BEARy Friendly Paediatrician

24/12/2025

Have a Holly Jolly Christmas!

20/12/2025

吃碗汤圆，圆一个心愿，
祝你冬至喜乐，身体康健。

19/12/2025

珍惜当下。
带孩子出去走走看看，体验异国他乡。
让孩子们“认知升级”。

https://www.facebook.com/share/p/1Ecxk3MTyS/

旅行不是奢侈品
是普通家庭最划算的一次“认知升级”

很多父母一听到“带孩子旅行”，
脑子里第一个跳出来的念头是——
太贵了，等以后条件好了再说。

但真相往往刚好相反。

真正昂贵的，
从来不是机票和酒店，
而是把孩子最关键的认知窗口，一再往后推。

钱，可以慢慢赚；
但孩子理解世界的那几年，
一旦错过，就不会重来。

旅行，给孩子的是“活的认知”

学校教孩子的是标准答案，
旅行教孩子的是如何看世界、如何应对世界。

第一次坐飞机，
他学会的是：
规则、秩序、耐心，还有等待；

第一次在陌生城市找路，
他学会的是：
观察环境、表达需求、独立判断；

第一次面对不同语言、不同文化、不同生活方式，
他开始明白一件很重要的事——
世界不是围着我转的，人生也不只有一种模板。

这种认知，
不是刷题能刷出来的，
也不是任何补习班能灌进去的。

普通家庭，更需要带孩子走出去

资源型家庭，
孩子可以靠背景兜底；

普通家庭，
孩子靠的是视野、适应力和内在稳定度。

旅行会让孩子慢慢理解：
生活有很多种可能，
不是只有“成绩好 → 找工作 → 过一生”这一条线。

见过世界的孩子，
更容易接受差异、
更不容易情绪崩溃、
也不容易被一次失败定义自己。

这不是浪费钱，
这是用最少的钱，换最重要的认知资产。

孩子也许忘了景点，但不会忘了你

很多父母说：
“他还小，记不住这些。”

但孩子真正记住的，
从来不是去了哪里，
而是——
那段时间，你在不在。

是你牵着他过马路，
是你陪他等车、排队、迷路、重新来过，
是你在陌生的地方，
让他知道：
只要有你在，世界是安全的。

这些感觉，
会在他心里慢慢沉淀成一种底气：
我可以走出去，我也能回来。

旅行，会放大一家人的真实关系

在日常生活里，
大家各自忙、各自累、各自滑手机；

但在路上，
只有彼此。

你会更清楚孩子的恐惧点、情绪点和安全感来源；
孩子也会在你身上，看见真正的依靠与稳定。

你会发现：
他其实没那么脆弱；
他只是需要被带着，一起跨出去。

这些理解，
在日复一日的生活节奏里，
几乎不会自然发生。

最划算的时间，其实就是现在

你当然可以等——
等收入再高一点，
等房子再大一点，
等孩子再懂事一点。

可现实是：
孩子的童年，不会等你准备好。

再过几年，
他可能不再牵你的手，
也未必还愿意跟你同行。

所以真正的问题不是：
值不值得花这笔钱，

而是：
如果今天不做，未来会不会遗憾？

旅行不是炫耀，也不是打卡

它不是给别人看的，
也不是用来证明“我很会养孩子”。

它只是——
在能力范围内，
陪孩子多认识一点世界，
也多认识一点自己。

对普通家庭来说，
这不是奢侈，
而是一笔回报率极高、却常被低估的教育投资。

爱自己🍀

18/12/2025

Proud to be part of this family!
😍😍😍

16/12/2025

How to prevent allergy?
Part 2: Breast Milk and Formula Milk

Breastfeeding is the recommended feeding method for all babies with benefits that extend beyond allergy prevention.

1. Breastfeeding is not specifically recommended for preventing allergy, but may provide a small reduction in risk of allergic disease for those who have breastfed for at least 4 months.
2. It possibly reduces the incidence of atopic dermatitis in children younger than 2 years.
3. Breastfeeding more than 3 to 4 months may reduce the risk of wheezing in the first 2 years of life.
4. Longer duration of breastfeeding may reduce the risk of developing asthma for children aged 5 to 18 years.
5. It reduces the incidence of cow’s milk protein allergy in the first 2 years of life, but does not necessarily reduce food allergy in general.
6. There are no clear effects of breastfeeding on allergic rhinitis.
7. Data are conflicting on whether exclusive breastfeeding longer than 3 months has an effect on the incidence of atopic dermatitis in children.
8. Some studies showed an increased risk of allergic disease with exclusive breastfeeding beyond 6 months.

Recommendations: (Breastfeeding)
>> During breastfeeding, maternal avoidance of allergenic foods is not recommended unless the mother has a known food allergy.

Recommendations: (Regular Cow’s Milk-Based Formula)
>> In infants with no prior exposure to regular cow’s milk-based formula, the use of regular cow’s milk-based formula over breastmilk to reduce the risk of allergic disease is not recommended.

>> In infants previously exposed to regular cow’s milk-based formula now transitioning to breastfeeding, continuous exposure is recommended to maintain tolerance and reduce the risk of cow’s milk protein allergy.

Recommendations: (Hydrolysed Formula)
>> For infants who cannot be exclusively breastfed, a hydrolysed formula given during the first 4 to 6 months of life appears to offer advantages to reduce the risk of allergic disease.

Recommendations: (Other Formulas)
>> Soy formula, Amino Acid formula, and Goat’s Milk formula are not recommended for the reduction of risk of allergy.

09/12/2025

How to prevent allergy?
“Malaysian Allergy Prevention 2nd Edition - Guidelines for Healthcare Professionals” highlighted a few areas for allergy prevention:
1.Maternal diet and behaviour
2.Breastfeeding
3.Infant formula
4.Complementary food
5.Environment

Let’s focus on “Maternal diet and behaviour” in this post.
Before I start, let’s revisit the concept of “Baby’s First 1000 Days”.
The “First 1000 days” refers to the critical period from conception to a child's second birthday, a time of rapid growth and development that lays the foundation for lifelong health and well-being.
Therefore, allergy prevention should start from conception when a mother is pregnant.

Based on scientific evidence, this guideline has listed a few recommendations for pregnant mothers:

A.Allergenic Foods
- Maternal avoidance of allergenic foods during pregnancy or lactation is NOT recommended.
- No evidence that avoidance makes any differences.
- Mother with a known dietary allergy should continue to avoid those food.

B.Inhalant Allergens
- Maternal avoidance of inhalant allergens during pregnancy or lactation is NOT recommended.
- No evidence that avoidance makes any differences.
- However, avoidance of cigarette smoke and other indoor pollutants is recommended.

C.Probiotics
- Probiotics use may be suggested in pregnant or lactating women who have a high risk of allergy in their children, because considering all critical outcomes, there is a net benefit resulting primarily for the prevention of eczema.
- Probiotics supplementation is recommended to begin during the prenatal period and continue during the postnatal period, both to the breastfeeding mother and to infants, regardless of their risk status.
- Benefits of probiotics for eczema prevention may be strain-specific, as some strains showed no benefits. The probiotic Lactobacillus rhamnosus GG has the most evidence on eczema
prevention.
- Consult your doctor to know more!

D.Prebiotics
- There is a paucity of studies on the use of prebiotics in the prevention of allergy to
recommend its use. More research is needed.

E.Fish Oils
- Limited studies have shown the lack of benefits for fish oil supplementation in
allergy prevention. Thus, no recommendation can be made.

F.Antioxidant and Vitamins
- No recommendation can be made as more studies are needed to examine the role of vitamin supplementation in the prevention of allergy.
- Vitamin D has been investigated for allergy prevention. At this time, there is insufficient data to recommend vitamin D during pregnancy and lactation for the purpose of allergy prevention.
- Maternal adherence to an antioxidant-rich and vitamin-rich diet (e.g., yoghurt, fruit, vegetables), along with increased infant diet diversity at 12 months, may reduce the risk of allergic disease in early childhood.
- Mother must beware of the toxic effect of high-dose Vitamin A (not exceeding 3000mcg/day)

G.Psychosocial Factors
- Maternal psychological well-being may influence allergic disease risk.
- Therefore, it is recommended for pregnant mothers to undergo mental health screening using the appropriate tools during antenatal check-ups.

H.Body Weight during Pregnancy
- Weight management preconception and during pregnancy is encouraged for the prevention of allergic disease in children.

I.Caeserean Section
- Caeserean section has been shown to have a slight increase in allergy risk in children.
- When clinically indicated, Caesarean section should not be deterred on the basis of allergy prevention.

- Mother with a known dietary allergy should continue to avoid those foods. vitamins, take appropriate probiotics, maintain good mental health status, control weight gain, and avoid caeserean section delivery by choice.

01/12/2025

Let’s talk about allergies today!
1. How common are allergic diseases?
2. How to assess your baby’s risk of allergy?
3. What is “Allergy March”?
4. Can an allergy be prevented?

1. How common are allergic diseases?
Allergy problems are on the rise worldwide!
Common allergic diseases include eczema (atopic dermatitis), food allergy, allergic rhinitis, and asthma.
UK data estimated up to 40% of children have at least 1 allergic disease, while US data estimated around 27% of children have at least 1 allergic disease.
Malaysia has no overall prevalence data, but some reports have quoted that up to 62.8% of children have allergic rhinitis, 63% have some form of food allergy, 13.4% have eczema.

2. How to assess your baby’s risk of allergy?
Family history is the most important risk factor in determining if your child is at risk of any allergies.

Risk of allergic disease in children
A.Low Risk (10-20%)
If no first-degree relative (parent or sibling) with allergy disease.

B.Medium Risk (20-40%)
If one first-degree relative has an allergic disease.
Either one parent or one sibling only

C.High Risk (50-80%)
If two first-degree relatives have allergic disease.
Either both parents or a parent and a sibling
>> Please refer to the diagram below.

3. What is “Allergy March”?
To understand the relationship between different allergic diseases, we need to talk about “Allergic March”.

The allergic march refers to the natural history of allergic diseases. It is also called the atopic march. This refers to how allergic diseases progress in a person over time.

Allergies often begin early in life, first expressing themselves as eczema in young children, then progressing later to food allergies, allergic rhinitis, and asthma.

Allergy March:
Step 1:
Birth to 1 year of age: Skin irritation, such as hives or eczema
Step 2:
1-3 years of age: Food allergies (top 8 are peanut, tree, nut, cow’s milk, egg, wheat, soy, fish, and shellfish)
Step 3:
4-6 years of age: Seasonal and environmental allergies, including allergic rhinitis
Step 4:
5-7 years of age: Asthma, a chronic disease characterized by inflamed airways in the lungs

- 60% of allergies appear during the first year of life.
- The “Allergic March” shows that one allergy can progress to another allergy over time.
- About 50 percent of children with eczema eventually develop asthma, and 33 percent develop food allergies.
- Children with eczema are also at higher risk of developing allergic rhinitis.
- Food allergies in childhood are also a risk factor for allergic rhinitis and asthma.

4. Can an allergy be prevented?
Yes and No.
To a certain extent, allergic diseases can be prevented, or rather, the disease severity can be modified with appropriate strategies.
However, it cannot be completely prevented, especially in those with a strong family history of allergy.

I will share some strategies for allergy prevention in the next post based on the recently published “Malaysian Allergy Prevention 2nd Edition - Guidelines for Healthcare Professionals”.

27/11/2025

Delighted to received this special "Graduation" gift yesterday.
Thanks. 😍😍😍

Always learning to serve you better.

26/11/2025

Let's talk about RSV (Respiratory Syncytial Virus) today.

1. What is RSV?
2. When to seek treatment?
3. How does RSV spread?
4. Is RSV serious?
5. How to prevent RSV?
6. How many types of RSV immunisation are currently available?

1. What is RSV?
RSV is a very common respiratory virus that usually causes mild cold-like symptoms.

However, RSV can cause severe disease in young children (less than 6 months old) and among the elderly.

Symptoms of RSV in infants may include:
- runny or stuffy nose
- coughing
- fever
- noisy and/or rapid breathing
- reduced or difficulty in feeding


2. When to seek treatment?
- If the fever is more than 39 °C , and especially if it is not improving after taking Paracetamol
- Poor oral intake with risk of dehydration (reduced urine, dry lips, etc.)
- Less active, lethargy or inconsolable cry
- Any forms or respiratory distress: rapid breathing, noisy breathing, chest indrawing, non-stop coughing, etc.


3. How does RSV spread?
RSV is highly contagious.
It spreads through droplets or in contact with contaminated fluids.
- coughing or sneezing
- direct contact, like kissing
- touching a contaminated surface and touching your face
- exposure to RSV among childcare or school
Be aware that some children can continue to spread the virus even without symptoms.


4. Is RSV serious?
RSV is the leading cause of hospitalisation in infants, especially those under 6 months of age.
A local study quotes that 1 out of 4 life-threatening (need ICU admission) lower respiratory tract infections in children were associated with RSV.
RSV poses a higher risk of death and hospitalisation in children under 1 year old compared to the common flu.
- RSV causes about 10 times higher risk of death compared to the common flu
- RSV lead to 16 times higher hospitalisation compared to common flu


5. How to prevent RSV?
Back to basics:
- Washing hands frequently (with soap and water)
- Cover cough and sneezes
- Disinfect frequently touched surfaces
- Keep your child at home if they are unwell and stay away from people who are sick
Last but not least, speak to your doctor about RSV immunisation!


6. How many types of RSV immunisation are currently available in Malaysia?
There are 2 types of RSV immunisation
- For the mother during pregnancy (Abrysvo)
- For baby after delivery (Beyfortus)


ABRYSVO
What: Passive immunisation to protect babies against RSV infection.
Who: Pregnant mothers to protect their baby for the first 6 months.
When: The American (CDC) recommend it to be given 32-36 weeks of gestation.
The UK (NHS) recommend it to be given 28-36 weeks of gestation.
Why: There are reports of a very slight increased risk of preterm delivery.
How: Given to mother as an intramuscular injection, single dose ONLY.
Price: ~RM1000


BEYFORTUS
What: Passive immunisation to protect babies against RSV infection.
Who: For babies after delivery until 1 year old.
Protection is for 6 months, but reports indicate sufficient protection until 360 days.
When: Can be given immediately after birth before discharge from hospital.
Why: I usually give it in the clinic on the first follow up visit for jaundice monitoring because it is cheaper this way.
How: Given to baby as an intramuscular injection, single dose ONLY.
Price: ~RM 2200


Which one is better?
Both provide adequate protection for babies under 6 months against severe RSV infections.
International guidelines all suggest to take either one; no need to take both.

ABYSVO is cheaper but has a limited window for injection and has to be given at least 2 weeks before delivery to provide adequate protection for your newborn baby.

BEYFORTUS provides better and longer protection against RSV but is more expensive.


Some parents ask me why BEYFORTUS is so expensive?
Let me explain to you using a simple analogy:
Assume your baby is a country and the baby’s immune system is his soldier that protects his country.
- Regular immunisation (eg, 6in1, MMR or influenza) is like hiring a few instructors to train the soldiers. It takes time to train the soldiers (typically at least 2 weeks) before any effective protection, but it is for long term protection.
- BEYFORTUS is like hiring a team of mercenaries to protect the country. They are well trained from the first day, but only provide protection for ~1 year.
So, the cost of hiring a team of soldiers is definitely much more than hiring a few instructors.
One year of protection against RSV is sufficient, as RSV is usually less severe in older children.

25/11/2025

I am so happy and excited to received this video from my ex-prem warrior that I have treated back in Penang Adventist Hospital in conjunction with World Prematurity Day 2025.

Bean bean was born 25 weeks and 3 days with only 875gm. He has gone through a lot during his NICU stay.

This really bring back memories of those sleepless night fighting along side this brave boy through multiple hurdles including lung problem (RDS) , eye problem (ROP) and heart problem (PDA) that he has to go for a heart surgery.

I am so thankful that he has grown into a healthy boy now. May you have many happy and healthy years ahead. 😍😍😍

Check out the link in my comment below.

17/11/2025

It's World Prematurity Day today.
Wishing all my little warriors a happy and healthy life ahead with brighter future!