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Nutrition Tips for Kids with Diabetes

Eating right is important for everyone, especially children with diabetes. Maintaining healthy blood sugar levels is essential and can prevent hypoglycemia and growth problems. When a child is diagnosed with diabetes, parents often have a multitude of questions and are overwhelmed with so much new information at once.

Let’s start by looking at the basic overview of the two types of diabetes.

Type 1

With type 1 diabetes, the pancreas generates little to no insulin. Insulin is important because it helps transport sugar within the body to create energy. Roughly 5 percent of people with diabetes have type 1. “Children’s of Alabama treats around 2,000 type 1 patients every year,” said Rainie Carter, pediatric dietitian at Children’s of Alabama.

Type 2

More common in adults, type 2 diabetes occurs when the body either can’t make enough insulin, or rejects insulin, causing sugar to build up in the body’s bloodstream. Around 90-95 percent of people with diabetes have type 2. Meal preparation is especially important for type
2 patients.

Meals

When preparing a meal, try using smaller plates. Research shows that eating off a smaller plate can reduce overeating. This tip is especially useful for children with type 2 diabetes. Try to fill the plate with vegetables, grains, protein and fruit.

“Children with both type 1 and 2 diabetes need good fat from unsaturated sources. Foods like avocados, nuts, peanut butter and fish provide this,” said Carter.

It is also important to be aware of carbohydrates when preparing meals or choosing snacks. Carbs breakdown in the body and turn into sugar. Simple carbs such as sugary foods and white breads are broken down quickly, creating a sugar increase within the body. This can lead to high blood sugar levels. On the other hand, complex carbs such as beans, pasta and fiber-rich foods, break down more slowly, producing less of a sugar surge. “Complex carbs won’t raise blood sugar as quickly and also keep children full longer,” Carter said.

Snacks

While meals are crucial, snacks also play a big role in your child’s diet. Choosing snacks that have around 15 grams of carbs is a healthy option for diabetic children.

“String cheese, nuts, peanut butter and flavored almonds are good free food options and help children feel full,” Carter said. “Measure portions to more accurately count carbs. There are also apps available, such as CalorieKing.” It is also recommended that children with diabetes avoid sugary drinks and limit fried foods.

Grocery Shopping

Serving sizes are especially important to notice when buying food for your child. Be aware of portion sizes, carbs and fiber. “Notice the amount of fiber, and try to buy foods with a higher content of it,” Carter suggested. Insoluble fiber promotes a healthy digestive tract, while larger amounts of soluble fiber can lower cholesterol levels and boost blood glucose control. Fiber is especially helpful in keeping children full.

For more healthy eating tips, visit https://www.childrensal.org/snacks-and-recipes

E-Cigarettes and Vaping

E-cigarettes or electronic cigarettes are being marketed as a safe alternative to smoking, but health officials say they are not safe. Dr. Susan Walley is a pediatrician at Children’s of Alabama. She’s concerned about the increase in the use of e-cigarettes and vaping. “As a pediatrician there are two major issues with electronic cigarettes or vaping devices. One is that these are not safe products and the second is that they contain nicotine which is a tobacco product.” She believes many youth and adults don’t realize e-cigarettes contain nicotine, an addictive drug that affects the brain, nervous system and heart.


The use of e-cigarettes is on the rise. Starting in 2014, statistics show more youth use e-cigarettes than any other tobacco product. Five percent of middle school students are current users, while 16 percent of high school students consider themselves to be current users. That’s more than 3 million students.

Dr. Walley says it’s a disturbing trend, as she believes e-cigarette manufacturers are targeting children. “E-cigarette companies are using some of the same techniques that tobacco companies did decades ago by making these liquids appealing to children with candy flavors and dessert flavors,” she says. Some examples include “Skittles flavor” and “Death by Chocolate.”

Another concern, because e-cigarettes aren’t fully regulated yet by the FDA, is that the long term effects are still not fully known.

Parents who use e-cigarettes should know the liquid can be very dangerous for children. Between 2012 and 2015 the number of calls to poison control related to e-cigarettes went up by 1,492 percent. “It’s very scary,” Dr. Walley says. “These are completely preventable. There has even been a death from a child who ingested the mother’s e-cigarette liquid. The child had a seizure and couldn’t be resuscitated.”

Dr. Walley says it’s very important for parents, pediatricians and youth to be educated about the dangers of e-cigarettes and vaping. Because nicotine is so addictive, the best way to avoid the risks is to never start smoking or vaping. If a parent or child is a current user, they should talk to a doctor about ways to quit.

Croup

Croup can be a scary situation for a child and their parents. The symptoms usually occur at night. A child may awaken with a funny sounding cough and labored breathing. Peily Soong, M.D., a pediatrician at Pediatrics East, said croup is quite common in children. “It’s a very common illness,” Soong said. “It’s an illness that’s caused by a virus, the most common virus is one that’s called parainfluenza, but other viruses can cause it like the common cold or flu.”


The symptoms of croup are relatively unmistakable. They include a distinct cough that is described as sounding like a seal’s bark. It’s often worse at nighttime. Other symptoms that may accompany croup include cold-like symptoms such as a fever and runny nose, as well as a raspy voice.
“One thing about this illness,” Soong said, “It affects the throat area. It can cause swelling in the throat, which can cause something called stridor, a real wheezy sound that they can have while breathing. And that’s something to worry about,” Soong said.


Symptoms of Croup

  • Cough that sounds like a “seal bark”
  • Raspy voice
  • Common cold symptoms
  • Wheezy breathing sound

Parents should act quickly when their child demonstrates the symptoms of croup and particularly stridor, but oftentimes the symptoms can be handled at home. The key is helping the child to breathe in moist air. Soong offers these tips for treating croup:


Treating Croup at Home

  • Turn on hot shower, allow child to breathe in the steam
  • If it’s cold outside, take the child outside to breathe in cool air
  • If it’s warm, open freezer door and have them breathe the cold air from the freezer

In many cases, these actions can help alleviate the immediate symptoms of croup, however, it’s still a good idea to visit the pediatrician the next morning. He or she can prescribe a steroid to reduce swelling in the throat.
There are times when croup becomes an emergency situation. Get immediate care if:

  • Child has trouble breathing with no relief
  • Has stridor that is getting worse
  • Difficulty swallowing
  • Drooling
  • Shows signs of a “hot mouth”
  • Is pale or bluish around the mouth

The good news is in most cases children can recover quickly from croup with no lasting problems. With proper attention and recommended treatment, parents and child can rest easier.

Carbon Monoxide Poisoning

It’s called the “Silent Killer.”  Carbon monoxide poisoning can happen any time of the year, but people are especially at risk during the winter months.

Ann Slattery is the Director of the Regional Poison Control Center at Children’s of Alabama.  She says it’s estimated that 5,000- 6,000 people die from carbon monoxide poisoning every year and most everyone is at risk.  “Any time you have an appliance that uses natural gas, a kerosene heater or if there’s a garage attached to the home, or a fireplace you’re at risk for carbon monoxide poisoning,” she says.

Slattery says the number of people who visit the emergency department due to carbon monoxide poisoning is very high.  It’s estimated that 50,000 people a year are poisoned by carbon monoxide.  But because it can be hard to detect and the symptoms vary, one medical journal estimates that the number to be as high as 200,000.  Some of the initial symptoms may be similar to that of the flu.

Symptoms of Carbon Monoxide Poisoning

  • Headache
  • Weakness
  • Dizziness
  • Nausea or vomiting
  • Shortness of breath
  • Blurred vision
  • Confusion
  • Loss of consciousness

 

Carbon monoxide poisoning can be called the silent killer because it is:

  • Colorless
  • Odorless
  • Tasteless

Slattery says people often don’t realize dangerous levels of carbon monoxide are in the home.  “It can make you drowsy,” she says.  “Depending how high the levels are you can go to sleep.  Or you may be asleep when the levels rise and not wake back up.”  That’s why she strongly recommends carbon monoxide detectors throughout the home.

“If you have natural gas appliances, a garage, a kerosene heater or a fireplace you need a carbon monoxide detector,” she says.  Slattery says homes should have multiple detectors in key locations.  “You should have a carbon monoxide detector 10 -15 feet away from the garage door, inside the home.  There should be one 10-15 feet from the fireplace.  And there should be a carbon monoxide detector on each level of the home and outside the bedrooms.”

Locations of Carbon Monoxide Detectors in the Home

  • 10 -15 feet from garage
  • 10- 15 feet from fireplace
  • on each level of the home
  • outside the bedrooms

If it’s believed someone has been exposed to dangerous levels of carbon monoxide, leave the area immediately and call 911 or visit the emergency department.  For more information about carbon monoxide poisoning contact the Regional Poison Control Center at 1-800-222-1222.

Advances in genetic testing result in more effective diagnoses

By Bruce Korf, M.D., Ph.D.
UAB Professor and Chair, Department of Genetics

Dr. Bruce Korf

Dr. Bruce Korf

Birmingham pediatricians now have expanded options for easily accessing genetic expertise and testing, with the recent opening of a genetics clinic at Children’s of Alabama.

For physicians, it’s important to consider when to refer a patient for genetic evaluation, especially for those patients who were unsuccessfully evaluated in the past.

Most pediatricians have experience in recognizing children with congenital malformations, intellectual disability or developmental delay that may have a genetic component. When those patients receive a diagnosis, parents have at least a minimum understanding of what is happening with their child, how best to manage that child, and whether it may occur in their other children.

Unfortunately, in the past a large percentage of patients went undiagnosed, even with an evaluation, putting the parents of young children on a seemingly endless quest to decide how best to manage their child’s medical conditions.

A great deal has changed relatively recently, however, and new tools, including microarray and genome sequencing, are available, which means we have the ability to achieve diagnoses that were not available to us before. So if you have been following a patient with medical issues that you suspect are genetic in origin, and that patient has not had genomic sequencing, it is likely time to refer them to a clinic for retesting.

One of the new tools available to us is microarray testing, which gives us the ability to make a definitive diagnosis at much higher rates than we could expect just a few years ago. Older tools would enable us to see the big picture, much like a satellite picture of the earth. Today’s tools are more like the Google Earth app, allowing us to zoom down to street level, so we can see detail on the genome that was previously impossible.

Genome sequencing is another tool that has improved our ability to diagnose. The cost for the test is dropping dramatically. Once costing $100 million per run, the test and analysis are now in the $6,000 to $7,000 range. While that is still a lot of money, compared to the cost of other medical tests it is actually fairly reasonable.

Microarray can be expected to pick up the genetic cause of 15 to 20 percent of autism spectrum disorder cases. Genome sequencing can pinpoint a diagnosis in about 30 percent of cases of children with intellectual disability, autism spectrum disorder, or congenital anomalies. Putting the two tests together means we can expect a definitive diagnosis in 50 percent of the cases presented to us. Considering that even five years ago we could only expect to diagnose about 5 percent, that’s a tremendous step forward in a very short time.

At one time, a genetic diagnosis relied on the physician’s ability to predetermine the underlying problem in order to test for that particular disorder. Today, we are able to diagnose based on the tests, even finding conditions so rare that no physician would have considered testing for them in the past.

And when a diagnosis still eludes us initially, we can now share results and experience with other geneticists around the world, enabling us to establish a diagnosis we may not have been able to make alone.

In short, the tools we have at our disposal now have never been more powerful, so if you are a pediatrician following a patient and have been unsuccessful getting a diagnosis in the past, it is worth taking a second look now.

Of course, putting a name to a disorder is only part of the battle. The next step is knowing how to treat a patient’s condition, and we have made progress in that area as well. Certainly, we can’t say we are able to treat every condition we see, but once we figure out which gene underlies the condition, we then begin to ask why the change in the gene causes the problems it does. And we are gradually figuring that out and identifying drugs that improve quality of life.

With such dramatic and rapid developments in the field of genetics, there are many implications to be considered as we move forward. There is increasing discussion that perhaps everyone should have their genome sequenced, as the cost goes down and the feasibility of the testing goes up. This emerging area will have to be addressed carefully. Between 1 to 3 percent of people whose genes are sequenced will discover a condition they did not realize they had or were at risk for, and virtually everyone can learn how their body manages specific medications or can become aware of risk factors for common diseases. But there are also questions about what options exist to manage these risks once they are known. We will have to proceed carefully in light of our increasing technological abilities.

For patients with known medical problems that can be addressed with genetic evaluation, however, there are ample reasons to make referrals and try to determine a diagnosis that can improve quality of life for the patient and their family.

We have a new clinic integrated into Children’s, with access to parking and other specialists, making genetic evaluation more convenient for parents than ever before. In addition to our Children’s clinic, we have a prenatal diagnosis program through ob/gyn and maternal fetal medicine at UAB, and our newest clinic at Kirklin Clinic for adults.

If you have questions about referring a patient to one of our Birmingham area clinics, please call (205) 934-4983 to discuss.

 

Holiday Nutrition

One of life’s enjoyments during the holiday season is all of the delicious treats and special meals we can enjoy, so it’s no wonder the holidays are never an ideal time to diet.

Rainie Carter is a Clinical Nutritionist at Children’s of Alabama. She says it’s best for parents to focus on weight management and healthy choices for their children and themselves during the holidays. “It’s easy to add five extra pounds of weight during the holiday season. But the concern is that over the holidays, from October through January, we can put on five pounds of fat, but keep in mind it can take five months to lose it!” She says that can add up. “If you don’t lose it, you are ultimately adding 10 pounds in two years, 15 pounds in three years of holiday eating,” she says.

One tip she offers is to use smaller plates. She serves her meals on salad plates instead of dinner plates. “The difference is huge portion sizes. If you add the same amount of food portions to a dinner plate versus a salad plate, the larger plate doesn’t look as filling so you end up adding more or going back for seconds,” she says. “You need to trick your brain into being fuller by putting it on a smaller plate.”

Carter says it’s not necessary to deprive children treats during the holidays. But if you do indulge, be sure to pay attention to portion sizes. “Just think portion control,” she says. “Be sure to look at the ingredients, including calories, grams of fat and sugar and stick to portions rather than overeating.” She also recommends children stay full on healthy food so they don’t get as many sugar cravings.

Carter says a lot of holiday treats can be made using healthy substitutions like apple sauce and pumpkin instead of oils and fats. But if a true dessert is on the menu, a good rule of thumb is to consider portions again. A fist or palm of the hand is a good guide for a single portion.

The main goal during the holidays is weight maintenance. Children and adults can enjoy a few holiday indulgences without compromising their weight or overall health.

Cold or Flu?

The fall and winter months are cold and flu season. Many children develop sore throats, a cough and sometimes a fever. So how can parents determine if that illness is just a cold or the flu? Both the cold and the flu can present similar symptoms, including cough, congestion and runny nose.

Dr. Lisa Venable, a pediatrician at Midtown Pediatrics, offers these tips. “In general, the flu hits a lot harder than a cold does, and a lot quicker,” she says. “You can have a high fever, fatigue and body aches and feel very, very tired.”

SIGNS OF THE FLU

  • Comes on faster and harder
  • High fever
  • Fatigue
  • Body Aches

Dr. Venable says now is the time to consider a flu shot. The American Academy of Pediatrics (AAP) recommends the flu shot for everyone over 6 months old. Flu shots can still be administered all the way through the end of the flu season in February or March.

In the event a child does get sick, there are things parents can do to help mitigate symptoms. “Make sure your child is drinking plenty of fluids,” Dr. Venable says. “You can give Tylenol or Motrin if they have a fever. And make sure they are getting plenty of rest.”

TREATMENT

  • Fluids
  • Rest
  • Tylenol or Motrin for fever

Dr. Venable advises parents to bring their child to the doctor if they’re concerned, however, she says it’s not necessary to see the pediatrician for a cold. Most of the time parents can care for their children with plenty of rest, fluids and extra comfort.

 

Talking to Children about Current Events

In this day and age, children are exposed to violent and disturbing topics on the news. Reports on natural disasters, shootings and terrorist attacks can be confusing to a child, teaching them to view the world as a scary place. But there are benefits in raising children who are aware of what’s going on in the world.

Dr. Dan Marullo is a Pediatric Psychologist at Children’s of Alabama. He says whether parents should share current events with their child depends on the age and developmental level of the child.

“It definitely depends on the age of the child,”Dr. Marullo says.”Kids of different ages have different needs and different developmental levels. I think regardless of the age of the child, one thing to keep in mind is children learn how to cope with adversity by watching their parents.”

Dr. Marullo says the first thing for any parent to do is to check how they’re coping with the news or what’s going on around them. Parents should keep things in perspective and help children to understand that television has a way of shrinking the world and bringing it into our living rooms. A child watching a news story about an earthquake in California may lose sleep thinking the same thing could happen in Alabama.

Dr. Marullo says younger children, toddlers and preschoolers probably don’t need to see a lot of the bad things on television. “They would have a very hard time managing that so minimizing exposure would be important,”he says.

For school age children, the approach should be different. “For older children, they’re probably going to come across media on their own,”Dr. Marullo says. “It’s important for parents to have a dialogue with their child. Watch the media with them, watch the news with them. It certainly makes a great topic of conversation for dinner time. That way parents can monitor their child’s exposure but also answer their questions and model their own behavior.”

For parents of school age children, keep in mind a little exposure to adversity is beneficial. “The way we learn to deal with adversity is by experiencing adversity,”Dr. Marullo says. “That doesn’t mean we expose our children to everything, but a little exposure with good guidance from a parent is crucial for their healthy development.”

Parents may also want to talk to their child about what can be done to help in a tragic event. Children may gain a sense of control and feel more secure when they think of ways they can help those affected by the tragedy.

If a child seems overly anxious, parents should encourage a break from television. Read, play board games or go outside. Look for opportunities to bond as a family and put things in perspective.

Preparing your child for surgery

Surgery is never fun, but it’s even more intimidating when it involves your child. So how can you prepare your child when they are about to have surgery?  Good preparation can actually help children feel less anxious about the procedure and get through recovery faster.

Danelle Paz is a Nurse Anesthetist at Children’s South.  She says first and foremost it’s important for parents to be honest with their children. “They’re not going to Disney World,” Paz says. “That’s the most important thing, is to help them understand they’re having surgery and to be honest when questions are asked.”

The key is to provide information at your child’s level of understanding, correct any misunderstandings and help eliminate any fears. Help your child understand why surgery is needed.

In terms of preparations, Paz says it’s very important that parents follow instructions given by their doctor. This may involve taking a bath the night before as well as special instructions about when to cease food and drink.

Having the procedure at a pediatric facility like Children’s South ensures that all aspects are catered to the comfort and unique needs of the child.

“When it’s your child, you want your child to be taken care of like it’s their child and that’s what we do here,” Paz says.  “We’re all pediatric trained physicians, nurses and child life specialists and your child and family are truly our focus.”

Special attention is given at a pediatric facility to take a “pain free” approach prior to surgery.  At Children’s no shots are given while the child is awake. Instead, the child is put to sleep with a mask.

After surgery, the doctors will be very attentive to care for the child and give pain medicine as needed.  During recovery, there may be times of discomfort for your child.  Parents should explain that even if this happens they will get better.

Parents can do their part to make recovery more pleasant with a new book, toy, or a visit from a friend or relative.  Just make sure the child gets plenty of rest to recuperate.

Moms and dads can be assured their child will be in good hands with a pediatric staff to care for them and help them through this challenging time.

Back to School Safety 101

From incoming kindergartners to graduating seniors, back to school is an exciting time. As children prepare to meet their new teachers and reunite with classmates, here are a few tips to help them return to the classroom. 

Backpacks

An essential accessory for students of all ages is a backpack. More important than a backpack with trendy designs and favorite cartoon characters is one with a good fit, said Karen Cochrane, Children’s of Alabama patient health and safety information educator. Select a backpack that is lightweight when it is empty. “It will only get heavier – and harder for a child to carry – when it is full of textbooks, notebooks and binders,” Cochrane said. A general rule is that the child shouldn’t carry more than 10 to 15 percent of his body weight.

Cochrane recommends a backpack with features such as:

  • multiple compartments to distribute the weight of backpack contents
  • compression straps to cinch up the sides of the backpack, bringing the weight closer to the body
  • two padded shoulder straps to evenly distribute the bag’s weight; wider straps are preferred over narrow straps that can dig into the shoulders
  • waist straps to bring the backpack’s weight closer to the body
  • cushioned back panel that makes the bag more comfortable to wear and also keeps pencils and other sharp objects from poking through

Parents should be prepared to buy a bigger backpack as their students get older to ensure they are using an appropriate size, Cochrane said. The load will get heavier as well. Elementary students may only carry their backpacks to and from school, while middle and high schoolers will carry their backpacks throughout the day, full of books, to different classrooms.

School Buses

Before the first day of school, particularly for first-time bus riders, parents should walk with their students to the bus stop to review safety procedures. Cochrane shared these suggestions:

  • Wait for the bus on the sidewalk, at least six feet from the curb.
  • Line up and wait until the bus driver gives the OK before boarding the school bus.
  • Sit quietly on the bus to keep from distracting the bus driver.
  • Never walk behind the bus.

If children need to cross the street once they get off the bus, they should do so in front of the bus, Cochrane said. Then they should take five giant steps (about 10 feet) in front of the bus and make eye contact with the driver before crossing in front of the bus.

“If a child drops something while crossing in front of the bus, don’t pick it up right away. Make eye contact again, and tell the driver right away,” Cochrane said.

And for those of us driving cars, be alert once school is in session. “As you approach a school bus stop, even if you don’t see the bus, assume that children are around,” Cochrane said. If lights on the bus are flashing, be prepared to stop.

Home Alone After School

Some children may come home to an empty house after school. Alabama doesn’t have a law that sets an age when children can be left home unattended. “Even without a law in place, it’s more important that parents ask themselves if their child is ready,” Cochrane said. Consider:

  • the child’s maturity level
  • a record of responsible behavior
  • physical ability to provide care
  • good decision-making abilities
  • how the child responds to stressful situations
  • how comfortable the child is being home alone

“Take the time to talk to your child, discuss the house rules and set the expectations,” Cochrane said. “Another way to prepare with your child is to role play likely situations they could face while home alone: What would you do if ‘this’ happened?” she said.

Parents should specify exactly what the child is allowed to do in the home after school, such as watch television, use kitchen appliances, have friends over, or do chores. But even with rules in place, Cochrane advises that the time when children are home alone should be within limits. “Don’t overdo it,” she said. “Even the most responsible child shouldn’t be left home alone too frequently.”

Avoiding Germs

With a classroom full of students, there will be germs. Washing hands and covering coughs and sneezes are two ways to keep germs from spreading. “If your child is sick, it’s better they stay home,” Cochrane said. “If you’re sick and keep pushing through, you’ll never get better, and the same applies for our children.” And chances are, if your child is attending school when they aren’t feeling 100 percent, they aren’t able to give 100 percent in the classroom.

Establishing Back to School Routines

Summer may be a time when rules are bit more relaxed, and bedtime is later than it is during the school year. But it’s not too soon to resume some school year routines, Cochrane said.

  • Make sure your child is getting enough sleep.
  • Serve a healthy breakfast.
  • Write down ‘need to know’ information: locker combinations, class schedules, teacher names.
  • Organize the night before (pick out clothes, pack a lunch, etc.) so that the morning isn’t rushed.

A few simple changes now could lead to a smoother transition when school is back in full swing.