Dr Thomas - Baby and Children Specialist Kemena Pacific Hospital Bintulu

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.

04/02/2026

I recently came across a report highlighting a concerning trend: the average height of children in Malaysia is gradually being overtaken by that of our neighboring countries. A decade or so ago, children in countries such as Thailand, Vietnam, and even Cambodia were generally shorter than Malaysian children. Yet over the past ten years, the rate of height growth among children in these countries has accelerated significantly, and today, their children are on average taller than ours. As for Singapore, it surpassed Malaysia long ago and has remained far ahead for many years.

This raises an important question: what has gone wrong?

One major factor—well known, yet often overlooked—is children’s lifestyle.

When we talk about lifestyle, it profoundly influences a child’s growth potential through at least three key areas.

1️⃣First, dietary habits.
An imbalanced diet characterized by highly processed foods, excessive sugar and unhealthy fats, coupled with inadequate intake of high-quality protein and essential micronutrients, directly impairs physical growth.

2️⃣Second, a serious lack of physical activity.
Many Malaysian children do not engage in regular exercise. Reduced outdoor play and insufficient weight-bearing or muscle-strengthening activities mean that bones and muscles are not adequately stimulated, limiting a child’s ability to reach their full height potential.

3️⃣Third, poor sleep quality and insufficient sleep duration.
Growth hormone is primarily secreted during deep sleep. Chronic late nights—often due to heavy academic demands and tuition classes—along with sleep disruption from electronic devices, significantly compromise a child’s growth. Quite literally, children are not growing because they are not sleeping enough.

Seen from this perspective, a child’s height is not merely a biological outcome. It is a reflection of the collective lifestyle choices shaped by families, society, and culture.

Points for reflection:

This is not a sudden decline in genetics
→ Our neighboring countries’ genetic makeup has not changed dramatically within a decade.

It is the result of environment and daily choices
→ What children eat, how much they move, and when they sleep accumulate over time.

Height is only the visible surface; what is truly at stake is long-term health
→ Metabolic health, bone strength, and psychological resilience are all affected together.

03/02/2026

Red alert!!

Malaysia's childhood stunting rate has been rising since 2012, hitting 24% in 2024, unlike poorer neighbouring countries that have shown marked declines since 2000, especially Cambodia, Vietnam, and Indonesia that are now better than Malaysia.

Childhood stunting rates in 2024:
🇲🇾 24%
🇮🇩 23%
🇰🇭 22%
🇻🇳 19%
🇹🇭 12%
🇸🇬 3%

In 2000, Cambodia (51%), Vietnam (41%), and Indonesia (40%) had much higher childhood stunting rates than Malaysia (19%).

Malaysia's childhood stunting rate decreased slowly from 19.3% in 2000 to 17.8% in 2011, but began increasing from 18.1% in 2012 to 24.3% in 2024.

Over the past two decades, Thailand's childhood stunting has remained below Malaysia, dropping from 16% in 2000 to 12% in 2024.

Singapore's childhood stunting was at a very low 4.4% in 2000, declining further to 2.8% in 2024.

Malaysia seeks to reduce stunting in under-five children by 10 percentage points to 14.2% by 2030, even as Malaysia is on an upward trajectory compared to continuous declines by neighbouring countries.

Health Minister Dzulkefly Ahmad says there are no "quick-fixes" for malnutrition, like other public health problems, and it will take "generations" to see results.

Read more: https://codeblue.galencentre.org/2026/02/malaysias-childhood-stunting-rises-to-24-worse-than-poorer-neighbours/

19/12/2025

Finally I am a "Certified Lifestyle Medicine Physician"! +1 to my CV.


🌿 Why lifestyle medicine?

I used to think hypertension was a disease of the old — something far away, something for another generation. But time moves quietly. Without realising it, I’m now surrounded by friends and family who have hypertension, diabetes, heart disease, high cholesterol, even stroke at the age of 40.

These aren’t strangers. They’re people my age. And it made me pause — when did chronic disease become so normal?

As a paediatrician, I see this story beginning much earlier. Children today spend more time sitting than moving, more time on screens than in sunlight. Some are already overweight, sleepless, allergic, or anxious — the early signs of tomorrow’s lifestyle diseases.

That’s why lifestyle medicine speaks so deeply to me. It’s not a trend, but a return to the fundamentals of health — backed by evidence, practiced with compassion.

In medical school, our very first lesson in pathology was inflammation. We studied it by heart — the redness, swelling, pain, heat, loss of function. And now, years later, in my clinic, I see inflammation everywhere: asthma, eczema, allergic rhinitis — all part of that same inflammatory story.

If you ask any doctor what treats inflammation, most will say, “Steroids.” And rightly so — steroids work wonders when used correctly. But over time, I’ve learned something deeper: if I truly want to calm inflammation at its roots, I also need to prescribe exercise and fiber.

Because exercise isn’t just movement — it’s a biological signal. Our muscles release healing messengers like Irisin and Lac-Phe, molecules that tell the body to reduce inflammation, balance metabolism, improve mood, and even protect the brain.

And fiber isn’t just roughage — it’s food for our gut microbes, which in turn produce short-chain fatty acids that help regulate our immune system and cool inflammation from within.

So now, in my practice, I don’t just prescribe steroids. I prescribe movement, fiber, rest, and connection — the kind of medicine that rewires the body toward healing.

My wife and I are both in medical field. We know the power of medication — and we’ve seen it save lives. But we also know its limits. Medicine can control numbers, but not transform habits.
It can sustain life, but not restore vitality.

That’s why we choose the 中庸之道 — the way of balance. We don’t reject medicine, but we also don’t idolise it. Instead, we integrate both — prescribing when needed, and teaching patients to live in a way that prevents disease before it begins.

Lifestyle medicine is not guesswork — it’s evidence-based. We now know how much movement, rest, and nutrition our bodies need to thrive.

Do you know how much exercise is adequate for your age? What type suits your goals? How intense it should be to protect your heart and brain?

If you don’t, that’s where we — as healthcare professionals — want to walk with you. Because health isn’t just about avoiding disease;
it’s about building capacity for life — energy, clarity, joy, and purpose — every single day.

We may not stop time, but we can choose how well we live through it. And perhaps, that is where healing truly begins.

18/12/2025

🍼 Case Study: Why we didn’t choose Soy for this 2-month-old. 🚫

I recently saw a lovely 2-month-old baby boy in the clinic who was having a really tough time.

🔹 The History: He was breastfed for his first month and doing well. But after switching to standard infant formula, things changed. He developed moderate eczema, and started suffering from vomiting and diarrhea.

🔹 The Diagnosis: These are classic signs of a Cow's Milk Protein Allergy (CMPA). His immune system was attacking the proteins in the standard cow's milk formula.

🔹 The Challenge: We initially wanted to try a Rice-based formula, but as many Bintulu parents know, sourcing specific special formula locally can be a headache! The parents then asked a very common question: "If he can't drink cow's milk, should we just switch to Soy formula?"

My advice was a "No" for a baby this young. Here is why:

1️⃣ The "Copycat" Allergy: In babies under 6 months with a milk allergy, up to 50% will also be allergic to soy. The proteins are similar enough that the body often attacks both. Switching to soy might not solve the problem.

2️⃣ Hormones: Soy contains phytoestrogens (plant hormones). For a tiny 2-month-old going through rapid development, we want to avoid these hormonal mimics.

✅ The “Partially" Happy Ending: We started him on a Partially Hydrolyzed Formula (where proteins are broken down into smaller pieces) and a good eczema skin care routine. We are happy to see his eczema improving (but not totally free from eczema) , and the tummy troubles have settled!

⚠️ A Critical Note on Guidelines: It is important to know that Partially Hydrolyzed Formula is NOT the standard treatment for confirmed Cow's Milk Allergy.

The Guideline Gold Standard: An Extensively Hydrolyzed Formula (eHF) is usually required because the proteins are broken down much smaller OR rice infant formula OR amino acid formula.

This Case: While this specific baby was lucky and tolerated pHF (and supply is easier to find), most allergy babies need the specialized eHF or rice formula or Amino Acid formula to get better.

The Takeaway: If your baby is reacting to formula, soy infant formula is rarely the right first step for infants under 6 months. Discuss with your paediatrician so we can find the safe solution together. 💙

16/12/2025

Sanofi and AstraZeneca’s Beyfortus (Nirsevimab) is now approved by the National Pharmaceutical Regulatory Agency (NPRA) and is available for the prevention of respiratory syncytial virus (RSV) lower respiratory tract disease in newborns and infants born during or entering their first RSV season.

RSV is predominantly seen in infants less than one year old and infected children below two years old had a high hospitalisation rate of 84.5 per cent.

As a tropical climate country, RSV circulation in Malaysia is seen throughout the year with distinct peaks.

Datuk Dr Zulkifli Ismail, Technical Chairman of Immunise4Life and former president of the Malaysian Paediatric Association, said “In Malaysia, RSV remains a significant but under-recognised public health burden. Hospital data consistently show that the majority of infants admitted with RSV are full-term and generally healthy, which highlights the importance of preventive solutions that extend protection to all babies across the board.