Precious tiny beings, children rely on their caretakers to thrive. In Malaysia, we are fortunate to have good access to medical care, growing awareness of children’s health and wellbeing, and an adequate supply of vaccines. Sharing more on the topic – including on how to identify red flags in an unwell child – Timberland Medical Centre’s paediatrician, Dr Choy Yee Yi, speaks to Sarawak Tribune about it.
Child health first: What every parent should know
IN conjunction with the recent World Health Day on April 7, with this year’s theme being ‘Healthy beginnings, hopeful futures’, it is vital to ensure the wellbeing of children – the precious gems of not only families but also the future of society.
According to statistics compiled in December 2024 by Statista research expert, Amanda Siddhartha, Malaysia’s under-five child mortality rates from 2014 to 2023 range between 7.3 to 8.8 per 1,000 live births.
Meanwhile, statistics from the World Health Organisation (WHO) indicate that the neonatal mortality rate in Malaysia was 4 per 1,000 live births in 2022, while the under-five child mortality rate was 7.8 per 1,000 live births in the same year.
While Malaysia’s statistics are relatively good, countries such as Niger – which holds the highest under-five child mortality rate – recorded 117.3 per 1,000 live births in 2022.
In contrast, countries like Switzerland, Norway, Japan, Sweden and Iceland have the lowest rates in the world, each recording 3 per 1,000 live births.
Meanwhile, a 2023 Child Mortality Report by UNICEF reveals the top six leading causes of death among newborns and children under five worldwide:
- Prematurity (18 per cent)
- Lower respiratory infections/pneumonia (14 per cent)
- Other under-five deaths (14 per cent)
- Birth asphyxia/trauma (12 per cent)
- Malaria (9 per cent)
- Diarrhoea (9 per cent)
The report also emphasises that these deaths – while tragic – can often be prevented through simple, effective, and low-cost essential interventions, including:
- Access to essential healthcare services
- Births attended by skilled health personnel
- Increased number and support for community health workers
- Antenatal and postnatal care services
- Care for small and sick newborns
- Preventive services such as vaccination
- Timely diagnosis and treatment of key childhood illnesses
- Efforts to reduce malnutrition through therapeutic foods, improved water and sanitation, and environmental risk reduction
Timberland Medical Centre’s paediatrician, Dr Choy Yee Yi, added that vaccination remains one of the most crucial and effective disease prevention strategies.
She also stressed the importance of raising awareness among parents and the public regarding children’s safety.
“Be it at home or outside, it is important to ensure a child’s safety – whether they are seated in a car with proper use of seat belts, riding a motorbike with a helmet, or swimming under supervision,” she said.
On the subject of vaccinations, Dr Choy highlighted that vaccines protect young children from serious illnesses that could lead to long-term complications or even death.
“Vaccines teach the immune system to defend against various germs without the dangers of a full-blown infection.
“They imitate an infection and stimulate the immune system to create antibodies that protect children from diseases,” she explained.
With adequate vaccination coverage, Dr Choy noted, mortality rates caused by infection can be significantly reduced.
She added, “Vaccines such as Pertussis and Pneumococcal can prevent severe pneumonia.”
Red flags that require urgent medical attention
Since babies and young children can’t always express their discomfort, Dr Choy shared eight red flags parents should watch for:
Temperature ≥ 38°C in babies under 3 months:
- Infants may not show clear signs of illness, especially early on.
- A high fever might be the only sign.
- If untreated, their condition can deteriorate rapidly – even within hours.
- Any baby under 3 months with a fever ≥ 38°C should be brought to the hospital immediately.
Abnormal breathing:
- Fast breathing, head bobbing, flaring nostrils, or visible chest movements during breathing
- Abnormal sounds, coughing, or signs of breathlessness
- These symptoms warrant immediate medical attention.
Not feeding properly (especially in babies):
- Babies can become dehydrated quickly if they feed less or refuse to feed.
- This could signal illness or a serious underlying issue.
- Either way, it’s a cause for concern and needs prompt attention.
Reduced urine output/fewer wet diapers than usual:
- Low urine output may indicate dehydration or kidney trouble.
- Urgent medical review is required.
Not alert/cannot be awakened/inconsolable crying:
- Excessive drowsiness or lethargy outside normal sleep time is concerning.
- Unresponsiveness or weak/high-pitched cries also require immediate attention.
High fever with a non-blanching rash:
- A non-blanching rash (red/purple that doesn’t disappear when pressed) may signal meningococcal infection.
- If any rash appears with a high fever, seek medical care — don’t wait for a rash if other red flags are present.
Abnormal skin colour – blue, pale, grey, or blotchy:
- Blue lips, nail beds, or body = medical emergency
- Paleness or grey tone in an unwell child is also alarming
- Mottled/blotchy skin might be normal in cold weather, but parents know best what’s usual for their child
Parental gut feeling:
- This is the most important red flag.
- If your gut tells you something is wrong, trust it.
- Parents often sense illness before symptoms escalate.
- In many cases, parental instinct has saved lives.
