Healthy Start For Your Baby

Healthier Child, Brighter Future

www.hpb.gov.sg 1800 223 1313

Contents 01

CONTENTS

For easy reference, the book has been classifi ed into different age groups and a section for dads. Some information apply throughout all age groups.

03 Note from HPB 34 Problems and Conditions 04 Milestones Common infant problems and 06 Acknowledgements conditions

40 Immunisations 0-6 MONTHS Inject to protect 09 After Birth Baby’s here! What’s next? 44 Your Baby’s Growth and Development 11 Dealing with Changes Help your baby develop Baby’s home 46 Safety First for Your Baby 16 Nutrition for Your Baby Up and about safely Nature’s best food – breast milk 48 Oral Hygiene 24 Care of Your Newborn Smile a little smile To have and to hold 50 Going Back to Work 30 Rest and Relax Mummy’s off to work! Time to unwind 02 Contents

6-12 MONTHS 12-24 MONTHS 57 Nutrition for Your Baby 79 Nutrition for Your Toddler Getting ready for solids Nutrition after the fi rst year

66 Allergies 84 Physical Activities for Your Toddler When allergies occur Let’s go, Mummy!

70 Play-based Activities for You and 88 Safety First for Your Toddler Your Baby Keeping your child safe Let's play, Mummy! 90 Alternative Child Care Arrangement 72 Safety First for Your Baby Placing your child in a child care centre Safe home for your baby 93 Hygiene 74 Social and Emotional Skills Washy washy clean Your baby needs soft skills too 95 Coping with Your 2 Year-old When a fi rm hand is needed

ALL ABOUT DADS 101 Daddy, You are Important Daddy dearest

106 Raising Healthy and Happy Children Creating a happy home

OTHERS 112 Services, Support Groups and Helplines Where to get help

114 Books from National Library Board (NLB) Read a book a day to your child

117 Survey Making it better

121 The First Two Years Note from HPB 03

A Bundle of Joy!

Congratulations to you and your spouse! You must be thrilled to welcome this new life into your family. We are sure you want to give your baby the best.

You can start by helping him or her cultivate healthy habits and by setting a healthy example. Healthy habits formed from an early age are more likely to persist into adulthood.

This Healthy Start For Your Baby guide provides you and your spouse with informative and practical tips to nurture the health and well-being of your baby. It is designed for easy reading and use. Sections are categorised according to your baby’s age. We have included pages for you to create a journal of your baby’s childhood memories.

We hope this guide will help both of you ease your journey into parenthood and prepare you in giving your baby the healthiest head start to a brighter future. Have a wonderful and healthy journey.

Ang Hak Seng Chief Executive Health Promotion Board

Healthy Start For Your Baby is published under the Healthier Child, Brighter Future initiative 04 Milestones

MilestonesHere is a quick guide on your baby’s developments

• Looks at you • Responds to sounds • Smiles back at you • Make sounds like “UH”, “OO”, “EH”, “AH”…

12 – 24 months

• Walks well with • Stands alone for good balance 10 seconds or more • Copies what you • Drinks from a cup are doing such as • Scribbles when without spilling household chores you give him a much pencil

• Points to at least 2 parts of his body such as eyes, nose, etc when asked

• Uses a spoon to • Says at least • Walks up several feed himself 3 words other steps of the than “papa” and staircase by • Builds a tower “mama” himself with the of 4 blocks or support of wall/ more without rail blocks falling Milestones 05

These are some milestones during your baby’s fi rst 2 years. Remember that babies develop at different rates, and these milestones are just a guide. 0 – 6 months

• Holds a rattle in • Holds his head his* hand for a upright steadily in • Holds head and few seconds a sitting position chest up, on outstretched • Follows an object • Bears weight on arms, when from one side to his feet for a few placed on his the other side seconds while stomach being supported

• Passes something small from one hand to the other hand

• Sits alone for • Responds by • Pulls himself more than 5 waving when you to a standing seconds say bye-bye and position without wave to him help • Picks up a small object such as raisin with fi nger- thumb grasp 6 – 1212 monthsmonths

YThe detailed Developmental Checklists can be found in your baby’s Health Booklet (pages 7-21).

YIt is important to monitor your baby’s milestones by completing the detailed Developmental Checklists as listed in your baby’s Health Booklet.

YTake your baby to the polyclinic, family doctor or paediatrician for the recommended developmental screenings.

Y Note that baby will develop along different timelines. If your baby is not achieving the milestones in the Health Booklet, please consult your doctor.

* For the sake of simplicity, he/his/him are used to represent both genders. 06 Acknowledgements

Acknowledgements

The Healthy Start For Your Baby guide was conceptualised by the Health Promotion Board as part of our Healthier Child, Brighter Future initiative. It was developed in collaboration with the following healthcare institutions:

• Gleneagles Hospital • KK Women's and Children's Hospital • Mount Alvernia Hospital • Mount Elizabeth Hospital • National University Hospital • Parkway East Hospital • Raffl es Hospital • Singapore General Hospital • Thomson Medical Centre

The Health Promotion Board would also like to express our sincere thanks to the following partners for their contributions to the development of the book:

• Association for Breastfeeding Advocacy (Singapore) • Centre for Fathering Singapore • Child Care Division, Ministry of Community Development, Youth and Sports • Children’s Services, National Library Board • Dads for Life 0-6 months

The journey of discovery continues...

0-months6

After Birth 09 Baby’s here!

What’sRead on to fi nd out whatnext? to expect as you welcome your bundle of joy

ou have been waiting for your y Your baby will be given a vitamin K baby’s arrival and he is fi nally injection to prevent the possibility here. Here is a guide on what of bleeding. you can expect to happen at y A doctor will give your baby a thorough the hospital and later at home. check-up within the fi rst 24 hours. Baby — what he would go y Your baby will be given his fi rst through immunisations: Hepatitis B (fi rst dose) y Your baby will have his weight, length and BCG. and head circumference measured y He will also have a newborn hearing at birth. screening, usually by day one or day y His temperature, breathing rate and two. heart rate will also be noted. 10 After Birth

y It is recommended that newborns y Check the timing for babycare be sent for metabolic screening. workshops provided by the hospitals Do check with your doctor regarding on breastfeeding and bathing your this test. newborn. Attend these sessions with your husband so that he can learn to Mummy — what to expect and help with caring for the baby. what to do y You will have bleeding (lochia) for a y If you and your baby are well with few weeks. This is normal. But if you no medical concerns, you are seem to be bleeding excessively, encouraged to place your baby on alert the doctors or nurses. your chest within fi ve minutes after y If you have diffi culty passing urine or delivery for at least an hour of skin- having pain, get help. to-skin contact. Your baby’s suckling y You can usually go home 1-3 days refl ex is most intense in the fi rst hour after a normal delivery. If you had a after birth. Guide him when he shows caesarean, you may go home after signs of readiness to feed. 3-5 days. y You will be able to rest in the labour y You will see your doctor again ward (or observation ward if you had 4-6 weeks later to check that the a caesarean) before being transferred episiotomy wound has healed well to your room. and that you are coping well with motherhood. A Pap smear will also y If you and your baby’s condition be conducted. Notify the clinic for permit, you can request to room-in a change of appointment if you 24 hours a day with your baby in are having your period. your room to facilitate breastfeeding You may wish to discuss and promote bonding. Let your baby contraception with your suckle on demand. doctor at this time. y Make the most of your time in hospital At home, make sure that to learn how to breastfeed properly. Do y you eat healthy meals and not be afraid to ask for help, especially get proper rest. in latching your baby onto your breast when you have easy access to the nurses and lactation consultants.

Provide a totally tobacco-free environment for your baby’s well-being. Opening windows and doors do not protect your baby from secondhand smoke as toxins from tobacco smoke (now known as thirdhand smoke) settle on surfaces such as sofas, curtains, carpets as well as clothing and hair can take a long while to go away. These toxins may get into your baby’s body though contact while he plays or crawls or while he is being carried by a smoker. Dealing with Changes 11

Baby'sYou are goinghome home with your new bundle of joy! It is exciting, of course, but why do you feel a bit anxious?

ost mothers, especially In general, here are what you may need to fi rst-time mums worry that be prepared for: they have to manage their Mbaby’s needs – diaper Disrupted sleep changes, baths, etc, on their own upon Your baby’s little tummy cannot hold discharge. Do not worry. This is normal. much. That is why he cannot get through the night without waking up for milk. In If you have to, get help from a family the early days, this could be as often as member or a confi nement nanny. She can every 2- 3 hours. If you are breastfeeding help to take care of both you and your baby through direct latching, seek help from for at least the fi rst month. Give yourself your family members or your confi nement time to adapt to living with your baby. lady to put your baby back to sleep after feeds so that you can get back to sleep. 12 Dealing with Changes

What to do vagina) during childbirth, which is • Rest as much as you can during the day. stitched after delivery. Keep the area • Nap when your baby naps. clean for the wound to heal faster. To • You may try latching your baby on to prevent infection of the wound, change feed while lying down to get some rest. the sanitary pads regularly and wash the area each time you pass urine and Post-delivery recovery motion. While you are fi guring out how to • The caesarean wound is an operation cope with your baby, these are some cut at the lower abdomen to facilitate the discomforts you may experience after delivery of the baby. A dressing will be childbirth: placed on the area. Avoid lifting heavy • Lochia is a bloody discharge that begins objects during confi nement to allow the immediately after delivery. The discharge wound to heal. will be quite heavy for the fi rst two days but it will get lighter slowly. What to do • Afterpains or postpartum cramps is • Lochia, afterpains, and pain from the a mild ache that you may feel in your episiotomy and caesarean will go away lower abdomen in the fi rst few days after some time, so do not worry. after delivery. The pain is caused by the • However if you experience heavy contraction of the uterus as it returns bleeding, or you notice that there are to its normal size before pregnancy. clots, or that there is swelling and Breastfeeding mums will feel their uterus persistent pain from the episiotomy or contracting as their baby suckles. caesarean wounds, see your doctor • An episiotomy is a cut made at the immediately. perineum (between the anus and the Dealing with Changes 13

• Do not be afraid to ask for help if you need it. Family, friends and experts are aware of the demanding nature of caring for a baby and will be more than happy to offer advice and help.

Changes to your body After delivery, you may have to deal with hair loss, stretch marks or urinary incontinence. You may also fi nd that your belly still looks bloated after giving birth. These are perfectly normal. Getting back in shape may take a few months.

What to do • Accept that the changes to your body is part of the birthing experience. • If you breastfeed, you are likely to get back in shape faster. • Start a gentle exercise routine like walking to help you get back in shape. • If you have hair loss, do not worry. The shedding process should stabilise within 6 -12 months. • Stretch marks on your tummy, thighs and breasts will not disappear, but they will fade after some time. • Do pelvic fl oor exercises by squeezing the pectoral muscles as if you are trying to hold back urine. A new routine • Eat a well-balanced diet. Avoid alcohol With the arrival of your baby, you may have and tobacco products. to make some adjustments to your usual routine. Caring for your baby will be a whole new experience for you, so be patient as you learn the ropes. Stay positive, learn to manage your expectations and cope with the changes.

What to do • Start a new routine with your baby in mind. You will probably end up liking this a lot more than the old one! 14 Dealing with Changes

Postnatal blues Symptoms of postnatal blues can last for a If you are feeling easily irritable, tearful, few hours, or days and usually fade away anxious or frustrated, you may be having without the need for treatment. However, postnatal blues. Postnatal blues refer to when postnatal blues last for more than a temporary period of emotional rejection two weeks, it can worsen to postnatal and withdrawal that usually occurs in depression. Some of the tell-tale signs of the the fi rst week after delivery and may condition include: not last more than two weeks. It is due • Feelings of self-blame. to hormonal as well as physical and • Withdrawal from family and friends. emotional changes that come from taking • Thoughts of harming yourself or the baby. care of the newborn. If you suspect that you may be suffering from What to do postnatal depression, speak with your doctor • Establish open communication with immediately. Refer to Page 113 for helplines. family members especially when you are feeling low. Do not bottle up your Ties with siblings feelings as suppressing them will only The baby’s arrival might be unsettling for make you more moody and depressed. an older child in the family. You may have • Complete tasks that need immediate prepared him, but no amount of preparation attention. Let family members take over can prevent him from feeling left out since household chores so that you do not he has been used to getting your attention stress yourself out. especially if he has been the only child. He • A positive outlook in life is another key may display behavioural regression: behaving to handling postnatal blues. Do not like a baby again, asking for a bottle when he compare yourself to other mothers. is already drinking from cups, wetting himself • Recharge by doing things that relax you, even though he is already toilet-trained or like taking a stroll, or listening to music. throwing tantrums. Plan quiet time for yourself even if it is only for 15 minutes a day. • Consider joining mothers’ support groups to get to know other mums who are in a similar situation.You can exchange tips on caring for your baby as well as to alleviate stress. • Eat well-balanced meals and add a little exercise to your routine. Stay tobacco- free and abstain from alcohol. Smoking and drinking will not help you cope with stress. Dealing with Changes 15

Confi nement “Confi nement” is an Asian concept observed after birth by the Chinese (30 days), Malays (44 days) and Indians (40 days) here in Singapore. Here are some common myths:

Myth: Food must be cooked with sesame oil, herbs and ginger to drive “wind” out from the body. Fact: It is important to eat everything in moderation.

Myth: A meat and liver-only diet will replenish blood. Fact: Just having meat and liver will not allow you to meet all your nutritional needs, especially for breastfeeding mothers. Meat and liver also contain fats and cholesterol and should be consumed moderately. Find positive ways to A well-balanced diet should consist involve your older child of food from the 4 food groups, i.e. rice and alternatives, meat and in baby’s care and alternatives, fruit and vegetables. S entertainment.T Myth: Drinking alcohol keeps the body warm and improves blood circulation. Fact: Alcohol may be transmitted through What to do breast milk to your baby. It also • Find positive ways to involve your prevents oxytocin release and reduces older child in the baby’s care and the production of breast milk. There entertainment, like singing and reading to are also adverse effects on the baby’s the baby, or trying to make him smile. growth and development. Avoid • Keep to your older child’s routines as far alcohol totally during confi nement, and as possible, so he does not feel that his if you are breastfeeding. life is in a major upheaval because of the baby. Myth: Liver and spinach soup, black chicken • Make it a point to spend quality time and wine increase milk production. with him every day. Fact: There is no proven benefi t that these • Be loving and patient with him. will increase milk supply. The best way to increase milk supply is to latch your baby on as often as required and to express milk regularly. PHOTOS ISTOCKPHOTO 16 Nutrition forYour Baby Nutrition for Your Baby 17 Nature’s best food- breast milk Breast milk is the best food for your baby. Here are some tips to get breastfeeding right

very parent wants the best for y The close body contact and interaction their baby and it is important to during breastfeeding aids in creating start right. Breast milk is the per- a special bond between you and your fect nourishment for your baby. baby. y Breastfeeding reduces the risk of Why is breastfeeding best for Sudden Infant Death Syndrome (cot my baby? deaths), obesity and diabetes in y Breast milk meets all of your baby’s adulthood. nutritional needs as it contains all y Babies who are breastfed are known the essential vitamins, minerals and to have higher IQ scores and better nutrients for your baby’s complete eyesight. growth and development. y Breast milk is more easily digested Why is breastfeeding best for and your baby is less likely to develop me too? stomach upset, constipation and y Early suckling helps your womb to diarrhoea. contract faster and reduces blood loss y Breast milk is supercharged with after childbirth. antibodies which will improve your y It delays the return of your menstrual baby’s immunity and reduce the risk period and exclusive breastfeeding of infections. is a natural (although imperfect) contraceptive. 18 Nutrition for Your Baby

y You burn calories during breastfeeding and this helps you to shed some of the weight gained during pregnancy. y Your risk of developing breast, ovarian and womb cancers, heart disease and osteoporosis is lower.

Why is breastfeeding good for the family and the community? y Breastfeeding is free and convenient. y It is environmentally friendly. y Your baby will not fall sick so easily, so medical cost is reduced. You are also less likely to miss work as a result. y You can save money from the direct cost of formula milk, and from fewer visits to the doctor.

How long should I breastfeed? For optimal growth, development and health, the World Health Organisation (WHO) and Health Promotion Board (HPB) recommend exclusive breastfeeding (with no other food or drink) for the fi rst 6 months (i.e. 180 days) of a baby’s life. You are encouraged to breastfeed your child until he is 12 months old and thereafter as long as mutually desired, together with the timely introduction of solid food from 6 months of age.

When and how should I initiate breastfeeding? If you and your baby are well with no medical concerns, place your baby on your chest for at least an hour of skin- to-skin contact within fi ve minutes after Breast milk meets your delivery. Your baby’s suckling refl ex is most baby’s nutritional needs and protects your baby S from infections.T Nutrition for Your Baby 19

intense in the fi rst hour after birth. Being y The areola is drawn into your close to each other after sharing the birth baby’s mouth. experience helps your baby to calm down, y The baby’s cheek is round. keeps him warm and encourages him y You may feel the initial tug on the to breastfeed. Guide your baby when he nipple when baby suckles but you shows signs of readiness to feed. should not have nipple pain or discomfort. You are also encouraged to room-in y You can observe your baby’s sucking 24 hours a day in your room with your rhythm to ensure good milk transfer. baby to promote bonding, facilitate Suck > Swallow > Breathe (pause) breastfeeding and allow you to recognise rhythm. the early feeding cues. Do not be afraid to seek help from the nurses or lactation consultants if you need to.

Observe for early feeding cues. Feed your baby when he does any of the following: areola y Increases his eye movements under closed eyelids or open eyes. y Opens his mouth, stretches out the tongue and turns his head to look for

the breast. Tongue over gum ridge. Nipple drawn y Makes soft sucking sounds. far into mouth and milk flows. y Shows a strong rooting refl ex such as sucking or chewing on hands, fi ngers or other objects that come in contact with the mouth. y Moves towards your fi nger when you place it near the corner of his mouth. areola

What are the signs of a good latch? y Your baby’s upper and lower lips fl are out to form a good seal on the breast. Tongue behind gum ridge. Nipple is y Your baby’s chin is touching the breast pinched and milk cannot flow. and the nose is slightly away from the breast. 20 Nutrition for Your Baby 0-6 mths nutrition for babies | 011

How should I position my baby to feed him? You can breastfeed sitting or lying down. y Sit comfortably, making sure that your back and the arm which you hold your baby with is well supported (with a pillow or cushion). y Gently massage your breast to clear any blocked milk ducts. y Hold your baby at the breast level with your baby facing you (chest to chest). Support your breast with the other hand. y Tease your baby to open his mouth as wide as possible and direct your nipple to the roof of your baby’s mouth. y Make sure your baby takes in the whole areola and not just the nipple. y Finally, take a breath, sit back and relax.

You can breastfeed in various positions. Pick a position that is comfortable for you.

1. Cradle hold is suitable when you and your baby are able to co-ordinate well and latch on easily. Support your baby’s head in the crook of your arm and hold buttocks with your hand with the baby’s face and body turned towards you.

2. Cross cradle hold is ideal for newborn, small or premature babies. It is also good for mothers with a short nipple. Support the back of the baby’s head and shoulder at the nape of neck using your palm, and the baby’s body and buttock with your forearm.

3. Football hold is ideal for small babies, mothers with large breasts and short nipples or mothers who have undergone a caesarean section. Support your baby’s head and shoulder at the nape of neck with your palm and the baby’s body and buttock with your forearm. Tuck your baby under your arm so that the legs are behind you and the head is at your breast.

4. Lying down is ideal after a caesarean section, forceps delivery or for feeding at night. Lie on your side with a pillow under your head and behind your back, with your baby facing you.

If you have any problems, approach your hospital’s lactation consultants for help. Nutrition for Your Baby 21

How do I overcome some possible problems with breastfeeding?

Do not worry or be discouraged if you y Keep the affected breast as empty as encounter some diffi culties when you fi rst possible by nursing frequently. breastfeed. By being aware of the possible y Apply mild pressure with a warm towel problems, understanding their solutions and on the lump gently pushing it towards asking for help, your beastfeeding journey will the nipple. be a smoother one. Here are some examples y Change feeding positions to help of the common problems encountered and empty the breast and hand express their solutions. breast milk if necessary.

Sore or cracked nipples Breast infections (mastitis) Cause: Cause: Your baby is not positioned or latched on A bacterial infection that usually affects one properly. breast. The affected breast may be red, hot and swollen or may have a painful lump. Solutions: y Gently take your baby off your breast and Solutions: re-attach and re-position him. y Get help from your doctor or lactation y Reduce the nursing duration but increase consultant. the number of feeds. y You may be given antibiotics and y Initiate breastfeeding on the unaffected painkillers for pain and fever. breast. y The breast infection will not affect y Express a few drops of breast milk on the your baby and you may continue nipples to soothe them. to breastfeed if it is not too uncomfortable. Engorgement Cause: Thrush Missed feeds Cause: A yeast infection caused by Candida Solutions: albicans that affects both you and baby. y Express some breast milk before nursing You may experience itchy, red or sore if your baby has trouble latching on. nipples and your baby may have white y Massage your breast gently while you patches in the mouth. are feeding and express after feed if your breast still feels hard or swollen. Solution: y Use cold packs after a feed to be y See your doctor who may advise anti- comfortable. fungal medication for you and your baby.

Plugged ducts Can I continue with Cause: breastfeeding after going A blocked milk duct which is not draining well back to work? into the nipple. You can continue with breastfeeding even if you resume work. Turn to Solutions: pages 53 and 54 for tips on how y Start nursing from the affected breast fi rst you can continue with breastfeeding when your baby’s suckle is vigorous and while at work. strong. 22 Nutrition for Your Baby Some ffrequentlyrequently aaskedsked qquestionsuestions on breastfeeding Breastfeeding may sound challenging initially but once your baby latches successfully, it is fulfi lling and enjoyable. These are some common questions you may have:

What is “let-down refl ex”? • Express regularly and store breast milk When your baby starts suckling, a hormone if your baby is not feeding well or is called oxytocin releases milk into the breast separated from you. ducts causing it to fl ow towards the nipple. • Rest, eat well and drink plenty of fl uids. This is called the “let-down refl ex”, which • Reduce caffeine intake and completely has a tingling or tightening sensation on the avoid alcohol and tobacco products as breast. If you are stressed, the let-down refl ex these can inhibit the milk “let-down refl ex”. can be inhibited. So, relax! How do I know if my baby is getting If milk production comes later, will enough milk? my baby “starve” in the fi rst few If your baby has had enough, days? • Your breasts will feel soft after nursing. When you fi rst start breastfeeding, your fi rst • Your baby is contented and satisfi ed. milk is colostrum which is: • Your baby is passing clear urine and has bowel • Yellow, thick and sticky, very rich in protein, movements 2 - 5 times or more in a day. minerals and antibodies. • Your baby’s weight is increasing after the • Small in quantity, but that is all your baby initial drop in birth weight. Your baby will needs in the fi rst few days. gain about 150 - 200 grams per week. Breast milk changes to mature milk by about 7 - 10 days after birth. Mature breast milk How long and how often do I feed consists of: my baby? • The initial foremilk which is watery, low in • Allow your baby to suckle for as long as fat and serves to satisfy the baby’s thirst. possible on one breast to ensure he gets • The later hindmilk, which contains more the high caloric hindmilk. This takes about fat, nutrients and antibodies, will satisfy his 20 - 30 minutes. Avoid looking at the hunger and ensure weight gain. clock; instead observe his suckling and swallowing. Offer the other breast if he Will I have suffi cient milk? wants more. It is normal for mothers to worry that they • Alternate the breasts for subsequent feeds. may not have enough milk for their babies. • If you have to take your baby off your Milk production occurs regardless of the breast, insert a small fi nger at the side of mode of feeding. Frequent and effective milk your baby’s mouth between the gums to removal is important to ensure a good supply. release the suction before removing the Hence, nipple from his mouth. • Ensure that your baby latches on correctly. • As breast milk is easier to digest, feed on • Breastfeed regularly every 2- 3 hours demand (every 2 - 3 hours) round the clock. and avoid supplementary feeding with formula milk. Nutrition for Your Baby 23

If I latch my baby on as well as feed • Learn how to express, collect, transport him expressed breast milk from a and store breast milk correctly. bottle, will it confuse him? This is known as “nipple confusion”, which Once your premature baby is able to feed, occurs when a baby is offered both the support will be given to you on how to latch breast and a bottle. Suckling from the breast him on directly before he is discharged. and drinking from a bottle require different techniques. Some babies who have been fed What are the risks of not expressed milk from a bottle at the start may breastfeeding? refuse to latch on. To prevent confusion, feed Babies who are not breastfed are at greater exclusively from the breast where possible. If risk for: you need to express milk for various reasons, • Gastrointestinal infection give him expressed milk in a cup, a spoon or • Urinary tract infection from a syringe. • Respiratory disease • Obesity and diabetes later in life My baby seems to be feeding all the time. Is it because I am not Mothers who do not breastfeed are at greater producing enough milk? risk for: During growth spurts – around 2- 6 weeks, • Breast and ovarian cancers 3 and 6 months of age – there will be an • Osteoporosis increased demand for nursing. The increased frequency of feeding will help to increase the Can I breastfeed after six months? milk supply to meet the baby’s needs. Do not You can breastfeed up to one year and worry; it only lasts for a few days. Just feed beyond. Although your baby may be getting on demand and get enough rest and food. nutrients from other sources of food, breast milk is still an important form of nutrition. What about breastfeeding premature Breastfeed as long as you and your baby babies? desire. You can continue to breastfeed even if Premature babies often have medical you are pregnant. problems that require close monitoring in the hospital. Mothers of premature babies can: Turn to pages 112 -113 for breastfeeding • Initiate expressing of breast milk 6 - 8 times a helplines and support groups. day including at night and store the milk.

TIPS FOR SUCCESSFUL BREASTFEEDING: • If you and your baby are well with no medical concerns, place your baby on your chest within fi ve minutes after delivery for at least an hour of skin-to-skin contact. Guide your baby when he shows signs of readiness to feed. Room-in 24 hours a day in your ward with your baby to promote bonding, facilitate breastfeeding and allow you to recognise the early feeding cues. • Ensure a good latch to ensure smooth fl ow of milk. • Make sure you have a well-balanced diet, limit caffeine intake and avoid alcohol and tobacco products. Get enough rest and sleep. • Feed your baby on demand. Allow him to suckle for as long as possible. • Avoid supplementary feeds as far as possible because your baby will have no desire to suckle to maintain the milk production and fl ow. • Avoid feeding from a bottle or using a pacifi er in the fi rst few weeks until breastfeeding is established as that will discourage the learning process of breastfeeding for your baby. 24 Care of Your Newborn To have and Your baby is here, and you are all excited. Get to know how you can give him the best care to hold

our newborn is as delicate as he looks. Hence, it is important to handle him Y with care. Handling baby A baby has little control over his head as his neck muscles are still weak. By the time he is about 6 months old, his neck muscles and head control should be stronger. y Always support the head and neck. Cradle the head when carrying your baby, and support it when carrying him upright, and when laying him down. y Never shake your newborn. This can cause bleeding in the brain and even death. y Your newborn baby is not ready for rough play. Do not jiggle him on your knee or throw him into the air. Do not do anything too bouncy or rough. y If you put the baby in a carrier, a stroller or a car seat, always make sure that he is positioned correctly and the seat belts are properly fastened. y Do not go up an escalator with your baby in a stroller. Take the lift instead. Care of Your Newborn 25

What you might notice pimple-like spots on the face. These are in newborns called milia. They are harmless and will • Head disappear after a few weeks. You may Your baby’s head may have an odd shape. also notice small red bumps. This is It may look like a cone or elongated. This newborn acne, and will disappear after is because his skull bones had to shift and a few months. Some babies may have overlap due to pressure from the narrow bluish-grey patches on the buttocks or birth canal, while he was being delivered. lower back. These are called Mongolian It would be more obvious if forceps or spots which usually disappear after a a vacuum extractor was used during few years. delivery. Do not worry, his head will return to a more rounded shape within a few • Legs days. Your baby’s legs may look bowed or bent. This is due to the lack of space in • Soft spots the womb. Most will straighten out on These soft parts of the head are called their own as your baby starts to stand fontanelles. They are at the top and back and walk although some babies may of the baby’s head, where the skull bones need medical attention. have not yet grown together, and they may bulge slightly when your baby cries • Other body parts or exerts himself. They usually close up Both boys and girls may have swollen within 12 -18 months. breasts as hormones from the mother pass into the baby’s system before birth. • Hair and scalp Girls may have a little vaginal discharge or Some newborns have fi ne hair covering bleeding. This is normal and will stop after their back, shoulders, forehead and several days. Boys may have fl uid around temples. This is called lanugo. It will clear the scrotum. This is called a hydrocele. It up after a few weeks. can take 6 -12 months to disappear.

• Face Your baby’s eyelids may be puffy and swollen. This is because of pressure on the face during delivery. As your baby spent the last few weeks before birth in a very cramped space, his nose may be fl attened or pushed to the side, and his outer ears may be folded over. These will correct themselves in a few weeks so there is no need to worry.

• Skin The top layer of your baby’s skin will fl ake off so be prepared to see skin peeling off from his hands and feet for the fi rst couple of weeks. You may notice white, 26 Care of Your Newborn

Basic Newborn Care • Bathing Bathing a newborn can get a little cotton ball for each part of the face. challenging as he is so tiny and fragile. y Tuck him under your arm like a football, Be assured the experience will get better supporting his head with the same with practice. hand. Wash his hair. Dry his hair so that y Keep the water in the baby bath he will not catch a chill. tub shallow. y Remove the towel and gently put him y Remember to add hot water to cold into the water. Support the head, neck water while fi lling the tub to prevent and shoulders with your arm. scalding accidents. y Use a napkin to gently wash him under y Check the temperature of the water his armpit, then turn him over to wash with your elbow before putting the his bottoms and genitals. A young baby in. It should be warm, not hot. baby needs constant support in water. Pour in a little hypoallergenic baby Never leave him unattended. bath liquid. y Lift the baby out of the tub, wrap him in y Undress the baby and wrap him up in a a dry towel and dry him thoroughly. Put towel. Clean his eyes fi rst, then his face on a clean nappy and clothes. using moist cotton balls. Use a new Care of Your Newborn 27

Cleaning and care of different parts of your baby: • Eyes • The umbilical cord stump Wash each eye gently with a cotton ball Keep it clean and dry. Do not put any that has been dampened with warm, boiled medicated oil on it or in your baby’s belly water that has cooled down. button. Use cord spirit to clean the cord everyday. The stump will change colour from • Ears yellowish-green to brown and black, and Ears are self-cleaning. Ear wax and dust will eventually fall off by itself in 12 - 15 days. gradually be pushed out to the surface so In the meantime, keep diapers below the that these are easy to get rid of. A gentle stump so that it is exposed to air, not urine. wipe with a soft washcloth or a damp Sometimes, when the stump falls off, there cotton ball is enough. Never stick anything may be a little blood. Your baby will not into your baby’s ears. feel pain as there are no nerve fi bres in the umbilical cord. • Nose Use a cotton ball dampened with warm, • Nails boiled water to gently clean off any dried Many newborns have long and sharp mucus around your baby’s nose. fi ngernails and toenails. Put mittens and booties on him so that he will not scratch • Genitals himself. Avoid trimming these during the fi rst Use a moist cotton ball to wipe the area. For few weeks as the nails are very soft. When girls, always wipe from front to back to avoid the nails have hardened a little, use baby transferring bacteria from the anus to the clippers or scissors to trim them. You may vagina. fi nd it easier to do this while your baby is sleeping or nursing.

• Diapering All newborns pass out meconium – stools y If you use cloth diapers, wash them with a that are thick, sticky, black or greenish-black fragrance-free detergent. for the fi rst 2 - 3 days. Thereafter breastfed y Consult the baby’s doctor if there is a rash. babies tend to have yellow stools that are mostly runny with small seed-like objects. Breastfed babies use up to 6 - 8 diapers a Hygiene tips day until they are about 6 weeks old; and • Diaper changing should be done away thereafter about 5 - 6 diapers a day. from the kitchen or any food preparation y Change the baby’s diaper when it is wet area. or soiled. Clean the genital area with each • Clean the surface of the changing mat change. with disinfectant wipes after each use. y Apply a protective ointment or cream with • Dispose of used diapers immediately. each diaper change. Use one with zinc • Empty rubbish bins or diaper bins oxide, which acts as a moisture barrier. regularly. y Remove the baby’s diaper for some time • Wash your hands properly after each each day so that his skin has a chance to diaper change. air-dry. 28 Care of Your Newborn

• Soothing Babies love attention and sounds, so talk, sing, coo, and babble to him often. If he is fussing, try singing or reciting nursery rhymes. The beat and rhythm of these will soothe him as well. Some babies like the long “shh” sound. They can calm down and even fall asleep when this is repeated to them over and over again. It is okay to pick your baby up and carry him when he cries. He needs to know that someone is there for him.

• Burping Newborns tend to swallow air while feeding, especially if they are drinking from a bottle. It is important to burp the baby after each feed. • Swaddling You may even need to stop a feed halfway to In the hospital, you will see babies all burp him if he is getting irritable. Here are some wrapped up. Swaddling provides newborns positions that will help your baby burp. with a sense of security and comfort as this is the position they were cocooned in while y Over-the-shoulder burp: in the womb. You’ll need a thin large square Put the baby on your blanket (wrap) to do this: shoulder so that y Spread the blanket on a fl at surface and his tummy is fold down the top corner. pressed against y Lay your baby on his back. Put the baby it. Pat or rub in the middle of the blanket, with his his back gently head on the fold. in an upward- y Wrap one side of the blanket over the sweeping baby, tucking the end under his back movement. beneath his opposite arm. Make sure y Pull the bottom of the blanket up and you have a cloth over the tummy. protecting your shoulder. y Bring the other side of the blanket over your baby and tuck it under his back. y Over-the-hand burp: y Make sure it is not too tight, but not so Sit the baby on loose that it will fall apart once the baby your lap. Grasp moves. his chin gently with your • Bonding hand. Lean Enjoy bonding time with your baby by him forward holding him close to your chest, cuddling and rest most or giving him a light massage. Giving your of his weight baby a massage after his bath each evening against the palm before he goes to bed is a good way to calm of your hand and him down, indicate to him that it is bedtime your arm. Pat or rub and get him in the mood for sleep. him gently on the back. Care of Your Newborn 29

Why is he crying?

Crying is a form of communication. Below are some reasons why he may cry. If you’ve checked and tried everything and to no avail, and if your baby is otherwise fi ne, then you just have to wait it out.

Cause Signs What to do

Hunger Sucking the fi sts, turning towards Feed him. Always respond to early your breasts and ‘rooting’ when signs of hunger to avoid this. you pick him up.

Wind His fi sts are clenched, tummy is Burp him, especially if he is bottle-fed. tight, knees pulled up to chest and Some doctors may prescribe colic he’s howling. remedies.

Soiled diaper His diaper is heavy and smelly. Change his diaper immediately.

Too cold/hot He is uncomfortable and may be Feel the back of his neck. If he is cold, crying. add clothing or increase the room temperature. If he is too hot, remove some clothing, change to light clothing or decrease the room temperature.

Over- He is tired but cannot sleep, Calm him down by giving him a warm stimulation so he is frustrated. bath, relax him with a massage or carry him and try to soothe him.

Loneliness He loves to be with you, and cries Carry him close to you and stay within when you put him down. his sight as often as possible.

Illness He may have a runny nose and a Check his temperature. If it is above cough and feel hot to the touch. 37.5˚C, bring him to the doctor. 30 Rest and Relax

Time to Unwind Getting your baby to unwind and relax can be a challenge. Read on to fi nd out how to soothe your baby so that he can sleep with ease, or just to rest and relax

any newborns tend to up every few hours as they get hungry sleep during the day, and need to be fed. They may also stay and stay awake at night. awake for an average of two hours before They do not know the they start getting fretful. Since you are differenceM between day and night yet. also likely to have a disrupted sleep You can teach your baby how to pattern, it is best to nap when your baby differentiate day and night by behaving sleeps. As he gets older, his nap time will differently at these times. In the day, talk be reduced. to your baby more, play with him, and keep the house bright. At night, keep the Get your husband or someone else to lights dim, speak softly and calmly in a help you with housework, laundry and lower tone of voice. meals so that you do not have to worry about these chores. It is more important Newborns need to be fed every few for you, the mother, to be well rested so hours because they have an immature that you are in a good frame of mind to digestive system. As such, they will wake take care of your baby. Rest and Relax 31

Put your baby to sleep on his back. This with him as he winds down. Then give helps to reduce the risk of sudden infant him his bedtime feed. Put him in the cot death syndrome (SIDS) or “cot death”. when he is drowsy. Let him fall asleep Make sure the cot does not have fl uffy by himself. This is the hard part. Some toys, pillows, cot bumpers or quilts to babies do it naturally, some do it with a reduce the possibilities of accidental little help: sucking their thumb, cuddling suffocation. Newborns do not need a favourite toy, or fi ngering the edge of a pillows, but you could move your baby’s sleep suit. head position each night (right to left, left to right) to prevent him from developing You could put on some lullabies or a fl at spot on one side of his head. classical music while doing the bedtime Avoid putting your baby to sleep in cloth routine. Your baby will soon associate cradles as these are unsafe. that particular piece of music with sleep, and settle down with less fuss when he Routines For Sleep hears it. This is especially useful when One of the best ways to teach your baby travelling! to sleep well is to develop a bedtime routine. This means that you do the same It can be a frustrating process if your things each evening to prepare him for baby does not sleep well and wakes up bed. You can start doing this when he is many times throughout the night. You can about 6 - 8 weeks old. take turns with your husband or other family members to put the baby to sleep. Most parents follow the popular bath- Make sure that everyone is consistent in massage-quiet time-feed routine. A nice, the way they put the baby to sleep. warm bath is soothing and most babies easily get in the mood for sleep after one.

Once the baby is dried and diapered, you can give him a short massage with a little massage oil, cream, or lotion that has been specially formulated for babies. A massage will also help him to calm down and relax. It also helps to promote parent and child bonding.

After your baby is dressed, you can read, sing, or chat 32 Rest and Relax

Step by step guide for massage INFANT MASSAGE Express your love with a baby massage while moisturising his delicate skin. For Touch is powerful, especially when it is given newborns, a massage up to 10 minutes is with love. It is the universal language of love, suffi cient, while older babies can enjoy a and one that babies can understand before massage for up to 20 minutes. they can talk.

Benefi ts of infant massage • Promotes parent-child bonding. PIace your • Calms a fussy baby and helps him release palms on his tension, anxiety and irritability. head and • Helps the baby to relax and fall asleep easily. massage gently • Enhances circulation and digestion. down to • Reduces ‘wind’, colic and digestive problems. his chin. • Contributes to healthy weight gain. • Improves the baby’s immune development. • Promotes emotional growth. With your index Tips on infant massage and middle fi ngers • It is best to do it after a warm bath, before placed on his bedtime, when your baby is still alert, but forehead, gently not drowsy. draw small circles • Lay your baby on a fl at surface, like a bed. around his temples. You can also sit on the fl oor and make a diamond shape with your legs, your soles facing each other. Place a blanket over Gently make a your legs to form a “cradle” for the baby to smile on your lie in. baby’s upper lip • Remember to dress the baby in his diaper. with your thumbs. • Use a little baby oil or lotion. It makes the Do the same on massage smoother. Do a patch test fi rst, the lower lip. to make sure that the oil or lotion is not too harsh for your baby’s delicate skin. Do not use pure concentrated essential oils. • Rub the oil or lotion between your palms With both to warm it up before putting your hands on hands together your baby, so that he does not get a shock at the centre of if your hands are cold. his chest, gently • Sing, hum or talk softly to your baby as you push out to the massage him. He will like that! sides, following the rib cage, after which, bring them You may attend infant massage workshops around in a heart-shaped motion to to learn more about the techniques of the centre. baby massage. Check with the parent craft centres in hospitals (refer to pages 112-113) for more details of the workshops. Rest and Relax 33

The next three steps are named Hold your hands “I Love You”. together around 5 I: Start under your baby’s arm the rib and at his shoulder, draw an “I” then lightly move down to the hip your hands in joint. opposite directions, from the shoulder to his hand, squeezing gently.

Love: Stroke Massage his from left to left wrist using right across your thumb or your baby’s forefi nger. Then abdomen, stroke his palm, forming the uncurling his long side of a sideways “L”. Use a short fi ngers as you go. Do the same with the downward stroke on the right side of his right hand. stomach to complete the “L”. Massage your You: Finishing baby’s ankles, with an upside then feet, one at down “U” stroke a time. Support up from your his ankle with baby’s hipbone, one hand and on the left side use your thumb to massage from heel to of his stomach. Move your fi ngers along toe along the sole. the top of your baby’s tummy and then down your baby’s right side. Hold your baby’s leg; move your hands up his leg Use the outside together, turning in of your hand opposite directions, and make squeezing gently. gentle paddling strokes on your baby’s tummy, Lay your baby one hand following the other. on his stomach. Stroke down your baby’s Starting at back from neck the abdomen, to bottom, gently stroke including the bottom. With your upwards with fi ngertips, lightly massage the muscles your fi ngertips. on either side of the spine.

Information courtesy of Johnson & Johnson 34 Problems and Conditions

Common infant problemsBabies may feel unwell at one & point orconditions another. Knowing what the different baby problems and conditions are will help you ease your baby’s discomfort Problems and Conditions 35

here are some common Cough problems or conditions that What it is: The sound of your baby your baby may experience as coughing does not always mean that T he grows up. Here is a list of something is wrong. In fact, it is actually some baby’s problems and conditions the body’s way of clearing bacteria, mucus and what you can do to help him. and irritating substances from the airways. What to do: Monitor and give him lots of Common Infant Problems rest and fl uids. See a doctor if the baby’s cough makes him vomit or if he has Your baby will experience coughs, diffi culty breathing or if he also has a colds, and other problems as part of high fever. the growing process. This is natural and helps him to build his immune system. Bronchiolitis What it is: It is an infection of the small Cold airways of the lungs. It causes wheezing What it is: Symptoms include a blocked (a high-pitched whistling sound when and runny nose, watery eyes, sneezing breathing out), and rapid or diffi cult and coughing. He may also have a breathing. temperature. The mucus that comes out What to do: Offer your baby more fl uids, of his nose is clear at fi rst but may become as breastfeeding/suckling can be tiring thicker and change to yellow or green. especially if his nose is blocked. Avoid What to do: Give him plenty of fl uids smoky places as tobacco smoke can to keep him hydrated. Keep him away make his condition worse. See a doctor, from crowded public places and sick especially if his breathing is laboured and if people. Consult a doctor. Your doctor he is lethargic, listless and refuses to eat. may prescribe nasal decongestants (a drug used to relief nasal congestion) Constipation to help clear the mucus and What it is: Constipation this helps the baby to sleep is not common better. among younger babies, especially Fever breastfed ones. What it is: A temperature Some babies may above 37.5˚C indicates not have bowel a fever. He will be movements daily. It uncomfortable and will becomes a problem probably cling to you. Fever is only when your baby’s a symptom of an infection; and not bowel pattern slows a disease. Most fever with viral illnesses down very much, his stools are range between 38.3˚C and 40˚C, and may harder than usual or if he shows visible last 3 - 5 days. discomfort, a hard abdomen, or becomes What to do: See a doctor especially if cranky. your baby is less than 3 months as he What to do: Check with your doctor may not have the immunity to fi ght before trying anything to relieve your the fever. baby’s discomfort if he is constipated. 36 Problems and Conditions

Diarrhoea What it is: This is when your baby The crying is intense and it is extremely passes out smelly, watery, muscous- diffi cult to calm him down. He may clench streaked stools. It is his body’s way of his fi sts, tense his abdominal muscles getting rid of an infection. and curl up his legs. Colic usually starts What to do: Give your baby lots of fl uids a few weeks after birth, peaks at 4 - 6 to prevent dehydration. These are special weeks and ends by the third month. fl uids, electrolyte solutions, which are The exact cause of colic is not known. designed to replace water and salts lost Some possible contributing factors during diarrhoea. include excessive swallowing of air, milk allergy and an immature digestive system. Consult your doctor, if you have any What to do: Comfort your baby by: concern or if symptoms persist. See your • Giving him small but frequent feeds, doctor immediately if you detect any of and burp him well. these signs: • Cuddling him close to you, swaying or • Dehydration, especially when he passes rocking him. very little urine and has fewer tears • Talking or singing softly to him. when crying. • Sunken eyes. It may cause a great deal of stress and • Dry skin, mouth and tongue. worry for you when your baby has colic. • Sunken fontanelle (the soft spot on top These are some tips to help you cope of baby’s head, if he is younger than with stress: 18 months). • If you are overwhelmed, feel helpless • Refuses to drink. or depressed, confi de in your husband, • Has passed six or more watery stools friends, family members or talk to other or vomited three or more times in a day parents to fi nd out what have worked or has green vomit. for them and their babies. • Has severe stomach pain. • Do not panic, take a break from care • Is lethargic or irritable. giving by asking your husband or other • Has cool hands and feet; feels clammy family members for help. to the touch. • Know that this condition is temporary. • Has shallow breathing and a fever. Colic episodes usually ends by the third month. Colic What it is: If your baby cries more than three hours a day, at around the same time (usually late afternoon or evening) more than three days a week for more than three weeks, he probably has colic. 0-6Problems mths neonatal and Conditions problem | 0 1737

Consult a doctor if you notice Spit ups the following: What it is: It is normal for babies to spit • Your baby does not stop crying, even up (throw up a small amount of milk) or to after you have tried everything. have a refl ux. This happens when milk is • Your baby takes in only half of the usual thrown up. Spitting up is less forceful feeds or refuses to eat at all. than vomiting. • You are worried and cannot cope. What to do: Feed your baby in an upright • When you want to ensure that there is position. Burp him frequently during and no medical cause for his discomfort. 38 Problems and Conditions

Use gentle, non-drying shampoo periodically S when you wash your baby’s hair. T

after each feed to keep air from building up Common Infant Conditions in his stomach. You could also try feeding him more often, but with less milk at each There are some medical conditions your feed. See a doctor if your baby chokes, baby may experience. Always speak to coughs, and seems to be in pain, or if the your doctor for the best way to manage spit smells bad. these conditions.

Heat Rash G6PD Defi ciency What it is: These are clear or red spots. What it is: It is an inherited condition They usually appear on the forehead, face, where the body has insuffi cient glucose- the folds of the neck, chest, and arms. 6-phosphate dehydrogenase (G6PD) What to do: Avoid overdressing your enzymes. If your baby does not produce baby. Dress your baby in cool, lightweight enough G6PD, the red blood cells can clothing in hot weather. Turn on the break down more easily and cause air-conditioner, fan or keep him in cool jaundice and anaemia. All newborns are places. Heat rash will usually go away by screened for G6PD defi ciency. itself. What to do: If your newborn is diagnosed Common Infant Conditions with G6PD defi ciency, talk to your doctor to understand more about this defi ciency and the precautions to take for your baby. 0-6Problems mths neonatal and Conditions problem | 0 1739

Jaundice may recommend physical therapy. More What it is: When the baby’s skin and serious cases may need to be treated the whites of his eyes look yellowish, he with corrective shoes or surgery. probably has jaundice. It is caused by too much bilirubin in the blood. Jaundice is Cradle Cap common in babies for the fi rst 3 weeks of What it is: Greasy, crusty, scaly patches life. But it can get serious and even life- on the baby’s scalp. It will usually threatening if it is not treated properly. disappear by itself after a few months. What to do: Bring your baby to the What to do: Use gentle, non-drying doctor for a check up. If his jaundice shampoo periodically when you wash your levels are too high, he may need to stay baby’s hair. You can also apply a layer of in the hospital. The usual treatment is olive oil and leave it on for a few hours phototherapy, where your baby is placed to loosen the scales so that they wash under blue light. Babies with jaundice are off more easily or be brushed off with a usually sleepy and have to be woken soft baby brush. If the cradle cap seems to feed. to be increasing instead of lessening, your baby’s doctor may recommend a medicated shampoo or a lotion.

Eczema What it is: These are light red or tan-pink patches of rough scaly skin that turns red later. It could be caused by a change in your baby’s formula milk, laundry detergent, a strong soap, certain fabrics or even if the weather is too hot. What to do: Check your home for things that could have irritated your baby’s delicate skin. Try not to expose him to extreme temperatures (too hot or too cold). If the condition does not improve, seek a doctor’s advice as your baby may need medication. Club Foot What it is: Due to your baby’s position Yeast Infection in the womb, he may point his feet What it is: It looks like a bright red rash, downwards and inwards. This is usually in the diaper region or where diagnosed during a newborn’s physical the skin folds are. It is caused by micro- examination. The problem is not painful organisms that fl ourish in a warm, moist but it can interfere with walking if environment. not corrected. What to do: See the doctor. Your baby What to do: Consult your doctor who will need prescription medicine to clear it. 40 Immunisations Inject

Immuniseto your little one to protect him againstProtect infections

mmunisations are very important. Consult your doctor if you have any They protect your baby against concerns or doubts. infections that can lead to disability or even death. Some babies may suffer from minor side- effects after immunisation. These include Some vaccines give rise to lifelong fever and soreness or swelling at the site immunity upon completion of the full of the injection. course. Other vaccines have to be given again later in life to maintain your child’s Some parents are concerned about the immunity to the disease. This top-up link between the MMR vaccine and autism, dose is called a booster. but there is no evidence to support this.

Most babies are fi t for immunisations. Singapore has a National Childhood and However, should your baby have high Adolescent Immunisation Programme to fever or a previous bad reaction to give your child the best possible protection immunisations, he may not be suitable from serious infections. It is important for them. If your baby’s immune system is that you ensure your child is immunised weak due to illness or medical treatment, according to the recommended schedule. live vaccines like MMR (measles, mumps and rubella) or polio must be avoided. In Singapore, diphtheria and measles immunisations are compulsory by law. National Childhood and Adolescent Immunisation Schedule, Singapore For persons aged 0 to < 18 years (With effect from 1 December 2011)

Immunisation for Vaccination Birth 1 3 4 5 6 12 15 18 6-7 10-11 Diphtheria and Measles are against months months months months months months months months years^ years^^ COMPULSORY by law. Tuberculosis BCG Hepatitis B HepB HepB HepB (D3) # Medisave400 (D1) (D2) Use of Medisave is allowed for Diphtheria, DTaP DTaP DTaP DTaP Tdap Hepatitis B vaccine, pneumococcal Tetanus, (D1) (D2) (D3) (B1) (B2) conjugate vaccine, and HPV vaccine Pertussis under Medisave400 for up to $400 Poliovirus OPV OPV OPV OPV OPV OPV per Medisave account per calendar (D1) (D2) (D3) (B1) (B2) (B3) year. All vaccinations under the Measles, MMR MMR (D2) ## National Childhood and Adolescent Mumps, (D1) Rubella Immunisation Schedule would be routinely offered to parents who Pneumococcal PCV PCV PCV Disease (D1) (D2) (B1) bring their infants and children for immunisation or whenever opportunities Human Recommended for females 9 to 26 years; 3 doses are required at intervals of 0, 2, Papillomavirus 6 months arise, as a standard of care. Infl uenza Recommended for all children aged 6 months to < 5 years and children aged 6 months to < 18 years in high-risk groups Baby Bonus Parents can also pay for the vaccination Notes: using their child’s Baby Bonus cash gift and/or savings in his Child Development BCG Bacillus Calmette-Guérin D1/D2/D3 1st dose, 2nd dose, 3rd dose

st nd rd Account (CDA) at Baby Bonus- HepB Hepatitis B vaccine B1/B2/B3 1 booster, 2 booster, 3 booster Immunisations approved healthcare institutions. More DTap Paediatric diphtheria and tetanus toxoid and acellular ^ Primary 1 pertussis vaccine information on the Baby Bonus and its ^^ Primary 5 approved healthcare institutions can be Tdap Tetanus toxoid, reduced diphtheria toxoid and rd rd acellular pertussis vaccine #3 dose of HepB can be given with the 3 dose of DTaP and OPV for the convenience of parents. found at http://www.babybonus.gov.sg. MMR Measles, mumps, and rubella vaccine The Baby Bonus and CDA can also be ## 2nd dose of MMR can be given between 15-18 months 41 OPV Oral polio vaccine used to pay for siblings’ vaccinations. Babies who turn 12 months of age on or after 1st December 2011 should PCV Pneumococcal conjugate vaccine receive 2 doses of MMR vaccine as per above schedule. 42 Immunisations 28 | First Steps

The National Childhood and Adolescent Immunisation Programme protects against 12 diseases. They are:

• Tuberculosis (TB) • Mumps TB usually attacks the lungs, but it can also A common childhood viral infection that infect any other part of the body. If it is not causes the glands that produce saliva properly treated, it can be fatal. TB spreads (on both sides of the jaw) to swell. It is through the air. contagious 1- 2 days before symptoms appear until 1-2 days after they disappear. • Hepatitis B A serious case of mumps can lead to brain This is a serious viral liver infection that infection, deafness and sterility. spreads by direct contact with blood or bodily fl uids of a carrier. Your baby’s fi rst • Rubella dose of the Hepatitis B vaccine will be Also known as German measles, this is given soon after birth. In all, there are three usually mild when it affects children. A rash doses to take. may appear. Your child should stay at home while sick or up to a week after the rash • Diphtheria disappears. Expectant women if affected This is a bacterial infection that affects during early pregnancy may give birth to the throat mainly. In more serious cases, deaf, blind or mentally retarded babies. it can affect the heart and nerves and block the breathing passage. Diphtheria • Pneumococcal infection is very contagious and is potentially life- This disease is common in children under threatening. 2 years and the elderly. It can lead to chest, ear and brain infections (which can be • Tetanus potentially fatal). Also known as lockjaw, this affects the body’s muscles and nerves. Without • Human Papillomavirus treatment, tetanus can be fatal. The major cause of cervical cancer is a virus called the human papillomavirus. The • Pertussis (whooping cough) Human Papilloma Virus (HPV) can infect This is very contagious and can cause the cervix, causing the cells to change. In serious illness in infants and children. It can most of the infection cases, the virus clears lead to pneumonia (lung infection) and brain by itself and the cells return to normal. damage. However, in some cases, the infection can persist and cause the cells to grow in an • Poliomyelitis (Polio) abnormal way, developing into cervical Often called Polio, this can lead to cancer. paralysed and deformed arms or legs. • Infl uenza • Measles Infl uenza, commonly known as the “fl u”, is a A highly contagious viral infection that affects contagious disease that can affect anyone the body’s breathing system. It usually including healthy people. It attacks the starts with high fever and causes a rash. respiratory tract in humans (nose, throat, Lung infection, deafness and brain damage and lungs), causing infl ammation of the can occur. It is spread through coughing mucous membranes. The disease can be and sneezing and through touching deadly to some people who develop life- contaminated surfaces. Most people recover threatening complications like pneumonia. completely but some people can get very ill especially if complications arise. First Step 0-6 0-6 mths mths ImmunisationsImmunisations Immunisation | 2943

Combination vaccines* The MMRV vaccine combines vaccines These newer childhood vaccine against four common childhood diseases, formulations combine vaccines against Measles, Mumps, Rubella and Varicella (also four, fi ve or six diseases into a single known as chickenpox). injection. These combination vaccines have been proven to be safe and effective. Optional vaccines With the introduction of these vaccines, There are also optional vaccines for your child can be protected without the your baby. Some examples of optional anxiety of multiple injections. The costs of vaccines (valid at the time of printing) the ‘5-in-1’, ‘6-in-1’ or MMRV vaccines are Chickenpox, Rotavirus, Hepatitis A, are not subsidised by the government. For Meningococcal and Haemophilus Infl uenza more information, speak to your doctor. type B (Hib). It is best that you discuss the need for these vaccines with your doctor * The ‘5-in-1’ injection combines vaccines and make a decision on whether it would against Diphtheria/Pertussis/Tetanus (DPT), benefi t your baby. Bring along your baby’s Polio and Haemophilus Infl uenza type B (Hib). Health Booklet during the clinic visit to The ‘6-in-1’ injection combines vaccines record the immunisation given. against Diphtheria/Pertussis/Tetanus (DPT), Polio, Hepatitis B and Haemophilus Infl uenza For more information regarding type B (Hib). immunisations, visit www.hpb.gov.sg or www.nir.hpb.gov.sg 44 Your Baby's Growth and Development

Set baby on the right path to better motor, visual and auditory development

Help your baby develop

hen your baby was growing • Tummy time in your womb, you could Let your baby spend some time on his feel him moving, pushing, tummy. This will strengthen his back and help Wshoving, turning and kicking. him learn to crawl. Place some toys in front of These actions will continue after he is born. him so that he will be motivated to stay in this If you lay him down on a fl at surface, he will position. Only put him in this position when be moving his limbs, trying to turn his head, you are around. Do not allow him to sleep on and attempting to wriggle around to fi nd the his tummy as it increases the risk of Sudden source of a sound. Here are some ideas to Infant Death Syndrome (SIDS). help your baby in his motor, visual and auditory development in the fi rst few months. • Back practice Place your baby on a blanket and roll the Motor Development sides in so that he is in the middle. Place Help your baby learn how to control the a clean, rolled diaper under his knees to movements of his head, body, arms and legs support his hips. Slowly and gently pull up by positioning and playing simple games from the blanket so that he is raised to a sitting birth, particularly through fl oor-based play in a position. As your baby grows older, you may safe environment. This is important as these reduce the support on his head and neck. movements will help your baby learn to sit, crawl, stand and eventually walk. Your Baby's Growth and Development 45

• Time on the side • Exploration Put your baby on his side, with a rolled Put interesting toys just out of your baby’s blanket supporting his back and another reach while he is having tummy time. This supporting his front. Tuck in his legs. You can encourages him to move and explore. lie down next to him and sing, talk or play fi n ger games. Auditory development One of the best ways to soothe a baby Visual development is by using your voice. What’s more, you A newborn is unable to focus on anything can use different sounds to help develop further than 25cm from his face. It is thus his hearing and help your baby make the important to structure his visual world to fi t his connection between sight, action and range of vision. A stimulating and interesting sound. environment will help your baby develop his vision which is important for him to explore the • Song time environment and acquire new skills. Hold your baby close to you and sing or coo at him. This will help him learn • Human faces to focus through listening and moving Decorate the side of your baby’s cot with towards your voice. photographs of yourself or one of your children. This helps your baby learn to focus • Eye tracking exercise as he surveys the pictures and objects Use a noise-making toy to attract your around him. baby’s attention while you move the toy slowly from one side of his face to • Mobile fun another. See if your baby’s eyes follow the Hang a colourful mobile over your baby’s cot, movement – this is called eye tracking. or hang interesting toys on his pram or stroller hood. Ensure that the mobile and toys are Adapted from the brochure, "Your Guide properly attached. This gives your baby extra to Helping Your Baby Grow" courtesy of interesting things to look at and focus on. Singapore General Hospital.

Hang a colourful mobile over the baby’s cot, or hang interesting toys S on his pram or stroller hood.T 46 Safety First for Your Baby

Up and about Find out how you can keep your 0 -6 month old baby safe at home and on the move safely Safety First for Your Baby 47

t this stage from newborn to 6 Travelling with a baby months, your baby may not crawl Invest in a car seat for your newborn as he will and lift his head easily, but will start need to travel in one, right from the fi rst ride home A to wiggle and push things with his from the hospital. Car safety for your newborn or feet. Some parents may mistakenly believe that child is very important. Holding or placing him on it is safe to leave babies unattended because of your lap does not ensure his safety. Even at slow their limited mobility. However, this may result in speed, he can be thrown forward in a sudden serious consequences. stop. His neck and back muscles will not be strong enough to withstand these forces, which At home may result in his head being thrown forward and Even in the fi rst few months of your baby’s life, his brain could be damaged by bumping inside there are potential hazards in the home. The against his skull. following are some safety guidelines to help you keep your baby safe. These are some car safety guidelines for children of all ages: If your baby is sleeping in a baby cot, ensure that the screws are tightly and properly Always have your child secured in a car seat screwed and the mattress and bedding fi t when you drive. snugly in the cot to prevent your baby from The car seat should be suitable for your child’s getting tangled in the excess material. age, size and weight. Read the information on The distance between the slats of the cot the packaging carefully and choose one that should not be more than the width of a soda is most suitable for your child. can so as to prevent your baby’s head from Make sure the car seat is properly installed in getting stuck in between. the car. Let your baby sleep on his back in a clean, Ensure that the straps are properly adjusted uncluttered cot. Do not put fl uffy bumper and the seat is well-padded to give your child pads, soft comforters, pillows or stuffed toys maximum protection during a sudden stop. into the cot. These products can cause some Car seats with metal fi ttings can get extremely babies to suffocate. hot in the sun. Be sure to cover the seat if you Always make sure that the cover or mattress leave your vehicle in the sun. over the diaper-changing table is fi rmly Newborn babies should use a rear-facing car secured. seat (the baby faces the back of the vehicle) Never leave him alone on a bed or a diaper- which is well-padded. The car seat should be changing table as he may fall off. placed in the back seat. Never leave him alone with a bottle propped Do not use a rear-facing car seat on a car in his mouth. seat that faces an airbag. Never leave your baby alone in the bath, even for a moment. Babies can drown in as little as Childhood injury is no small matter. Besides 5cm of water.* causing hurt to your baby, it puts considerable Never leave small objects like buttons or physical, mental and emotional stress on you or plastic bags within your baby’s reach to other caregivers. Most of these injuries can be prevent choking. easily prevented. Thus it is important that you Do not hang a pacifi er on a cord attached to take simple preventive measures to keep your his clothing or hang anything else around his baby in a safe environment. Remember to pay neck. They could be potential strangulation attention to reports on baby product safety or hazards. product recall too.

*Information adapted from Safe Kids Canada, http://www.safekidscanada.ca 48 Oral Hygiene

Good oral hygiene starts from young and here is how to make sure your baby has smilehealthy teeth a little smile our baby is drooling so much is about 3 years old. This set of teeth will that you have to change his start to be replaced by an adult set from bib frequently. He is also around 6 - 7 years old. putting everything into his mouth to ‘chew’. He has swollen and red Y How to ease the discomfort gums, fl ushed cheeks and his sleeping A tooth pushing its way out of the pattern seems disrupted. Nothing you do gums can be uncomfortable. Since seems to help. He is grouchy, irritable the process takes days, this can mean and restless. These are common signs extended discomfort for your little one. of teething. Here are what you can do to make it less unpleasant for him: A baby’s fi rst tooth usually appears from about 6 months of age, though for some y Give him something to chew on. babies this may be earlier or later. The Teething rings, chilled rubber teething two lower front teeth (incisors) are the fi rst toys and hard biscuits or rusks remove to appear. The full set of baby teeth is the pressure on your baby’s gums. usually visible in the mouth by the time he Make sure that these rings or toys are clean before giving them to him. Oral Hygiene 49

y Rub or massage his gums with clean once at night before sleeping. Having fi ngers and a cold towel. This will help good oral hygiene practices from young soothe the discomfort. will go a long way in keeping his teeth y Cuddle and play with him to healthy in adulthood too. provide him with assurance and comfort and distract him from the uncomfortable feeling. EARLY y Give your baby cold food and water CHILDHOOD CARIES to help numb the discomfort. y If your baby cannot be soothed, Some parents give their babies a bottle consult your doctor for some of milk or sweetened beverage to drink pain-relief medication. while putting them to sleep. The milk or sweetened drink will pool around their Cultivating good oral habits teeth and cause tooth decay. This is called from young early childhood caries. Milk teeth or baby teeth are important. They help your child to chew and speak How to prevent early childhood properly. They also create space for the caries permanent teeth to erupt in the mouth. After each feed, clean your baby’s Healthy looking teeth are a tremendous y teeth with a wet cloth or a clean, damp boost to a child’s self-confi dence and self piece of gauze. esteem. As soon as your baby’s fi rst tooth y appears, start brushing it. There is no Start your baby on good oral habits early. need to use toothpaste at this stage. Begin by cleaning your baby’s gums daily By the time your child can spit from birth with a small piece of clean wet y effectively, use a smear of adult muslin cloth or a piece of gauze. This strength (1000ppm) fl uoride toothpaste will help your baby get used to the daily to brush his teeth. routine of cleaning his teeth later on. y Do not let your baby go to bed with a bottle of milk. The liquid will pool in the Brush your baby’s teeth as soon as they mouth, creating a breeding ground for appear. Use a soft bristled toothbrush bacteria. This can lead to tooth decay. that is specially designed for babies. Do not use a bottle of milk as a pacifi er Remember to wipe the surface of his y during the day, or let a toddler walk tongue as well, as milk or juice left there around with the bottle in his mouth. can cause tooth decay and plaque. Do not put any beverage (e.g. juice) When your child can spit effectively, y other than water or milk in the bottle. introduce a smear of adult strength (1000 Teach your baby to drink from a cup as ppm) fl uoride toothpaste to help prevent y soon as he can hold one. tooth decay. y Arrange regular dental checkups for your baby from as early as his It is important to cultivate the habit of fi rst birthday. brushing your baby’s teeth twice a day from young, once in the morning and 50 Going Back to Work Mummy’s

off to Havework peace of mind returning to work with your precious bundle being well cared for Going Back to Work 51

our maternity leave is ending of the domestic helper in managing the soon and you are feeling anxious household chores and caring for the baby and uncertain about resuming should be set. Having a trusted relative at Y work, and adjusting to the home to supervise and oversee the helper is working routine after such a long break. To a good option. ensure a smooth transition, you might want to start exploring your child care options Tips before returning to work. Are your parents, • Set clear rules and expectations from the parents-in-law or other trusted family beginning so that she is able to balance members able to care for your baby? Should handling household chores with caring you have your baby cared for by a domestic for the baby. Get her to follow your helper, a nanny or in an infant care centre? methods of child care. Observe that she You may also have to learn to work with understands what is expected of her and your support system to help with the care reinforce through further explanation and of your baby while you are at work. There clarifi cation. is bound to be some separation anxiety but • In your selection, do take note if the you can overcome this by planning your care domestic helper has children of her own arrangements early and assuring yourself that or has experience caring for a young your child is in good hands. child while working for a local family with children previously as this would be a Family member good reference to gauge her competency Getting a trusted family member like your and ability. mother or your mother-in-law to care for your baby is a good option. You can be assured Nanny that she would love your baby, is reliable and Nannies look after children in their own trustworthy, and will therefore look after him homes or in the baby’s home. There are well. She is also likely to care for him in your agencies that can help you fi nd a nanny home or hers, which is a familiar environment who lives near you. Nanny services are not for your baby. However, if your parents or in-law licensed. are elderly, they may or may not be equipped or able to deal with strong-willed babies and toddlers.

The care and development of children has seen much change over the years so your parents may have different views on how to care for your baby.

Tips • Discuss with your family member who is the primary caregiver on your expectations on how you want your baby to be looked after. If you are still breastfeeding, ensure she supports your decision to breastfeed. • Check that she is physically up to the job.

Domestic helper Some families may engage a domestic helper to look after the baby. A realistic expectation 52 Going Back to Work

Tips Infant Care Centres • Get feedback from parents who have used There are infant care centres providing full- her services; ask for a trial run to see if it’s and half-day care programmes for babies going to work out. from 2 months - 18 months old. Some • Visit her home to check the environment centres offer fl exible programmes and have a chat with her before you hire her. that cater to different work • Choose one who lives near you so that it arrangements. Before you will be more convenient dropping off or decide on an infant care picking up your baby. centre, it is important to • Set ground rules from the start. Tell her know and understand the what you expect regarding your baby’s programme at the centre. feeding, sleeping, TV-watching and discipline. If you are still breastfeeding, Information: ensure that she supports your decision to • Child and infant care centres breastfeed. are licensed by the Ministry of • When you have decided, bring baby to Community Development, Youth & spend some time with her and see how Sports (MCYS) and are required to meet they interact with one another. Do this for a acceptable standards of health, safety, couple of weeks before you return to work nutrition and hygiene measures. as your baby needs time to adjust. • Parents can receive a subsidy on fees for children of Singapore citizens. • Teachers and educarers (personnel What you need to know about working with children below 3 years tobacco products of age) have relevant training in early • If a family member or someone at the childhood education. Some centres also nanny’s place smokes, request him have a registered nurse on hand. to avoid doing so when your baby is • The staff to infant ratio set by MCYS is 1:5. at their home. This is because babies exposed to secondhand smoke Tips can suffer from chest infections, ear • Visit the centre prior to registration. See infections and have a higher risk of cot if the teachers and the children appear death. happy and comfortable. • Opening windows and doors does not • Observe how the teachers interact with the protect your baby from secondhand children. smoke. Research has shown that • If you are still breastfeeding, make sure the toxins from tobacco smoke (now centre supports breastfeeding. known as thirdhand smoke) settle on • Talk to parents whose children are in the surfaces such as sofas, curtains and centre to get fi rst-hand feedback on the carpets, as well as clothing and hair, place. and can take a long while to go away. These toxins may get into your baby’s Visit the Child Care Link website at body, through contact while he plays www.childcarelink.gov.sg or call 6258 5812 or crawls, or while being carried by a for more information on centre-based smoker. infant and child care. Going Back to Work 53

Breastfeeding at work There is no need to stop breastfeeding just you are away expressing. You need to because you are returning to work. With a be relaxed and comfortable to express. bit of planning, your baby can still be fully Thinking about your baby or looking at a breastfed and receive the best nourishment picture of him can stimulate milk fl ow. for him. Here are some tips to help you • Have a balanced diet andnd ttotallyoto alallyy aavoidvooidd juggle with resuming work and the desire to alcohol and tobacco productsoduccts aass thtthesehesese continue to breastfeed: can affect your milk production.duction.

• Two weeks before your maternity leave ends, start expressing and storing your milk. • At the same time, introduce your baby to the bottle by replacing one or two feeds with the bottle. Get someone else other than yourself to feed the baby. • Feed the baby just before you go to work and as soon as you arrive home. • Select clothing that facilitates milk expression such as a front-buttoned shirt. • While you are at work, express and store your breast milk in the fridge (usually at lunch break and just before leaving) or at regular intervals. • If your offi ce does not have a dedicated breastfeeding room, speak to your boss about using a spare room or the meeting room. • Get support from your colleagues and thank them for covering for you while 54 Going Back to Work

Expressing breast milk You can express your breast milk manually by using your hands or with a manual or electrical breast pump.

How to express breast milk with a breast pump? • Wash hands thoroughly before expressing milk • Ensure all the equipment are clean and sterilised. • Use your pump correctly, starting with low pressure and switching between breasts after 5 -10 minutes of expressing milk. • Express your breast milk every three hours and store the breast milk in the refrigerator or freezer.

Storage of the expressed milk Recommended

Place of Storage Storage duration Expressed milk at room temperature of 25°C 4 hours Expressed milk in a cooler with ice pack at 15°C 24 hours Breast milk freshly expressed and stored in the fridge at 4°C 48 hours Frozen milk in 2-door fridge stored at -5°C to -15°C 3 - 6 months Frozen milk in deep freezer at -20°C 6 -12 months Thawed breast milk stored in the fridge at 4°C 24 hours

Thawing process • Thaw frozen milk in the refrigerator or in a cup of warm water. • Use the milk immediately or within one hour. • Avoid boiling or heating breast milk in a microwave.

If you have problems with breastfeeding or are worried, be sure to speak to your doctor, lactation consultants or mothers who have managed breastfeeding successfully despite returning to work. Engage with baby as he learns and discovers new things... 6-12 months

6-months12

Nutrition for Your Baby 57

Getting You have breastfed your babyready for 6 months and now you want to start him on solids. for solids Here is how you can do it 58 Nutrition For Your Baby

he process of switching an infant from a milk-only diet to a mixed one that includes other solid food Tis called complementary feeding or weaning. Parents are recommended to introduce a good balance of solid food to their babies from 6 months of age (i.e. 181 days).

Starting on solids From 6 months of age, your baby is just about to learn how to swallow food. While milk should still be his staple, you can try giving him half a spoonful of a single ingredient food to taste.

Most parents begin weaning their babies with plain rice cereals. These cereals are usually fortifi ed with iron to help meet the baby’s increased need for dietary iron at this time.

Vegetables, fruit and small amounts of unsweetened fruit juices can also be included to provide vitamin C which You can also give him porridge blended enhances iron absorption. with mashed or pureed vegetables like pumpkin, sweet potato and carrot. Introduce other cereals like wheat and mixed cereals when he is a little older. If your baby is eating well, gradually increase it to a meal. To see if your baby is eating well, look at his bowel movement, his weight and his height.

By about 6 - 7 months, you can slowly introduce some protein food. If your baby has a strong family history of allergy or has a personal history of other allergic problems, food allergy is more likely to occur. If you are concerned, consult your doctor.

The form and texture of each food should also vary with the age of your baby. Do not add sugar, salt and seasonings into the food as your baby has delicate taste buds. 7-12 Nutrition mths nutrition for Yourfor baby Baby | 04359 60 Nutrition For Your Baby

What and how much to feed Start your baby on solid food gradually. Use the Healthy Diet Pyramid as a guide. Start by introducing foods at the base of the pyramid and work towards the top in the following order: • Rice and Alternatives Group (iron-fortifi ed baby cereals) • Vegetables Group • Fruit Group • Meat and Alternatives Group

Select Less Fats, Oils, Sugar and Salt Use in small amounts

Meat & Alternatives

Select More Fruits & Vegetables

Rice & Alternatives

Introduce one new food every 3 - 4 days with the aim of giving Recommended number of servings your baby food from all the basic per day for infants 6 -12 months food groups eventually. Food groups Recommended number of The table on the right shows the servings per day recommended number of servings Rice and Alternatives 1-2 per day from each food group for (Do include the recommended whole-grain serving infants aged 6 -12 months. as part of the Rice and Alternatives serving needs.) Whole-grains ½ Start with giving only ½ teaspoon of solids at fi rst. Slowly increase Fruit ½ (Fruit should not be used to replace vegetables in the diet the amount to 1- 2 tablespoons of or vice versa because they contain different kinds of nutrients) solids, 2 -3 times a day. Prepare his food with no salt, sugar or oil. Vegetables ½ Once your baby starts on solids, Meat and Alternatives ½ he may also need extra fl uids. The best for him are water and Milk 750ml breast milk. Nutrition for Your Baby 61

As your baby grows, the form and texture of his food S should change. T

Know the serving sizes The table below will help you get familiar with serving sizes of the various food groups. This will help you in meal planning for your little one.

Examples of one serving:

RICE & ALTERNATIVES VEGETABLES 2 slices of bread (60g) ¾ mug** of cooked leafy vegetables (100g) ½ bowl* of rice (100g) ¾ mug of cooked non-leafy vegetables (100g) ½ bowl of noodles, spaghetti or beehoon (100g) 150g raw leafy vegetables 4 plain biscuits (40g) 100g raw non-leafy vegetables 1 thosai (60g) ¼ round plate+ 1 large potato (180g) 1½ cups of plain cornfl akes (40g) MEAT & ALTERNATIVES 1 palm-sized piece fi sh, lean meat or skinless FRUIT poultry (90g) 1 small apple, orange, pear or mango (130g) 2 small blocks soft beancurd (170g) 1 wedge pineapple, papaya or watermelon (130g) ¾ cup cooked pulses (e.g. lentils) (120g) 1 medium banana ¼ cup*** dried fruit (40g) 1 glass pure fruit juice (250ml)

*Rice bowl **250ml mug ***250ml cup +10-inch plate 62 Nutrition For Your Baby 7-12 mths nutrition for baby | 045

These sample daily menus will give you an idea of the food you can prepare for your little one.

Sample Daily Menu for Babies: 6-9 months (smooth and lumpy food)

Sample meal plan No. of servings

Rice and Meat and Fruit Vegetables Milk Alternatives Alternatives

Early-morning snack

150ml breast milk/formula 150ml

Breakfast

3 - 4 tablespoons* of brown rice cereal mixed with 60ml breast milk/ ½ 60ml formula

Mid-morning snack

¼ medium banana (pureed) ¼ 180ml 180ml breast milk/formula

Lunch

¼ - ¾ bowl** of porridge with minced chicken (23g) and mashed pumpkin ¼-¾ ¼ ¼ (25g)

Afternoon snack

180ml breast milk/formula 180ml

Dinner

¼ -¾ bowl** of porridge with ½ small block of mashed tofu (43g) ¼-¾ ¼ ¼ ¼ and mashed broccoli (25g) ¼ small pear (scraped)

Supper

180ml breast milk/formula 180ml

Total Servings 1-2 ½ ½ ½ 750ml

*1 tablespoon ≈ 15g **Rice bowl

Please note that the above table is only a guide. Ideally feed your baby according to his appetite. Infants know how much milk or food they need and will regulate how much they take. This results in optimal growth. Let your child decide whether he wants to eat and how much to eat. Nutrition for Your Baby 63

These sample daily menus will give you an idea of the food you can prepare for your little one.

Sample Daily Menu for Babies: 10-12 months (mashed, chopped and cut food)

Sample meal plan No. of servings Rice and Meat and Fruit Vegetables Milk Alternatives Alternatives

Early-morning snack

150ml breast milk/formula 150ml

Breakfast

3 -4 tablespoons* of oat cereal mixed with 60ml breast milk/formula OR ½ 60ml 1 slice of wholemeal bread

Mid-morning snack

¼ wedge cut papaya ¼ 180ml 180ml breast milk/formula

Lunch

¼ -¾ bowl** of porridge with ½ small block of diced tofu (43g) and fi nely ¼-¾ ¼ ¼ chopped chye sim (25g)

Afternoon snack

180ml breast milk/formula 180ml

Dinner

¼ - ¾ baked/mashed large potato (45-135g) mixed with cooked 1 minced/ chopped chicken (23g), /5 1 ¼-¾ ¼ ¼ ¼ fi nely grated carrot (15g) and /3 fi nely chopped tomato (15g) ¼ wedge cut watermelon

Supper

180ml breast milk/formula 180ml

Total Servings 1-2 ½ ½ ½ 750ml

*1 tablespoon ≈ 15g **Rice bowl

Please note that the above table is only a guide. Ideally feed your baby according to his appetite. Infants know how much milk or food they need and will regulate how much they take. This results in optimal growth. Let your child decide whether he wants to eat and how much to eat. 64 Nutrition For Your Baby

How to introduce solids • Minimize distractions. Keep toys away Establishing a routine whilst allowing and do not switch on the television. your baby to enjoy his food Your baby may be ready for solids but he Feeding baby may not want to eat as he is not used to • Start your baby on a single-ingredient it yet. You need to establish a routine for food. Give him only half a spoonful eating. Once he is used to it, the process of the food. Bring the spoon towards becomes easier and enjoyable for your his mouth and if he opens his mouth, baby. Here are some tips on how to place the food gently at the back of establish a routine: the tongue. Remove the spoon and see how he learns to swallow. • Set a time for breakfast, lunch, dinner • Give your baby suffi cient time to fi nish and snacks. his food. Do not force him if he is • Seat your baby in the same place not hungry or is not interested. If he at mealtimes, preferably at the rejects the food, give him milk and try dining table. Put him in a high chair. weaning again during the next meal. Remember to pull the straps on the It may take your baby up to 8 times high chair fi rmly so that he cannot before he accepts a new food. Many climb his way out. babies have a tongue-thrusting refl ex 7-12 Nutrition mths nutrition for Yourfor baby Baby | 04765

when trying new solids, but this Food preparation does not mean that he does not • Food hygiene in food preparation is like the food. very important. • Use the table on “Recommended • Wash your hands before and after number of servings per day for preparing your baby’s food. infants 6 -12 months” (page 60) to • Have a designated space in the transit your baby towards eating kitchen for food preparation. Clean regular meals and snacks from all surfaces before and after preparing the food groups in age-appropriate food. portions. • Do not use cracked or chipped • Teach him how to feed himself. utensils (these have a higher chance Allow him to pick up food with his of harbouring germs). fi ngers or a spoon and to put it in • Do not mix raw food, especially his mouth. This will help develop meats, with cooked food. Meats, if his motor skills. Teach him to drink used, must be cooked thoroughly. from a sipper cup. Do not be fussy • If you re-heat food, make sure you about neatness during mealtimes. bring it to full boil for a few minutes. • Discard unfi nished food from your Prevent choking baby’s bowl. • Never leave your baby alone when • Keep food storage areas pest-free. he is eating. Always watch him to • Cover rubbish bins properly and make sure he does not choke. empty them regularly. • Ensure that the food is properly pureed, mashed or scraped so that it is easy for your baby to swallow without choking. As he gets older, food should still be soft, but chunkier and textured to help him learn how to chew properly. Avoid: - Hard food such as nuts, raw carrots, apples. These should be grated or cooked until soft. - Food with small bones. Fish bones should be removed. - Small, round food such as grapes and berries. These should be cut into bite-size portions and served. • Ensure he sits upright and is not slouched over while eating. 66 Allergies Whenallergies The environment and certain type of foods can cause an allergic reaction. occur So what can you as a parent do? Allergies 67

n allergy occurs when the like mosquito bites. Both can be caused body comes into contact by food allergies, medicines, and viral with a protein which contains infections. The patches do not stay in the A foreign substances that same spot. Hives will fade within minutes trigger an abnormal immune response in to hours, while allergic contact dermatitis sensitive people. may take days to disappear.

The immune system is your body’s Food allergy: Food or parts of a food defence against bacteria or other (e.g. nuts in a muffi n, eggs in a cake) can harmful substances. Sometimes, it may trigger reactions in people who may be mistakenly identify something that is sensitive to them. Most reactions are mild usually harmless as dangerous, and such as skin rashes. But some can be trigger a series of reactions in the body. serious such as anaphylaxis – a severe life threatening allergic reaction that can The exact cause of how someone be fatal if left untreated. develops an allergy is still not known. Although allergies tend to run in families, Other allergic conditions that may it does not mean that just because there manifest in early childhood are: is no history of allergy in your family, your baby will not develop it. If either parent Allergic rhinitis: The baby will have an has an allergy, there is a likelihood that itchy, runny and sneezy nose. It is caused the child will have the same condition. by inhaling dust mites, mould and animal dander (material shed from the body of Allergies can occur at any age, but they an animal). usually appear during a baby’s fi rst year. Most children, however, outgrow the Asthma: This is a condition where there allergies by the time they hit puberty. is chronic infl ammation of the airways, resulting in wheezing, shortness of Common Allergic Conditions breath, chest tightness and coughing. For An allergic reaction can come from what children with sensitive airways, asthma we eat, inhale or touch. It can also result attacks can be triggered by inhaling from medicines taken. Some common allergens. allergic conditions are: Allergens Allergic eczema: An allergic reaction of An allergen is a substance that triggers the skin that presents as dry, itchy, and an allergic reaction. red patches on your baby’s face and body, often in the folds of the neck, arms There are many types of allergens. In fact, and legs. anything around your baby could be an allergen, as long as his immune system Hives and allergic contact identifi es it as one. Common allergens dermatitis: Both conditions show include pollen, mould, household dust, raised, red, itchy skin patches that look dust-mites, pet fur and animal dander. 68 Allergies

There is no cure for allergies, though most children tend to S outgrow them in their teenage years.”

Common food allergens include eggs, If your baby’s doctor suspects that he has cow’s milk, soy milk, peanuts, shellfi sh, an allergy, the doctor may recommend a stone fruits (e.g. apricots, peaches) and skin prick test. In this procedure, drops grains such as wheat, oat and barley. of allergens that the baby is suspected to have are put on the baby’s skin. Then a Managing allergies tiny prick is made in each drop. How the There is no cure for allergies, though skin reacts will reveal which, if any, the most children tend to outgrow them in baby is allergic to. The doctor may give their teenage years. The most important him medication to reduce the symptoms, thing is to identify and avoid allergy hence reducing your baby’s discomfort. triggers, and work with your baby’s You will need to inform other caregivers doctor to address any symptoms. about your baby’s allergies and show them what to do in the event your baby has a reaction. Allergies 69

Get help Different symptoms last for different periods of time. Be alert and take note of your baby’s condition. It may not defi nitely be an allergy that he has but do consult a doctor just to be sure if and when your baby starts showing symptoms. Seek help immediately if your baby develops any of the following: • His lips, tongue or throat swell up. • He is wheezing, breathing loudly or has trouble breathing. • He is sweating or vomiting. • He has a widespread rash.

How to minimise your baby’s risk of getting an allergy

Minimising food allergy • If you have a family history of food allergies, avoid eating those foods that trigger the allergy, especially if you are breastfeeding. Allergens can be passed to your baby through the breast milk. • Seek professional advice. Consult your doctor on when and what solid food to offer to your baby.

Minimising environmental allergy • Do not let anyone smoke in your home or near your baby. • Keep your home clean and dust-free. Check that the place where your baby spends majority of his day (eg. nanny’s home, child care centre) is similarly clean. • Prevent your baby from coming into contact with pets. 70 Play-based Activities for You and Your Baby

Get your baby active with these great work outs

Let's play, Mummy!

eing active is natural for babies music in the background, and cherish this and it is an important part of time together with your baby. your baby’s development. Do not leave your baby in a Between 6 - 9 months, it is important for Bstroller or infant chair too often and for too your baby to continue spending time on long. These restrict his natural desire for his tummy to help strengthen his neck and movement. Put him in a safe place where back muscles, and develop coordination he can be stimulated with something to between his upper and lower body. He look at and something to play with. Keep may not be able to stay in this position for anything sharp, breakable or unstable out long, so do not force him to. Once he gets of his reach. Keep a lookout for small items stronger, he will be able to push up with his left on the fl oor and remove them. Play arms and look up. Play-based Activities for You and Your Baby 71

Also, try pulling your baby to a stand from a sitting position and let him bounce a few times before lowering him down. Between 9 -12 months, encourage your baby to pull himself to a standing position, walk by holding onto furniture or push a strong sturdy toy. Here are some age-appropriate activities that are great for babies to engage them physically as they have fun with you.

Play ideas with your baby • Cuddling and peek-a-boo Carry your baby out of the cot for loving cuddles. Play peek-a-boo with him, using your hands, his hands, and his blanket. Babies love the element of surprise in this game and will reward you with coos, smiles and chuckles. It is also a great way to get his muscles moving. When you need to do something, put him on a play mat on the fl oor and let him stretch and kick his legs around. Make sure there is plenty of space for him to wriggle around and check on him frequently. games to the tune of familiar songs such • Singing and talking as “Pop Goes the Weasel”. Your baby Babies love to be sung and spoken to. will learn to expect the surprise drop or Sit with your heels together, forming a bounce when he hears the individual diamond shape with your legs. Place a words. blanket over your legs and lay your baby on top, so that you have direct eye-to- • Dancing eye contact with him. Sing him nursery Play some music, carry your baby close rhymes and songs – anything with a to your chest, and dance! You do not rhythm will do. Or you could recite poetry! have to be an expert, just move, sway, You can clap your hands, move his dip, turn, glide, and bring your baby up hands, rock him gently and sway as you and down different levels gently as you do all these. You can also try bouncing move to the beat.

• Baby classes There are classes organised specially for mums and their babies. These are great fun as they introduce both of you to new friends who are going through the same experiences as you are. They also get you out of the house, offer a change of momentum and keep you connected to the world out there. 72 Safety First For Your Baby Safe home for your baby As your baby grows with increased mobility, youou may have to introduce new safety measures

house to make it safe for him to explore. Here is a look at some safety pointers.

y Try to stay within an arm’s reach of your baby. If you need to leave him for a while, place him in a safe place such as a playpen. y Keep everything within reach during bath time. Never leave your baby alone in the bath, even for a moment. Always have a hand to support him when he is in the water. Babies can drown in as little as 5cm of water*. y As soon as your baby can sit upright, move the mattress to the lowest position in the cot to prevent falls. t this stage, your baby may y Do not use a baby walker as it topples start to explore by crawling over easily and allows your baby to and pulling on anything to get to dangerous places quickly. stand upright. His newfound y Choose furniture with rounded A corners or use edge protectors to mobility brings a different set of safety concerns. While his tiny hands can reach cushion any bumps. for possible dangers, his wobbly legs can y Install safety gates in areas that you give way and result in potential head and do not want your baby to be crawling body injuries. Between 9 -12 months, or stumbling into, such as stair your baby may start to walk, climb and landings and the kitchen. pick up food and small objects with his y Small objects such as coins, buttons fi ngers. or parts of toys are choking hazards. Keep them out of your baby’s reach. Since your baby is likely to be active, Always check that you do not leave you may need to make changes to your small parts lying around for your little Safety First For Your Baby 73

one to pick up. If you have items such medicines and dangerous items such as plastic bags lying around, remove as pen knives, nail clippers or even them. Your baby can suffocate if he cotton buds out of your baby’s reach. puts his head in it or choke if he bites y Do not show your little ones how to on it. unlock doors, drawers or latches. y Fit electric outlets with covers, so They are quick learners and may pull that your baby cannot explore them. out dangerous items if you are not Do not leave him unattended where paying attention. electrical appliances are in use. y Remove pet care accessories such y Fill the bottom drawers of a chest as dog dishes and litter boxes so that with heavier items. This will prevent your baby cannot reach them. it from toppling over, in case your baby climbs on it. Make sure that For information on car safety for your other things such as table bookcases, baby, see page 47. vases, lamps or anything that could topple over are anchored down. * Information adapted from Safe Kids y Latch low cabinets and keep Canada, http://www.safekidscanada.ca 74 Social and Emotional Skills Your baby needs

softTo raise skills an all-rounded too child, pay attention to your baby’s social and emotional health Social and Emotional Skills 75

s babies grow older, they will such as having meals at regular times, a fi xed begin to express themselves time for bed each night, and following a specifi c more. Although they cannot sequence in bathing or eating gives him a sense engage in any meaningful of stability and contributes to his overall sense of A security and well-being. Your baby will enjoy the speech yet, they can respond by babbling loudly when someone talks to them. familiarity of the routine and this will be emotionally Between 6 -12 months, they will also start benefi cial for him. displaying emotions such as fear and anger to express their needs or discomfort. It is Lessons in behaviour also during this time that they look to their Your baby will not understand what is good and caregivers for consistent trust and security bad behavior unless you help him to. Establishing in times of uncertainty. Hence, this period rules on behaviour helps to enhance his social is critical for you to establish a strong awareness of others and helps him establish self- bond with your baby and provide a secure control. environment for him to grow healthily.

Providing assurance and security At this age, it is normal for your baby to feel insecure and fearful when you walk away from him. Recognise that this is due to his increased awareness of strangers and this apparent emotional dependency on you may pass in a few months.

Do not be irritable when he clings tightly to you. Instead, be patient and shower him with reassurance. Provide him with plenty of opportunities to be with others and assure him that the people around him are dependable. Speak words of support to him, hug him when necessary and shower him with praise when he makes efforts to cope positively. Even if he fails, your praise and approval act as encouragement for him to persevere and try again. At the same time, it helps to boost his confi dence.

Establishing a routine Putting your baby into a routine helps in his emotional development at this age. Routines 76 Social and Emotional Skills

Show your baby what is good and bad A positive and supportive relationship behaviour. To reinforce good behaviour, among family members helps promote reward him with attention by clapping positive emotions in your baby. Hence, your hands, smiling at him and praising avoid confl icts in front of your baby and him. For bad behaviour, say ‘no’ and be speak to each another in a calm and fi rm with him. Discourage bad behaviour pleasant way. As he develops his abilities, through your tone and expression, and he will also learn to communicate like ignore him for a while before reassuring you do. him that you still love him. Repeat this process until he understands it is your Encourage all family members to spend way of saying ‘no’ to bad behaviour. time playing with him and making him laugh. Playing and having fun together It is important to refrain from always helps to build happy memories which can correcting your baby on what he should make him feel confi dent about himself not do. Instead help him to learn and the people around him. appropriate behaviour by telling him what he should do and model that good As your baby becomes more sensitive behaviour. to your emotions, it is important for you to be able to manage your negative Building a safe, positive and emotions as you tend to him. Your baby happy environment can sense your frustration in your tone Your baby learns from the people he and your expression and react negatively interacts with and responds to the towards you, which might stress you environment he lives in. As parents, you out even more. Hence it is crucial that play a critical role in establishing a safe, you look for ways to calm yourself down positive and happy environment for the before attending to him. Once you are growth of your baby. calm, you can soothe him by cuddling and singing to him to make him feel safe, loved and secure. The discovery of the world for you and your child continues... 12-24 months 12-months24

Nutrition for Your Toddler 79 Nutrition after the first year

Eating well starts at a young age. Here is what every parent should know

t this age, your child’s Your child has been growing rapidly, digestive system should be tripling his birth weight in a year. Now mature enough for him to eat his rate of growth will slow down and A the same food as you. his appetite may lessen. This is normal. Ensure that his food is prepared with very Remember that his tummy size is still little salt, sugar or oil. He should also small. Do not force him to eat more drink enough water and get enough fi bre than he needs. It is best to offer smaller (from fruits, vegetables and whole-grains) portions of healthy food more often and to prevent constipation. You can continue let him choose how much to eat. to give him breast milk. If he has been drinking formula milk, it is fi ne to switch to What and how much to eat whole milk (after he is 2 years of age, you As a parent, you model food preferences may switch him to low-fat milk). and play an important role in setting a 80 Nutrition for Your Toddler

good foundation for your child’s dietary All you have to do is to: habits. Eating habits can infl uence y Be a good role model. the risk of developing lifestyle-related y Ensure that he has a balanced diet diseases such as obesity, diabetes, with a variety of food. high blood pressure and high blood y Be creative when preparing and cholesterol. There is growing evidence presenting food. that food preferences and eating habits developed from childhood can infl uence a Offer your child a variety of food from child’s eating habits when he becomes an the four main food groups to get all adult. Hence it is important to help your the nutrients he needs. Select the right child make better food choices now. This number of servings from each food group will have a big impact on his health and using the table below. quality of life later.

Recommended number of servings per day for children 1-2 years*

Food groups Recommended number of servings per day

Rice and Alternatives 2-3 (Do include the recommended whole-grain serving as part of the Rice and Alternatives serving needs.) Whole-grains ½-1

Fruit ½-1 (Fruits should not be used to replace vegetables in the diet or vice versa because they contain different kinds of nutrients)

Vegetables ½

Meat and Alternatives ½

Milk 750ml

* Refer to the table on papagege 61 for examexamplesples of one servinservingg forfor each ffoodood grgroup.oup. Nutrition for Your Toddler 81

Below is a sample daily menu for your child.

Sample Daily Menu for Children: 1-2 years

Sample meal plan No. of servings Rice and Meat and Fruit Vegetables Milk Alternatives Alternatives

Early-morning snack

150ml breast milk/whole milk 150ml

Breakfast

3 - 4 tablespoons* of oat cereal with 60ml breast milk/whole milk OR ¼-½ 60ml ½-1 slice of wholemeal bread with jam

Mid-morning snack

1 - 2 plain biscuits ¼-½ 180ml 180ml breast milk/whole milk

Lunch

1 ½ small block of tofu (43g), /3 large 1 potato (60g) and /3 medium carrot (25g) stewed with cooked rice (25g ½-1 ¼-½ ¼¼ to 50g) ¼ - ½ wedge watermelon

Afternoon snack

180ml breast milk/whole milk 180ml

Dinner

½ bowl** fi sh soup noodles (100g) with 1 small piece fi sh (23g) and 1 ¼-½ ¼¼ cooked spinach (25g) ¼ - ½ orange

Supper

180ml breast milk/whole milk 180ml

Total Servings 2 - 3 ½-1½ ½ 750ml

*1 tablespoon ≈ 15g **Rice bowl The above recommendations are only a guide. Babies go through growth spurts at intervals. At those times, they may drink more milk or consume more food. Be guided by your child’s appetite. 82 Nutrition for Your Toddler Nutrition for Your Toddler 83

Nurturing healthy eating habits is as easy asABC

void negative behaviours or being overly anxious during mealtimes. A Mealtimes should be relaxing, pleasant and a fun experience for your child.

e there with your child. reate a routine for your child. This B Having meals as a family C means setting a time for breakfast, creates opportunities for you to lunch, dinner and snack times. Once you have model healthy eating habits to a routine, mealtimes become more relaxing for your child. your child and for you too!

o not allow distractions stablish the habit of sitting in D during mealtimes. These E a regular place for include watching television or meals. Do not let him playing with toys. lie down, walk or run about while eating.

ood choices are cultivated from young. Find F simple ways to increase your child’s awareness of healthy and nutritious food. For example, you could take him along to the supermarket and teach him to make healthier choices. 84 Physical Activities for Your Toddler

Let's go,AnyAny formforMummy!m ofof pphysicalhysical aactivity,ctivity, iincludingncllududing pplaying,laying, iiss iimportantmportant ttoo youryour cchild’shild’s developmentdevelopment

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Try these with your child: such as “The Wheels on the Bus” and “Hokey Pokey” are not only fun to learn, • Encourage outdoor activity but encourage movements too. You can Bring him to the playground in the evening also try simple play activities such as when it is not too warm. Encourage and chasing balloons around the house and help him climb up and down the stairs in encouraging him to try and catch the the playground. Go on a nature walk and balloon with both hands. Pulling along a engage him in simple activities such as toy while walking is great too. sand play or picking up objects (e.g. leaves or twigs) which helps to develop balance. • Explore new activities You can name objects and ask him to Let your child try different physical touch things as he walks. This helps to activities and encourage him to develop his physical and language skills. explore different equipments at the playground with your supervision. Being You can also engage him in water play at overprotective may hinder his exploration the pool with supervision. Do not include and development. activities such as reading, playing games on hand-held electronic devices or other • Engage his senses forms of near work activities at this age. Children need to engage their senses Instead, your child should be doing things to learn and to process information. Do that involve his whole body. It has also activities that allow them to see, hear, been found that spending time on outdoor touch, taste and smell. Try baking muffi ns activities may reduce the risk of developing or cookies and decorating them. Children myopia (short-sightedness). love helping to mix the ingredients and watching them blend together. • Be active indoors too If the weather does not permit, your Help your child adopt a child can keep active indoors too. Even healthy lifestyle reading a bbookook can bbee tturnedurned iintonto an A childchild wwhoho iiss pphysicallyhysically acactivetive wwillill grgrowrow activity. Act out the characters and thetheirir up to be an active adult and continue actions and have fun with yoyourur child. leadinleadingg a healthhealthyy lifestyle. Throughh dress-up and role-play ggames,ames, he can iimitatemitate bbehavioursehaviours ththatat hhee sees and learnrn interactiveinteractive,, social and negotiationgotiation skills. Movementment rrhymeshymes 86 Physical Activities for Your Toddler

lasting longer than 90 minutes with Here are some tips to help your child 5 -10 minutes of moving around, playing, adopt a healthy lifestyle: standing or doing some physical activity.

• Engage your child from young • Walk the talk Involve your child in different types of Set a good example and participate physical activities from young. This will enthusiastically in different types of cultivate his interest in these activities and physical activities with your child. Take the he will be more likely to continue with an lead and be pro-active! active lifestyle as he grows up. • Select gifts that promote • Make it a routine physical activity Make time for daily physical activity. Try Gifts such as balls can provide your child incorporating it within the daily routine with a pleasant surprise and endless through structured and unstructured hours of physical activity. activities such as getting your child to help with the household chores (picking up • Plan an active weekend his own toys or wiping his own table), Weekend outings need not be sedentary. using the stairs instead of taking the Plan a family outing to the park where lift or alighting one-stop earlier and everyone can explore these open walking with him to the destination. spaces or simply run around, or to malls where there are opportunities for • Limit sedentary activities your child to play at the playground Limit time spent on sedentary activities or water play areas. such as watching television to less than This will allow you and two hours per day. Break up sedentary your child to engage in activities (except time spent sleeping) physical activity and also promote family bonding. Physical Activities for Your Toddler 87

Active Family Fun!

Parks and gardens When your child becomes a toddler, he will enjoy exploring open spaces. Bring your child to the playground and other beautiful green spaces. Here is what you can expect from some of the parks in Singapore: • Sand and water play areas. • Tree houses with slides and stairs; opportunities to see, touch, feel and smell all sorts of fl ora and fauna. • Giant space-nets, cableways and innovative play stations. • Stroller-friendly paths; mums can work the weight away through “strollercise”. • Diaper-changing tables. For more information on parks and gardens, log on to www.nparks.com.sg

Malls Some malls provide great avenues for active play with their playground or water play areas. Parental supervision is necessary during play. Many of these malls have diaper-changing and nursing rooms, child-sized basins, toilet bowls, seats and boys' urinals.

Some of these malls are also Health Promoting Malls (HPM) which provide a range of opportunities, in the form of events, facilities, products and/or services for its shoppers, employees, tenants and local community to improve their health. For more information on HPM, log on to http://www.hpb.gov.sg/healthyliving/article.aspx?id=8960

Plan, prepare and go! • Know your child’s napping habits. Go out only after he has had his nap. Otherwise, he will be grouchy. • Let him sleep in the car while travelling so he arrives refreshed and ready to play. • If the journey is a little long, get a sing-a-long DVD or a favourite toy so that he will be entertained. • What to pack: - Changing mat - Diapers - Baby wipes - Plastic bags/Ziplock bags - Milk or snacks - Bibs - Sunscreen, hat, umbrella - Toys, books - Sling/baby carrier - An extra set of clothes 88 Safety First for Your Toddler Keeping your child

At 12 - 24 months, your child still needs your protection, and child-proofi ng is still a must

rom 12 - 24 months, your child will begin to explore places that used to be out of reach. He will love to safe F climb and will quickly learn how to open doors, drawers and even bottles. Your curious child might get himself into some trouble and hurt himself badly. If you plan to have your child cared for by a relative or a babysitter, you have to ensure that the caregiver follows your instructions as closely as possible. Here are some measures and precautions you should take to ensure your child’s safety.

Living room and bedroom You may think that your child is safe here but you still need to ensure that child-proofi ng details are in place. house by himself or enter rooms that y Ensure that there are window grilles in the are not child-proofed. rooms and that they must be locked at all y Do not allow him to jump on the bed, times. Keep the keys in a safe place. sofa or other furniture. y Window guards and stops are necessary y Do not leave tobacco products, to prevent your child from opening the matches or lighters lying around where windows. your child can reach them. Your child y Place furniture – chairs, side tables, may either burn himself or attempt to shelving units – away from windows to use the tobacco products. prevent him from climbing up and falling out of the windows. Kitchen and bathrooms y Cover the corners of furniture with edge These are some safety measures you protectors, especially those with sharp may want to implement in the kitchen and edges. bathrooms. y Keep stairs and fl oors free of clutter so y Lock bathroom and kitchen cabinets. that he will not trip and fall. Safety gates You do not want your child to come are a must at all stair entrances to block into contact with liquids like cleaning his access to stairs. detergents or bleach, or with sharp y Always ensure that the fl oor is dry so that objects like knives, scissors or shaver he does not slip and fall. blades. y Ensure that he cannot get out of the y Use a stove guard. Place pots and Safety First for Your Toddler 89

saucepans with their handles facing the y No pushing or rough play and he has to side or the back. A child’s skin is much learn to wait for his turn. thinner than an adult’s and burns more y Hold on with both hands when swinging quickly and deeply. or climbing. y Use an appliance latch or lock to secure washing machines, microwaves, ovens Water Safety and dishwashers. You may be thinking of taking your child for y A toilet seat lock will prevent him from water-play or teaching him how to swim. falling into the toilet bowl. Here are some safety rules: y Make sure pails and bathtub are empty. y Make sure your child is always closely Babies can drown in as little as 5cm of supervised when in the water at all times. water*. Do not get distracted and lose sight of y Use rubber mats in the bath or wash area him. During social gatherings, adults to prevent him from slipping. Make sure can take turns to be the “designated you buy the non-slip mats. watcher”. If you must leave, take your y Keep the bathroom fl oor as dry as child with you. possible. y Keep him out of the water during bad weather such as thunder, lightning or rain. * Information adapted from Safe Kids You should also endeavour to learn CPR Canada, http://www.safekidscanada.ca (Cardio Pulmonary Resuscitation). y Do not depend on air-fi lled swimming Playground Safety aids, such as water wings, in place of a Play is a very important part of any child’s proper life jacket. Flotation devices are development. Spending time at the NOT life-saving devices. playground can be a great way to help your y Follow safety rules and signs. Make sure child grow socially and creatively through you know where the lifeguard and rescue play. Here are some simple safety guidelines: aids are. y Do not allow him to play or run near the Reducing the risk of injury at the pool as he may slip and fall. playground y Do not let your child play in clothes that have cords or drawstrings. y Do not bring him to the playground during rainy weather. y Supervise him closely at the playground and ensure he plays with age-appropriate equipment. y Inspect the playground for hazards such as broken or poorly maintained equipment. Ensure there are strong handrails and barriers to prevent falls.

Teaching your child the basic rules of safe play y Not to walk across a moving swing or see-saw. y Slide down feet fi rst and sitting up; and only one person on the slide at a time. 90 Alternative Child Care Arrangement

Placing your child in a child care centre If you have to put your child at the child care centre, it is important that you choose the right one for him. Here are some tips to help you

or some working parents, Infant and child care centres in Singapore there may come a time when provide full- and half-day care and you have to consider placing development programmes for children from your child in a child care centre ages 2 months -7 years: F • Infant care: ages 2 -18 months if you have no alternative child care arrangements. Child care would be a new • Child care: 18 months - below 7 years experience for your child and may require some getting used to. Children benefi t Generally, they are open from 7am -7pm from the ample socialising opportunities a on weekdays and 7am -2pm on Saturdays. child care centre provides. Some centres have fl exible programmes for parents who work part-time or fl exible hours. Alternative Child Care Arrangement 91

Child care centres are licensed by the Step 3- Visiting the centre Ministry of Community Development, • Visit the centre, preferably with your Youth and Sports (MCYS). They are child. required to meet acceptable standards • Speak to the supervisor and teachers. of health, safety, nutrition and hygiene Find out more about the centre’s measures. Centres must also provide age philosophy on child development, care and developmentally appropriate activities and education and child management to stimulate a child’s mental, physical and methods. Check the operating hours, social development. fees, mode of payment, your eligibility for government child care subsidy, Getting started availability of trial period, notice period With so many child care centres, how do for withdrawal and their procedures for you go about choosing the right one for handling sick children. The staff should your child? Here are some tips to get you have the required qualifi cations and started: the centre’s programmes should be holistic, balanced and appropriate to the Step 1 – Finding a centre developmental needs of the child. • Use the search function on MCYS’ Child • Observe how the staff interact with the Care Link website at www.childcarelink. children. gov.sg or call 6258 5812 to locate a • Look at the children. Do they like child care centre that is most convenient their teachers? Are they happy and for you. engrossed in their play? Are they engaged in stimulating activities Step 2 – Selecting a centre and given opportunities to explore • Pick a centre near you or your with materials and equipment? Are caregiver’s home or even your offi ce. the furnishings and furniture age- That way, you don’t have to travel far to appropriate? bring your child to school if you are on sick leave that day. If it is near your work Step 4 - Talking to other place, you can visit him during the day. parents If it is close to the home of your parents • Talk to other parents at the centre. or parents-in-law, they can pick him up if • Are they happy with the service you are running late. provided? Are their kids interacting well • A centre participating in Health with their teachers? Promotion Board’s “Healthy Eating in Child Care Centres Programme (HECCP)” provides healthier food options that meet dietary requirements and teaches your child the importance of healthy eating. The cooking staff are also trained on healthier methods of preparing meals. • Make an appointment to visit the centre. 92 Alternative Child Care Arrangement

• Have the parents had concerns that toddlerhood. Recognise that your child is were not addressed by the supervisor or going through a transition – just like you teachers? Talking to these parents will give are! – and continue to reassure him of your you a better perspective of the centre. love. You may want to let your child bring a familiar item from the home such as a Step 5 – Quality Indicators favourite toy or a pillow to give him a sense • A 24-month licence means that the of familiarity/security. Do not prolong the centre has a high standard of care while a time of separation as this may worsen the 12-month licence means that the centre separation and mislead the child to think that has met the minimum standard. you will stay with him if he continues to cry. • Centres which have attained the Singapore Ensure your child is in the safe hands of the Pre-School Accreditation Framework caregiver, assure him that you will return and (SPARK) offer kindergarten programmes leave the caregiver to manage your child. with high quality standards endorsed by the Ministry of Education. • Give your child time to adjust Be patient with your child. Do not scold or Tips to help your child cope tell him that he is being silly. Remind him that and adjust you will be back to pick him up and make • Prepare your child for the sure that you are punctual. Different children experience take different lengths of time to adjust. Some Start preparing your child for child care a children cry for a day or two, others may stay few weeks before admission. Explain to upset for weeks. Once your child gets used him what a child care centre is. Let him to the daily routine in the child care centre know what he will be doing there and tell and realises that he will be reunited with you him how much fun he will have learning at the end of the day, he will be fi ne. If you new things, playing with new toys and are concerned about the length of time that making new friends. your child is taking to adjust, talk to the • Accompany him to the centre teacher about Familiarise your child with the centre by how you bringing him there for 1 - 2 short visits to can work see the place and to meet the teachers. together to When your child starts school, it is help settle advisable to accompany him for only a few your child. days but not more than a week so that he will not become dependent on you.

• Help him manage separation anxiety and transition It is normal for children to cry when they are put in a new environment. They fear that their parents will not return. This is called separation anxiety. It can start between 6 - 9 months and can last through Hygiene 93 washy

"WashyGood hand washing habits start from young clean" hildren love playing outdoors, as the doctor’s clinic, play gyms and exploring and touching new other play areas things. They will touch their y After touching dirty items such as rubbish faces, rub their eyes or put their hands into their mouths, not Remember to model good hand washing knowing that they are dirty. Their immune behaviour to your child from young system is not as well developed as adults so that he will carry this healthy habit to fi ght infections and diseases such through to adulthood. He will be more as diarrhoea and hand, foot and mouth willing to do it if he sees you doing it as disease (HFMD). Thus, it is important for well. Just 30 seconds of hand washing you to teach your child good personal could make a difference to your health, hygiene such as hand washing. and the health of your little one!

Proper hand washing is the fi rst line of defence against the spread of germs OTHER USEFUL HOUSEHOLD that will lead to various infections and HYGIENE TIPS diseases. The simple act of washing hands with soap and water for 30 POTTY seconds reduces germ count up to • Keep the potty in the toilets 99 per cent. (not in the bedrooms or living area). • Ensure that your child cannot reach - Encourage your child it when he is not using it. to wash his hands: • Flush the contents down the toilet y Before and after eating bowl, wash and disinfect the potty y Before and after helping out in immediately after each use. the kitchen y After using the toilet TOYS y After sneezing, blowing his nose • Have washable toys. and coughing • Wash (with warm, soapy y After playing outdoors water) and disinfect toys y After touching common surfaces regularly, especially if your such as lift buttons, door knobs and child likes to put them into table-tops his mouth. y After touching pets y Upon leaving 'high risk' places such 94 Hygiene

- "Washy Washy Clean" Children are more open to hand washing if you make it fun. Get your child to wash his hands to this jingle, sung to the tune of ' If You're Happy And You Know It'.

{ “We start with washing palm to palm” | “Between each fi nger let us rub” } “Now the back of the hands, it’s such a simple plan. We washy washy clean, scrub scrub.” ~ “Clean the base of the thumbs one by one”  “Then the back of the fi ngers, this is fun!” € “Don’t forget your fi ngernails, it’s about details. We washy washy clean, scrub scrub."  “Now move on to the wrists, let us rub. I think we’re nearly done, so now what?" ‚ “Just rinse the soap away, dry our hands and we’re ok. We washy washy clean, scrub scrub.”

Chorus: “So we washy washy clean, scrub scrub We washy washy clean, scrub scrub It’s fun to wash your hands and I know you’ll understand We washy washy clean, scrub scrub!”

Download the song from Apart from hand washing, having a healthy www.hpb.gov.sg/studenthealth lifestyle (healthy diet and regular exercise) is equally important to strengthen one's immune system to fi ght against diseases. Coping with Your 2 Year-old 95

Your 2 year-old can be a handful. But here are steps to keep him in line When a firm hand is needed... s babies grow from 1 - 2 years Common Behaviour old, the world really opens up Clinginess to them. They are no longer Your child is afraid to be separated from A completely helpless. They you and becomes upset when you are out will start to assert themselves and test of sight. He cries when you go away and boundaries before someone stops them. he will not let go of you. Bringing him to preschool each day is a trial. They will become more curious than before; they are eager to fi nd out how things work; What to do excited to communicate their experiences • Offer lots of hugs and cuddles to calm to you in different ways (as they have limited his fear and anxiety. vocabulary); and cannot bear to be away • Keep reassuring him that you love from you even for a minute or so before they him, even though you are not with him turn to screaming or crying. physically. • Find out if he has other fears or things If you fi nd yourself wondering whether you that are causing him to be anxious will ever make it through this stage, do not other than separation anxiety (e.g. a worry! Many parents have gone through this fi erce teacher, a naughty classmate passing phase. Here are tips to help you who bullies him at school) and help manage the different kinds of behaviour that him to resolve the problem and you may encounter with grace and patience. conquer his fear. 96 Coping with Your 2 Year-old

Possessiveness Show of independence Your child is still at the age where he may Your child will have diffi culty controlling his refuse to play with other children or let emotions as he gets frustrated with the them play with his toys. He is likely to be limitation he has in expressing himself. more self-absorbed and self-centred. This is a time when he is learning to assert himself, striving for independence and What to do getting his own way. Throwing a tantrum • At home, play with him and teach him is often a reaction to not getting what he howhoh w to shareshare aandnd ttakeake tuturnsurnns to pplaylay wawants.nnts. withwithh toys.toys.s. • LetLet himhihim knowknowo thatthat his totoyy wiwillll ccomeomme WhWWhatat ttoo do backback toto himhih m eveneven ifif heh letslets anotheranotther • K Keepeee p yoyoururu ccoolool anaandd do nnototo rreact.eact. IfI childchilld playplp ay withwith it.it. youyou showshhowo youryour anger,anangeg r,r iitt wiwillll wworsenoro seen • Iff therethere arearee conflconfl icicts,cts, hehelplp hhimimm thethhe situationsituuata ioon ass hehe stillsts ill doesdod ese nnotott understandunndeersr tandn thethe needneed to playplaay ninicelycec ly wwithith understandunu derstat nd whatwhaat is wrongwrongg wwithitth hihiss others.othersr . behaviour.behaaviouo r. • EncourageEncouragge andand prppraiseraia se hhimim wwhenhen he • T Teacheach hhimim tthehe wwordsords ttoo exeexpressprp ese s hihhiss makesmakek s an efforteffort to pplaylaay orr ssharehah ree wwithith wantswaants so thatthat heh cancana saysayy themthem ininsteadsts eaead others.othersrs. of cryingcryyinng or screaming.scrreaming. • E Explainxpplaain ttoo hihhimm hihhiss bebehaviourhavviour is nnotot acceptable.accceeptp able. • H Helpelp hihhimm gegett ovoverer tthehe uunhappiness.nhappinnesss . Coping with Your 2 Year-old 97

• Give him time to calm down but through ways that are easy for him to remember not to reward him with too learn. Humour helps. much attention or in any other way. • Do not give in to his tantrums no matter Great curiosity how embarrassing it can be, as his Your child will start to explore and experiment behaviour may get worse each time. with what he can get his hands on. He • Give him options to choose from so he may become frustrated and anxious when can have a sense of control that he is he cannot reach or do what he sets out to making his own decision. complete. • Note that his tantrums may also be a sign of distress, or a sign that he is just What to do tired and needs a nap. Pay attention to • Provide lots of space for him to explore his habits, personality and temperament his environment, but ensure safety. for signs of changes. Do not brush the • Offer him things or toys that he can touch, tantrum off as naughty behaviour until you press or squeeze to stimulate creativity fi nd out more about the circumstances and encourage exploration. Make sure that surrounding the tantrum. they are durable and not easily broken. • Praise his good behaviour and efforts • Give him a hand when he is frustrated so that he can distinguish between by tasks which he can’t cope with. acceptable and unacceptable behaviour. Encourage him to keep trying in order to build his perseverance and patience. Whining Whining is another act that your child may STRATEGIES TO HANDLE do to get your attention other than throwing YOUR 2 YEAR-OLD tantrums. Your child may whine to express his needs and, at times, for no apparent Start with yourself reason. It is normal for your toddler to want Happy, well-adjusted and confi dent parents to be the centre of your attention and to get form secure relationships with their children. what he wants. It is important to take care of your mental well-being and fi nd avenues to relax and What to do calm yourself down before you manage your • Stay calm when your child begins child, especially when dealing with his diffi cult to whine. He whines to express his behaviours. frustration or because he wants to be heard. Seek help if you need to as you do not have • Find out what may be triggering this to do this on your own. Remember, your child behaviour since toddlers are not able models his behaviour after yours. If you are to verbalise their feelings and needs able to respond to him positively even during well. Explain to him why whining is not his most diffi cult times, he will learn positive acceptable. coping skills from you and be assured that • Do not give in because you don’t want to you can be depended on at all times. encourage your child to use whining again the next time he wants something. Consistency in discipline and • Be consistent in showing your child control whining is not to be used and is It is important to agree with your spouse something you will not tolerate. on a set of consistent rules for your child. • Teach him to express himself calmly and Be consistent in disciplining your child – 98 Coping with Your 2 Year-old

maintaining fi rm boundaries will help Encourage child’s play as him develop positive behavioural and children learn through play emotion management skills. They will Playing is an important activity for all also learn to differentiate right from children. This is when your child uses his wrong. Children who are more diffi cult to knowledge and his creative and social skills manage require more patience, warmth to interact with others. He will also get to and encouragement. As you are a role learn from mistakes through fun and play. model, what you do and say will have a big impact on his life. As he is only 2 Building happy memories and a years old, set a few simple rules for him to positive self remember. Set realistic expectations and Your child’s capacity for memory will always fi nd out the cause of his actions. expand and he will remember the things he sees, hears, smells and touches through The power of praise his experiences, even though they may be Encourage and praise your child when he in fragments. Building happy memories completes a task, no matter how small from a young age is one way to help him it is. Praise the effort, not the ability. That become optimistic. Having memories of way, he will know that he can turn to you good times allows him to give meaning to if he has problems because he learns his life and can be especially useful during that you appreciate his effort rather than diffi cult times to help him recover from his ability. It will motivate him not to be any setbacks. Help him appreciate the afraid of going through multiple attempts positive aspects of life and verbalise your until he succeeds. This will help build thankfulness for even the little things. his character, and help mould him into a confi dent, determined and resilient child. Because your baby wants you in his life.

All about

dads All about dads

Daddy, You are Important 101

Children look up to their dads. Be there for your little one dearestDaddy

ingaporean fathers are important people. That is what the Public SPerception Survey on Fatherhood in 2009 found. At least 97% of Singaporeans believe that fathers play a valuable part in their children’s lives.

The survey was commissioned by the Ministry of Community Development, Youth and Sports, and covered more than 2,000 respondents. It also found that:

• 82% of fathers have a strong infl uence in shaping their children’s values;

• 96% of the fathers surveyed feel very committed in their role as a father;

• 95% of fathers feel that raising children is one of the most fulfi lling experiences a man can have. 102 Daddy, You are Important

As a father, you play a unique role in your interact positively with them. The more child’s life and you make a signifi cant time they can spend with their children, difference in shaping his self esteem, the bigger the impact on their children’s character and values. lives.

A father’s influence Other studies show that when a child Fathers have a huge impact on their develops an attachment to the father, he children’s psycho-social development. will feel emotionally secure, confi dent to Fathers who spend time with their explore his surrounding and have better children provide a sense of security and social connection with their peers as authority to the family. Children look to he becomes older. That’s not all. Play their fathers for comfort and assurance makes learning fun and inspiring for whenever they feel insecure or uncertain. children. When fathers engage children Thus, it is important for fathers to make in play, they are verbally and physically time for their young children and learn to stimulated. The way fathers play with their children has an important impact on their children’s cognitive, emotional and social development. Children with an involved, nurturing and playful father have better educational outcomes and Becoming a father has made me are better able to regulate their realize I need to take better care of my own emotions and behaviour. health as I am now a primary infl uence on my child. For example, I have started eating more vegetables, which I didn’t like, to infl uence my daughter into eating them. She also feeds me corn, which is her personal favourite food. I can’t reject her as it is out of love that she has offered me! Low Young Fei, 30 years old, Father to Emma Low, 2. Daddy, You are Important 103

I was at the playground with my son when he scrambled up a rock-climbing wall. The other parents were impressed at how brave he was because he was among the youngest kid there. I was really proud because I'm glad I've raised a boy who has the confi dence to try new things. Zhang Jin Hui, 33 years old, Father to Zheng Jie, 3.

The father’s role is signifi cant and benefi cial, not just to his children, but for themselves as well. Research suggested learn to build self-confi dence and develop that men who are fathers are more their problem-solving skills during their satisfi ed with their marriage and have growing years, which is critical to their closer relationships with their children. mastery of new skills and building of They are also more connected and are their self-esteem. Children whose fathers able to cope with work-related stresses expect them to learn how to cross the better. street on their own or take a bath without help tend to be more self-confi dent. Raising an all-rounder On the contrary, fathers who discourage Fathers tend to challenge their children their children or insist on their own way to explore, learn new experiences and be may hamper their children’s creativity, more independent. As a result, children motivation and problem-solving skills. 104 Daddy, You are Important

Here are 10 steps to help you become a ] Be your wife’s best friend great dad and a supportive husband: Encourage your wife as she may be easily distressed over your baby and breastfeeding X Be encouraged after birth. Help her fi nd ways to get Even as your wife is preoccupied with comfortable. Get her some healthy snacks, caring for your baby and has no time for books to read or even pop in her favourite you, do not be discouraged. Now is the DVDs so that she can relax while she time for you to build that special baby- breastfeeds. and-dad bond. At the same time, pamper yourself a little more by exercising, relaxing If your wife is expressing milk for your baby, and refl ecting. A happier you will translate you may want to take over the feeding of the into positive vibes for the family. baby. You can bond with your baby and give your wife her much needed rest. Y Practice makes perfect Show care for your baby by learning how ^ Cuddle up to change his diaper; give him a bath; Cuddle up with your baby whenever you comfort him when he is fretful. It gets have the chance, so that you strengthen the easier once you have done this a few bond between the two of you. times. _ Uniquely yours Z Make time Your child’s personality, gifts and talents are After work, put your baby in a pram and unique to himself. Affi rm your child and he take him for a walk. Alternatively, you can will believe in himself, thereby cultivating a read to him which is a good start to foster healthy self-image. a reading habit. Spending more time with your baby is important, so if need be, ` Role model review the extra time spent at work and Your child will look up to you; so be a role your own favourite pastime. Your presence model of healthy lifestyle habits for him. Your with your baby matters and will contribute positive attitude will rub off on him and he will towards his overall well-being. better relate with others as he grows.

[ Be calm a More time with toddler Your wife may get upset easily and your Once your child is out of babyhood, you can baby may need more attention. It is bond even more with him. Do this: important to stay calm and be the pillar • Go for a walk in one of our nature reserves. of strength so that you can make good It is great to spend some time outdoors. decisions for your family. • Spend an afternoon at the library. You will be helping him with word recognition \ Make a stand and introducing him to one of the greatest If your wife criticises you for the way pleasures in life. you hold your baby, or the way you fold • Play with him. Your baby will appreciate the his clothes or his nappies, do not be good memory later in life. discouraged or upset. Instead, assure her • Set boundaries. Your child needs to learn that you can do it and that you will get responsibility and respect for others. better with more practice. In fact, tell her When you set limits for him, he will learn to to trust you to do the best you can for respect them and he will appreciate you your baby. for it. Daddy, You are Important 105

I play badminton with my three girls regularly and it's a great bonding activity for us. I still play ‘Catching’ with them – except they outrun me now! Other than the physical fun, fathers have an even more important role to play in developing their daughters’ emotional health. Inculcating good values and beliefs from young will affect their behaviour in future. The anchor lies in building trust. It's all about being authentic and sincere when my wife and I communicate with our children. They learn by watching their parents. Ng Sua Keong, 40 years old, Father to E-dyl,16, K-cia, 14, and J-cyn, 12. 106 Raising Healthy and Happy Children

Here is a look at three important aspects for you, Creating a your spouse and your baby happy home Raising Healthy and Happy Children 107

our baby has arrived, and giving him your undivided attention and both you and your spouse are unconditional care and love. As parents, relieved and overjoyed. Even you play an important role to nurture, Yas the family celebrates, there teach and provide a safe and secure are three areas that require your attention environment so that he grows up to be a – bonding with your child, taking care confi dent, positive and happy child. of your fi nances and nurturing your own mental well-being. Here’s a look at these Here are some tips on how to build a three areas. strong, happy, and lasting relationship with your little one. Bonding with your child It is important that you and your spouse Activities spend quality time with your child. No Find different ways to engage your matter how busy you are with your work, child, and expose him to different age- it is important to make time for your child, appropriate activities so that he can expand his thinking, communication, social and creative skills, as well as improve his motor skills. Through fun and games, your child will learn helpful ways to overcome obstacles and problem solving, which are critical in building his resilience as he grows up. Activities like board games, sport, or home activities like cake- or cookie-making session, or even simple chores like picking up the toys and folding clothes can have a positive infl uence later on in life. Avoid electronic games where possible as nothing beats the power of human touch.

Outdoor fun The natural environment is a great source of stimulation and learning for your child. Grow plants with your little one or take him to the park or to the beach and educate him on the wonders of the natural environment. That way, he gets to enjoy the fresh air, the sun, learn and bond with you at the same time. Spending more time outdoors can also protect him against myopia.

Reading together Reading is one of the best gifts you can offer to your child. Not only are you 108 Raising Healthy and Happy Children

able to spend quality time together, you Positive reinforcement will help your can also enhance your child’s learning child grow up to be a confi dent adult. capacity and inculcate good values in Therefore, it is also important to talk to them as you read to them regularly. him immediately about his bad behavior; praise his effort whenever he puts on his Discipline best behavior so that he is clear about Try to fi nd a balance between playing what is acceptable and what is not. the roles of a parent, a teacher and a friend to your child. While it is essential to Choices have a set of rules to govern your child’s As soon as he starts to show an behaviour, it is equally important to build opinion, engage him by letting a trusting relationship with your child so him decide which story to read, that he feels comfortable confi ding in you what outfi t to wear, what to eat about his problems. and where to go. However, do not give him too many choices; Consistent rules in the family provide young children can get a secure environment for the child to confused very easily when learn what is right and what is wrong. It that happens. Instead, can reduce the confl icts you and your offer him two alternatives spouse have when it comes to disciplinary and stick to them. measures for your child. Your child will also not be confused when there are clear rules and boundaries for him to follow. Raising Healthy and Happy Children 109

Benefits for your child Taking care of your finances Parents who make a conscientious Having good fi nancial planning and effort to bond and establish a positive stability are important components relationship with their child ensure that he: in establishing a stable and secure environment for your family. With some • Becomes independent effective money management tips, you • Makes positive decisions will be able to live comfortably as a family • Applies good social skills of three or even more! • Becomes a team player • Is able to communicate effectively To start, set a time with your spouse to • Learns to problem-solve sit down and discuss budgeting matters. • Is positive and confi dent Do this before your baby arrives. Here are • Enhances his motor skills some tips from “Are You A Money Sensible • Respects and appreciates discipline Family?”, a comic by MoneySENSE. • Adopts good behaviour 110 Raising Healthy and Happy Children

This is a collaboration between various baby doctor). These will add to the government agencies in Singapore, the medical cost. Association of Banks in Singapore, and eight major retail banks in Singapore. You Insurance policies and can get more information and ideas on investment family budgeting at www.moneysense. Start an insurance plan early for your gov.sg. child as premiums are likely to be lower. To cater to future education needs, many Live within your means parents buy an endowment or education • Having a baby need not strain your policy to take care of their child’s higher fi nances. Focus on the basic priorities education fees. Ask friends who have fi rst. Buy what you need and can afford. fi nancial expertise for views and advice. • If you can, breastfeed your baby until he is at least 12 months-old and thereafter. Nurturing your own mental It is the best food for him. well-being • Consider buying good quality cots and Both you and your spouse’s mental well- prams from your friends or through being has an impact on your little one. online communities. If you are stressed, angry or depressed, • Consider hand-me-downs. Your baby your child will sense it. If you react will outgrow his clothes and shoes very negatively towards him, it can cause him quickly. Hand-me-downs from your distress. If you are positive and happy, relatives and friends are a good way to your child can feel it and he is likely to save on clothing items. feel more secure and assured. Thus, it • Your child really does not need the is important that you know what your latest toy or a collection of cars and triggers are and fi nd ways to manage dolls. Giving him a new toy every your stress or anger. month is not a solution as it will rapidly lose its Here are some ways that you and your novelty. Play with spouse can foster mental wellness for him and sing to yourselves and be good role-models to him instead. your child:

Savings Lead a healthy lifestyle Save a portion of • Have three balanced, nutritious meals your income instead a day. of spending it all. Be • If you need an energy boost in between prepared for additional meals, snack on healthier options such expenses such as doctor’s as fruits, vegetable sticks and nuts. fees, especially when your baby Ideally, you should have at least two is really young and may need the servings of fruits and two servings of attention of a paediatrician (specialist vegetables daily. Raising Healthy and Happy Children 111

• Drink water regularly to hydrate your • Be realistic. Know your limitations. Don’t body. take on more than you can manage. • Exercise regularly. • Take responsibility for your own actions. • Avoid alcohol and tobacco products. If you have made a mistake, admit it and work on fi xing it. Nurture yourself • Maintain a regular sleep pattern by going Seek or accept social support to bed at the same time every night. Aim • Talk it out. Share your troubles and for 6 - 8 hours of sleep. worries with someone you trust. • Maintain a work-life balance. Do not • Reach out to the people you are close bring work issues home. to. Make an effort to spend time with • Take time for yourself to do things that them. you enjoy. • Make time to be with your spouse. Go • Spend time on a new hobby or pastime on a date and do something fun and once a week. relaxing together. • Step back to refl ect on your life and • Get involved in community activities make changes if necessary. where you can meet new people. • Build relationships. Widen your support Manage your time network to include people who listen to • Use a diary or a calendar to keep you and can offer good advice. track of important occasions and • If you prefer to, seek professional help. appointments. • Plan and prioritise your daily activities Your child looks up to you as his role with a to-do list. Start with the most model. If you cultivate good healthy habits important activity fi rst. Everything looks and coping skills, your child is more likely more manageable this way, but you to follow suit. This, coupled with a loving, have to avoid procrastination as well. safe and stable environment, will allow • Set realistic goals and reasonable your child to grow up healthily and happily. expectations. • Schedule time for your family and yourself. • Unload unnecessary tasks and learn to say “no”.

Practise good coping skills • Maintain a positive attitude. • Confront negative thoughts and work them through. • Manage your anger by walking away and calming yourself down at a quiet place. • Be fl exible when confronted with unexpected everyday situations. 112 Services, Support Groups and Helplines

Here are some references to get you started if you think you need some assistance or just a listening ear

LACTATION CONSULTANT SERVICES / PARENTCRAFT SERVICES

Gleneagles Hospital National University Hospital Lactation consultant 6470 5852 Lactation consultant 9722 0376 (NUH services services Breastfeeding helpline - 8am to 11pm) Parentcraft services 6470 5852 Parentcraft services 6772 2255 / 9722 0152 Website www.womenandchild.sg Website www.nuhgynae.com.sg

KK Women’s and Children’s Hospital Parkway East Hospital Lactation consultant 6225 5554 services Parentcraft services 6340 8681 Parentcraft services 6394 1268 Website www.womenandchild.sg Website www.kkh.com.sg Raffl es Hospital Mount Alvernia Hospital Lactation consultant 6311 1516 / 1517 Lactation consultant 6347 6641 services services Parentcraft services 6311 2350 Parentcraft services 6347 6641 Website www.raffl eshospital.com Website www.mtalvernia-hospital.org Singapore General Hospital Mount Elizabeth Hospital Lactation consultant 6326 5923 / 5926 or Lactation consultant 6731 2313 / 9646 8308 / services 6321 4530 / 4531 services 9651 4076 Parentcraft services 6321 4530 / 4531 Parentcraft services 6731 2313 / 9646 8308 / Website www.sgh.com.sg 9651 4076 Website www.womenandchild.sg Services, Support Groups and Helplines 113

Thomson Medical Centre HELPLINES Lactation consultant services 6251 4090 Association of Women for Action & Research Parentcraft services 6251 4090 1800 774 5935 Website www.thomsonmedical.com www.aware.org.sg

POLYCLINICS ComCare Hotline The Singhealth and National Healthcare Group (NHG) 1800 222 0000 polyclinics provide primary healthcare services to the community. They play an integral role in promoting a healthy lifestyle within the community and empowering families with Institute of Mental Health the knowledge of common health issues, care and treatment 6389 2200 options. www.imh.com.sg

Singhealth Polyclinics Samaritans of Singapore To contact the individual polyclinics listed on the website. 1800 221 4444 (24 hours) http://polyclinic.singhealth. com.sg www.samaritans.org.sg

National Healthcare Group (NHG) Polyclinics ParentLine (For parents with parenting and 6335 3000 child care issues) http://nhgp.com.sg. 6289 8811

BREASTFEEDING RESOURCES CHILD DEVELOPMENT CO-SAVINGS (BABY BONUS) SCHEME Breastfeeding Mothers’ Support Group (Singapore) For queries relating to the Baby Bonus Scheme, Counselling Hotline 6339 3558 visit www.babybonus.gov.sg or call 1800 253 Workshop 6337 0508 7707. Email [email protected] CHILD CARE SERVICES Website www.breastfeeding.org.sg For one-stop portal to child care information and services, visit www.childcarelink.gov.sg or Joyful Parenting and Breastfeeding call 6258 5812. 6488 0286

Association for Breastfeeding Advocacy Singapore [email protected] HEALTH PROMOTION BOARD www.abas.org.sg HEALTHLINE For more information or advice on COMMUNITY SERVICES general health issues, call HealthLine at 1800 223 1313* to speak to the Counselling and Care Centre experienced Nurse Advisers. 6536 6366 www.counsel.org.sg QUITLINE For advice on how to quit smoking or how to help someone quit, call QuitLine Family Service Centre Hotline at 1800 438 2000* to speak to the Quit (Find your nearest counselling centre) consultants. 1800 838 0100 QUITLINE SMS Text your questions or concerns on quitting smoking to +65 9463 3771. Standard connection charges apply.

*Operating hours Monday to Friday: 8.30am to 5.00pm Saturday: 8.30am to 1.00pm

For more information, visit www.hpb.gov.sg/pregnancyparenting/ All contact details are correct at the time of printing. 114 Books from National Library Board (NLB) Read a book a day

to yourHelp your littlechild one learn and grow

Little Rabbit’s Eat Your Peas, New Baby Ivy Louise! Author: Horse, H Author: Landry, L in Co., 2005 Publisher: Atlanta, Ga: Publisher: Boston, MA: Peachtime, 2008 Houghton Miffl in Co., 2005 Call Number: JP HOR Call Number: JP LAN All Rights Reserved Houghton Miffl All Rights Reserved Charlesbridge, 2006

Little Rabbit is upset that his parents are Ivy Louise plays with her food and refuses always thinking about his baby siblings. One to eat her peas, imagining them in all kinds night, he decides to help his tired parents of wild circus scenarios. For every parent and realises how special it is to be a big who has ever tried to get a toddler to eat. brother. A lovely story to show older kids they play an important part in the baby’s life.

No More Bottles Clarabella’s Teeth for Bunny! Author: Vrombaut, A Author: Ford, BG Publisher: New York: Publisher: London: Clarion Books, c2003 Boxer, 2009 Call Number: JP VRO All Rights Reserved Ri ht 2009 Boxer, R d Call Number: JP FOR All Rights Reserved Clarion Books, c2003

Bunny loves his bottle very much. One day, Clarabella, the crocodile, has many teeth he sees Ducky and Piggy drinking from cups and she takes such a long time to brush and asks if his tea can be poured into his them that she has no time to play. Her bottle. Ducky refuses and tells Bunny that animal friends decide to give her a special bottles are for babies. He realises that he is crocodile toothbrush! Now, Clarabella no longer a baby and tosses his bottle into has time to play with her friends and yet the trash. An ideal read for parents who are maintain good dental hygiene. weaning their toddlers from bottles to cups. Books from National Library Board (NLB) 115

I Am Sick Sneezy Louise Author: Jensen, P Author: Breznak, I Publisher: New York, NY: Publisher: New York: Children’s Press 2005 Random House, 2009 Call Number: JP JEN Call Number: JP BRE All Rights Reserved Random House, 2009 All Rights Reserved 2005 Press Children’s

A girl’s fear of seeing a doctor is put to Louise’s eyes are itchy, her throat is rest when she realises that he is kind and wheezy and her nose is itching to sneeze. prescribes medicine for her headache and She does not cover her mouth when she sore throat so that she can feel better. A sneezes and her sneezes upset a bowl simple story to help young children dispel of cereal, blow papers off and cause her their fears of seeing a doctor. friends to fall. Will Louise remember to cover her mouth when she sneezes again?

Felicity Floo Visits A Potty for Me!: A Lift-the the Zoo -Flap Instruction Manual Author: Redmond, ES Author: Katz, K Publisher: Somerville, Mass: Publisher: NY: Little Candlewick Press, 2009 Simon, c2005 All Rights Reserved Ri h 2009 Candlewick Press, R d Ri ht R d

Call Number: JP RED Call Number: JP KAT-[BA] All Rights Reserved Little Simon, c2005

Felicity visits the zoo when she has the Kids will enjoy lifting the fl aps in this book to fl u! She passes on the germs and viruses see how children use the potty every day. A to all the animals in the zoo! From the fun book to encourage little kids to use the mighty lion to the beautiful peacock, all the potty, and to keep trying even if they don’t animals are not spared. A story to teach get it right the fi rst time. children simple social responsibilty.

It’s Your First Day of I Love My New Toy School, Annie Claire Author: Willems, M d Author: Carlstrom, Nancy White Publisher: NY: Hyperion Publisher: NY: Abrams Books Books for Children, c2008 tR for Young Readers, 2009 Call Number: JP WIL Ri h

Call Number: JP CAR All Rights Reserved Abrams Books for Readers, 2009 Young All Rights Reserved c2008 Hyperion ,Books for Children,

Annie Claire has many questions and worries The animals were not happy with Piggie’s that her fi rst day in school will not turn out new toy. Elephant accidentally breaks it well. Mama reassures her on every concern and after feeling angry and upset with each and shows her love. A heartwarming story other, they learn to make up. A book that for every child who’s starting school. introduces different feelings to children in a comic book style with word bubbles.

Books are available at NLB Libraries. Notes Survey 117

The Healthy Start For Your Baby guide has been designed to help you make informed choices on giving your baby a healthy start to life. Making It Help us make this guide better so that it can further benefi t others. Please be assured that all information gathered will be kept strictly confi dential. The collected information will be aggregated and may be used by the Health Promotion Board for programme planning, Better offi cial reports, publications and enhancement of this guide. Please complete the survey and mail it to the Health Promotion Board using the return envelope attached at the back. You will receive a voucher from us as a token of appreciation. Completed survey must reach us before 30 June 2014.

Part I How far do you agree with these statements? Place a tick in the appropriate box.

BEFORE reading the Healthy Start For Your Baby guide

Strongly Disagree Neither Agree Strongly Disagree Agree nor Agree Disagree 1. Healthy habits start from young.

2. I intend to help my child cultivate healthy habits from young. 3. I intend to be a good role-model of healthy habits to my child.

AFTER reading the Healthy Start For Your Baby guide

1. Healthy habits start from young.

2. I intend to help my child cultivate healthy habits from young. 3. I intend to be a good role-model of healthy habits to my child.

Part II How far do you agree with these statements? Place a tick in the appropriate box.

1. The Healthy Start For Your Baby guide is useful to me. 2. I would use the journal pages (see pages 117 to 130). 3. I would recommend this guide to my friends.

4. I would buy this guide off the shelf.

5. I would like to have discount coupons on baby-related products in this guide. 118 Survey

Part III

1a) What is your biggest concern during the fi rst two years of looking after your baby?

b) Is this addressed adequately in the Healthy Start For Your Baby guide? If not, why?

c) Which topic(s) should there be more information on?

2) Where do you get information on child health from? You may tick more than one box. Books Events / fairs Magazines Friends Internet Family/relatives Online forums Others:

3) Any other comments about the Healthy Start For Your Baby guide?

Personal Particulars Name: Would you like to be on our mailing list to receive NRIC no.: updates on health-related information and Nationality: workshops? Age: Yes No Ethnicity: If yes, what is your preferred mode of receiving such Relationship to child: *Father / Mother / Others: information? E-mail SMS Newsletter Contact Number: Others: Email address: Address: Thank you for taking the time to do this survey. Please mail it to the Health Promotion Board using the attached return envelope. You will receive a voucher from us as a token of appreciation. Completed survey Child’s Particulars must reach us before 30 June 2014. Child’s name: * Delete where appropriate. Date of birth: Birth order of baby: *1st child / 2nd child / 3rd child and above Postage will be paid by addressee. For posting in Singapore only.

BUSINESS REPLY SERVICE PERMIT NO. 08067

(080677) Glue Glue Youth Community & Parent Outreach Department Health Promotion Board 3 Second Hospital Avenue Level 4 Singapore 168937 Glue Glue

The First

The little book of my childhoodTwo memories Years My fi rst photo

My name :

My date of birth : My time of birth:

My weight at birth: My length at birth:

My blood type: My head circumference: The hospital I was born in:

My hospital tag:

My hospital tag My fi rst smile

My fi rst tummy time

My fi rst hair cut

My fi rst tooth rst time The fi I sat up

My fi rst step

rst time The fi I waved bye-bye

“...... ”

My fi rst word on ...... My fi rst month celebration

My fi rst outing My fi rst festival celebration My fi rst birthday

My second birthday

Healthier Child, Brighter Future

The Healthier Child, Brighter Future (HCBF) initiative is Health Promotion Board’s child health strategy. It aims to establish strong foundations of health and well- being for all children from the pre-natal stage of their lives and through their childhood years. HCBF is a call to action for parents like you to influence the health of your children and set them on the path to achieve their fullest potential. You will be equipped with knowledge and skills to provide your children with a healthy head start to a brighter future.

Cultivate healthy habits early. Set a healthy example.

Supported by:

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Copyright © HPB B E 708-12 March 2012 This book is not meant for commercial sale.