As a family physician working in a polyclinic, I have the good opportunity to see patients young and old from all walks of life. In my clinic, we have a maternal and child health cluster where doctors get to see children of all ages for their developmental assessments and mothers coming in for postnatal check-ups.
The parents' quest for answers
Health booklets are well known to be useful tools, serving as reference guides for both parents and healthcare professionals to monitor and assess a child's growth and development. For routine developmental assessments, parents can refer to the health booklets to check whether their child has attained the age-appropriate milestones. The checklists help parents take note of their child's development and flag up any delays in attaining milestones.
In this digital era, tech-savvy new parents do not rely solely on health booklets, but do their own searches online, read books, as well as consult their peers on parenting experiences to answer their many questions and doubts before coming in to see the doctor. This is especially so for first-time parents who are simply at a loss as to how to best care for their little ones. It goes without saying that every parent wants the best for their children, and would go to great lengths to ensure that their children are given the best environment and resources to maximise their full potential.
However, many young parents today have to learn to cope with raising children on their own. Gone are the days when it was a common sight to see grandparents and older relatives chipping in to care for the family's newborns, with the new parents being given "on-the-job training" on how to care for the children. With many grandparents today still actively working and preferring more "me time", it is harder for them to help take care of their grandchildren. It has thus become a norm to put the few-month-old newborn in infant care centres once both parents return to work.
Although not a parent myself, I am not unfamiliar with the anxieties, struggles and concerns that parents of the newer generations have. From my relatives to friends and colleagues, their vivid, mind-boggling firsthand accounts of raising their newborns paint a simply onerous picture of infant care. As doctors, we frequently draw an analogy of caring for a newborn to be like "going for sleepless night calls". Raising kids in a modern, affluent society like ours with both parents working is no mean feat, and it often takes a toll on both parents' mental and physical health.
Guidelines in practice
The various infant and maternal healthcare guidelines published by the Academy of Medicine, Singapore; the College of Paediatrics and Child Health, Singapore; and the College of Obstetricians and Gynaecologists, Singapore have proven to come in handy when family physicians like myself are faced with a barrage of questions about children's growth and development, and when dealing with perinatal mental health.
Taking reference from the Singapore Integrated 24-hour Activity Guidelines for Early Childhood (<7 Years) published in 2022, I found them particularly useful to advise parents on the appropriate diet and/or appropriate amount of screen time and sleep for newborns and young children. The guidelines contain important tips such as how screen time, regardless of the type of device, is not recommended for toddlers younger than 18 months of age, and that parents should not use electronic devices as a source of entertainment or distraction for their toddlers. Instead, parents should take them out for daily outdoor play, something which modern parents need to set aside their time for.
For toddlers from one to three years old, it is important to increase the variety of foods offered to your children and wean them. This is important as parents sometimes have difficulty weaning their children, and some children end up having their growth percentiles drop due to over-reliance on milk as their main source of nutrition. By further discussing the various snacks and meals that parents can prepare for their children, we empower parents to take charge of their children's growth through managing their nutrition.
The Singapore Guidelines for Feeding and Eating in Infants and Young Children published in 2024 also highlights an important principle of establishing regular, family-centred mealtimes in a calm and distraction-free environment. For the young toddler, mealtime is a good opportunity to promote social interaction and eating enjoyment with the family, but sometimes parents might not appreciate its importance and the child may end up eating alone. Encouraging parents to eat with their children as a family helps foster bonds and make eating fun for children. It is also important not to use screen time or toys to distract or encourage children to eat, something which parents might rely on when children refuse to comply.
The 2023 Perinatal Mental Health Guidelines on Depression and Anxiety serves as a reminder to family physicians and other primary care providers that it is crucial to screen mothers for postnatal depression and anxiety using the Patient Health Questionnaire-2 and Generalized Anxiety Disorder 2-item tools. It is important to take a holistic approach for mothers who suffer from postnatal mood disorders, and involving their spouses and other family members is crucial to give patients the necessary support. Whether it is by giving lifestyle advice, providing supportive counselling or introducing pharmacological interventions, our ultimate aim is to reduce the adverse impact of mood disorders for the mother and child.
Hard work, love and care
Parenting is a craft that is honed with patience and experience. Every child and family is unique so what doctors can do is to help parents understand the basic principles of taking care of children and to provide them the space to tailor their parenting approach to their children. We always talk about encouraging children, but we often forget to encourage and applaud the mummies and daddies for all the hard work and effort they put in for their children. By acknowledging their efforts, we empower parents to continue finding ways to better care for their children and make parenting an enjoyable experience rather than a chore.
Children are the hope of the future, and without healthy and happy mothers, we will not be able to nurture the next generations of healthy and happy children. For parents, behind the joy and excitement of shaping a new life lies a lifelong pledge of commitment and responsibility. The old Chinese saying “养儿一百岁，长忧九十九”, literally translated to "if you raise a child for 100 years, you spend 99 years worrying about him/her", holds true indeed!
Let us give our support and understanding to parents as they raise children amid life's challenges, and let us all give thanks to our parents for the love and care they have showered upon us!
Resources for family physicians
Maternal and child health guidelines developed or supported by the Integrated Platform for Research in Advancing Maternal and Child Health Outcomes can be found at the following links:
- Guidelines for the Management of Gestational Diabetes Mellitus (2018): https://bit.ly/4aZe853.
- Guidelines on Optimal Perinatal Nutrition (2019): https://bit.ly/3wtPpqh.
- Guidelines on Physical Activity and Exercise in Pregnancy (2020): https://bit.ly/3w9CWbn.
- Singapore Integrated 24-hour Activity Guidelines for Children and Adolescents (7-18 years) (2021): https://bit.ly/3y3nOg7.
- Singapore Integrated 24-hour Activity Guidelines for Early Childhood (<7 Years) (2022): https://bit.ly/3V6y7YS.
- Perinatal Mental Health Guidelines on Depression and Anxiety (2023): https://bit.ly/44kxf6Y.
-
Singapore Guidelines for Feeding and Eating in Infants and Young Children (2024): https://bit.ly/3vYiPgg.
Other useful maternal and child health publications can be found at the following links:
- College of Obstetricians and Gynaecologists, Singapore publications under Academy of Medicine, Singapore: https://bit.ly/4aZrePr.
- College of Paediatrics and Child Health, Singapore publications under Academy of Medicine, Singapore: https://bit.ly/44sIIl0.