Every person has the right to safe, quality healthcare, particularly from birth. 

Newborns and young children encounter more risks because of their rapid development, evolving health needs and different disease patterns.

They depend on adults to make decisions for them.

Their socioeconomic circumstances may also impact on the care needed.

As such, they are more susceptible to harm if their care is not commensurate with their age, size, context and health condition, if any. 

Child health, particularly in the first five years of life, impacts on health later in life.

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As such, it is an issue that should be of concern for everyone.

Many conditions are preventable, although there are some that are not.

World Patient Safety Day will be commemorated tomorrow (Sept 17).

The theme this year (2025) is “Patient safety from the start”.

Malaysian data

The first month of life is the most vulnerable period for a newborn.

Malaysia’s neonatal mortality (death) rate was 4.3 and 4.9 per 1,000 live births in 2023 and 2000 respectively.

Prematurity, sepsis, birth asphyxia (suffocation) or trauma in term neonates, chromosomal abnormalities, cardiovascular (heart) malformations and neural tube defects were reported to be the most common causes of deaths in neonatal intensive care units (NICUs).

Neonates are infants up to 28 days old.

The infant mortality rate, which refers to death in the first year of life, was 6.7 and eight per 1,000 live births in 2023 and 2000 respectively.

The data of Brunei, Singapore and Thailand in 2023 were 6.8, 2.2 and 5.3 per 1,000 live births respectively.

Singapore and Thailand have better numbers, compared to Malaysia.

The mortality rate for children aged less than five years was 8.1 and 10 per 1,000 live births in 2023 and 2000 respectively.

The data of Brunei, Singapore and Thailand in 2023 were 8.3, 2.5 and 7.0 per 1,000 live births respectively.

Singapore and Thailand have better numbers, compared to Malaysia.

Tackling malnutrition issues

Malnutrition is common in Malaysian children.

According to the Global Nutrition report: “Malaysia has made no progress towards achieving the target for stunting, with 21.8% of children under five years of age affected, which is equal to the average for the Asia region (21.8%).

“Malaysia has also made no progress towards achieving the target for wasting, with 9.7% of children under five years of age affected, which is higher than the average for the Asia region (8.9%).

“The prevalence of overweight children under five years of age is 5.2% and Malaysia is ‘on course’ to prevent the figure from increasing.”

Malaysia is committed to achieving the United Nations (UN) Sustainable Development Goals (SDGs) by 2030.

SDG2 is zero hunger and SDG3 is good health and well-being.

The latest UN sustainable development reports for all countries are available online, including for Malaysia.

The score for Malaysia’s prevalence of stunting and wasting in children under five years is deteriorating, with major challenges remaining.

The neonatal and under-five-years mortality rates are on track, or maintaining SDG achievement.

The universal health coverage score of service coverage shows moderate improvement, but is insufficient to attain the 2030 goal.

There was insufficient data on the minimum dietary diversity among children aged six to 23 months.

Parents, take note

The World Health Organization (WHO) has recommendations for everyone on the occasion of World Patient Safety Day.

Families should be the child’s safety champion by staying informed, involved and speaking up.

Be alert by keeping a record of your child’s symptoms, medications and medical appointments, and sharing their complete medical history with healthcare providers.

Stay informed by learning about common medical conditions in children to facilitate recognition of symptoms and understanding of treatments.

It is also helpful to be aware of safety protocols, e.g. hand hygiene and visitor restrictions in hospitals.

Ask questions whenever unsure.

Doublecheck that your child and their allergies (if any) have been correctly identified and noted, as well as their medications, before interventions.

Trust your instincts: If anything does not feel right, speak up immediately – you know your child best.

Participate in decisions about your child’s care.

For doctors and hospitals

Healthcare providers are exhorted to deliver safe and child-centred care with the following measures:

• Tailor care to the child

   

  Every child is different.

  Always adjust for age, weight and development.

  Verify a child’s identity before any intervention and check for allergies.

• Prevent harm

   

  Watch for the main causes of harm, e.g. medication errors, healthcare-associated infections and diagnostic errors.

• Act early

   

  Spot signs of deterioration early.

  Respond promptly.

• Partner with colleagues, parents and children

   

  Communicate clearly.

  Share information clearly with colleagues during handovers or referrals.

  Listen actively.

  Encourage questions and involve everyone in the decision-making.

  Support families by actively including them in decisions; take time to listen, explain clearly and answer their questions.

  When the child is hospitalised, they and their family need help to feel safe with reassurance and comfort.

  Contribute to improvement by reporting every safety concern.

  Every report and suggestion contributes to continuous improvement of a safety culture.

A healthcare facility management’s duty is to ensure that safe care is the standard for every child with the following measures:

• Streamline safety

   

  Apply WHO or national quality-of-care standards.

  Establish core safety systems, e.g. patient identification, safe medication, infection prevention and care escalation.

• Support the workforce

   

  Ensure staff are trained in safe paediatric practice.

  Foster teamwork, open communication and standardised care.

• Ensure child-friendly care

   

  Provide appropriate child-friendly spaces and equipment.

• Use data for care improvement

   

  Establish a safety culture.

  Support incident reporting by all healthcare providers.

  Monitor safety indicators and act appropriately.

Policies and awareness

Policymakers and healthcare leaders have a duty to invest in safe child care and to save lives and resources with the following measures:

• Ensure child safety is embedded within policy

   

  Safety needs to be integrated into national health policies and strategies.

• Investing in safer care

   

  Build workforce capacity and equip healthcare facilities with the tools, training and infrastructure needed to keep children safe.

• Lead with data and learning

   

  Strengthen data systems.

  Promote a culture of safety and learning.

• Engage communities

   

  Involve civil society, patient advocates, child protection groups and educators in building safer systems and promoting patient safety in schools.

Civil society and advocacy groups have an important role in raising awareness, mobilising communities and demanding safe care for every child with the following measures:

• Raise awareness

   

  Promote health literacy.

  Share clear, accessible information on patient safety risks and harm prevention.

• Promote equity

   

  Advocate safe care in all settings, especially those in low-resourced, marginalised or humanitarian settings, where risks are the greatest.

• Amplify voices

   

  Represent patients in health dialogues.

  Co-create safer systems with health workers.

Teachers and educators can play an important role by empowering child participation in their healthcare with the following measures:

• Empower children

   

  Teach them to speak up, ask questions and share symptoms or concerns.

• Create safe spaces

   

  Listen with empathy.

  Reduce fear of healthcare.

• Promote safety education

   

  Partner with healthcare providers.

  Build children’s hygiene habits, health literacy and awareness of patient safety.

• Practice and celebrate

   

  Recognise and praise children for safe health decisions, e.g. regular handwashing, coughing into elbow, etc.

Guard our future

It is obvious that greater efforts are needed to ensure Malaysia achieve its SDG2 and SDG3 indicators for children by 2030.

Many conditions in the newborn and the first five years of life are preventable, while a few are not.

Preventive measures can be taken before, during and after birth.

As children are our country’s future, everyone has a role to play in preventing harm in newborns and children, and to build a safer, healthier future for every child.

Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.