Antibiotics are medications prescribed by the doctor to treat and cure diseases caused by bacteria. Infections can be caused by bacteria, viruses, fungus or parasites. Most sore throats, coughs, and colds and gastroenteritis are due to viruses initially and not by bacteria. In children, bacterial infections include pneumonia, otitis media, (ear infection) and meningitis (infection of the brain) and urinary tract infection. These can be very serious especially in the younger infants and some may need to be hospitalised.

Antibiotics are useful when given properly but may harmful if used wrongly.

Antibiotics are given when the doctor suspects the illness is caused by bacteria or tests (e.g. Urine sample tests) are done that confirm the presence of bacteria. Other times antibiotics are given to prevent bacterial infection. It cannot fight viruses and are only useful for bacterial infections.

Proper use of antibiotics is important to prevent bacterial resistance. When this happens, the child's infection may not improve and may even worsen. Then "stronger" and more expensive antibiotics will have to be used.

• Complete the course of antibiotics as ordered even though the child may be feeling better.
• Do not expect antibiotics to work immediately, normally the effect can be seen in 2 to 3 days time.
• See the same doctor again if the illness worsens or does not improve so that the doctor can reassess the situation; do not "doctor-hop".
• Never share or use left-over antibiotics
• Do not ask for antibiotics for all types of illness but consult your doctor when in doubt.
• Understand the amount of antibiotics to give to your child and how to store the antibiotics.

1. Open the cap
2. Add cooled (to room temperature) boiled plain water to the marking on the bottle or follow the volume instructed.
3. Close the bottle and shake well until all powder is dissolved.
4. Check at eye level if the water level falls below the marking on the bottle. Top up to the exact level so that the concentration of the syrup is accurate.
5. Store the mixed syrup in the refrigerator (except for Klacid syrup) for the duration instructed. Storage in the refrigerator is important so that the antibiotics remain effective and prevents contamination.

Diarrhea is the increased frequency of bowel movement with the passing of abnormally soft stool or watery faeces. Acute diarrhea happens quickly and can be accompanied with nausea and vomiting, abdominal cramps and flatulence. It is commonly caused by a gut infection (Gastroenteritis). The diarrhea normally lasts for 2-4 days but may go on for a week in severe cases.

As large amount of fluid can be lost with diarrhea, it is crucial to have adequate intake of liquids. Particular care is needed in the very young infants (< 1 year old) as they can become dehydrated (dry out) easily. Dehydration can be prevented by increasing the liquid intake of the child.

Good hygiene habits can help to prevent the spread of germs. This is especially important for young infants who are more susceptible to infections. Thus, milk bottles must be sterilised properly for newborns and infants. For older children, hand washing and good toilet habits should be taught.

1. For breastfeeding babies, continue to breastfeed you baby.
2. For formula fed babies, your doctor may want you to stop the formula feeds for 1 day as cow's milk protein can sometimes worsen the diarrhea. This allows the gut to rest. In replacement, give rice water or oral rehydration liquids.
3. If the diarrhea persists, soy formula feeds can be given instead of normal cow's milk formula.
4. The milk can be diluted for the older infant. Do not give plain water.
5. The normal feeds can be resumed when the stools improve.
6. For the older child on solids, give more fluids than solid food for easier digestion. When there is less bowel movement, introduce solids gradually and this should be soft, easily digestible diet (e.g. Clear porridge) Limit protein and fats.
7. If there is vomiting together with the diarrhea, give clear fluids in small amounts and more frequently and slowly increase the fluids and soft solids as the condition improves.

1. Oral rehydration fluids in the form of ready to drink liquids, effervescent tablets or popsicles are normally given to replace the fluids and electrolytes (salt) lost through the diarrhea. This can be given in a few times a day depending on the frequency of the stools.
2. Lacteol forte contains a probiotic (good bacteria). This guts digestive system and limits the diarrhea. The powder can be diluted in water or milk.
3. Smecta powder coats the gut and protects the gut wall from toxins. The powder is added to water and stirred and should be given immediately to prevent the clay like substance from setting.
4. Kaolin liquid changes the consistency of the stool.

Check with your doctor if your child:

• Has persistent diarrhea > 1 day (for infants < 1 year), 2 days (children < 3 years) or > 3 days for the older child.
• Has severe vomiting and fever
• Has blood or mucus in the stool
• Has suspected reaction due to a medication taken

Fever in children is a response to many different stimuli which changes the "set point" in the temperature control centre in the brain (body thermostat). In an illness or infection, the bacteria release chemicals that readjust the thermostat resulting in fever. Fever (high temperature and may include shivering) is the body's way to fight the infection. At times, after vaccination the child may have slight fever as a normal reaction to the vaccine.

The normal body temperature is ranges from 36.5 C to 37.5 C and this may vary with age and condition. Fever cause by viral infections may persist for 5 to 7 days and only settle when the viral infection is resolved.

The treatment is symptomatic to relief discomfort and in children; it is a preventive measure against febrile convulsions (FITS).

1. Normally paracetamol or acetaminophen is given. This is available as syrup or chewable tablets for children. There is a dosage range and usually given every 6 hours. The shortest duration apart is 4 hourly.
2. Ibuprofen syrup is given if fever persists or is very high (> 38.5 C) this is normally given every 6 hours.
3. Suppositories are available for faster action and if the child does not take oral medicines (e.g. fussy or vomiting). Diclofenac suppositories or paracetamol suppositories can be inserted easily into the anus.

1. Tepid sponging (with tap water) is a safe and effective way to reduce a child's temperature. This is especially useful if the fever is high. Tepid sponging is done about half an hour after giving the fever medication.
2. Do not use ice cold water or alcohol.
3. Apply cool compress to forehead, armpits, groin, back of the neck and tummy. Leave it on for a few minutes to help the heat dissipate.
4. Sponge the whole body on the front and back.
5. Stop sponging if child is shivering vigorously and normally not more than 30 minutes at a stretch.

When your child shivers, stop and cover him lightly and resume sponging after waiting awhile.

6. Give plenty of fluids to the child to prevent dehydration.
7. Remove excess clothing or thick blankets. Dress the child in light clothing to allow heat exchange.
8. Keep the room well-ventilated and cool to allow ambient temperature to bring the fever down.

Check with the doctor if your child with fever:

• Is very young (especially less than 3 months old)
• Is drowsy, lethargic, vomiting or feeding very poorly
• Has abdominal pain or discomfort
• Has rash
• Has decreased urination
• Has difficulty in breathing
• Is sicker than previously and does not improve

Medication given accurately and at the right time is important so that the medication is effective and sage to treat the illness in the child. Check with the doctor the frequency and duration of giving the medicine. Know what to do for missed doses and what the interval is between the doses.

Most medications for children come in liquid form and is sweetened and flavoured.

1. Check if the medication can be mixed with milk or water or juices. Some medications cannot be taken with food as it becomes ineffective or is not absorbed into the bloodstream.
2. If the medication can be mixed with milk, mix the medicine in a small portion of the milk feed. After the baby finishes the whole amount, then add the remainder of the formula. This is to ensure all the medicine is taken even if the baby does not finish all the milk formula.
3. Shake the bottle first before pouring or syringing the liquid.
4. Measure the liquid accurately with a spoon or a syringe. If using a syringe, check the amount at eye level. Do not store measured medicines in syringes but immediately.
5. The syringe can be used to slowly push the medication gently into the child's mouth.

Some medications are not available commercially in liquid form.

1. If the child cannot swallow the table/capsule, the medication needs to be crushed and dissolved in an appropriate type of solution (water. Milk or syrup) and given immediately. Tablet cutters and crushers and small mortar and pestles are available for this purpose.
2. Do not let the dissolved medication settle or keep the leftovers. Gelatine capsules can be opened to remove the powdered medicine inside to give to the child. Some tablets are chewable.

Medications in powder form normally need to be dissolved in water before giving to the child.

1. Use cool boiled water (room temperature, not hot or cold water) to dissolve the powder.
2. Use a small amount of water so that it is easier for the child to finish all the medication.
3. Stir the solution well so that it is well dissolved.
4. Do not leave the solution standing too long as the powder may settle at the bottom. Give it immediately after mixing with water.
5. Some of the powders that are not flavoured may be mixed with milk (use luke warm, not hot milk). Other powders may be mixed with cereal or porridge.

Proper storage of medications is vital to ensure the medicines are effective and not contaminated.

1. Keep the medicines away from the reach of children as some of the liquid medicines are sweet and colourful and may entice children to take them on their own.
2. Generally store the medicines in a cool and dry place (e.g. Awa from the hot stove in the kitchen)
3. Some medicines need to be stored in refrigerator:
   • Liquid medicines that are opened
   • Powder antibiotics that have been mixed with water
   • Eye drops, ear drops and nose drops and eye creams
4. Keep the medicines in the container that was provided and labelled. Do not pour out into other containers to prevent mix up and confusion and to ensure that the expiry date can be checked.

Some antibiotics for children are in powdered form and not liquid or syrup. The reason for this is that the antibiotics do not keep well (not stable) for a long period in a liquid form. This means that the powdered antibiotics need to be mixed with water when it is time to start the course of medicines for the child.

The water that is used is normal, plain drinking water which has been boiled and cooled down to room temperature. Do not use hot boiling water nor ice cold water. This may affect the effectiveness of the antibiotics and the way it dissolves. Once water is added, the antibiotics can be taken for a certain period only (this range from 7 to 14 days normally depending on the antibiotic and this is stated on the bottle). The antibiotics would not be effective after that period. The date of mixing or reconstitution should be noted down so that you know when to discard the medicine. This is especially important for antibiotics taken for prevention of diseases.

The way to mix powdered antibiotics to syrups:

1. Tap the powder off the bottom of bottle and open the cap.
2. Carefully add cool boiled water to the marking on the bottle or use the measure provided (e.g. cap of bottle for Cefuroxime antibiotic)
3. Close the bottle and shake well until all the powder is dissolved.
4. Check the water level and if it falls below the marking of the bottle after shaking, top up with water until the marking.
5. The antibiotic syrup is ready to be consumed orally.
6. Store the mixed antibiotics appropriately (normally in the refrigerator) and shake again before giving the next dose. Give the antibiotics for the duration ordered by the doctor and until the period that is stated after reconstitution.

Other points to consider include the way the reconstituted antibiotics are kept. The storage condition is normally in the refrigerator (except for Clarithromycin antibiotic) for stability and sterility. The antibiotics must be shaken well after mixing and prior to giving the medicine to the child. This is to ensure all the antibiotic powder is dissolved. The powdered antibiotics are normally flavoured and will be syrupy after water is added. The amount of water used is important as it affects the concentration of the medicine and subsequently the accuracy of the dosage of antibiotic given.

Jaundice is a yellow discoloration of the skin and the whites of the eyes. Usually occurs in newborn babies in the first few days after birth. This is more common in certain races. (eg. The Chinese) generally, it does not cause problems and will clear within a week to 10 days without any treatment.

This is due to bilirubin, which is a substance that is produced when old blood cells are replaced by new blood cells. The bilirubin is processed by the liver and then removed from the body through faeces.

In the newborn baby, the liver is not matured yet, i.e. it may not work very efficiently initially. The bilirubin which collects and is not removed from the body causes the yellow discoloration.

High Risk babies include the following:

• Premature Babies (Babies born much earlier than the expected delivery date)
• Those with jaundice within the first 24 hours after birth
• Those with G6PD deficiency (A condition where there is deficiency of a normal enzyme, this result in babies being more prone to developing jaundice).
• Those with blood group incompatibility. (e.g. Mother O+, Baby A+)
• Those who have infections (e.g. Urinary tract infections)

Blood has to be taken from the baby to check the bilirubin levels. The doctor also may need to reassess the baby at regular intervals to check if the bilirubin levels are decreasing.

If the jaundice worsens, the baby may need to be admitted or may not be able to be discharged after birth. Phototherapy and other investigations and procedures will have to be carried out.

This is a very safe procedure where the newborn baby is placed under bright fluorescent lights. These lights help to change the bilirubin in the baby to harmless substances which are removed naturally through the urine or faeces. The baby's eyes are normally covered for protection. The baby's clothing is removed so that the whole skin is exposed. The lights do not hurt the baby but some babies may cry as most do not like being exposed and prefer to be wrapped up in cloth (swaddled) for security.

Blood tests will be done daily to check the bilirubin levels.

When the bilirubin level decreases sufficiently, the phototherapy is stopped. Then the baby is checked again for one or two more days before being discharged.