The Life Changing Story of Charlie

On Your Side | Real Life Story: Often times, we hear stories of people with health-related problem and their successful journey of healing. This time, Parents Avenue brings you the life-changing story of Charlie from Kota Marudu, Sabah.

Written by Sylviannie Jreneus 
Parents Avenue Magazine Issue No.11 April to June 2018

Charlie with his parents in the ward on the day of discharge.

Charlie bin Magawa is a 9-year-old boy from Kampung Mantus, Kota Marudu. He is the fifth and the youngest child of Magawa bin Malugot, 55 and Roining binti Kulamau, 49. Charlie has two older brothers and two older sisters. The first two siblings, aged 28 and 25, are currently working with a private agricultural company in Australia. The third sibling, aged 21, is currently unemployed, whilst the fourth sibling is studying in Form One in SMK Tandek, Kota Marudu. As for Charlie, he goes to SK Tanjung Batu, Kota Marudu as a Year 3 student. With a big passion for badminton and art, Charlie leads a normal life just like every other boy at his age. But, little do we know, that Charlie was previously diagnosed with a serious health condition that, had he been left untreated, could have cost him his life.

It all started when Charlie, who was then only 5 years old, was down with fever and later begun to experience breathing difficulties. As every concerned parent would do, his parents brought him to a Kota Marudu Hospital to seek for further help. The doctor on duty did an X-ray on the little boy, which led to the first diagnosis – Charlie had heart issues. The same day that he was diagnosed, Charlie was sent into emergency and was straightaway transferred to Sabah Women and Children Hospital, Likas, Kota Kinabalu.

He received more detailed tests in Sabah Women and Children Hospital. A blood test was performed and the results came in positive that he was suffering from Rheumatic Heart Disease (RHD). A paediatric cardiologist from Sabah Women and Children Hospital, Likas did an X-ray on Charlie. He had found that one of Charlie’s four heart valves was infected.

After detection, Charlie was given antibiotics to fight off against his valve infection, and that treatment lasted for a year. Unfortunately, the valve was still infected, so Charlie had no other choice than to receive a monthly injection during the second year until proper treatment could be done; which is to undergo a heart surgery.

Charlie’s scar 3 months after the surgery.

Rheumatic Heart Disease (RHD) suffered by Charlie is a condition of permanent damage to one or more heart valves. It is caused by rheumatic fever, which is a complication of an untreated bacterial infection with Streptococcus, or “strep”. Like in Charlie’s case, it is all started when he was down with fever but at the same time, he experienced breathing difficulties. Rheumatic fever, which symptoms are shown by Charlie during the early detection, is an inflammatory disease that follows a strep infection. If it is left untreated, it can affect many tissues, especially the heart, joints, skin, or brain. The infection may cause heart damage, particularly scarring of the heart valves. This forces the heart to work harder than usual to pump blood. In some cases, the damage may resolve on its own. However, there are also cases where the damage is permanent, which eventually causes heart failure. Heart-related complications of rheumatic fever may develop months or even years after the initial strep infection.

The doctor who handled Charlie’s case in Sabah Women and Children Hospital, Likas made an effort to ease out the family’s application to get funds from Sabah Council of Social Service (SCSS) as little Charlie needed to undergo a heart surgery as soon as possible. They waited for less than a year before the application was finally approved by YB Datuk Hajjah Jainab DSP Hj Ahmad Ayid, the Ministry of Community Development and Consumer Affairs. That was the first good news received by the family for Charlie’s case. In the meantime, Charlie still depended on the monthly injection until he turned 8.

At first, Charlie’s parents were informed about their available options on where the surgery can be performed, which was at a hospital in India, or Gleneagles Kota Kinabalu Hospital. Due to distance, going to India was not the family’s first option, so they opted for Gleneagles Kota Kinabalu Hospital as they were able to perform the heart surgery for Charlie there. That was indeed the second good news for the family.

Dr. Abu checking Charlie’s heart.

Dr. Abu Bakar, Cardiothoracic Surgeon of Gleneagles Kota Kinabalu Hospital finally handled Charlie’s case. Before surgery, Charlie’s condition worsened up until the point where he turned terribly weak. His skin turned pale, he lost a lot of weight and he was down with swollen chest. He also experienced abdominal and chest pain which made his condition even worse. He was still facing difficulties in breathing due to the worsening of his heart condition. His parents were very heartbroken to see their youngest child being in that condition and have been praying hard to be able to see Charlie’s health back on track again. The strong parents refused to give up on their son.

So the heart surgery was done and there comes the third good news and the biggest blessings for the family. Charlie’s heart surgery was a success! Thanks to all doctors who did their parts throughout his journey as a Rheumatic Heart Disease patient, from a very weak and thin little boy, Charlie is now an active boy and he gained weight as his appetite increased. His parents’ prayers have been answered. Just like typical adventurous boys of his age, he is always with his outdoor activities, especially cycling and playing badminton. The surgery done by Dr. Abu Bakar from Gleneagles Kota Kinabalu Hospital is indeed life changing. Charlie’s case is a living proof of that.

The operation cost is approximately RM60,000 to RM80,000 and was fully funded by Sabah Council of Social Service (SCSS). SCSS, or also known as Majlis Perkhidmatan Masyarakat Sabah (MPMS) is established under the Chairmanship of the Commissioner Labour and Welfare with the main purpose of assisting voluntary welfare work and it includes for health-related cases like Charlie’s. SCSS is later became the constituent partner of The National Council of Social Welfare, Malaysia alongside with the Sarawak Social Welfare Council.

Charlie with his parents at Gleneagles Kota Kinabalu Hospital

As parents, Magawa and Roining were over the moon and were very thankful to be able to receive full funding from SCSS to cover Charlie’s heart surgery cost at Gleneagles Kota Kinabalu Hospital. It was a blessing for the family who are desperate to see their beloved child to live a normal life again. And Charlie just did!

As a father, Magawa has a message for every family who are facing similar situation like theirs. To him, patience is the key. There must be a cure for all diseases, as long as we follow what the doctor’s advice. Doctors are specialised in their own fields and of course the suggestions made by them are the best. As for Charlie’s mother, Roining, she said that it is important for us to act fast for treatments and don’t be afraid to do the surgery because it does change our life. Like her husband, she also encourages each of us to listen to the doctor’s advice.

Gleneagles Kota Kinabalu Hospital, where Charlie’s life-changing heart surgery was performed, is a tertiary level hospital bringing Sabah a Healthcare facility of International standards that shall work towards enhancing care in the state of Sabah. It is assimilated with regionally well-established premium Gleneagles brand inculcating a facility with high quality amenities / comforts, service levels to match, infused with cutting edge technology and have a highly trained team of consultants and staffs.

Gleneagles Kota Kinabalu Cardiac Centre is bolstered by prevention program, diagnosis and treatment directly to the patients, both adults and children. The cardiac team consists of Interventional Cardiologist, Cardiothoracic Surgeon, Cardiac Anaesthetist, Perfusionist, Peadiatric Cardiologist & Cardiac Technicians. They have a standby cardiac catheterization laboratory that would operate for 24 hours. Thanks to the professionalism of the Gleneagles Kota Kinabalu Hospital, many lives were saved, that including Charlie’s.

A hole in the heart, toddler Nurnafisyah's Story

Real Life Story: 

A hole in the heart,
Toddler Nurnafisyah Jafarlie's Story.

Siti Nurnafisyah Jafarlie was only 4 months old baby when the doctor discovered she had ventricular septal defect (VSD) or commonly known as hole in the heart. “We were surprised, sad and heartbroken when the doctor informed us about her heart condition. Since she is our first child, we were very afraid of losing her,” said Siti Norihan Ibrahim.

Siti Norihan Ibrahim and husband Jafarlie Matusin have two daughters. The eldest is Siti Nurnafisyah Jafarlie and the youngest is Siti Nurnazihah Jafarlie. Siti Norihan work as an assistant chief cashier while her husband is a supervisor and they all live in Papar.

It was one of the regular review and vaccine day for baby Nurnafisyah. Suddenly, the doctor discovered an irregular heart beat. The doctor told Siti Norihan that her 4 months old baby may have a heart condition and advised her to take her baby for an ECHO scan. The ECHO scan allows doctor to clearly see any problem with the way the heart is formed or the way it’s working. After the scan, it is confirmed that baby Nurnafisyah has a hole in the heart.

A complete happy family, one year after the operation. From left: Jafarlie

(father), Siti Nurnafisyah, Siti Nurnazihah (youngest sister) and Siti Norihan (mother).

VSDs are quite common, varying from tiny defects such as a pinhole in size to much larger ones. Most children with hole in the heart may not have any major symptoms, but they may get easily tired, always sleeping or out of breath. Larger hole will require surgery to correct the defect.

Nurnafisyah was given medication soon after they found out about her heart condition. About 30% or more babies’ with small defects will close spontaneously during early childhood but Nurnafisyah is one of the 70% that did not.

By the age of 3, Nurnafisyah’s hole in her heart did not go away which made her mother determined to find another way to help her daughter's condition. The doctor that has been treating Nurnafisyah advised Siti to seek further advise at a private hospital. This lead Siti to meet Dr. Abu Bakar Mamat, a Consultant Paediatric Cardiothoracic Surgeon at Gleneagles Kota Kinabalu Hospital.

After consulting Dr. Abu Bakar Mamat, they were given options for further treatment in Kuala Lumpur or Kota Kinabalu (Gleneagles Hospital) and they chose Kota Kinabalu after considering the logistics problems, travelling and undue stress of having to leave behind the rest of the family.

The operation was scheduled for their 3 years old toddler on the 21st November 2015 at Gleneagles Kota Kinabalu Hospital. Siti and her husband was very anxious and scared about the entire procedure as there are endless of risk and complication that may occur during the operation.

Five days after operation, Nurnafisyah lying in bed (centre) with her parents and
Consultant Paediatric Cardiothoracic Surgeon Dr. Abu Bakar Mamat.

Nurnafisyah’s open heart surgery was successfully conducted and giving a new milestone to Gleneagles Kota Kinabalu Hospital as the first private hospital in Sabah to perform paediatric open heart surgery locally.

Finally, Siti and her husband’s heart is also completed, relieved and happy. The successful operation may left a massive scar on Nurnafisyah but the entire family is happy that she is now a normal active child and doesn’t have to take any more medications. She has also started attending Kindergarten in Papar.

In Sabah itself, there are nearly 400 new cases of congenital heart disease diagnosed every year with up to 10 of every 1,000 newborns. An open heart surgery is a major operation and the medical expenses can amount up to RM60,000. Siti and her family could not afford the surgery therefore her case was proposed for the Khazanah IHH Healthcare Fund by the doctor.

Nurnafisyah’s hospital expenses were fully paid by the Khazanah IHH Healthcare Fund, which provides partial and fully-sponsored medical treatment to needy patients in IHH’s home markets of Malaysia, Singapore and Turkey.

The hospital also to engage with the State Government to provide help to members of the local community who may require paediatric heart surgery.

“ Previously, most children with heart congenital heart disease had to travel to Peninsular Malaysia or abroad to get treatment. With the establishment of Gleneagles Kota Kinabalu in Sabah, we are now able to perform paediatric heart surgeries locally, giving a new lease of life, ” Dr. Abu Bakar Mamat, Consultant Paediatric Cardiothoracic Surgeon.

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Can You Choose To Have A Boy or A Girl?

By Dr. Alagammai Ramanathan | Gleneagles Kota Kinabalu Hospital

For as long as we’ve been MAKING BABIES people have been exchanging ideas about how to increase their chances of having either a boy or a girl. Unfortunately there’s no medical evidence that any of them actually work. Having said that, there’ll always be a mum who tells you an old wives’ tale that worked for her. So if you fancy defying the experts and trying to tip the balance towards one sex yourself, why not try some of the suggestions below. People talk about positions, days, methods, massages and the list goes on and on.

Q1) Is there any proven method for me to choose to have a boy or a girl?

YES! There is a scientific way to get a particular sex. Fertility specialists have the ability to create and identify embryos of either sex. It is called PGD (part of IVF or the test tube babies). Only pre-implantation genetic diagnosis (PGD) has been approved as a technique which does this gender pre selection.

Q2) What are my chances of pregnancy with this method?

Well it is the same as having test tube or IVF babies. Most centers quote a success rate of about 30 to 40%.

Q3) How is it done?

Just like IVF. The fertility specialist will have to induce ovulation (by medication) and take the eggs out once matured and insert the sperm into the egg to await fertilization. Once it is at a certain stage transplant it back into the womb.

Q4) Is it done in Malaysia?

YES, at fertility centers with IVF facilities

Q5) Is it legal? Can anyone walk in and ask for it?

Legally you only allowed to choose your baby’s gender if you have a serious genetic condition that you risk passing on to your children. In other words you can’t medically intervene with conception

just to balance your family, or for social or cultural reasons.

FACTS OF LIFE

While it is very difficult to choose a boy or a girl, knowing some facts of life and conception may help. Men produce two types of sperm — X being female and Y being male (only men determine the sex of the baby).

Male sperm is smaller, weaker and faster than the female sperm which is bigger, stronger and slower. Sex of the baby depends on which sperm reaches the egg first, once a sperm penetrates the egg it forms a hard coat around the egg so that the other sperms cannot enter after that. So even though the Y chromosome is faster they are weak, if they do not penetrate in time the X will reach and as females are stronger they tend to fertilize the egg much easier.

1) Timing of intercourse (this is only if you can predetermine your ovulation time)

As the male sperms are faster,if you want to have a boy then it is advisable to have sex on the day of ovulation. For a girl baby, start early before ovulation. Ovulation is the time the egg is ready for penetration of sperm, so whichever sperm is there it will penetrate. For female, sex before ovulation will ensure adequate time for the sperm to travel up to the egg and once the sperms are around the egg, even if there are male sperms around the egg, the female sperm which is much stronger will be able to get in.

2) Vaginal pH

Usually the vaginal pH is acidic, on the day of ovulation it is alkaline. An acidic environment is more favourable for the conception of a girl. It’s apparently not as welcoming for male sperm. The acidic environment kills the weaker male sperm first. So if you want a boy then sex during ovulation may help.

3) Abstinence

For a boy- do not have intercourse for four to five days prior to ovulation. You should use a condom if you wish to have sex during this time. Sex during ovulation is important. For a girl- try daily intercourse from the end of your period until 2-4 days prior to ovulation, then no intercourse until 2-3 days after ovulation.

4) Sexual Position

Sexual position is said to help your chances of gender selection due to both depth of penetration and pH levels. The closer to the opening of the vagina, the more acidic the woman’s reproductive tract (vagina) is. Hence with deeper penetration (e.g. doggy-style)your chances of a boy go up. This will apparently place the male sperm closer to the egg, giving them a head start. Missionary position could be used when trying to conceive a girl.

5) Orgasm

To conceive a boy, the woman should try to achieve orgasm either before or at the same time as her partner. Multiple female orgasms can help! It is believed that the waves of the orgasm will help to draw up the sperm quicker to the egg, again giving the boys getting a head start on the girls. For a girl, it is recommended for women to avoid orgasm.

Here’s one for the men: if you’d like to try for a boy, the shettles method suggests that men try to keep their scrotal temperature cool. This means no hot spas or baths and no tight clothing or underwear. Boxer shorts are a good alternative. Avoid scuba diving and heated vehicles for extended durations (or other areas of high heat).

How about sex selection kits?

DIY kits which claim to help with sex selection are based on the Shettles theory. Separate girl and boy kits are available (overseas). They include instructions, a basal thermometer, ovulation predictor test sticks, supplement tablets, and douches that are supposedly gender specific.

In Malaysia we don’t have DIY kit but we do have ovulation kits and you will need to visit your gynecologist for the supplement medications. If you do have difficulty in conceiving both husband and wife will need to undergo some tests to ensure both partners are healthy and ready for a good pregnancy journey ahead.

For more information, please contact Gleneagles Kota Kinabalu Hospital at 088-518 888.Address: Riverson@Sembulan, Block A-1, Lorong Riverson@Sembulan, 88100 Kota Kinabalu, Sabah. For Emergency, please call 088-518 911

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For the complete article about this subject can be read on this July to September issue of  Parents Avenue Magazine. Disclaimer: All information is for your general reference only. We do not accept any responsibility whatsoever in respect of such information.

Mommy, my tummy hurts!!! Abdominal Pain in Children

By Dr. Alvin Khoh | Consultant Paediatric Gastroenterologist | Gleneagles Kota Kinabalu Hospital

Abdominal pain in children is a common occurrence. Thankfully, in most cases, it is not caused by a serious condition. Irregardless, it does cause a lot of discomfort and distress to both the child and the family. It tends to interfere with the child’s daily activities, including schooling and other play activities.

Abdominal pain can happen suddenly or developed slowly over time. Most often, it is associated with other symptoms e.g.. vomiting, diarrhoea or fever.

The causes of abdominal pain in children are quite diverse. Among the more common cause may be food related (too much food, fizzy drinks or food poisoning), constipation or even viral infection (including gastroenteritis, causing vomiting and diarrhoea).

Other causes includes:
• Gastritis
• Heartburn
• Food allergy
• Appendicitis
• Urine infection
• Period pain in girls

In some children, the cause of abdominal pain may not be easily diagnosed at the onset. Over time, as more symptoms appear, it becomes more obvious. Thus it is very important for the child to be closely followed-up by their regular doctor in these instances.

Diagnosis and Treatment

Depending on the signs and symptoms that your child has, your doctor may order some tests: e.g.. blood, urine, x-ray or ultrasound. However, in most cases, investigations are not needed.

Similarly, treatment depends on the cause of the abdominal pain. Pain relief such as paracetamol are commonly used if needed. Antibiotics and gastric medications are used when necessary. If appendicitis is suspected, then your child may require surgery.

My child has been having abdominal pain for a long time!!

Some children have recurrent abdominal pains for months without any obvious cause. These children are usually healthy looking and growing well. This phenomenon is usually described as functional abdominal pain” and is not caused by any serious disease.

However, the pain tends to interfere with their daily activities, including school. It is usually triggered by stress or significant emotional events in life. These can cause the brain to send “excessive signals” to the nerves in the gut- thus causing the pain.It is important to recognise that the pain is real to the child, and not to brush it away by calling it “attention-seeking” behaviour.

These children should be assessed and managed by a specialist doctor thoroughly to ensure that they are not suffering from any significant disease.

When to seek help from a doctor?

If the pain or problem persists more than 1 day, it is best to seek medical advice. Seek help urgently if your child has the following:

• Has severe pain, frequent pain or the pain has moved
• Does not want to move
• Becomes pale, sweaty, lethargic or has high fever
• Refuses to drink fluids
• Vomiting > 24 hours and unable to keep fluids down
• Blood in the vomit or stools
• Recent injury to the abdomen (eg. falling down from bicycle, sports-related etc)

What can you do if your child develops abdominal pain?

Many children with abdominal pain get better quickly without any specific treatment. It is advisable for them to get lots of rest. The following may also help your child:

• Encourage your child to drink fluids
• If hungry, let your child eat what they want, or offer bland food - eg. biscuit, banana, porridge
• Do not force feed
• Encourage sitting on the toilet - passing motion may help
• Rubbing a child’s tummy gently and distract them (eg story telling)
• Paracetamol may be used (in the correct dosing)

Conclusion

Many children get abdominal pain, and most get better by themselves. Often, no cause can be found and at other times, the cause only becomes more obvious with time. Seeking timely help is important in managing these children, especially if they are unwell.


For more information, please contact Gleneagles Kota Kinabalu Hospital at 088-518 888.
Address: Riverson@Sembulan, Block A-1, Lorong Riverson@Sembulan, 88100 Kota Kinabalu, Sabah. For Emergency, please call 088-518 911

Understanding Autism Spectrum Disorder

By Dr. Fauziah Zainal Abidin 
Consultant Paediatrician with special interest in Developmental Paediatrics
Gleneagles Kota Kinabalu Hospital 088-518 888


“Ahmad’s mother has been concerned about him for sometime now. At three years of age, he has not started talking like the rest of his siblings. He has not even called her “mama” and sometimes she was not even sure whether he can hear well. He hardly looked at her or responded to her calls. He would be quite happy being on his own rather than playing with his siblings.

He somehow finds watching the wheels of a moving car or the turning of a fan more fascinating than anything else. She is also concerned with his feeds. He does not like anything else with his rice and efforts to feed him the fried chicken or meatballs have resulted in almost battlefield like scenes and a
meltdown for Ahmad. She had talked to her husband and her own mother about her concerns but she would be reassured that he would “grow out of it” as one of her cousin’s did before.”

What is Autistic Spectrum Disorder?

Autism Spectrum Disorder (ASD) is a developmental condition which affects an individual in the areas of communication, social interactions and having restricted, repetitive patterns of behaviour, interests or activity. This affects the individuals ability to interact with others and they often find the world to be a confusing place as they have difficulty adjusting and adapting to new and unfamiliar people and surroundings.

They may also have sensitivity issues, either being too sensitive or less sensitive in any of the five senses, hence the preference for or avoidance of certain foods, noises, clothing or even certain lights. Every individual with ASD is also different. The term itself reflects that no two people with ASD are alike, even though they all have difficulties in communication and socialisation, each will have a unique combination of character and so may seem quite different.

ASD affects around one in every 100 people and is diagnosed 4 to 5 times more common in boys than in girls. Although it is a life long condition and there is no cure, early intervention can have a tremendous results in helping those affected to live to their full potential.


What are the causes?

There is no known direct cause of Autism. Much research is being done to try to find out more of the cause but at this point it is believed to result from changes in the brain development which may be caused by a combination of genetic factors and environment. ASD is known to run in families but no specific genes have been determined so far. ASD is not caused by parenting or social circumstances. Various reputed research has been done to prove than ASD is NOT cause by vaccines or other medical treatments.

Assessments and diagnosis

Whilst receiving a diagnosis can be distressing or a heartbreak for most families, sometimes it can come as a relief to all their questions and worries before. For the young children, diagnosis leads to acceptance and empowerment for their parents to seek assistance and can dramatically improve their outcome. There are no laboratory or imaging tests that diagnose Autism. Diagnosis are made based on the ability of the individual in the main area of concern ie. social and communication and behavioural patterns.

For older children and adults, a diagnosis can help to explain why they feel different and allow them to access support and assistance to improve their quality of life. Developmental Paediatricians, Psychiatrist, Clinical Psychologist are trained to diagnosed individuals through a series of clinical evaluation and assessments.

Experts disagree about the true increase in ASD prevalence. More awareness about ASD leads to parents become more likely to take their children to be diagnosed and more doctors now are able to properly diagnosed ASD.

Living with ASD

ASD causes individuals to struggle to understand and relate to other people and environments. This can often result in extreme behaviour, such as tantrums in a young child or rudeness in older individuals. It is the only way they can cope with their stresses and feelings of anxiety. Parents on the other hand are often perceived as bad parents who are unable to control their children from behaving badly.

Adults with ASD also struggle with social situation and ‘small talk” They may appear rude, overly critical and awkward. They will have difficulty in forming relationships and maintaining friendships. Parents may feel unprepared or doubtful of their ability to provide the necessary care and education.

On a positive note, there are many treatment options, social services and programmes that can help. The problem is usually how to get access to them. Meeting with a healthcare provider or an educator can be a good source of information. Talking to an Autism Support group can help find local resources.

Meeting with a Paediatrician can help evaluate a child’s development and rule out other problems that may be helped and subsequently referred to the other experts who will develop an intervention plan for the child. Going through the transition to adulthood should be dealt with together with family members, healthcare service providers and other professionals.

Communications and reports should be kept well. Some adults with ASD are able to achieve independence to a certain extent thus self-advocay is an important aspect for individuals and family members with ASD. Through Self advocay, they may take on more responsibility for their education, employment, health care in their own community and else where.


For more information about this topic, please feel free to contact Gleneagles Kota Kinabalu Hospital at 088-518 888 

Paediatric Forum at Gleneagles Kota Kinabalu Hospital

In collaboration with JCI Tanjung Aru, Gleneagles Kota Kinabalu will be having the first Paediatric Forum on the 20th of February 2016 at ‪#‎GleneaglesKK‬ starting from 1PM.

Come and join us for a day of educational and informative talks given by our experienced speakers. You could learn something new and valuable for your child, granchild, nieces or nephews. Entrance is free and refreshments will be provided.

Date: 20th February 2016

Time: 1pm

Venue: Gleneagles Kota Kinabalu Hospital

For more info about this program, call us at 088-518880, 088-518882 or 088-518888!

Sex and Pregnancy

By Dr. Alagammai Ramanathan | Consultant Obstetric & Gynaecologist
Gleneagles Kota Kinabalu Hospital (Tel: 088-518 888)

Sex is considered a taboo subject especially for Asian community. Both women and men are just too shy to bring the subject up for discussion and hence do not get accurate information on this subject be it.

Most women wait at least six to eight weeks after giving birth to have sex again, according to a new study published in BJOG: An International Journal of Obstetrics and Gynaecology. It may also be the absolute last thing in your mind especially while you are dealing with nausea and vomiting and later on with the baby, breast feeding and diaper changings through the night.

Most women avoid sex during pregnancy for the fear of losing the baby. It is good to take time and
discuss it with your partner as intimacy is an important part in life. Other women, however, may crave sex in pregnancy. And men, too, are split into different groups regarding sex during pregnancy. Some men may find nothing sexier than a pregnant woman, but other men may be too afraid of hurting the baby. But desire aside, is sex during pregnancy even safe?

Can I have sex during pregnancy?

A lot of times the male partners are more frightened to have sex than the women. In most cases, sex is 100% safe for mom and baby. During the first trimester most women needs to deal with nausea, vomiting and hormonal changes to the body so sex may be the last thing in your mind. During the second trimester women most feel better, there is more lubrication, and have engorgement in the genital area and the tummy is not so rounded yet. This is usually the best time.

As for third trimester the stomach grows and it becomes more tiring, sex may seem less attractive- not to mention physically difficult during the final weeks of pregnancy. There are some exceptions, which your gyny doctor will warn you about. Among other issues is, if you have an incompetent (or weakened) cervix, unexplained bleeding, diagnosed with placenta previa, frequent premature contractions with no known cause or rupture of the amniotic membranes. The best will be to discuss with your gyny doctor along with your partner. It is important for both partners to be there during this session.

Sex can hurt the baby?

Babies are well cushioned. Below the skin is our fat layer, followed by muscles, thick uterine muscles, amniotic fluid only then the baby. As there is water surrounding the baby, it is well cushioned and most movements do not harm the baby. So go ahead! babies are very safe inside the womb and the jolt will not affect the baby.

Can infection occur due to sex?

Well from below the cervix is closed and it has a mucous plug to seal and hence infection does not enter into the cavity. So it is safe. Same goes for swimming, it is ok to swim during pregnancy, the water does not enter the vagina and into the uterus and harm the baby, so there is no need to change your lifestyle. In fact swimming is a good form for exercise during pregnancy.

Can I develop contractions during sex and will that lead to delivery prematurely?

If you start cramping after sex, don’t jump. An hour or two of mild cramps isn’t unusual because both orgasm and the prostaglandins in semen can cause uterine contractions. Increased blood flow and congestion makes blood vessels more fragile on the cervix surface, and they may bleed a bit if
your partner’s penis rubs against the cervix.

However, heavy bleeding warrants call to your gyny because the placenta could be breaking away from the uterus and other causes needs to be looked into for example a cervical growth. But don’t worry - it’s all unlikely to happen. Having an orgasm causes the release of prostaglandins, which can theoretically cause contractions, unfortunately never been completely validated in scientific studies. Does it work? Well...if you’re ready to deliver, a little sex might jump-start the process.

Sexual positions during pregnancy.

This is by far the most difficult question to answer. Well usually what is good and comfortable for the baby is good and comfortable for you. The traditional man-on-top position is more uncomfortable for pregnant women and in the 3rd trimester it is not advisable for women to be flat on the back as the pregnancy can compress the blood vessels and cause a little fall in the blood pressure.

If possible avoid oral sex as bowing air into the vagina may predispose to air embolism though it is very rare.

You can have satisfying sex when pregnancy. You will need to find the most comfortable position, it is the time to explore and experiment together. Communication and openness are the keys to maintaining or improving sexual satisfaction during your pregnancy.

Riverson@Sembulan Block A-1, 
Lorong Riverson@Sembulan, 
88100 Kota Kinabalu, Malaysia
Tel: 088-518 888 
Website: www.gleneagleskk.com.my
Facebook: Gleneagles Kota Kinabalu
EMERGENCY 088-518 911

Gastro-oesophageal Reflux in Infancy

Blergggh!! Regurgitation in young infants - should I be worried?

By Dr. Alvin Khoh, Consultant Paediatric Gastroenterologist

Gleneagles Kota Kinabalu Hospital | Tel: 088-518 888

A newborn baby!

Congratulations all around! The birth of a child is definitely a joyous occasion for the family. One can spend hours just staring at a newborn baby - watching every expression and every movement that the baby makes. And then suddenly, the baby regurgitates out its milk! And not for the first time. The baby seems to regurgitate various amount of milk every now and then.

The above scenario happens quite frequently to many newborn babies and causes a lot of distress among parents. Various unhappy thoughts would often come into mind: Will my baby have enough milk, since he seems to “vomit” everything out? Will my baby grow well? Am I feeding my baby correctly? Is there anything wrong with my baby’s digestive system? Will the milk go into my baby’s lung and cause damage? Should I change formula? Thankfully, for the majority of these babies, these episodes of regurgitation are not harmful to them.

Gastro-oesophageal reflux (GOR) is a common condition and is a normal phenomenon in healthy babies. Reflux happens when there is movement of stomach content back up into the oesophagus. The oesophagus is the food tube that carries food from our mouth into our stomach. When reflux happens in babies, the milk may regurgitate all the way up into the mouth. This manifests as regurgitation or “posseting”.

Many parents often perceive these episodes of regurgitation as vomiting. From a doctor’s perspective, vomiting occurs when there is a forceful contraction of the stomach, leading to emptying of the stomach content out through the mouth. Usually, vomiting is a symptom of an underlying illness.

Compared to vomiting, the process of regurgitation is effortless and occurs spontaneously. Some babies regurgitate more than others - this does not necessarily mean that anything is wrong. It does not harm your child and is unlikely to cause problems in later life.

Why does reflux happen in babies?

The lower oesophageal sphincter (LES) is a muscle the closes the oesophagus from the stomach after we swallow. In babies, this muscle relaxes more frequently, thus allowing the stomach content to reflux upwards into the oesophagus. Studies have shown that a healthy baby can reflux up to 30 times a day, although not all reflux leads to visible regurgitation. Most babies tend to regurgitate at least once per day, although in some, it can be as frequent as after every feed. It mostly happens after feeding, but it can occasionally occurs at other times, e.g. after coughing or crying.

For most babies, you don’t have to do anything about reflux and regurgitation. It is a natural process and will resolve by itself with time. This is because as the baby grows, the oesophagus gets longer, the stomach grows larger and more importantly, the lower oesophageal junction also becomes more mature and stronger. After 6 months of age, an infant also starts to take more solids and spend more time sitting upright, and this will also lead to an improvement in symptoms. Generally, the problem disappears around 1 year of age.

When should I worry about my baby’s reflux?

Generally, if parents have any concerns or uncertainty about their baby, they should seek medical advice. You should also seek treatment if your baby has the following:

• blood or bile (greenish) in the vomit
• fever, unwell, irritable
• choking episodes
• breathing difficulty or fast breathing
• not gaining weight or losing weight
• feeding refusal

What is the treatment for reflux?

In most babies with reflux, there is NO need for medical treatment. As mentioned before, reflux is a normal phenomenon and will get better over time. However, the following practice may help in some

babies with frequent regurgitation.

You should regularly burp your child after each feed. In babies with more frequent regurgitation, some parents find it helpful if they stop and burp their baby midway, or hold the baby upright for 20 to 30 minutes after each feed. You can also try giving smaller and more frequent feeds, but definitely avoid overfeeding, especially with bottle-feeding.

Changing from breastfeeding to bottle feeding/formula is NOT RECOMMENDED as it does not have effect on reflux. If your baby is already on infant formula, it is also not recommended to routinely change formula for the same reason. There are some special infant formulas in the market that may reduce the frequency of visible regurgitation, but it is generally better to consult your doctor first before switching formulas.

Gastro-oesophageal Reflux Disease

In a small percentage of babies with reflux, it can lead to problems. This is when doctors call it Gastro-oesophageal Reflux Disease. These babies may have breathing problems due to milk aspiration, or sometimes poor weight gain. In these group of babies, the doctor may start some

medication or suggest the use of a special thickened infant formula.

Conclusion

Regurgitation or reflux is a common problem in young infants. In most cases, it does not cause harm to them and will improve with time. It does however cause parents to be distressed and often leads to

tired parents from constant washing and mopping up. It is best to seek professional advice is you are worried about your baby’s condition.


Please feel free to call Gleneagles Kota Kinabalu Hospital 088-518 888 should you need more information or advice regarding to this topic.