Dr Thomas - Baby and Children Specialist Kemena Pacific Hospital Bintulu

29/08/2026

KUCHING (Aug 29): It started with a cough, followed by a restless night with an unusually fussy baby. The next morning, a pair of young parents debated whether medical attention was necessary. Family members chided them for being overly cautious, but before a decision could be made, the wheezing beg...

24/08/2026

Probably many people are still unaware that Dengue vaccine is available in Malaysia.

Qdenga is a vaccine that helps protect against dengue caused by dengue virus serotypes 1, 2, 3 and 4.

Efficacy:
- up to 80% reduction in symptomatic dengue cases at 12 months after vaccination.
- 90% reduction in dengue-related hospitalizations at 18 months after vaccination.
- up to 7 years of protection after 2 doses of Qdenga

Qdenga (Dengue vaccine) can be administered to those over 4 years old + adults.
- 2 doses
- 3 months apart

17/08/2026

"Doctor, my child keeps taking deep breaths... Is it asthma or even something dangerous like heart problem" ?

​Eight-year-old "Adam" was brought to my clinic by his mother. For few weeks, his mother noticed he frequently took very deep, forced breaths followed by long sighs—almost like he was struggling to catch a "full breath." Yet, upon examination, there was no cough or wheeze, his lungs are clear, and his breathing was completely normal while sleeping.

​For the past 1 year, I have encountered at least 3 patients aged 8 to 10 years old with Pediatric Sighing Syndrome.

​Of course, initially, I did not come out with the diagnosis! The first thing that came to my mind was bronchial asthma. Next was gastritis with reflux. And of course, at the back of my mind, it is always anxiety. However, there is always no obvious stressor when I ask them directly.

​When I searched more on sighing syndrome—true enough, sometimes there will be stress behind the syndrome.

​🧠 Pathophysiology:

​What fascinates me is that the breathing exercise I learned from Lifestyle Medicine—whereby expiration should be longer than inspiration—can help to regulate stress via parasympathetic nervous system (vagal nerve) activation to make us calmer.

​When children are under subtle stress, their breathing naturally becomes shallow and rapid, leaving stagnant air at the base of the lungs. Our body can help us subconsciously to "expel" the air at alveoli deadspace—and this presents as sighing!

​In simple terms:
​The Body's Biological Reset: The sigh is actually an automatic "reset button." It purges trapped gas, restores alveolar surfactant, and attempts to calm an overstimulated nervous system.

🙊​Why Kids Deny Stress?
At 8 to 10 years old, children process subtle daily pressures (screen overload, routine changes, school dynamics) somatically through their bodies rather than with words.

​💡 What Should Parents Do?
1️⃣​Reassure, Don't Panic:
Understand that their lungs are completely healthy and their body is simply trying to self-regulate.

2️⃣​Avoid Pointing It Out:
Drawing constant attention to the sighing can create hyper-awareness and prolong the habit loop.

3️⃣​Practice Belly Breathing:
Help them learn controlled diaphragmatic breathing (slow nose inhalation, prolonged mouth exhalation) so their body doesn't have to force the automatic sigh.

​Learning from my young patients reminds me how remarkably smart the human body really is!

​

20/05/2026

The result shared is an 8-year-old boy, both parents are "typical" Malaysians. The parents migrated to US more than 10 years ago. He was born and raised in the U.S. What fascinates me is the pattern of his allergy is very much similar to the Western. And he even has white rice allergy.

Many parents think allergies are mainly genetic.

But here’s the fascinating part:

An Asian child growing up in the U.S may end up having allergy patterns more similar to an American child than to a child growing up in Malaysia.

Why do Malaysian children commonly react to:
🦐 Seafood
🪳 Dust mites
🌧 Humidity-related allergens

…while Western countries see more:
🥜 Peanut allergy
🌾 Grass/pollen allergy
🐶 Pet dander allergy

Because the immune system is heavily influenced by the environment it “trains” in during early childhood.

In other words:
our immune systems are shaped by the world around us.

Different climate.
Different microbes.
Different foods.
Different indoor environments.

This is one reason allergy rates around the world are changing so rapidly over generations.

03/05/2026

10/04/2026

🌟 Autism Awareness Month

In conjunction with Autism Awareness Month, I would like to share two real cases from my clinic over the past 6 months.

👦👧 Both were children aged 3–4 years old with autism.
Both were brought in for the same concern:
👉 Refusing to walk for 1–2 months

🔍 What was unusual?
• No history of trauma or injury
• No fever or acute illness
• But both had significant feeding difficulties
(very selective / picky eating with limited food variety)

💡 The underlying cause?
After further evaluation, both children were found to have:
👉 Vitamin D deficiency

This led to:
• Muscle weakness
• Reduced ability / willingness to walk

💊 What happened after treatment?
With:
• Vitamin D supplementation
• Physiotherapy support
• Dietician advice

✨ Both children gradually regained strength
✨ And started walking again within weeks

⚠️ Why is this important?
Children with autism often have:
• Sensory sensitivities
• Strong food preferences
• Limited diets
This puts them at higher risk of:
• Nutritional deficiencies (especially Vitamin D, iron, calcium)

📌 Key takeaway for parents & caregivers
If your child (especially with autism) shows:
• Refusal to walk
• Easy fatigue
• Delayed motor activity
👉 Don’t assume it’s purely behavioral.
👉 Consider medical causes—especially nutritional deficiencies.

❤️ Final thought
Not everything in autism is “behavioral.”
Sometimes, it is biological, treatable, and reversible.
Early recognition makes a huge difference

12/03/2026

07/03/2026

Why do we suddenly crave coffee in the afternoon? It turns out it’s related to a molecule called ATP.

Recently I revisited some biochemistry concepts, and it struck me how fascinating it is that what we once studied in textbooks is actually happening inside our bodies every day.

In the hospital ICU, one lab value we pay close attention to is phosphate. This is because ATP (Adenosine Triphosphate) is the body’s primary energy currency, and phosphate is a critical component of ATP. When critically ill patients have low phosphate levels, we often supplement it because without adequate ATP, the body simply does not have enough energy to function and recover properly.

But this made me think about something else:
In our daily lives, how do we actually increase our energy levels?

When our body uses energy, ATP is gradually broken down:
ATP → ADP → AMP → Adenosine
In other words, adenosine is a by-product of ATP being used.

Interestingly, when adenosine accumulates in the brain, it sends a signal to the body:
👉 “You’ve been active for a long time. It’s time to rest.”

So as adenosine builds up, we begin to feel:
💢tired
💢sleepy
💢less focused

This explains why many of us start craving coffee in the afternoon ☕.

Coffee contains caffeine, which does something quite clever.
It blocks adenosine receptors.

In simple terms:
Adenosine tries to tell the brain
“It's time to sleep.”

But caffeine occupies those receptors first, preventing adenosine from delivering that signal.

The result:
➡️ the brain doesn’t receive the “sleepy” signal
➡️ we feel more alert

However, there is an important point:
Caffeine does not remove adenosine.
It only temporarily blocks its signal.

Another interesting fact is that caffeine’s half-life varies widely between individuals — from 1 hour to as long as 12 hours, though on average it is about 4–5 hours.

This is why many doctors recommend avoiding coffee after 2 pm, because caffeine may still be circulating in the body and can interfere with sleep at night.

Personally, I notice that without coffee, my energy tends to dip in the afternoon.

Which led me to wonder:

If not coffee, what can truly boost our energy levels?

The answer is surprisingly simple — and a bit counterintuitive:
👉🏻 Exercise.

Regular exercise helps the body:
👉🏻increase the number of mitochondria
👉🏻improve ATP production capacity
👉🏻enhance overall energy metabolism, clears off Adenosine more effectively

So an interesting conclusion is this:
The best way to increase energy is actually to spend energy first.

Sometimes when we reconnect biochemistry with everyday life, we realize how beautifully our bodies are designed.

☕ ATP
☕ Adenosine
☕ Caffeine
☕ Sleep
☕ Exercise

They are all interconnected.

03/03/2026

Croupy Season Is Back — What Parents Should Know About Viral Croup

Recently we are seeing more children coming in with a “barking cough” and hoarse voice.

Today, one mother describes it very accurately —
“Suara dia jadi macam penyanyi Ella!” 😄

That rough, hoarse sound is actually one of the key signs of viral croup.

******************************************************************
What is Viral Croup?

Croup is a common viral infection affecting the upper airway (vocal cord/ peti suara).

Because children’s airways are small, even mild swelling can cause noticeable symptoms.

Common Symptoms:
✅ Barking cough (sounds like a seal)
✅ Hoarse voice
✅ Noisy breathing (stridor), especially when crying
✅ May start with fever, runny nose

05/02/2026

Yesterday, I shared about the malnutrition situation in Malaysia, especially the issue of stunting, which is closely related to our modern lifestyle.

Later that same day, I brought my kids to Tanjung Batu Beach. Nothing elaborate—just about 30 minutes of outdoor activity. They played with bubbles by the beach, ran around the playground, felt the breeze, and had some sunlight.

That evening, even their grandfather noticed something interesting: the children were noticeably calmer and more well-behaved at the dining table.

This reminded me that outdoor activity is dose-dependent. While guidelines recommend 60 minutes of physical activity per day for children, the benefits do not suddenly start only at the 60-minute mark. Any amount helps. Even short periods of outdoor play can already make a meaningful difference. Some is better than none.

From a neuroscience perspective, when we engage in physical activity—especially outdoors—the brain releases important neurotransmitters such as endorphins, serotonin, dopamine and BDNF (brain-derived neurotrophic factor). Endorphins help children feel calm and relaxed, serotonin supports mood and emotional regulation, and dopamine plays a key role in attention, motivation, and self-control. BDNF supports brain development and neuroplasticity.

In other words, movement and outdoor exposure help to regulate the brain. That may explain why a brief session of outdoor play can translate into better behaviour, improved focus, and emotional balance, which can last for 4-5 hours.

When we talk about stunting, it is not nutrition alone. But lifestyle factors—movement, sunlight, outdoor play, and daily rhythms—are just as important. Growth and development is not only about height and weight; it is also about how a child’s brain and behaviour are shaped by everyday experiences.

Sometimes, meaningful change begins with something very simple: letting children step outside and move their bodies, even for a short while.