Injury prevention in children

By

Dr P S Sugathan,

Specialist Paediatrician,

RIPAS Hospital

Worldwide, pedestrian injuries are a leading cause of death among children. This form of injury is relatively less frequent in Brunei. AFP

Injury is a major cause of death in children. Death is only part of the problem.

For every child who dies, another 30 or more are admitted in the hospital. Of these, many are discharged with lifelong disabilities.

The role of injury prevention is even more important in countries like Brunei where other causes of death like infection get effectively prevented and treated.

Injury is preventable
Many people believe that injuries result from "accidents" and therefore are not preventable.

About 200 years ago, infections were similarly considered to be beyond our powers to prevent and treat. It's not the case anymore. Yes, injuries also are preventable using current knowledge.

We now have much better understanding of the risk factors for injuries.
Consequently, we are better able to develop programmes for prevention and control of injuries.

Types of injuries
There are numerous ways by which children get injured. But we need to focus on injuries that are frequent and severe and for which proven prevention strategies are available.

The most important of such injuries in Brunei are: motor vehicle passenger injuries, pedestrian injuries, bicycle injuries, submersion, burns, and accidental ingestion of drugs and poisons.

Motor vehicle passenger injuries
Motor vehicle injuries are the leading cause of serious and fatal injuries at all ages. Therefore lot of efforts is to be made in this area.

Specific preventive steps include the following:
a. Child restraint devices: Proper use of appropriate child restraint devices can reduce serious injuries and fatalities by about two-third in children under four years; and by half in older children.

Observation in the United States have indicated that about 90 per cent of child restraint devices are improperly installed; and about 20 per cent of them are seriously misused. Brunei lags far behind developed countries in the use of child restraint devices.

Often as a direct consequence, we see a lot of children getting seriously injured during road traffic accidents. The proper use of child restraints has to be popularised on a priority basis in Brunei.

b. Adolescent drivers are responsible for a disproportionate number of motor vehicle injuries. This is due to their inexperience and is worsened by alcohol or drug abuse.

Perhaps our adolescents need to wait till a bit older before they start driving around unsupervised.

Pedestrian injuries
Worldwide, pedestrian injuries are a leading cause of death among children. This form of injury is relatively less frequent in Brunei.

Injuries typically occur when children run out into the street and are struck by oncoming vehicles. Educational programmes aimed at improving street related behaviour of children can achieve prevention.

This should be supplemented by roadway interventions like proper lighting; provision of sidewalks and speed barriers.

Bicycle injuries
Bicycle related trauma is the leading cause of childhood head injuries in many countries. Bicycle is probably less popular in Brunei.

Use of bicycle helmets can prevent about 85 per cent of head injuries and 88 per cent of associated brain damage.

Parents should be made aware of the need for bicycle helmets. The reluctance of children to use helmets should be reduced by ongoing education about the need and effectiveness of helmets.

Submersion
Drowning is a significant cause of death and disability in children. For every death due to submersion six children are hospitalised. Approximately one-fifth of hospitalised survivors suffer severe brain damage.

Brunei is endowed with tropical climate, long coastline, rivers and lakes, abundance of swimming pools and a sprawling water village. All these make the country particularly prone to occurrence of submersion injuries.

Specific preventive measures should include the following:
a. Parents should be constantly aware of the dangers to children from any body of water.

b. Young children should never be left alone in bathtubs or near swimming pools, ponds, rivers or beaches.

c. Swimming pools should be completely surrounded by a 5-foot fence with self-closing, self-latching gate.

d. Older children and adults, especially in water village, should learn CPR (life support training).

e. Children over five years should know how to swim.

f. No one should ever swim alone.

g. Even when supervised children should wear floatation devices when playing in rivers, streams, lakes or beaches.

h. Use of intoxicating drinks and drugs should be avoided.

Burns and scalds
Approximately 80 per cent of burn related deaths occur from house fires.
Risk factors include age less than four years, overcrowding, single parents, poverty, inadequate supervision, and distance from fire department.

Smoke detectors, when used correctly can reduce death and severe injuries from burns by nearly 90 per cent.

Parents should be aware of these devices, which should be installed and properly maintained in every kitchen.

Children's clothes should be made of fire resistant fabric. Furniture, bedding and home building materials should conform to flammability standards.

Scalds occur from hot liquids. Young children should never be left alone in kitchen or bath.

Whenever a liquid is being warmed or boiled, beware of young children around. Always check tap water temperature when washing / bathing children.

Ingestion of drugs and poisons / choking:
Accidental ingestion of drugs and other harmful materials like detergents and medicated oils meant for external use, is common in Brunei.

Medicines and poisons should always be kept out of reach of children. Food items, like peanuts and roasted seeds, which could be potential foreign bodies, should not be offered to young children.

Toys with pointed edges or small detachable parts should be avoided.

Please remember:
Injuries are a major public health problem causing death and disability in perfectly healthy children (and adults).

They are NOT inevitable "accidents" but tragedies preventable by thoughtful action. Some specifics steps in this direction are described in this article.

Do try to implement them today; tomorrow may be too late for someone you love.


Ministry of Health Public Awareness Programme

Source: Weekend, 20 December 2008

Beat the baby blues: Understanding postnatal depression

By

Ministry of Health

What is postnatal depression?
It is a condition when a woman who has just given birth falls into a depressed state of mind.

There are no obvious causes and most of the time, there is no single cause that can be identified.

Is postnatal depression a common condition?
Yes. It is estimated that one in every 10 mothers who gives birth experience postnatal depression.

Usually the condition happens a month after childbirth, but can also surface within six months later. If not treated, the condition can affect the victim for months or even longer.

What are the signs of postnatal depression?
Depression/Sadness: Feeling more sad or depressed than usual, may feel worse at certain times, like in the morning or at night.

Quick to lose patience: Getting angry quickly with one's husband, other children or even your own newborn baby.

Always feeling lethargic: All new mothers who have given birth will feel tired. However, mothers who have postnatal depression feel even more tired than normal.

Difficulty in sleeping: Has sleeping difficulty and tends to wake up easily from sleep even though there is no external disturbance.

Loss of appetite: Often has no appetite or desire to eat. Sometimes, the opposite happens, where postnatal depression sufferer will overeat to overcome her feelings of depression.

Unable to participate in any activity: Loss of interest in activities she used to like doing.

Unable to solve simple problems/carry out simple chores: Feeling unable to carry out daily chores and to find solutions to simple problems.

Restlessness or fear: Feeling afraid that her child will be injured or something bad will happen, always worried whether or not the child is breathing, growing normally or healthy.

Postnatal depression can cause her to panic or feel tired, which then leads to fear of illness, such as heart disease. All these factors can cause a mother to feel afraid to be alone.

Don't all mothers feel depressed after childbirth?
No. About half of all mothers feel sad or lack of confidence several days after giving birth. This is known as "Postnatal Blues", but normally this feeling goes away after several days.

What causes postnatal depression?
It is not fully known what causes this condition.

Several known factors may increase the risk of postnatal depression:
- Being in an unsupportive environment, such as having an unsupportive husband.
- Having experienced depression previously.
- Having faced several stressful issues in a short period of time such as financial problems, loss of a loved one or family problems.
- Giving birth to a premature baby or the newborn baby has health problems.

However, a mother may still experience postnatal depression without the presence of any of the above factors.

What is the treatment for postnatal depression?
Medical treatment for postnatal depression includes the use of several types of antidepressant pills. The pills are to be taken orally on a daily basis and will take around two to three weeks before showing any effect.

The majority of mothers experiencing postnatal depression are unaware that they are suffering from the condition.

Support from family members, especially the husband, is important - be it through looking after the child as well as providing emotional support.

Ministry of Health Public Awareness Programme

Source: Weekend, 13 December 2008

Steps to prevent food poisoning

By

The Ministry of Health

File photo shows a sales attendant arranging products at a grocery store. AFP

When cooking meat and poultry, make sure it is well-cooked and not pink.





Do not store food too long in the refrigerator.

Good hygiene practices can contribute towards preventing food poisoning. Everyone must take part in ensuring food safety by following simple safety practices:

1. Grocery Shopping

Food safety begins when you do your shopping. This will help in reducing the risk of food poisoning.
Do:
- Buy food from a clean and reputable shop.
- Read labels carefully.
- Select fresh and wholesome foods.
Don't:
- Do not buy chilled or frozen food that is displayed at room temperature.
- Do not choose dented, bolted, blown or rusty canned food.
- Do not buy food beyond its expiry date.

2. Wash & Keep Clean

Bacteria can be found everywhere. These bacteria are carried on our hands, wiping cloths and utensils. The slightest contact can transfer them to food.
Do:
- Wash your hands with soap and water before handling and preparing food and after using the toilet.
- Wash and sanitise all surface and equipment used for food preparation.
- Wash dish clothes and towels frequently or use disposable towels.
- Keep your kitchen clean and protect from insects, pets and other animals.

3. Separate Raw And Cooked Food

Raw food may contain harmful bacteria.
They may be transferred onto other foods during preparation and storage which may cause food poisoning.
Do:
- Keep raw food separately from cooked foods.
- Wash knives and chopping boards between uses.
- Use separate chopping boards for raw and cooked food.
- Store food in covered containers to prevent cross contamination between raw and cooked foods.

4. Cook Your Food Well

Proper cooking will help to kill all harmful bacteria.
Do:
- When cooking meat and poultry, make sure it is well-cooked and not pink.
- Cook them at higher temperature.
- If food requires reheating, cook it thoroughly.

5. Keep Food At Safer Temperatures

Bacteria can multiply very quickly at room temperaure. Food must be kept under the right conditions so that it is safe to eat.
Do:
- Hot food should be served hot, cold food should be served cold.
- Keep cooked food piping hot prior to serving.
- Refrigerate promptly all cooked and perishable food.
Don't:
- Do not leave cooked food at room temperature for more than two hours.
- Do not store food too long even in the refrigerator.
- Do not thaw frozen food at room temperature. Thaw them in the refrigerator overnight, or use the microwave oven.
- Do not leave marinated food at room temperature. Keep them in a covered bowl in the refrigerator.

Ministry of Health Public Awareness Programme

Source: Weekend , Dec 6, 2008

Facts about diabetes & obesity

By

The Ministry of Health

Obese patients can reduce the risk of developing diabetes by 50 per cent if they were to lose five kilogrammes.

Foot ulcers.

Diabetes Mellitus is a disease in which the amount of glucose (sugar) in the blood is too high.

This is either due to lack of the hormone insulin or the body's own resistance to insulin action.

There are two main types of diabetes:
Type 1 diabetes (insulin-dependent) in which the pancreas fails to produce insulin which is necessary for survival. This type usually develops most frequently in childhood and adolescents, but is increasingly noted in adults.

Type 2 diabetes (non-insulin-dependent) which results from the body not able to respond properly to the action of insulin. Type 2 diabetes is more common and accounts for around 90 per cent of diabetes cases worldwide. It occurs frequently in adults, but is being noted increasingly in adolescents.

Symptoms:
-Excessive urination
-Increased thirst
-Weight loss
-Tiredness
-Blurred vision
-Coma in severe cases

In Type 2 diabetes, most people may not be able to tell if they have the disease as no early symptoms may appear and the disease is only diagnosed several years later after its onset and sometimes when complications are already present.

Obesity & Diabetes
Obesity and overweight are major risk factors for chronic diseases, including Type 2 diabetes, cardiovascular disease, hypertension and stroke, as well as certain forms of cancer.

This is predominantly due to increased consumption of energy-dense foods high in saturated fats and sugars, and reduced physical activity.

The likelihood of developing Type 2 diabetes and hypertension also rises steeply with increasing body fatness. This disease now affects obese children even before puberty. Ninety per cent of Type 2 diabetes patients are obese or overweight.

Did you know 50 per cent of Type 2 diabetes can be prevented through weight management?

Complications associated with Diabetes Mellitus
Most of the complications that occur are due to damage of the small blood vessels and nerves in the organs of the body resulting in:
- Blindness
- Kidney failure
- Heart diseases
- Impotence
- Foot ulcers
- Limb amputation

What you can do to prevent diabetes

Here are some tips to prevent diabetes:
- Maintain a healthy weight: Excess fat prevents insulin from working properly.
Find out your BMI and commit yourself to losing weight if you are overweight (BMI > 25).
- Adopt healthy eating habits
Eat healthily. Include five servings of fruits and vegetables.
Choose foods with low saturated fat, low sugar and salt.
Boil, steam or grill your food and garnish with herbs to add taste and flavour.
- Exercise regularly
Regular physical activity uses up blood sugar and body fat. Choose activities which you enjoy and relatively simple to do.
Exercise at least 30 minutes, five times a week.
- Check your diabetes risk factors periodically If you have most of the risk factors for diabetes, please consult your doctor as soon as possible to have your blood sugar checked.

Ministry of Health - Public Awareness Programme

Source: Weekend 29 November 2008

Diabetes Mellitus

By

Dr PS Sugathan

Specialist Paediatrician and Head of the Department of Paediatrics and Neonatology

RIPAS Hospital - Ministry of Health

"The world is facing a growing diabetes epidemic of potentially devastating proportions... the World Health Organisation and the International Diabetes Federation are working together to support ongoing initiatives to prevent and manage diabetes and its complications, and to ensure the best quality of life possible for people with diabetes worldwide... It is time for 'Diabetes Action Now' - Dr Robert Beaglehole, Prof Pierre Lefèbvre, World Health Organisation

What is diabetes?
Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin (as in Type I diabetes), or alternatively, when the body cannot effectively use the insulin it produces (as in Type II diabetes).

Insulin is a hormone that regulates blood sugar. It is also essential to process fat and protein. Hyperglycemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body's systems, especially the nerves and blood vessels.

A fasting plasma glucose of more than 7 mmol l-1 ( 126 mg dl-1) or / and 2-hour post-glucose load value of more than 11.1 mmol l-1 ( 200 mg dl-1) confirms the diagnosis of diabetes mellitus.

Values less than these but more than normal values indicate prediabetic states like Impaired Glucose Tolerance (IGT) and Impaired Fasting Glycaemia (IFG): If you have pre-diabetes, you have a higher risk of developing type 2 diabetes.

How do the two types of diabetes differ?

The table given below gives the differences between the two types of diabetes:

Table: Comparison between Type I and Type II Diabetes

How is insulin resistance, pre-diabetes, and type II diabetes linked?

If you have insulin resistance, your muscle, fat, and liver cells do not use insulin properly. The pancreas tries to keep up with the demand for insulin by producing more. Eventually, the pancreas cannot keep up with the body's need for insulin, and excess glucose builds up in the bloodstream. Many people with insulin resistance have high levels of blood glucose and high levels of insulin circulating in their blood at the same time.

What causes insulin resistance?
Because insulin resistance tends to run in families, we know that genes are partly responsible. Excess weight also contributes to insulin resistance because too much fat interferes with muscles' ability to use insulin. Lack of exercise further reduces muscles' ability to use insulin.

Many people with insulin resistance and high blood glucose have excess weight around the waist, high LDL (bad) blood cholesterol levels, low HDL (good) cholesterol levels, high levels of triglycerides (another fat in the blood), and high blood pressure, all conditions that also put the heart at risk.

DIABETES FACTS
The World Health Organisation (WHO) estimates that more than 180 million people worldwide have diabetes. This number is likely to more than double by 2030.

In 2005, an estimated 1.1 million people died from diabetes.

Almost 80% of diabetes deaths occur in low and middle-income countries.

Almost half of diabetes deaths occur in people under the age of 70 years; 55% of diabetes deaths are in women.

WHO projects that diabetes deaths will increase by more than 50% in the next 10 years without urgent action. Most notably, diabetes deaths are projected to increase by over 80% in upper-middle income countries between 2006 and 2015. What are the possible consequences of diabetes?

Depending on the type of the disease itself and the quality of management, diabetes can be a life- threatening and life-shortening disease. Diabetes can have immediate and severe (acute), as well as long-term complications.

Acute complications reflect the difficulties of maintaining a balance between insulin therapy, dietary intake, and exercise and include hypoglycaemia (lows), hyperglycaemia (highs), and diabetic ketoacidosis.

Long-term complications arise from the damaging effects of prolonged hyperglycemia and other metabolic consequences of insulin deficiency on various tissues.

While long-term complications are rare in childhood, maintaining good control of diabetes is important to prevent complications from developing in later life. Long-term complications include the following:

- Retinopathy (damage to inside layer of eye; leading eventually to blindness if not treated)
- Cataracts (hardening of the lens of eye leading to progressive impairment of vision)
- High blood pressure
- Progressive kidney failure
- Early heart disease
- Peripheral blood vessel disease
- Damage to nerves
- Increased risk of infection

Treatment
Let us now consider some aspects of care of a child with type I diabetes.

Insulin treatment

All children with IDDM require insulin therapy.

Only children with significant dehydration, persistent vomiting, or metabolic derangement, or with serious intercurrent illness, require inpatient management and intravenous rehydration.

A well-organised diabetes care team can provide all necessary instruction and support in an outpatient setting. The only immediate requirement is to train the child or family to check blood glucose levels, to administer insulin injections, and to recognise and treat hypoglycemia. The patient and/or family should have 24-hour access to advice and know how to contact the team.

Consultations
Experienced dietitians are involved in the patient's care, typically as a regular member of the diabetes care team. Review by eye specialist may be needed at diagnosis. All children with diabetes aged 12 years and older need a careful annual eye examination to identify and, if necessary, treat diabetes-related eye complications. Access to psychological counselling and support is desirable, preferably from a member of the diabetes care team.
Diet
Dietary management is an essential component of diabetes care. Dietary management of diabetes emphasises a healthy, balanced diet, high in complex carbohydrates (eg, cereals) and fiber and low in fat.

The aim of dietary management is to balance the child's food intake with insulin dose and activity and to keep blood glucose concentrations as close as possible to reference ranges, avoiding extremes of hyperglycemia and hypoglycemia and providing energy and protein adequate for growth and normal physical activities.

Activity
Diabetes requires no restrictions on activity; exercise has real benefits for a child with diabetes. Most children can adjust their insulin dosage and diet to cope with all forms of exercise. Children and their caretakers must be able to recognise and treat symptoms of hypoglycemia.

Hypoglycemia following exercise is most likely after prolonged exercise involving the legs, such as walking, running or cycling.

It may occur many hours after exercise has finished and even affect insulin requirements the following day. A large pre-sleep snack is advisable following intensive exercise.

Some key messages about diabetes
Diabetes is a major threat to global public health that is rapidly getting worse. Diabetes is a life-threatening condition

Worldwide, 3.2 million deaths are attributable to diabetes every year.

One in 20 deaths is attributable to diabetes; 8,700 deaths every day; six deaths every minute.

At least one in ten deaths among adults between 35 and 64 years old is attributable to diabetes.

Three-quarters of the deaths among people with diabetes aged less than 35 years are due to their condition.

Diabetes is a common condition and its frequency is dramatically rising all over the world
At least 171 million people worldwide have diabetes. This figure is likely to more than double by 2030.

In developing countries the number of people with diabetes will increase by 150% in the next 25 years.

The global increase in diabetes will occur because of population ageing and growth, and because of increasing trends towards obesity, unhealthy diets and sedentary lifestyles. A full and healthy life is possible with diabetes

Studies have shown that, with good management, many of the complications of diabetes can be prevented or delayed.

Effective management includes lifestyle measures such as a healthy diet, physical activity, maintaining appropriate weight and not smoking.

Medication often has an important role to play, particularly for the control of blood glucose, blood pressure and blood lipids.

Through the provision of optimal health care the risk of developing diabetic complications can be reduced substantially.

Helping people with diabetes to acquire the knowledge and skills to manage their own condition is central to their leading a full and healthy life. In many cases, diabetes can be prevented

The prevention of type I diabetes is not yet possible and remains an objective for the future.

The prevention of type II diabetes has been shown to be possible and requires action now.
Trials have shown that sustained lifestyle changes in diet and physical activity can reduce the risk of developing type II diabetes. For example, the Finnish Diabetes Prevention Study showed that a better diet, increased physical activity and modest weight loss could substantially reduce the development of type II diabetes in middle-aged adults at high risk.

The scale of the problem requires population-wide measures to reduce levels of overweight and obesity, and physical inactivity.

The urgent need for prevention
Simple lifestyle measures have been shown to be effective in preventing or delaying the onset of type II diabetes. They include:

Increased physical activity - it is estimated that currently 60% of the world's population do not do enough physical activity, with adults in developed countries most likely to be inactive. Studies have shown that just 30 minutes of moderate exercise a day, five days a week, is enough to promote good health and reduce the chances of developing type II diabetes.

A healthy diet - eating between three and five servings of fruits and vegetables a day and eating less sugar and saturated fats has been shown to be important in maintaining appropriate weight, and therefore a lower risk of type II diabetes.

Weight loss - more than one billion adults worldwide are overweight; at least 300 million of whom are obese. It is estimated that well over half of all cases of type II diabetes could be avoided if excessive weight gain in adults could be prevented.

Non-smoking - people with diabetes are at greater risk of dying from coronary heart disease, stroke and peripheral vascular disease than people without the condition. Smoking increases the risk even further.

Conclusion
Most of the facts and figures about diabetes mellitus discussed in this article are relevant in the Brunei context in terms of magnitude and urgency. The scale of the problem and the increasing incidence of diabetes require population-wide measures to reduce levels of overweight and obesity, and physical inactivity. Informed policy decisions on transport, urban design, and on food pricing and advertising can play an important part in reducing the population-wide risks of developing type II diabetes. On the eve of the World Diabetes Day - November 14, 2008- let all of us rededicate ourselves for concerted and coordinated action to prevent and treat diabetes from childhood onwards.

- Ministry of Health Public Awareness Programme

Source: Weekend 15 November 2008

Safest plastics for food and beverages

By Lori Bongiorno

Some plastics are safer to eat and drink from than others. Here's a quick guide to help you make informed choices. If you want to dig deeper, take a look at the Institute for Agriculture and Trade Policy's Smart Plastics Guide (PDF).

It's worth avoiding the following plastics when you can. You can identify a plastic by looking at the recycling code number that appears inside a triangle at the bottom of many containers.

Polyvinyl chloride (PVC) can leach phthalates, known male reproductive toxicants. It can be identified by code 3. One way to avoid it in the kitchen is by choosing plastic wrap made from polyethylene rather than PVC. If a box is not labeled, find a brand that is or call the manufacturer.

Polystyrene is used in Styrofoam products. It may leach styrene (a neurotoxin) when it comes into contact with hot, acidic, or fatty foods. It's marked with recycling code 6.

Polycarbonate can leach bisphenol-A (BPA), an endocrine disruptor associated with a long list of health concerns. Baby bottles, "sippy" cups, 5-gallon water jugs, and reusable beverage bottles are typically made out of this plastic. Products may be marked with recycling code 7 (also includes any plastic that doesn't fit into the 1 to 6 recycling code categories) and/or the letters "PC."

In response to the widespread concerns about BPA, baby bottles and other items made from alternative materials are springing up. Experts say stainless steel is your best bet for reusable water bottles right now. ThinkSport and Klean Kanteen are two widely available brands.

The following plastics are considered safest for food storage. Glass and stainless steel are also good options.
Polyethylene terephthalate ethylene (PETE), code 1.

High-density polyethylene (HDPE), code 2.

Low-density polyethylene (LDPE), code 4.

Polypropylene (PP), code 5.

Here are some tips for using all plastics safely:

· Don't microwave food plastic containers. Chemicals are more likely to leach out when plastic is heated. "Microwaveable plastic" doesn't guarantee that chemicals won't leach. Cover foods in the microwave with wax paper or a plate. If you do use plastic wrap, then make sure it doesn't touch the food.

· Avoid putting hot foods in plastic containers. Let leftovers cool off before storing them in plastic.

· Take good care of plastics by not washing them with harsh chemicals, and dispose of scratched and worn containers. Research has shown that older, scratched items will leach more, says Kathleen Schuler at the Institute for Agricultural and Trade Policy. (Don't put them in the dishwasher if you want to be completely risk-averse, she suggests.)

[Environmental journalist Lori Bongiorno shares green-living tips and product reviews with Yahoo! Green's users. Send Lori a question or suggestion for potential use in a future column. Her book, Green Greener Greenest: A Practical Guide to Making Eco-smart Choices a Part of Your Life is available on Yahoo! Shopping.]

Parent's role in children's oral health

By

Dr Mary Cheong Poh Hua

Senior Dental Officer
Ministry of Health

The size of the fluoridated toothpaste to be used should not be more than the size of a pea. PHOTOS: MINISTRY OF HEALTH

The toothbrush of the child should be changed if the bristles begin to splay.

Parents, especially mothers, have a major role in the oral health of their children, in particular the young and very young children.

This is because very young children are totally dependent on adults, in most cases, their parents, for virtually everything; from feeding, bathing, toilet, sleeping to safety, nurturing and educating.

They are the most effective people to help instil habits in the child that contribute to good dental health.

However, the converse is also true, where parents are also responsible for developing habits in their children that contributes to poor oral health.


WHY IS THIS SO?

Dental disease/caries - multifactorial and preventable

We need to understand the cause and progression of dental disease and the factors that influence or modify the disease.

It is well known that dental disease, in particular, dental caries is a multifactorial disease that is influenced by lifestyle and is entirely preventable. The cause of dental disease is primarily bacteria (in particular Streptococcus Mutans) that are present in the mouth called plaque. The bacteria metabolise the sugars present in the mouth and produces acids as waste products.

These acids dissolve the minerals of the tooth structure and soften the enamel and later the dentine, causing cavities in the tooth.

However, other factors that influence this process are time; the frequency, type and amount of sugar that the tooth and bacteria is exposed to; the resistance of the tooth structure to acidity; the removal of bacteria from the teeth and mouth/the presence or absence of cariogenic bacteria in the mouth; the presence of intervention procedures such as fissure sealants, topical fluoride rinses or gel.

Studies have shown that preventive approach rather than curative approach plays a significant role in improving oral health status. It has been found that the presence of dental services alone was relatively unimportant in improving the oral health status of children. Other dental preventive and social factors play a significant role in improving the oral health status. Studies have indicated a relationship between the parental socio-economic characteristics and the oral health of their children. In addition, the primary socialisation process between the parents and their children in all aspects of life such as dietary practices, dental health awareness and perception will also influence the oral health status of their children.

Importance of early intervention and education for the child

It is very important to introduce good dental health care early in the child's life as this would most likely lead to good oral health in adult and would eliminate the negative psychological and emotional impact that dental pain and it's related treatment has on the younger age group and it's long term effect and implications to dental health in their adult life. There is also the greater chance of maintenance of good oral health later in life if primary health care (prevention of dental disease and promotion of dental health) is started at a young age.

Parental influence has the greatest impact on determining the dental caries of their young children, as they are largely dependent on their parents. A child is not a free agent. The ability of a child to act is limited by parental willingness and ability to assist the child. A child may be taught the importance of eating low-sugar foods. However, if his mother continues to serve high-sugar foods, the child will not be able to adopt healthier habits. Therefore, parental attitudes towards oral health are important factors in a child's oral health.
Since children are dependent on the adults for their general well being, including their oral health, it is therefore, important to recognise the role and responsibility of parents in providing early intervention and education for their children during their formative years.


The responsibility of pregnant mothers

Studies have shown that gum (periodontal) disease and poor oral hygiene are related to: -
Low birth weight, Premature birth and Heart disease
It is therefore important for pregnant mothers to be responsible to their babies by taking very good care of their oral health during pregnancy.


Recommended guidelines

Tooth brushing
Parents should brush their children's teeth from the moment the first tooth erupts till the child begins to develop the manual dexterity to brush independently with supervision at age two-seven years old.

Children's fluoridated toothpaste should be used for brushing the child's teeth only when the child can spit or rinse, usually from the age of two years onwards. Parental supervision must be emphasised. This is for plaque removal effectiveness and also to ensure that the child does not swallow any fluoridated toothpaste.

The size of the fluoridated toothpaste to be used should not be more than the size of a pea.

The toothbrush of the child should be of a small head, ie about the length of a 20 cents coin in diameter and the bristles should be soft. The toothbrush of the child should be changed if the bristles begin to splay

Infant feeding

Breast-feeding is preferred to bottle-feeding.

If bottle-feeding: -
Bottle-feeding are encouraged to be stopped by the age of one to three years old and should be replaced by a cup.
Bottle-feeding time should NOT be prolonged.
The bottle should NOT be in the child's mouth for extended periods of time. Bottle-feeding should NOT be a pacifier for the child. Appropriate attention and nurturing should be given and should NOT be replaced by bottle-feeding.
Bottle-feeding before sleep/nap should NOT be encouraged. Bottle feeds should NOT have any sugar or sweetened beverages added.

SNACKS
Sugary snacking should be discouraged and should be limited to less than three times a day.
Sweets/candies should not be used as rewards for good behaviour or good performance as this may encourage it to be a habit, which will jeopardise the oral health of the child.
When forced to give sugary snacks, it should only be during meal times and not in-between meals.
Parents should know the sugar contents of foods given to the child. Parents are encouraged to read and understand food package labels. Children are only allowed not more than 25 grammes (five teaspoons) of sugar per day and adults 50 grammes (10 teaspoons) of sugar per day. NOTE: One can/tin of sweet beverage contains about five to 10 teaspoons of sugar.

Child education
Parents should not instil fear in their children regarding dental health or dental treatment.
Parents should not threaten their children with "toothache" or dental pain and it's related dental treatment (injection, extraction) for bad behaviour or disobedience.

Dental Health should be taught in a positive manner that will build awareness in their children regarding their oral health care without undue fear that is unbeneficial to the child. This will cause the child to have a negative attitude towards dental health and indirectly jeopardise their dental health. The child may develop an irrational fear towards dental clinics and dental treatment later on in life when there is a need for it.

Source: Weekend 1 November 2008

Beating depression

By

The Ministry of Health

Most people will feel sad or miserable at some point in their lives. But usually we can cope and continue with our daily activities and the feelings pass after a few days or a week or two.

Someone is said to be significantly depressed or suffering from depressive illness when their feelings of sadness persist day in, day out for weeks at a time.

Many will interfere with their everyday functioning. At this point, they will need medical help and treatment.

HOW DO YOU KNOW IF YOU ARE DEPRESSED?

You may be suffering from depression if you have five or more of the following symptoms:

- Feeling unhappy most of the time.
- Loss of interest in life - can't enjoy everything.
- Hard to make decisions.
- Feeling tired all the time.
- Sometimes restless and agitated.
- Losing your appetite and weight (although some people put on weight - comfort eating).
- Having disturbed sleep, waking in the early hours of the morning.
- Losing interest in sex.
- Losing self - confidence.
- Feeling inadequate and hopeless.
- Avoiding others.
- Feeling irritable.
- Feeling worse at a particular time each day, usually the morning.
- Considering suicide.

Often people do not realise how depressed they are, because it has crept up on them so gradually.

Delay in seeking advice can have major consequences such as marriage breakups and losing jobs.

WHAT CAUSES DEPRESSION?

Many different factors play a part such as stressful events, physical illness and genetic vulnerability.

The end result is that there is a chemical imbalance in the brain leading to depression.

WHAT KIND OF HELP IS AVAILABLE?
The doctor can assess your condition, give counseling and depending on severity may start you on an antidepressant medication. If your illness is severe, they may refer you to a psychiatrist.

Antidepressant medicine helps 80% of people with depression, they work by correcting the chemical imbalance in the brain.

These medicines have a slow onset of action and it may be two to three weeks before any effect on mood is noticed. However it is still very important to take these medicines regularly, if you take them on and off or just when you feel down, they will not work.

It is important to note that these medications are not addictive.

Even when you feel better these medicines should be continued for at least a year to 18 months and then tailed off slowly. So if you are depressed, or know someone who has these symptoms, please see your doctor.

Source: Weekend 25 October 2008

Keeping fit during pregnancy

By

Ministry of Health

A combo photo shows a series of exercises that is safe for pregnant women

Staying fit during pregnancy is an important part of feeling your best.

In the past there were many beliefs about pregnancy and exercise that have now been proven to be untrue.
In fact if done properly, it has been found that regular exercise will promote an easier pregnancy and possibly a faster and less painful delivery.

Benefits oF Exercise During Pregnancy:
--Increased energy, strength, stamina fitness levels and muscle control.
--Enhanced circulation and flexibility.
--Reduced effects of biomechanical changes to your body.
--Reduced discomfort from water retention, stress, tension, depression and excessive weight gain.
--Minimise stretch marks, varicose veins, abdominal separation and hyperventilation.
--Minimise postpartum depression or the "Baby Blues".
--Increased relaxation.
--Improved calcium absorption.

Note: Consult your doctor to ensure that any selected exercise is safe for you and your baby.

Things to Avoid When Exercising During Pregnancy:
- Rigorous bouncing
- Arching your back
- Poor posture
- Dehydration
- Strenuous movements
- Sitting past 45 degrees

Activities You Can Start During Pregnancy:
- Low impact aerobics

- Cycling / stationary bike
- Rowing machine
- Stairmaster / stair climbing
- Swimming
- Walking
- Light Weight training

Safe Ways To Stay In Shape:

- Avoid injury or overexertion by taking part in low to moderate exercises.
- Stay consistent. Exercising three days in a week is a good routine.
- Take it easy. Avoid activities that require jumping motions or sudden changes in direction. This may strain your joints and injure you.

Watch your back. After the first 12 weeks avoid any exercise that require you to lie on your back. Also avoid long periods of motionless standing. Both actions can reduce the blood flow to the uterus.

Don't overexert yourself. Stop exercising if you feel sick, tired or dizzy - and don't get so breathless that you can't speak.

Keep your balance. Avoid exercises that cause a quick loss of balance or mild trauma to the abdomen.

Have a good healthy diet. Be sure you eat an adequate diet that allows you to gain about 12.5 kilogrammes over the nine months. Most women will need to eat an extra 300 calories which should be healthy nutritious calories sourced from a well balanced diet.

Drink up! Drink plenty of water to keep you hydrated and prevent from overeating.

Get comfortable. Wear comfortable, cool and supportive clothing.

Keep cool. Be mindful not to get overheated. On hot humid days choose to exercise at the gym or go for a swim.

Avoid certain sports. When pregnant you should avoid certain sports that are associated with the risk of falling or colliding with other participants such as netball, volleyball and running.

(Ministry of Health Public awareness Programme)

Source: Weekend, 18 October 2008

Healthy sungkai for a healthy you

By

The Community Nutrition Division,

Department of Health Services, Ministry Of Health

One of the Ramadhan stalls offering barbecued fish. - JASON LEONG

We are already half way through Ramadhan, and the surrounding at Gadong Market is abuzz.

It is merrier and packed with people.

From the far end of the first stall, people are asking for different types of delicacies to be served during 'sungkai' or breaking of fast. "May I have B$2 of kelupis, B$1 of selurut and B$2 of kuih pinyaram, please?"
At the other corner, a lady is asking for two packs of chicken rice. People all over Brunei will not miss this time of the year where many types of delicacies and food will be sold only during Ramadhan.

If we look deep into the meaning of fasting, then sungkai is a gift and blessing from the Almighty to all Muslims.

It is the perfect time for family gathering, and a time to savour the moments together and be grateful with what the Almighty has provided us.

Some may think that it is the best time to enjoy food of the day. Let's not get carried away by its purpose, then we will be able to avoid overeating.

Yes, we will not be eating from dawn till dusk, but that does not mean that we have to consume more at sungkai.

The truth is eating pattern during the fasting month should not be much difference from what we have during normal days. There is no need to consume excess food.

A healthy and balanced diet, which include a healthy and balanced sungkai, will be able to improve blood cholesterol, reduce gastric acidity, prevent constipation and improve blood sugar level.

Bear in mind, healthy eating pattern is timeless - it is never too late to start the practice and it should be practiced for as long as we live.

The best way to get healthy food is by preparing the food yourself. That way, you are in control of what you and your family are going to have for sungkai. So mothers, wives, sisters and the men too, you have a role here in making that happen.

Having said that, of course, you can enjoy the food at the Ramadhan stalls, for food is to be enjoyed too. Plus some of the foods are sold only during Ramadhan.

It is a question of how often, how much and which choices to go for. Here are some useful tips for all readers to consider.

* Before you hit the Ramadhan stalls, make sure you make a list of food you would like to buy and roughly make a budget. The shorter the list and the lesser the budget, the better. This way you can avoid being spendthrift.

* Once there, head for stalls that sell main meals first, before you go to the delicacies and drinks stalls.

* Try not to bring the entire family to every time you go there to avoid overspending.

* Go to the stalls early, around 2pm to 3 pm. If you go there a bit late, there is a great tendency you will buy more food because you already feel hungry by that time. By going there in the afternoon, you are less likely to wander around the stalls for too long because the weather is still hot.

Health benefits of dates
* Dates, or 'tamar' in Arabic, are very nutritious. They are high in carbohydrate, protein, fibre, iron, calcium, phosphorus, magnesium, vitamin C and potassium.
* Dates contain simple sugar and get digested very easily. Within half an hour, your tired body will regain a renewed vigour. Therefore, dates are used for supplying quick energy to the brain and body cells, thus Mahgrib and Terawih prayers can be performed better.
* With an energised body, it will avoid excessive eating.
* Being a laxative food, dates have been found to be beneficial for those suffering from constipation.
* Dates are eaten with the skin/outer layer that are high in fibre that can help to avoid colon cancer by avoiding constipation.
* Regular consumption of dates has been found to check the growth of pathological organisms and help in the growth of friendly bacteria in the intestines.
* Dates are excellent cure for intestinal disturbances.

(Ministry of Health Public Awareness Programme)

Source: Weekend- 20 September 2008

Know your risks for heart disease

Echocardiogram in progress

Stress test in progress

By
Dr Hj Nazar Luqman,
Specialist Cardiologist & Head of Cardiology RIPAS Hospital

Photos/Graphics: RIPAS Hospital

Cardiovascular diseases, commonly called heart diseases, are one of the leading medical problems in Brunei Darussalam, and they are a leading cause of death worldwide too.

Among all the heart diseases, coronary artery disease that leads to heart attack is the most common.

Coronary arteries supply blood to the muscle of heart, thus helping it to pump. When blocked, these arteries cannot supply enough blood to the heart muscle - as a result, various grades of "coronary artery disease" develops.

This may lead to angina - chest pain, myocardial infarction (heart attack), heart failure (poor pump function of the heart), or even sudden death. It is not a disease of old age alone - many young people suffer and can die too from this disease.

There are many risk factors that predispose to the development of coronary artery disease.

A combination and multiplicity of these risk factors determines the development and progression of coronary artery disease. Some risk factors cannot be modified like age, sex and family history but many others can.

Thus with proper control and management of risk factors, the disease spectrum of coronary artery disease can be modified or prevented. The modifiable risk factors are diabetes, high blood pressure, raised cholesterol and smoking.

Control of these risk factors is, therefore, of vital importance in the prevention of coronary artery disease.

Once the heart arteries are diseased, patients develop chest pains, heart attacks and even sudden death. Therefore, early recognition of symptoms by patients and hence, early diagnosis and treatment by doctors, are equally important in the management of heart disease.


Risk factors for coronary artery disease

Modifiable:
- Diabetes
- Hypertension
- Raised cholesterol
- Smoking
- Obesity & metabolic syndrome
- Lack of exercise

Non Modifiable:
- Age >40 in males, post menopausal females
- Male gender
- Family history of coronary artery disease


Managing the risk factors

Diabetes, hypertension, hyperlipidemia, obesity and smoking are major risks for Ischemic heart disease. All of these can be screened and all of them are modifiable.

Early detection, prompt treatment and adequate control of these can lead to an enormous impact on the burden of IHD domestically. Studies published indicate high prevalence of diabetes and hypertension.

40.7 per cent of patients who have diabetes also develop hypertension. Therefore, the risk of IHD increases several folds in this group of patients.
It is important to note that the incidence of diabetes and hypertension increases after the age of 40. This information should be assimilated with the fact that elderly population here is fast increasing. This also gives us an idea of the target population to screen and focus on preventive strategies.

An audit conducted on patients of coronary artery disease who require intervention shows the high prevalence of hyperlipidemia, hypertension and diabetes in these patients.

Up to 80 per cent of the patients have hyperlipidemia as defined by international criteria, 60 per cent have hypertension and 40 per cent diabetes. Smoking is also highly prevalent in these patients.


Measures to Control Coronary Risk Factors

Prevention:
1. Raising public awareness
2. Institution of screening programmes
3. Appropriate dietary measures: avoiding excess fat and calories
4. Regular exercise and physical activity
5. Avoid smoking and smokers

Controlling the risk factors (in consultation with your doctor):
1. Adequate control of diabetes through diet, drugs and exercise
2. Regular medication and control of hypertension
3. Achieving guideline-based target cholesterol
4. Early detection of any coronary artery disease through proper investigations like ECG, Stress Test, Echocardiogramn and Cardiac CTAngio.

Secondary prevention (for those who already have coronary artery disease):
1. Aim to prevent progression or recurrence of coronary artery disease
2. Regular medications
3. Regular exercise for at least 30 minutes daily.
4. Controlling underlying risks like diabetes, hypertension and hyperlipidemia
5. Stay away from smoking and smokers
6. Recognise cardiac symptoms early and prompt reporting to doctor

This article was prepared in conjunction with the World Heart Day, through the help and efforts of all healthcare personnel in the Cardiac Centre at RIPAS Hospital

Source: Weekend 23 August 2008

The healthy way to weight loss

By

Awg Ilham bin Hj Md Ali,

Dietitian, Community Nutrition Division,

Public Health Department,

Ministry of Health

PART 1 OF 3

WORKING IT OUT... An overweight boy doing sit-ups at a school in Singapore. AFP

Weight Loss (Behaviour Modification)

"I'm a serial yo-yo dieter and have tried all the fad diets, one of them being high protein low carbohydrates diet. I always look for the easy option. I've finally realised it doesn't exist. I can lose weight on certain fad diets but always revert back to my old eating habits."

Proper nutrition and physical activity are not the only prerequisites to achieving and maintaining appropriate body weight. Behaviour and attitude are supporting factors. Therefore, the real success of losing weight permanently is through changes made in one's lifestyle. Every change works best if you are prepared.

Once you have made up your mind to lose weight, you should make that commitment and go into it with a positive attitude. We all know that losing weight is a challenge. It takes time, practice and support to change lifetime habits. But it's a process you must learn in order to succeed. You and you alone are the one who has the power to lose unwanted pounds.

If you always look at the negative side of things, you'll become a downbeat, pessimistic person. Even slightly negative thoughts have a greater impact on you and last longer than powerful positive thoughts.

The first step you should take is to adopt healthier eating habits. Habits, good or bad, are formed by repetition. Eating habits are no exception.

If you are in the habit of snacking when you watch TV, you were reinforcing that habit until finally it became a part of you. Other habits are formed in the same way.

Some of these habits are: eating while reading, eating the minute you come in the house, eating when the kids come in from school, or eating while cooking dinner.

What you can do is keeping a diary which refers to recording some aspect of your behaviour, such as foods eaten, exercise sessions, medication usage, etc, or an outcome of these behaviours, such as weight.

Self-monitoring of a behaviour can be used at times when you're not sure how you're doing, and at times when you want the behaviour to improve.

Self-monitoring of behaviour usually changes the behaviour in the desired direction and can produce "real-time" records for review by you and your health care provider.

For example, keeping a record of your exercise can let you and your provider know quickly how you're doing, and when the record shows that your exercise is increasing, you'll be encouraged to keep it up.
Some people find that specific self-monitoring forms make it easier, while others prefer to use their own recording system.

A motivation list will help you keep track of the things you want to get out of losing weight.

Here are a few examples:

- More energy to spend quality time with family and friends.
- Fit into all your clothes.
- Live a long, healthy life
- Not be uncomfortable in public
- Not become breathless climbing stairs
- Do "active" things
- Wear nice clothes

The following techniques can be adapted as part of your daily routine in achieving a healthy, long term weight loss:

1. Eat three meals a day in accordance with 'The National Healthy Food Pyramid.' Don't skip meals.
2. Prolong your meals by: eating slowly, putting down your eating utensil between each bite: do not pick up your eating utensil until you have swallowed the bite hesitating between bites, even if you're eating finger foods.
3. Don't shop when you are hungry.
4. Carry appropriate snacks from home and avoid vending machines.
5. Choose a specific place in your home or office to eat all of your meals. This will become your "designated eating place" and should not be changed. Try not to eat at your desk at work. This would make you prone to eat all daylong and not just at mealtime.
6. Engage in no other activities while eating (such as reading or watching television).
7. Do not keep food in any room in your house except the kitchen. Do not keep food such as cookies out on the counters. Do not store items in "see-through" containers.
8. Serve yourself on a smaller plate. Minimise contact with excessive food (serve individual plates; do not put serving dishes on the table).
9. Encourage others to eat appropriate foods with you.
10. Arrange for rewards for each unit of weight loss.
11. Ask family and friends for reinforcement (praise and encouragement).

Next time you go and grab a quick snack, ask yourself - "Am I really hungry?"

You would be surprised at how many times we eat for other reasons such as depression, habit or sheer boredom.

If you find that the reason is one other than hunger, try and replace it with another pleasure to take its place.

(Ministry of Health Public Awareness Programme)

- To be continued

Source: Weekend, 16 August 2008

Ready, set, go breakfast!

Fibre in wholemeal bread and vegetables will make you feel full for a longer duration.




Dosai / chapatti contains fewer calories compared to murtabak.

By

The Community Nutrition Division (CND),

Health Services Department, Ministry of Health

Kring! I slowly opened my eyes and grabbed the screaming alarm clock beside my bed. I rubbed my eyes twice for I could not believe that it was already 6.50am. I thought to myself: "I am running late! My kids are going to be late for school."

I'm sure that this is a typical scenario that many readers can relate to. When we are in a hurry, some of us would choose to skip breakfast altogether. However, we should not skip breakfast, as it is the best way to start the day.

Breakfast literally means "breaking the fast". Imagine you sitting in a car. Early in the morning before you go to work, you need to warm up the engine first before you hit the road. The same applies to our bodies. We need to "fuel it" with breakfast first before we start our day.

Ask yourself these questions: Did I have breakfast this morning? Why is breakfast so important? Why do dieticians and nutritionists all over the world keep reminding people to have breakfast before starting the day?"

Apart from providing you with energy and nutrients, a healthy breakfast gives you many benefits.

The following are the plus points for having breakfast:

(1) Breakfast beats binge eating
Do you ever wonder why those office workers tend to go for high calorie foods during their mid-morning break such as nasi lemak, nasi katok, cucur, murtabak and fried noodles?

This is because most of them skip breakfast. Eating a healthy breakfast will keep you from getting too hungry and thus, will prevent you from overeating later in the day.

(2) It works for weight loss
Skipping breakfast is a common strategy for losing weight, but it is definitely not a smart one.

There's no evidence that suggests skipping breakfast will help one lose weight. Instead studies have shown that most people who skip breakfast tend to eat more calorie-dense foods throughout the day.

Skipping breakfast can also slow down your metabolism, while eating a good breakfast will give your metabolism a boost. If you're trying to lose weight, slowing down your metabolism is definitely something that you do not need.

(3) Breakfast improves performance at work and schools
Breakfast helps to replenish blood glucose levels. Studies have shown that eating breakfast is associated with improved strength and endurance in the late morning, along with a better attitude toward work.

While eating breakfast is important for all ages, breakfast is especially important for children and adolescents.

Studies have shown that children who eat breakfast are more likely to have better concentration, problem-solving skills and eye-hand coordination. They are also more alert and creative and less likely to miss classes.

(4) Helps lower cholesterol, which reduces the risk of heart disease
Research has shown that people who eat breakfast consume less cholesterol than those who skip it.

(5) Better mood
Hormones like estrogen and progesterone regulate the serotonin level in the brain. Unbalanced serotonin level produces mood swings. If your serotonin happens to drop, so will your mood.

Bear in mind that having a healthy nutrition is important because it can balance serotonin levels in your brain, helping you to feel more upbeat and energised. So do not skip your breakfast!

(Ministry of Health Public Awareness Programme)

USEFUL TIPS
What excuses do you have not to take breakfast? Not hungry? No time? Upset my stomach? Not used to having breakfast? Well, breakfast need not be anything difficult to prepare.

* Not hungry?
Something is better than nothing. Drink milk or juice, Eat wholemeal crackers, buns or fruits like bananas.

* No time?
Prepare breakfast that needs little preparation time like breakfast cereals with fresh milk (for kids)/ low fat milk (for adults), toasted bread with peanut butter / cheese or yoghurt with a piece of fruit.

* Perk up cereals
Top cereals with fruit or chopped nuts such as peanuts, pecans and walnuts.

* Having upset stomach?
If you are not used to having breakfast, it is common to have upset stomach once you start taking it. This is because your stomach is used to being empty early in the morning.

Try eating in small portions first and slowly increase the portion size according to your requirements.


Source: Weekend, 9 Aug 2008

BREASTFEEDING: Workplace & Employment

By

Dr Onn Fei Wen

Senior Medical Officer

Obstetrics & Gynaecology, RIPAS Hospital

World Breastfeeding Week (WBW) 2008 will be celebrated today (2 August 2008) until August 7.

The objectives this year are:

- Expand awareness of the need for and the value of providing support to a breastfeeding mother
- To disseminate updated information about the support for breastfeeding mothers
- To create optimal conditions for the provision of mother support in all circles of support.
The official Olympic symbols of five interlocking coloured rings are ideal for describing the five circles of support for breastfeeding.

These circles illustrate the potential influences on a mother's decision to breastfeed and to have a positive breastfeeding experience.

The circles of support are:

Family and social network
Workplace and employment
Government and legislation
Healthcare
Response to crisis or emergency all surrounding the woman in the centre circle.

This article will emphasise on the influence of the workplace and employment where employed women face challenges and need support to succeed at working and breastfeeding.

Women work for a variety of reasons, including financial and social rewards.

Today, working women are the rule, rather than the exception.

Most women return to work at a time when they could still be breastfeeding. It is certainly possible to successfully combine breastfeeding and employment.

A supportive workplace can make a big difference.

The benefits are far reaching for the babies, mothers and employers.

Creating a breastfeeding-friendly workplace

Some of the benefits:

Benefits to the employer:

Breastfeeding women are less likely to be absent from work to tend to a sick baby
Breastfeeding women are more likely to return to work (less staff turnover), enabling employers to keep trained, experienced and motivated workers

These women have improved work satisfaction, hence, improved productivity and morale
Companies who establish Mother-Friendly Workplace initiatives improve their corporate image and are viewed as progressive employers who are supportive of families.

Benefits to the baby:

- Breastfeeding meets a baby's nutritional and emotional needs for the first six months, and continues to contribute to the baby's nutritional and emotional health into the second year and beyond
- They have stronger immune system which means they have fewer infections, less frequent food allergies, and less severe illnesses, resulting in fewer hospitalisations
- Decreased risk of SIDS (Sudden Infant Death Syndrome)
- Improved IQ

Benefits for the mother:

Breastfeeding confirms a mother's unique ability to feed her infant in the best way possible. This in turn can be empowering

Breastfeeding offers satisfaction for the mother that she is providing her child with the best milk available to promote optimum infant health

Breastfeeding strengthens the bond between mother and child ahich is important for women whose job separates them from their children

Breastfeeding helps moms to get into shape faster and decreases their future risks of breast and ovarian cancers.

Creating a breastfeeding-friendly workplace for employees is easy

It is essential that the employee be offered:

Flexible time schedule to accommodate pumping or breastfeeding

A comfortable area to breastfeed. Many mothers appreciate a quiet space with a comfortable chair, a table and hand washing facilities nearby. Appropriate signage can also be offered

Mothers who pump may require access to an electrical outlet if using an electric pump

Mothers who express or pump their milk may need access to refrigeration.

It is suggested that the employee be offered:

Option of part time or job sharing
Extended maternity leave
On site or nearby day care
Working from home whenever possible
Support/ information from breastfeeding resource personnel

- Ministry of Health Public Awareness Programme

Source: Weekend, 2 Aug 2008