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Having children who are picky eaters can be a frustrating ordeal for parents. Luckily for us, Dr. David is back to the rescue! This is something he sees every day in his clinic as it seems to be a common problem in Dubai. But don’t worry – Dr. David has some useful strategies to help you feel less worried about your little one’s diet.
If your child’s eating habits is a sore topic in your household, then you’re not alone. It’s a common complaint parents bring up when I see them. Almost always, my first question to the parent is “who prepares your plate of food at dinner time”? We know what the answer is, but this highlights a fundamental issue with children and eating. When a parent prepares a plate of food for the child, they are making a huge assumption (or guess) how hungry that child is - but how do you know? You don’t, and children are like adults and only eat if they are hungry.
The second question I ask is “at mealtimes if there is a fight with your child, who wins?”. Again, we know that answer, the child! If someone (anyone, child or adult) isn’t hungry they won’t eat, so first rule is NEVER have a battle. Mealtimes need to be sociable and fun, no distractions, with an appropriate time to eat TOGETHER. I have worked as a pediatrician for over 20 years and almost all cases of “picky eaters” are children who are otherwise healthy, active and growing normally. If this sounds like your child, then please don’t worry but check with your doctor that this is the case. Then consider the following tips:
Your child’s appetite will vary during the day and day to day. Don’t force a meal or snack or bribe a child with anything like an iPad. Mealtimes are for eating only, and ensuring the best environment for a child to feel most comfortable to eat. There should be no stress or your child might come to associate mealtime with anxiety and frustration or become less sensitive to their own hunger and fullness cues. If you’re not hungry and you then sit in front of a large plate of food, you feel even less hungry. Who in Dubai goes to a brunch not hungry?! Provide small portions or even an empty plate as they sit down, and have the food on the table to encourage choice and give them the opportunity to independently ask for more. On the table, have something you know they like and ask them to try something new with gentle encouragement.
In Dubai there continues to be the misconception that children need to drink formula after the child is older than 1 year. In certain circumstances, yes, if there are underlying health reasons, but for the majority of children, there is no need for formula, especially if they aren’t underweight. A common problem why children don’t eat is because they are filling up on milk instead. In this case, it’s important to cut bottles during the day, live with the short-term pain of crying and upset as eventually the child will start eating food once they realize that that’s their only option to suppress hunger pains. At the very least, try to change mealtimes to when your child has had a period of no milk and give them food on an empty stomach. Avoid offering milk as this will keep your child expecting that milk will come. The best way is to reduce your child’s milk intake. At nighttime, a bottle is ok before sleep but once they are eating better, that can even be changed to normal supermarket cow’s milk.
Children eat better with other people around them. It’s common to hear that children eat better at nursery which frustrates parents, but at nursery mealtimes are sociable with no battles. If your child is spending the day with the nanny, get your child to eat when she eats. Try and eat as a family as much as possible and don’t become dependent on screen time or TV. Mealtimes are for eating and socializing and when everyone is finished, mealtime is over – so don’t eat too fast either. If you give up and then use the iPad or TV, at the end, the child will get used to that. After a reasonable time, take away the plate and offer water or a snack but the child will learn, I promise.
Children copy their parents so if you want your child to eat a healthy, varied diet you need to as well. It’s much better to share your food at mealtimes with your children and not focus on a few foods. New foods will need repeated offering over many days, but with gentle encouragement and patience, it will work. Why not take your child shopping and let them choose some foods, or read books about foods and serve the same ones alongside reading them? Make the effort from an early age as diverse diets for children reduces allergy and obesity.
Get your child involved with the food prep. It’s more interesting to eat something you have prepared yourself (well sometimes ). Even if on some occasions your child just plays with the food, that’s ok, they will enjoy themselves. Even if they then don’t eat it, be patient and keep offering it.
Eating needs to be fun for all the family. Be patient, lower expectations but do get your children checked by a doctor to confirm their growth is good. Often parents feel their children are underweight and are worried they can see their ribs. This is likely to be normal in a child who’s healthy and active. If you are worried about vitamin intake, I always suggest a daily multivitamin to reduce the stress of getting them eating fruit. And removing stress is something we all need to do right now.
Need to see a pediatrician? Reach out to Dr. David here if you want to book a consultation or call 800 1999
As a pediatrician with a special interest in Allergy, I know how often parents are worried about allergies in their kids. Over the next series of blogs, I will be focusing on all things allergy. To begin with, we’re taking a look at itchy rashes or hives. This is a common rash in children and one that can cause huge anxiety (especially when encountering a doctor who gets equally anxious when seeing it)....
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The internet has become a basic utility like electricity and clean water. Globally, 4.57 billion people use the internet (59%) of which 4.17 billion are mobile internet users. Of these, 3.96 billion are on social media. It’s a great source of information and entertainment but unfortunately, the internet has also become a source of many problems. One great area of concern is the effect of screen time and early use of digital gadgets among our young children.
The 2013 Zero to Eight study commissioned by Common Sense Media showed that 38 percent of infants younger than the age of two use mobile devices. A 2015 Pew Research Study reports that 73 percent of 13-17 year-olds have smartphones and 24 percent admit using their phones almost constantly. A survey by the Kaiser Family Foundation found that children spend more than seven hours per day on an electronic device on average.
• When they’re young, you hand over your phone to them willingly, to keep them occupied or quiet. This is how it starts.
• Kids may want a mobile phone or a video game because their best friend has one. This is when it aggravates.
• Eventually, physical play time turns into digital game time. This is when it becomes an addiction!
Emerging studies are showing screen time’s deleterious effect on the growing brain, socialization and general behaviour. The burden of the problem is too deep to cover everything in this short article but some of the negative effects are outlined below.
1. Hampers Cognitive Development
Research has shown that overexposure to gadgets can result in slow cognitive development, attention deficits, delayed speech and even impaired hearing. Problems with attention and focus may impact on a child’s performance in school, at home or when communicating with other people. Alarmingly, every 30-minute increase in handheld screen time translates to a 49% risk of expressive language delay. Brain scans also showed that kids with lots of screen time had a premature thinning of the cortex which processes different types of information from the senses.
2. Builds Obsession, Leading to Agitation
What starts as a means to pacify a toddler can soon turn into an obsession, increased agitation, temper tantrums, and difficulty in controlling emotions leading to hyperactivity, aggression, and anxiety.
3. Delays Physical Development
Lack of physical activity is bound to result in delayed physical development due to delay in manual sensory and physical stimulation.
4. Restrains Social Relationships
When kids and gadgets become inseparable, the attachment can stand in the way of bonding with family and friends of his/her age. This subsequently increases the amount of time a child spends alone leading to social isolation and trouble relating to other people.
5. Increases Risks of Obesity
Increased time spent in front of screens lead to increased snacking, and mindless eating habits thereby increasing the likelihood of childhood obesity. Overweight and obese children are more likely to remain obese into adulthood. This increases their risk to cardiovascular diseases, diabetes, joint diseases, endocrine disorders, respiratory problems, several types of cancers, psychological stresses, and other obesity-related conditions. A study in 2012 in Abu Dhabi showed that 14.7% of school-aged children are overweight and 18.9% are obese.
6. Causes Physical Strains and Pains & Sleep Disruption
Constant engagement with electronic devices causes eye problems, back pain and other muscle-related issues in children. The blue light emitted by display screens prevents the release of melatonin, an important sleep inducing hormone, which leads to sleep impairment.
Parents need to model responsible media use and establish family media plans that support balance, boundaries, and communication. Media should be viewed as a tool rather than a babysitter, reward, or punishment.
The American Academy of Pediatrics (AAP) recommends the following:
Avoid digital media use (except video-chatting) in children younger than 12 months
• For the 18-24 months age group, choose high quality programming and avoid solo media use
• For children 2 to 5 years of age, limit screen use to 1 hour per day of high-quality programming, and co-view with your child.
• Turn off televisions and other devices when not in use
• Avoid using media as the only way to calm your child
• Monitor your children’s media content, what apps are used or downloaded
• Keep bedrooms, mealtimes, and parent-child playtimes screen-free
• No screens 1 hour before bedtime
• Remove devices from bedrooms before bed
Nothing will ever replace human interaction and socialization. Play and interact with your child rather than using digital media. Talk and have an extensive discussion with your pediatrician about responsible screen time.
Authored by Dr. Romulo Dimarucut, Specialist Paediatrician at Filipino Family Clinic, Mediclinic Deira.
For appointments call 800 1999 or download the MyMediclinic24x7 app.
Winter is often a worrying time for parents as schools and nurseries become hubs for bugs. We reached out to Dr. David Cremonesini, a Consultant Pediatrician at Mediclinic Parkview Hospital for some useful tips.
Early in a child’s life, it is normal for them to get a cold every month, sometimes twice a month. This is because there are hundreds of different cold viruses, and young children only start to build up immunity to them when they start spending time with other children. Overtime they build up their immunity and therefore get colds less often. We especially see this in families where the firstborn child is well and never sick until they start nursery. Babies with older siblings, however, tend to catch colds as they have a brother or sister at home to catch bugs from. This helps them build up their immunity sooner.
Almost always, children with a cold develop a cough and this is something parents worry a lot about. It is normal for that cough to last a few weeks, even up to 4 weeks. In fact, the coughing, although distressing for the child and parent, is doing an important job. Young children are very bad at blowing their nose, so the mucus can fall backwards into the throat, especially at night when they are lying down. A big cough is the best way for the child to clear the phlegm from the throat, and prevent it going into the lungs and causing more severe problems like pneumonia. The cough is the body’s way to fight the infection and protect itself. When you need to be worried is when the child has other problems than coughing. Ask yourself these questions:
- Is my child drinking ok and staying hydrated?- Is my child breathing ok and not distressed or wheezy?- Is my child having periods of normal playing and activity?- Is the fever improving after a few days and not getting worse?
If the answer to all of these is yes, then good news! Give it a few weeks during which time the cough should slowly improve while the answers should remain yes to all of the above questions. Seek medical advice if the child is deteriorating, or if you are starting to say no to some of the questions.
The snot can be different colours, but again, it is all about how the child is as a whole. If the child has pneumonia, we would expect tiredness, persistent fever and breathlessness. If the child has asthma, you would expect to see breathlessness, decreased activity and expect to hear a wheezing sound.
One should consider allergy if the cough lasts a long time such as a few months, if your child gets an itchy nose a lot, and if what is running from their nose is clear, watery liquid. If there is associated wheezing, it makes allergy even more likely. It can be hard to be sure, however, as children can get one cold after another and therefore extend their coughing for several months. With normal colds though, we often see the cough improving as the child recovers from the first cold, just as they catch another.
Allergy is more likely if the child has other allergic problems like eczema or food allergy. Has something new happened at home like a pet arriving? Does the cough go away when the child is on holiday away from home? Is it seasonal and only there in the summer? Allergy cough is normally worse at night when exposure to dust mites is at its worse from the mattress and pillows in the bedroom. In Dubai, doctors often label a cough as allergy, but the best course of action is to get some allergy tests to confirm it before staying on allergy medication long term.
Children can get coronavirus but it seems to be a generally mild illness, much like other cold viruses. There are some very rare complications leading to more serious illnesess (e.g. PIMS – Pediatric Inflammatory multi-system syndrome) but the risk is very low, perhaps 1 in 5000 children may get this.
There is no specific treatment for a coronavirus cold, so if your child has a cough and has been in contact with the coronavirus, watch over them and make sure their drinking, breathing and activity is ok. Normally if children get a virus, it is not necessary to check which one it is, but with COVID-19 going around, we do need to test most coughs in children in nursery or school to reduce risk of spreading it. The best and most accurate test is still the nose test, so it is important to talk to your child and support them when having the test.
Coughing is a good thing and is the best way to clear mucus. Keep your child hydrated with plenty of fluids to keep the mucus less thick and easier to clear. Saline drops in the nose for young children is important, so they can still drink from the bottle and breathe through their nose. Cough medicines should be avoided, especially those that make the child drowsy as there could be a risk of accidentally overdosing. Treat the fever with paracetamol or ibuprofen and consult your doctor if you are worried.
More and more families are also starting to use nebulisers at home. If you have one, you could try a salty water (saline) nebulizer and continue using it if it helps your child. However, we recommend to only use Ventolin if the child has wheezing and breathlessness as it won’t help a cough or sore throat but will only make your child agitated and restless.
When it comes down to it, a cough or cold is nothing for moms and dads to be worried about if the child is otherwise ok. Give your child lots of cuddles and fluids but check with your doctor if you start to see more worrisome symptoms or behavior.
In doubt? Reach out to Dr. David here if you want to book a consultation or call 800 1999
Having your child being the shortest kid in class can be cause for concern for some parents. We spoke with Dr. Medhat Salem, a Specialist Paediatrician and Medical Director at Mediclinic Mirdif who helped shed some light on the matter.
“Doctor, my child is short, should I be concerned?”, is something Dr. Salem often hears from visiting parents. And this question is really important and interesting because of three reasons:
1) Short stature can cause lots of stress, especially psychologically, on the parents and on the child.
2) Short stature is not a disease, but it can be a symptom of a disease that should be treated and after the treatment, the child should grow normally.
3) The short child that is healthy can be treated with growth hormone and achieve an additional 7-12 cm at the final height.
Short stature means the child is two standard deviations below of what they should be according to their age and gender. If your son/daughter is the shortest in the class that doesn’t mean he/she is short in stature. He/she has to go below two standard deviations and other children might be taller.
We add height of the father and mother, then for the boys we add 13 and divide by 2, and for the girls, minus 13 and divide by 2.
80% of the causes are genetically determined. Genetic causes are familial short stature and constitutional short stature. Familial short stature is where the parents are short and the child is also short.
Constitutional short stature is when the child has delayed puberty, but when he/she reaches puberty the child gets to normal height. So he/she will be short initially and will achieve normal height when the child reaches puberty. This can be easily diagnosed, as one of the parents may have the same history, and this is the only condition where there is no treatment indicated.
Other causes will include the child being born small like IGR. Chronic diseases such as diabetes, chronic renal failure, malabsorption syndrome such as celiac disease or endocrine causes such as hypothyroidism can also cause short stature.
In addition, rare causes can be genetic syndromes, for example Down Syndrome, Turner Syndrome or disproportionate short stature where the trunk is normal but the limbs are short like in cases of achondroplasia.
We usually do a complete history and complete examination and necessary lab investigations. We investigate mostly endocrine causes like thyroid deficiency, gross hormone deficiency, pituitary deficiency and we investigate for chronic diseases. After doing the full investigation and having the full picture of what is going on, if there is a disease, we treat the disease and the child’s short stature and general health can be rectified.
If the child is completely healthy and normal, he/she is not constitutionally delayed and everything is OK, we can also give him/her a growth hormone to improve his/her height by 7-12 cm if you choose.
Always remember that short stature is treatable and you need to see your child’s paediatrician.
For appointments call 800 1999 or visit mediclinic.ae
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