First Year of Life

Is it time to go to the doc­tor again? Prob­a­bly

Oi Vietnam - - Kids & Education -

AS PE­DI­A­TRI­CIANS, WE SEE chil­dren ev­ery day—that’s the joy of this pro­fes­sion. Of course, we usu­ally see chil­dren when they are sick, but it’s also very im­por­tant that we see them when they’re healthy. Well­ness checks are our main tool to mon­i­tor the growth and devel­op­ment of a child from birth un­til late ado­les­cence, not only phys­i­cally but also men­tally. We need to en­sure that they’re achiev­ing their mile­stones by look­ing for red flags that may in­di­cate an un­der­ly­ing prob­lem. As with every­thing, prevention is bet­ter than cure, so if we catch some­thing ear­lier, we can then ad­dress it ear­lier—which is far bet­ter than catch­ing it late.

A good ex­am­ple of this is lan­guage ac­qui­si­tion. Re­search is very clear about what a devel­op­ing child should be able to ex­press lin­guis­ti­cally at each stage in their growth. Some­times a child may be slower than is nor­mal, and this could be be­cause the child suf­fers from a con­di­tion such as autism spec­trum dis­or­der. It could also be due to com­pletely be­nign rea­sons—it’s not un­com­mon for a child grow­ing up in a mul­ti­lin­gual house­hold to fall short of their mile­stones while their speak­ing skills de­velop in two or more lan­guages at once. It’s also less of a concern if a child has dif­fi­culty ex­press­ing him or her­self ver­bally, but is still per­fectly ca­pa­ble of un­der­stand­ing com­plex in­struc­tions such as “go into the bed­room and bring me my phone.”

Some­times a prob­lem can be caught dur­ing a well­ness check and cor­rected eas­ily—if you no­tice that a two-year-old child has the lin­guis­tic ca­pac­ity typ­i­cal of a one-and-a-half-year-old, there is only a six-month gap be­tween what is ex­pected and what the child is able to do. With spe­cial at­ten­tion this is­sue may be re­solved, whereas if a child does not re­ceive a well­ness check un­til four years old and is dis­cov­ered to have the de­vel­op­men­tal level of a two-year-old, that’s a far more chal­leng­ing prob­lem. If we see things that are not quite right, we ad­vise par­ents to see a spe­cial­ist.

Dur­ing the first year of life, there are many things hap­pen­ing—so the

fre­quency of well­ness vis­its is higher com­pared to when a child is older. Chil­dren should ide­ally re­ceive the first well­ness check straight af­ter birth fol­low­ing be­ing dis­charged from hospi­tal. This should be fol­lowed by checks at one month, two months, four months, six months, nine months and then at 12 months; and then af­ter that, ev­ery three months un­til 18 months; and then at two years, 30 months, 3 years, and then yearly af­ter that.

De­vel­op­men­tal Mile­stones

In Western coun­tries, new­born screen­ing is usu­ally rou­tine, while in Viet­nam this is not guar­an­teed.

One ex­am­ple of a con­di­tion that will be screened for is con­gen­i­tal hy­pothy­roidism. If you catch this con­di­tion early, med­i­ca­tion can be pre­scribed that should en­sure the child leads a nor­mal, healthy life. This is the im­por­tance of the well-baby check, to find clues that can help us to in­ter­vene and make dra­matic changes to im­prove a child’s life­long health.

Nor­mally we do well­ness checks, es­pe­cially for younger kids, to­gether with vac­ci­na­tions. This is a per­fect op­por­tu­nity to dis­cuss with par­ents any con­cerns they might have. We can ask about de­vel­op­men­tal mile­stones as well as check­ing nu­tri­tion and other phys­i­cal at­tributes, such as head cir­cum­fer­ence. As we ad­min­is­ter the vac­ci­na­tions, we give ap­pro­pri­ate ad­vi­sory guid­ance on top­ics such as healthy eat­ing or ac­ci­dent prevention if a child has just started to crawl or walk.

Par­ents usu­ally ap­pre­ci­ate pro­fes­sional ad­vice, although not al­ways—some­times for cul­tural rea­sons we run into dif­fer­ences of opin­ion. In this cul­ture, many par­ents may view an over­weight baby as be­ing healthy and happy, whereas as a doc­tor I find my­self hav­ing to warn par­ents of the po­ten­tial for heart dis­ease, di­a­betes, and other se­ri­ous prob­lems later in life brought on by child­hood obe­sity. Now we have a nu­tri­tion clinic at our prac­tice, so I of­ten re­fer par­ents of over­weight (or un­der­weight) chil­dren to our spe­cial­ist.

So far, I’ve never come across a par­ent who re­fuses vac­ci­na­tions in Saigon, although there are some who choose only cer­tain vac­cines that they want and refuse oth­ers. Some par­ents ques­tion why we vac­ci­nate against cer­tain dis­eases here when this is not done in their home coun­try. In fact, it is al­ways rec­om­mended to fol­low the im­mu­niza­tion sched­ule of the coun­try where you are liv­ing, be­cause the dan­gers can vary from place to place. In the case of chick­en­pox, for ex­am­ple, a vac­ci­na­tion is not rou­tinely given in some Euro­pean coun­tries be­cause con­tract­ing the dis­ease nat­u­rally will give a child the best pro­tec­tion. Vac­ci­na­tion is rec­om­mended in Viet­nam, so the chance of con­tract­ing the nat­u­ral ill­ness is rather low com­pared to in a child’s home coun­try. In this case, it is ad­vis­able to vac­ci­nate—con­tract­ing the dis­ease nat­u­rally later in life, es­pe­cially dur­ing preg­nancy, would be a far more se­ri­ous prob­lem.

In­ter­na­tional schools here usu­ally spec­ify a list of vac­ci­na­tions a child must have be­fore be­ing ad­mit­ted. A phys­i­cal ex­am­i­na­tion is also re­quired— dif­fer­ent schools have dif­fer­ent forms, but the for­mat of these well­ness checks is gen­er­ally the same. It used to be the case that we would need to run skin tests and check for TB, but blood and urine test­ing are no longer re­quired. Usu­ally these kinds of study-place­ment tests are only asked for by par­ents send­ing their chil­dren to schools over­seas. Even so, it is very im­por­tant to have a vac­ci­na­tion book, be­cause if a child doesn’t have a record of vac­ci­na­tions re­ceived, we can’t ac­cept hearsay. If a child doesn’t have a record, we will ei­ther test for an­ti­bod­ies or vac­ci­nate again.

Par­ents should be very care­ful to en­sure their child re­ceives all their well­ness checks, es­pe­cially dur­ing the early stages of life. We can mon­i­tor phys­i­cal growth, cog­ni­tive skills, eye­sight, hear­ing and a num­ber of is­sues that are most eas­ily re­solved fol­low­ing cor­rect di­ag­noses as early in life as pos­si­ble. By look­ing at the over­all pic­ture when a child is well rather than only fo­cus­ing on heal­ing when he or she is ill, we can help to en­sure a healthy pas­sage into adult­hood.

Drawn to pe­di­atrics by her pro­found love for chil­dren, Filip­ina Dr. Agnes R.

Viay prac­ticed at Fam­ily Med­i­cal Prac­tice be­tween 2006-2010, re­turn­ing here in 2013. In ad­di­tion to treat­ing pa­tients, Dr. Agnes was for­merly host to the Saigon In­ter­na­tional Mother & Baby As­so­ci­a­tion, dis­cussing pre- and post-na­tal top­ics with

new and soon-to-be moth­ers.

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