on. Well, I can only stuff a pacifier to his mouth but the baby is a selective brat who doesn't fancy NUK pacifier.

It is so challenging trying to figure out and deal with baby's cries (or feeling helpless when all else failed to console our babies).

Baby colic
Wikipedia provided suggested reasons for baby colic (inconsolable cries) and here is the list.
  • Stress
  • Hunger
  • Postpartum depression (mother)
  • Trauma from hospital visits or 
  • Child abuse (such as shaken baby syndrome). Violent shaking of babies will cause head trauma.
Normally baby colic will dissipate once baby reaches certain age (from 3 months and up to a year). Babies' cries are known to stimulate milk production in mothers and as family members, we should understand that baby's cries do not translate to mothers' incompetence in caring for babies. That is why I always remind myself and other members that baby's cries help to communicate with us and especially mother. If other family members are less anxious (anxiety), then the mother will not be anxious too.

Related blogs

Baby's (neonate) belly button (navel) shape and appearance

I noticed that my baby's (neonate) belly button (or navel), where the umbilical cord used to be located, is hard to the touch. When he cries, there is a depression (collapse) above the belly button. I wondered if that was normal and went to search for any information pertaining to baby's belly button and hardened and collapsed. 

To my disappointment, Google image search produced lots of babes with their belly button, or mum's with belly button or belly hardened. There were few pictures with neonates' belly buttons! Fortunately I found one (from YouTube).


Baby's belly button, showing hardened and collapsed area.

From the above picture, the region with depression isn't as obvious as my baby's when he cries. The following is my baby's belly button.

My baby's belly button and the region above the navel is collapsed (more obvious as shown above when he cries).

I give up trying to figure if this is normal because at 3 weeks old, my baby's navel is healing and that area of collapse or cave-in could be a normal process to close the gap/channel. The peritoneal membrane, muscle or whatever tissues that's supposed to be closed could still be opened in my case (which will eventually closes as the healing process progresses). Well, fortunately, there is no protrusion of the belly button or navel, which would indicate umbilical hernia in babies (or neonates), which is quite common. For more information about umbilical hernia in babies, visit WebMD. Just for my reference, here is a photo showing a baby with somewhat common umbilical hernia (but I would send my baby to see a pediatrician nonetheless). For umbilical hernia, some parents indicated that this will go away in few months time (but have to look out for complications such as infection or irregular bowel movement).

Photo sent by parents from the community in BabyCenter (link is here).

For now, I will try not to freak out considering that our pediatrician didn't suggest anything wrong with our baby's belly button. Hopefully the collapsed region will go away.


Updated: Our baby's hernia disappeared after 3.5 months.

Tuesday, February 10, 2015

Pigeon baby wipes - one pull three out problem

I uses Pigeon baby wipes and there is one problem with the product, a pull of a wet tissue produces three of them in a go. If it had been the automated teller machine (ATM), I would have been happy but I was definitely not impressed. It is really distracting especially when I'm cleaning my baby. The wipes that accidentally fall to the floor is not as hygienic as I wanted wipes to be. Is there better alternatives?



Instead of relying on Pigeon, I am going to try other brands and see if the problem with Pigeon is universal or just specific to a brand. Fortunately, there are other baby wipes out there where I can do a survey and decide which baby wipes is best for the household.

Other baby wipes

Huggies Gentle care baby wipes






Johnson's Baby wipes.

  • Tollyjoy baby wipes. I don't like the official website. It is difficult to find the product as there is no search entry. Also, there is no webpage for this product. Looking at the quality of the image will remind me how awful the website is.

Tollyjoy wipes. The official web site didn't appeal to me.

Mamypoko baby wipes.

Guardian's in-house baby wipes. I would definitely want to try the fragrance free wipes.

FairPrice baby wipes.


Watson's baby wipes.



Note
Search at FairPrice website shows return for all the baby wipes in store and the corresponding prices (accessed on 11 Feb 2015). E.g.
  • Pigeon Wipes 82 pieces x 3 packs (SGD 9.85; at 4 cents per piece)
  • TollyJoy wipes 84 pieces x 3 packs (SGD 7.90; at 3.1 cents per piece)
  • FairPrice wipes 200 pieces (SGD4.95; at 2.5 cents per piece)
  • Johnson's baby wipes 80 pieces x 3 packs (SGD 11.95; at 5 cents per piece)
  • BabyU wipes 80 pieces (SGD 3.00; at 3.7 cents per piece)
  • Kodomo wipes 70 pieces x 3 packs (SGD 8.80; at 4.2 cents per piece)
  • Huggies wipes 80 pieces x 3 packs (SGD 9.95; 4.1 cents per piece)

2 hours intermitent feeding, diaper changes, and more

Mothers are really strong. They can endure lack of sleep by waking up every 2 hours to feed and change diaper (or rather change diaper first then feed). I have been helping out by taking three to four slots (total > 6 hours) in feeding our baby (starting from 9 pm, then 11 pm, 1 am, and finally 3 am). It was really challenging.

At the same time, my wife has to take care of our older child who is currently adapting to the presence of a new member of the family. Fortunately, she has grown used (or rather fond) to the baby.

Products needed for baby
  • Breast pump
Thanks to Ameda pump Lactaline Personal (or purely yours), my wife could provide sufficient amount of milk to store and for daddy to feed the baby later. We keep freshly expressed milk at 4°C instead of in -20°C freezer (this prevents off-flavour of milk, our opinion)

Our baby is drinking milk at increasing volume (gradually). In just 3 weeks, he is already taking in more than 2.5 oz (approx. 75 ml), sometimes at 3 oz.

  • Sterilizer, bottles, warmers
In addition, we are using Philips Avent products, e.g. single electric pump (with manual pump available for outdoor expression if power outlet is not available), storage bottles, sterilizer, and Pigeon's bottle warmer. The models that we are using (bought three years ago) now are no longer available, and had been replaced by newer models.


  • Portable or mini fridge
Nowadays, mothers are getting usb portable fridge for storing expressed milk (which is a good thing to have in the office if the common fridge is messy and moldy - or there is a chance that the milk might be mistakenly drank by someone). Just search for USB fridge and you will get returns for different types. An example is the following. Alternative, mothers can pool resources and get a mini-fridge for use in the office.


Coco Digital Portable USB Mini Fridge at £22.66 (Amazon). However, a much cheaper alternatives are available at Amazon, eBay, Alibaba etc. These mini-fridge runs using the Peltier cooling method.
MIDEA BAR FRIDGE~4 TICKS (minibar fridge) at SGD 119 at Gain City Singapore. This smaller less portable fridge can be installed at a corner of office area for mothers to share the cost and space. Several types at more affordable price is available and milk is stored at 4°C (good for up to 5 days).
For information about expressed milk storage, refer to this site, "Breast milk storage: Do's and don'ts" by MayoClinic.

  • Preferred bottles (we prefer Playtex)
 We have tried Avent feeding bottles but our baby doesn't like it. After each feed, too much air is ingested. We haven't tried the latest version called "natural bottles" (Philips Avent). We have tried Nuk bottles and found that the nipple is a little quirky and unnatural for babies (nipple confusion). It is also difficult for us to feed our baby because of the nipple shape (see Nuk bottles here and try it on baby to see if he/she likes it). Most of the time, as parents, we wouldn't want to force any bottle on babies. We would try different bottles and maintain those that our baby loves (without nipple confusion).
Playtex VentAire bottles are our favourite. The nipple is not too confusing and the anti-colic mechanism works for us.

  • Diapers
We used to give our first baby cloth diapers with liner to wear (in order to prevent nappy rashes). However, having two kids reduced our time and luxury to change frequently the soiled/wet diapers of our second baby. That prompted us to use commercial diapers (we are using Huggies).

To prevent nappy rashes, we used Vaseline Petroleum Jelly to produce a "waterproof coat" on the groin and back area. It worked better than applying Desitin Rapid Relief (Zinc oxide cream). In addition to the above measure, we try to wash off poo poo with warm bath at least twice daily (so that baby will feel fresh and any residual urine and dried stool is cleaned), and after the wash, we will apply a layer of Vaseline to baby. We have not tried this but some suggested using lightly salted water bath to clean and sooth baby's skin.

  • Ambience
I believed that having silent surrounding for baby to sleep or rest is not healthy. This is considering that nature intended to enrich our hearing all the time, with at least some background noises, e.g. crickets, cicadas, lizards, wind, ruffling of leaves, etc. In order to emulate nature, I downloaded Android apps on my smart phone and would play the "background noise" to our baby. It soothed him to sleep and even at sudden noises, he wouldn't be jolted as when he was sleeping in silent. My favourite apps are Lullaby Relax and Sleep and Relax Night. There are others too, but I didn't try any other considering that Relax Night has plenty of cricket noise, croaking of frogs, and others.

As for temperature, Singapore is hot and humid. At night, it is humid and cold. For our baby, we try to use the air-con to reduce the humidity and maintain the temperature at 29°C. A fan will be blowing to move the air inside our room. To prevent our baby from catching a cold, we would cover him with a cozy blanket. Sometimes, leaving the window open to let in warm night breeze is fine (but the humidity at night can be a pain at some nights especially when we stay at lower floor of our HDB flat).

Lighting is maintained at low. We normally will switch on the bathroom light. Also, I will be holding a torchlight at night to peek in the diaper to see if it needs changing before feeding time.

  • Activity
There will not be too much activity in the room. During feeding time, I will try to feed baby without waking him up. When he is done, I would normally pat or rub his back to allow him to let our air after feeding. Then I will place him on a slanted baby rocking chair. On it is layered with a folded cloth diaper to prop his head. I will adjust the baby so that he is faced sideways in order to prevent any chocking if he puke milk at night. If he soil his diaper then, I will let him rest until he complains about it (only then I will change the diaper). Having baby and parents to rest enough is crucial! If you change baby's diaper, you will surely wake him/her up (guaranteed).

  • Cries
It is normal for baby to cry (it's the only work they do in order to get food and direct our attention to their any discomfort. It takes a lot out of them to cry, which is their means of communicating with adults. Normally, a healthy amount of cry will exhaust them afterwards and they will sleep better. However, some "experts" suggest that babies should not cry more than 5 min or else they will ingest a lot of air and that will cause tummy pain. If all else fail in understanding their cry, we can only let babies cry to sleep. However, a prolonged cry could indicate of problem requiring medical attention).

First thing I do when baby cries is to look at the time and see if it's feeding time. If it isn't, I will check the diaper and change it when needed. I will carry the baby and rub his back to see if there is any gas trapped in the stomach or throat. Any burp is an accomplishment. If the baby still cry, I will warm my palms by rubbing them together and then rest them on my baby's belly to sooth any discomfort there. I will apply medicated oil on the tummy as well. I will also massage the belly gently in a downward motion. If baby is still crying, I will carry him and walk around the room while rocking him gently on my arms. If all else fail, I will put him gently on the slanted baby rocking chair and let him cry for a while before carrying him again and rock him gently in my arm so that he will sleep after crying (a form of exercise for babies!). The reason babies cry inconsolably is due to discomfort (e.g. gas in the tummy, flatulence, or constipation due to formula milk or dehydration) BUT as parents, we have to be vigilant to ensure that inconsolable cries are not due to any discomforts that need medical attention.

That's all for now. It's a challenge being mothers. It would be nice if the dads can chip in once in a while to help. By feeding and changing my baby's diaper for two sessions, my wife gets to sleep for 4 hours  uninterrupted. That is a luxury to her!

Just to share.

Dengue alert in the neighbourhood

Recently, it has been hot and rainy and surely a pleasant time for mosquitoes to breed. Not all mosquitoes are bad, but the ones that carry pathogens that can harm people should be avoided.

For example, mosquitoes that carry the parasite that causes malaria belongs to the genera Culex, Anopheles, Culiseta, Mansonia, and Aedes could act as Plasmodium carriers (Wikipedia).

Physical appearance of the mosquitoes belonging to the genera Culex, Anopheles, Culiseta, and Mansonia. The Aedes mosquito is not shown. A mosquito pest control company has a site with a comprehensive description of mosquitoes and the corresponding pathogens, "Mosquito control - Mosquitoes in Malaysia" (JamesWhiteAnt).
Mosquito that carries the Dengue virus belongs to Aedes. For further information about the mode of transmission (and a brief introduction), read "Dengue transmission" (Nature) and "dengue control" (WHO).

Aedes aegypti mosquito (sourced VectorBase).
 In Singapore, active cluster of dengue outbreak can be referred to "Location of Active clusters" by DengueGovSg. Bishan and Tanah Merah currently in the red alert (with more dengue cases reported there).

Mine is at yellow alert. The National Environment Agency (NEA) officer came to visit my home recently to advise on removing probable mosquito breeding grounds, e.g. flower pots, plate, pail, slots for hanging poles outside to dry clothes, bathroom and toilet area.

The advisory note on Dengue had three important key points
  1. Remove mosquito breeding ground
  2. Kill the mosquito larvae and adults with insecticide
  3. Avoid getting bitten (Aedes mosquitoes bite at certain time and by avoiding outdoor activities around that time would be advisable)
Dengue alert - Take immediate action advisory note from NEA. Key points are highlighted.

For now, I guess if I am to bring my children out, I should at least use/wear the mosquito repellent on them. In addition, I should avoid bringing them out to sit at park's bench (and tempt mosquitoes to feast on us). I'm a B+ blood group and my kids are AB+. I'm not sure about the association between blood group and mosquito bites, but I can say that if I am among friends, I'm a "mosquito magnet". My kids are more prone to bites than me (so I can't shield them from bites by attracting mosquitoes to me instead).

Note that once an individual has been infected by dengue virus, that individual is immune against the virus. However, there are four types (or serotypes) of the virus. Immune against one doesn't preclude infection by the other three types. Also, if an individual is infected by one type followed by another at a short period of time, this individual could experience a severe immune response (due to the body memorizing the first attack and primed to give "all out" response to the second one - aka dengue shock syndrome (DSS)).

Summary
  • Identify the type of mosquito that carries the Dengue virus.
  • Check the information pertaining to where (or which alert level) the Dengue outbreak in my residential area is (DengueGovSg)
  • What to do to prevent breeding of the mosquito.
  • Protect ourselves by usage of insecticide and repellents.