Sleep is one of the most passionately discussed topics with parents of newborns. Whether it is the friendly neighbourhood aunty or the stranger you find yourself sitting next to at the clinic, everyone seems to have unsolicited opinions to give on what a newborn’s sleep pattern should look like. While some of these well-intentioned advice may leave you stressed, do keep in mind that according to the experts at the American Academy of Sleep Medicine there is a wide range of normal variation in duration and patterns of sleep in infants younger than 4 months. Normal sleep habits for newborns and babies Let’s first look at what falls within the normal range of infant sleep habits. Newborns typically sleep about 14 to 17 hours in a day. For the first 3 months, this usually follows a repeated pattern of sleep-alert-feed. As newborns don’t yet have a sense of day and night, they continue to repeat this pattern even throughout the night for the first few months. Generally, newborns sleep a total of about 8 to 9 hours during the day and a total of about 8 hours at night. They wake up every few hours to feed. As their stomachs are very small, they are only able to feed small amounts at any one time. As breastmilk is more easily digested, a breastfed baby would be up about 2 hours of their last feed while a formula-fed baby may go up to 3 hours. Starting at around 3 months of age, an infant’s daily sleep needs drop to 12 to 15 hours. Most babies start to sleep through the night from this time onwards. However, as they grow older there might be other issues such as teething, growth spurts or sleep regressions that may lead to nighttime awakenings. Signs of sleep trouble How can you know if your infant is not getting enough sleep? Firstly, it’s important to remember that what you need to monitor is the total amount of sleep in 24 hours and not any specific sleep schedule. Additionally, being alert when awake and feeding well are also good indicators that your baby is getting enough sleep. Some babies develop sleep problems at about 6 months when they begin to experience separation anxiety. This may be because they do not yet understand that separations are temporary or because they are overstimulated. You may notice these behaviours when this happens: Waking and crying one or more times after sleeping through the night Crying when you leave the room Refusing to go to sleep without a parent nearby Clinging to the parent at separation Helping your baby sleep well Your baby would usually let you know when they’re ready to sleep by fussing, crying, yawning or rubbing their eyes. Just follow these cues of sleep readiness to help them develop their sleep schedule. Creating a bedtime routine is helpful to help babies fall asleep on their own or go back to sleep when they are awakened in the night. Here are some ways you can help your baby with this: Cuddling and comforting your baby during the day to help them feel more secure Allowing time for naps as needed for your baby’s age Not having any stimulation or activity close to bedtime Creating a bedtime routine, such as bath, changing into a fresh diaper and pajamas and rocking under dimmed lighting Tucking your baby into bed when he or she is drowsy, but before going to sleep Comforting and reassuring your baby by patting and soothing without taking them out of bed for night awakenings As mentioned above, there are many ways you can help your baby fall asleep and stay asleep. What’s important is that you are consistent with the routine and your responses. It’s also important to remember that every baby is different and there are no fixed rules to follow. However, if you notice anything that bothers you don’t hesitate to talk to your paediatrician. Finally, do remember to rest well yourself as sleep is as important for mommies as it is for babies. References:Paruthi S, et al. J Clin Sleep Med 2016;12(6):785-786.Sleep Foundation. Babies and Sleep. Available at: https://www.sleepfoundation.org/baby-sleep Accessed 24 August 2021.Stanford Children’s Health. Infant Sleep. Available at: https://www.stanfordchildrens.org/en/topic/default?id=infant-sleep-90-P02237 Accessed 24 August 2021Stanford Children’s Health. Newborn Sleep Patterns. Available at: https://www.stanfordchildrens.org/en/topic/default?id=newborn-sleep-patterns-90-P02632 Accessed 24 August 2021      

Polycystic Ovary Syndrome commonly known as PCOS is a condition in which the ovaries produce an abnormally high amount of androgens. These are male sex hormones that are usually present in women in small amounts. The condition affects women during their childbearing years (ages 15 to 44) and often goes undetected in many women. Despite its name, not all women with the disorder develop multiple small cysts in the ovaries.  Causes of PCOS While the exact cause of PCOS is not clear, many women with the condition have insulin resistance. This means the body is unable to use insulin properly resulting in a build up of insulin levels. This may cause higher androgen levels. Obesity is a major cause of insulin resistance and make PCOS symptoms worse. Sometimes PCOS may also run in families, where sisters or mother and daughters have it. Additionally, low-grade inflammation is also common in women with PCOS, which stimulates polycystic ovaries to produce androgens.  Symptoms of PCOS Symptoms of PCOS may appear at different stages of a woman’s life. Some women start seeing symptoms around the time of their first period. Others only discover them when they have gained a lot of weight or have difficulty getting pregnant. Not all women with PCOS will have all of the symptoms, and each symptom can vary from mild to severe.  Symptoms of PCOS may include: Missed, irregular or very light periods Abnormally heavy periods Ovaries that are large or have many cysts Difficulty getting pregnant (infertility) Excess body hair, including on the chest, stomach and back Weight gain, especially around the abdomen Acne or oily skin Male-pattern baldness or thinning hair Small pieces of excess skin on the neck or armpits (skin tags) Dark or thick skin patches on the back of the neck, in the armpits and under the breasts Getting it checked If you suspect that you may have PCOS, fix an appointment with your gynaecologist or endocrinologist to get it checked. Most cases can be diagnosed with a thorough evaluation of your medical history and symptoms, as well as a physical examination. A blood test may be required to check the levels of various hormones, including androgen. In some cases, an ultrasound of the ovaries to check for cysts may help with diagnosis.  Treatment of PCOS Treatment of PCOS is highly dependent on your goals and symptoms. If you are trying to become pregnant, oral or injected fertility medications may be needed. Those who don’t want to become pregnant, may consider birth control pills or progesterone supplementation to regulate periods.  There is also a non-hormonal treatment option, which is a medication usually used for diabetes. This medication may help restore fertility and assist weight loss. Other medications are available to manage unwanted hair growth and acne.  Surgery can be an option to improve fertility if other treatments don’t work. A procedure called ovarian drilling makes tiny holes in the ovary to restore normal ovulation.  Lifestyle changes Making certain changes to your lifestyle can also help relieve some of the symptoms of PCOS and prevent further complications. These may include: A change in diet. Eating a low-calorie, nutritious diet can help if you need to lose weight and lower blood glucose levels. Limit starchy or sugary foods and increase your fibre intake. Losing just 5 to 10 percent of your body weight can help regulate your menstrual cycle and improve PCOS symptoms.  Exercise. Regular physical activity will also help with weight loss and blood glucose regulation. Try to engage in 30 minutes of moderate-intensity exercise at least 3 days a week.  Maintain a healthy weight. Weight loss can reduce insulin and androgen levels and may restore ovulation. Work with your doctor and dietitian to develop a weight-loss plan to reach a healthy weight and maintain it. There are also medications that can help with weight loss if needed. PCOS is a common yet underdiagnosed condition among women. Lifestyle interventions and medications are available to treat the condition. With proper management, symptoms of PCOS can be alleviated and normal menstrual cycles restored, making pregnancy a possibility.   References: Johns Hopkins Medicine. Polycystic Ovary Syndrome (PCOS). Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos Accessed 3 September 2021. Healthline. Polycystic Ovary Syndrome (PCOS): Symptoms, Causes, and Treatment. Available at: https://www.healthline.com/health/polycystic-ovary-disease#causes Accessed 3 September 2021.  NHS. Polycystic ovary syndrome. Available at: https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/ Accessed 3 September 2021. WebMD. Polycystic Ovary Syndrome (PCOS). Available at: https://www.webmd.com/women/what-is-pcos Accessed 3 September 2021.

  It is a crowded world out there in the supplement market. You are definitely not alone if you have wondered whether your child is missing out for not taking the latest vitamin gummy on the pharmacy shelves.  As its name implies, vitamin and mineral supplements are meant to supplement or compensate for any nutritional deficits in a person’s diet. Ideally children should obtain these nutrients through a well-balanced and healthy diet. However, in reality there are many reasons why this may not be achieved.  Which kids need supplements?  Paediatricians may recommend daily doses of specific vitamins and minerals for the following: Children who are not eating sufficient fresh, whole foods Picky eaters who lack variety in their diets Children eating a lot of fast food or processed food Children with restricted diets, including vegetarians Children who drink a lot of carbonated beverages, which can leach vitamins and minerals from their bodies Children with chronic medical conditions such as asthma or digestive problems and those who have had surgery  Recent studies have shown that children in Singapore do not consume enough fruits, vegetables and whole grains while their sodium and sugar intakes are high. While eating habits need to be improved in general, vitamin and mineral supplementation may be beneficial in addressing any nutrient deficiencies they may have.  What are the essential supplements? Several vitamins and minerals are critical for growing children.  Vitamin A aids in normal growth and development, as well as tissue and bone repair. It is also essential for maintaining healthy skin, eyes and immune responses. Vitamin Bs The B vitamin family, which includes B2, B3, B6 and B12, is important for metabolism, energy production and maintaining a healthy heart and nervous system. Vitamin B12 is the most important of the B vitamins and is found primarily in animal-based foods. Children who are vegetarian/vegan may not get enough B12 in their regular diet. Vitamin C aids the body’s ability to heal and fight off infections. It also helps to strengthen muscles, connective tissue and the skin. Reduced consumption of fruits and vegetables may result in a deficiency of this nutrient. Vitamin D helps the body absorb calcium, which is required for bone and tooth formation. Because infant formula and growing up milk are usually fortified with vitamin D, infants and children who consume them do not need additional supplementation. Calcium is the essential building block of bones and teeth. Building strong bones during their growing years will serve as reserves when bone loss occurs later in life. Iron builds muscle and is essential for healthy red blood cells. It is especially critical during periods of rapid growth. Some things to keep in mind Fresh foods are the best source of nutrients. So, while you are attempting to address any nutrient deficiency in your child through supplementation, it is also important to serve a variety of whole, fresh foods as much as possible so that they do not require supplements for long. Remember that it is entirely possible to overdose on vitamins through supplementation. Vitamin or mineral supplements can be toxic to children when taken in excess amounts. This is particularly true for the fat-soluble vitamins A, D, E and K. Vitamins that are in gummy forms can also be easy to overeat because of their candy-like taste and appearance. It is best therefore to consult with your child’s paediatrician to see if they are indeed in need of any supplements and to always keep the supplements out of reach of children.   References: Grow by WebMD. Vitamins for Kids: Do Healthy Kids Need Supplements? Available at: https://www.webmd.com/parenting/guide/vitamins-for-kids-do-healthy-kids-need-vitamins#1 Accessed 17 August 2021. Stanford Children’s Health. Kids Need Their Nutrients. Available at: https://www.stanfordchildrens.org/en/topic/default?id=kids-need-their-nutrients--1-19820 Accessed 17 August 2021. Manson JE & Bassuk SS. JAMA 2018;319(9):859-860. Brownlee IA, et al. Nutrients 2019;11(11):2615. Choy MJY, et al. Nutrients 2021;13(4):1335.