Children's

Marilyn Prier – Daisy Lifetime Achievement Award Recipient

Marilyn Prier, MPH, BSN, RN graduated from the University of Alabama Birmingham School of Nursing in 1986.  She immediately began her career at Children’s of Alabama where she worked for 37 years.  Marilyn’s life has been committed to ensuring that children have a healthy and happy life, whether at her job as a registered nurse at Children’s of Alabama or at home raising her four sons and enjoying her fifteen grandchildren. 

Upon graduation, Marilyn’s first position as a registered nurse was in the Pediatric Intensive Care Unit where she worked for two years.  She left Children’s for two years to work in home healthcare.  After receiving a call from a friend, she returned to Children’s and became the discharge planner for the inpatient units.  The CNO, Supora Thomas, had a vision for two big initiatives and she charged Marilyn with this task.  There were families whose children were discharged with a risk to suddenly stop breathing.  Marilyn put together a program to ensure that staff on the inpatient units could conduct CPR teaching for these families so they could intervene in these crucial moments.  She worked with a team reaching out to community partners and donors to supply CPR teaching kits over the years and this program remains in place today.

Another very important initiative was child passenger safety.  It was often discovered that parents did not have a car seat to safely get their child home upon discharge from the hospital.  Marilyn and her colleagues developed a program to identify these families and provide them with an appropriate child passenger safety seat.  Over the years Marilyn and her teammates became certified Child Passenger Safety Technicians, installing car seats and ensuring that families knew how to safety install their own seat.  The program has grown over many years and at the present time Children’s has a donor who supplies seats free of charge for families who are discharged from the hospital and in need of a car seat.  Another group of patients in need of car seats were patients with spica (body) casts or other physical or structural limitations.  These patients required a specialized car seat and again Marilyn and her team worked to ensure that a safe seat was acquired.  Since specialty car seats are very expensive and not needed for much longer than a few months, a loaner program was developed so that families could transport their child safely without the worry of additional expenses.

After a few years in the discharge planner role, Marilyn’s commitment to patient education prompted her transfer to the CHECK Center (Comprehensive Health Education Center for Kids) where she worked on developing printed patient health and education material for the hospital.   In partnership with BlueCross and BlueShield of Alabama, Marilyn was instrumental in creating the curriculum and design for an interactive mobile unit called Body Trek. Thousands of school age children have been given the opportunity to visit Body Trek. In the unit they learned how the human body works and important safety practices such as always wearing a seat belt and always wearing a helmet while riding a bicycle. Marilyn partnered with local schools of nursing to provide nursing students the opportunity to serve as volunteers with Body Trek while teaching the them the importance of teaching safety in the community.

In 2002, Marilyn returned to school and obtained a Master of Public Health degree.  This enabled Marilyn to grow and develop as a leader at Children’s of Alabama.  In 2006 Marilyn accepted the position as the Department Director for the CHECK Center.  The center later changed names to Patient Health and Safety Information.  She continued working on many initiatives including developing a strong liaison program between Children’s of Alabama and the Alabama Association of School Nurses and the Alabama State Department of Education’s School Nurse Administrator.  Children’s began providing annual educational sessions during the summer months so school nurses could obtain continuing education credits and stay on top of the many changing trends and treatment with school aged children. 

Marilyn is a strong advocate for child health and safety.  She was instrumental in developing partnerships that helped bring many programs into the schools and communities.   She also facilitated many new programs supporting staff inside the hospital.  Some of the programs she worked with are:

  • Kids on the Block – a national program which used puppets to educate students about peers with different abilities, disabilities and diseases. The focus was on tolerance and diversity amongst their groups.
  • Smoke House – a mobile unit funded by the Junior League of Birmingham that taught students about fire safety and how to escape from a burning house
  • Scoliosis Screening – this program was a national mandate to assess adolescents for scoliosis. Marilyn and her team worked with local schools of nursing to provide scoliosis screenings in the middle schools around Birmingham
  • Safe Sitter Inc. – this national program prepares school age children how to be safe at home alone or while babysitting.  Marilyn and her department staff taught this program at the hospital campus.
  • Hand in Hand for Fitness – a program whereby Marilyn and her team worked with donors to provide fitness equipment to elementary schools
  • Community CPR classes
  • Get Well Network – an interactive program available on smart TVs throughout the new inpatient bed tower. This program has information for families on way finding, new diagnosis teaching and videos, as well as movies for the patients to watch.
  • Daisy – this program is a recognition program specifically for nurses
  • Safety store – opened in the patient health and safety department where child and home safety items were sold. 

Marilyn retired in April of 2021 from a lifetime career of advocating for child safety. She has been an instrumental force in nursing leadership at Children’s of Alabama.

Health and Safety

Orthopedic Injuries

Orthopedic injuries in children are one of the most common visits to the pediatric emergency department (AAP). Courtney Trapp, an orthopedic nurse clinician at Children’s of Alabama, said, “the majority of patients we see come in for injuries related to sports or trampoline parks, especially during the summer months.”

Precautions to take against injury

School being out during the summer months and kids having more free time can lead to unforeseen incidents, including orthopedic injuries. While spending time outdoors is very beneficial for children, the risk of injury increases. Parents can take precautions to prevent their child from being injured.

Teaching kids how to use safety precautions when playing sports and supervising them while they play outside can decrease the risk of injury. Parents should ensure their child is wearing or using proper safety equipment depending on the sport or activity. For instance, if a child is riding a bike, they should wear a helmet. A safety net should always be used on a trampoline. If a younger child is playing with older kids, the younger child is more likely to be injured due to the size difference. Parents should be mindful of who their child plays with to reduce the risk of accidental injury. Implementing vitamin D in a child’s diet is recommended by The American Academy of Pediatrics to help maintain good bone health. Their general recommendation is 600IU (international unit) per day and can typically be found in an over-the-counter multivitamin. 

Signs of a broken bone

A broken bone, also called a fracture, is when a break goes through part or all of a bone. Broken bones typically happen from a fall, accident or sports. Fortunately, the healing process is typically faster for kids who break their bone. “Most kids stay in a cast for 4-6 weeks, wear a splint after and then avoid high-contact sports for several weeks,” Trapp said. 

The signs of a fracture depend on the type of break and the bone affected. Pain, swelling, bruising and lack of movement all indicate a broken bone. Sometimes, there is a deformity – when the body part looks crooked or different than it did before the injury. Doctors order X-rays if they think a bone is broken and treat the broken bone with a cast, splint or brace. Children wear one of these for several weeks or even months, depending on the injury.

What to do if my child breaks a bone?

In situations when a child’s bone breaks, they should not move the injured extremity. “If splinting materials are available, i.e. pillows or blankets, then the parent should try to stabilize the extremity on the way to get the child evaluated,” Trapp said. If caregivers notice an immediate deformity or swelling in a child’s extremity, they shouldn’t give them anything to eat or drink. If they have to be sedated, it has to be done on an empty stomach. Once arriving to a hospital, the child could go to the operating room or emergency room – depending on the injury. How do you know when to bring your child to the emergency room if their bone breaks? If you see a deformity of the extremity, a child should go to the emergency room. If there is not an obvious deformity, the orthopedic team at Children’s recommends visiting the child’s pediatrician to see if they need to be referred to an orthopedic department.

If safety precautions and supervision are implemented while children are engaging in sports and activity, visits to the emergency room can be avoided.

Children's

Tips for Packing School Lunches

Back to school season is stressful for children and parents alike, and parents are concerned about ensuring that their child eats a nourishing lunch to power through the school day. The situation can prove to be frustrating when the lunches come back home uneaten. Rainie Carter, director of Clinical Nutrition at Children’s of Alabama, offers tips for packing a lunch that will please both kids and parents.

Cover the Nutritional Bases

  • Include protein to help keep them full through the afternoon with items like string cheese, yogurt, meat, or nuts (if the school guidelines allow them). Carter’s favorite tips are to use a whole wheat tortilla to make pinwheels with lunch meat or freezing yogurt the night before for a creamy treat.
  • Fruits and vegetables are important for your child’s fiber intake. “Kids love to dip and scoop so you can pack a little bit of ranch dressing or hummus with vegetables,” Carter advises. For produce that turns brown when cut, like apples, Carter suggests squeezing a little bit of lemon juice over the chunks to placate picky kids.
  • Stick with whole grain for items like bread or crackers, and stay away from concentrated sweets like candy or gummy snacks as these can lead to an energy crash later in the day. “Also, avoid sugary drinks like soda or juice. Make sure that they have plenty of water, and a frozen water bottle will work as an ice pack too.”

Involve Them in the Process

  • Plan as a family for the week’s lunches. “Spend a little time pre-chopping veggies and fruit, and let your child put portions into bags or containers. If they’re old enough, let them do the cutting too. They are more likely to eat something if they remember helping with it,” Carter said.
  • Giving your child options can be a great way to gain their interest. “Let them pick within your constraints,” Carter suggests. “For instance, show them two choices for a fruit and say, ‘Do you want apples or grapes today?” Parents can also do this in the store to make sure they buy what the child wants to eat. She says to stick to the outskirts of the store for fresh produce and whole grains, avoiding the packaged foods in the aisles.

Have a Little Fun

  • Pack a variety of snacks to keep them interested and sneak in more nutrient-rich foods. “Lunch does not have to be a sandwich and a piece of fruit. Kids enjoy finger foods so bento boxes are popular to portion out a few snacks instead of one big lunch item,” Carter said.
  • Get creative if your child tires of the same lunch items. “Some parents will use a cookie cutter to remove the sandwich crust and make a fun shape. If the school allows it, try putting things on sticks like a fruit kabob. Kids love colorful lunches too, so find ways to incorporate that,” Carter recommends.
  • Try making trail mix with your child, letting them fill their own bags. Carter’s suggested ingredients are dried fruit, granola, nuts or chocolate chips.
Health and Safety

Heat Illness

Summer in Alabama can bring high temperatures and an oppressive heat index. Kids are at risk for heat cramps, heat exhaustion and heatstroke if they play outside or have athletic practices in this hot, humid weather. It’s important for parents and coaches to be aware of the signs and symptoms of heat illness.

Signs and Symptoms

Of heat exhaustion:

  • increased thirst
  • weakness and extreme tiredness
  • fainting
  • muscle cramps
  • nausea and vomiting
  • irritability
  • headache
  • increased sweating
  • cool, clammy skin
  • body temperature rises, but to less than 105°F (40.5°C)

Of heatstroke:

  • severe headache
  • weakness, dizziness
  • confusion
  • fast breathing and heartbeat
  • loss of consciousness (passing out)
  • seizures
  • little or no sweating
  • flushed, hot, dry skin
  • body temperature rises to 105°F (40.5°C) or higher

What to Do

If your child has symptoms of heatstroke, get emergency medical care immediately.

For cases of heat exhaustion or while awaiting help for a child with possible heatstroke:

  • Bring the child indoors or into the shade immediately.
  • Undress the child.
  • Have the child lie down; raise the feet slightly.
  • If the child is alert, place in a lukewarm bath or spray with lukewarm water.
  • If the child is alert and coherent, give frequent sips of cool, clear fluids.
  • If the child is vomiting, turn onto his or her side to prevent choking.

To help protect kids from heat illness

  • Teach kids to always drink plenty of liquids before and during activity in hot, sunny weather — even if they’re not thirsty.
  • Kids should wear light-colored, loose clothing on hot days and use sunscreen when outdoors.
  • On hot or humid days, limit outdoor activity during the hottest parts of the day.
  • Teach kids to come indoors, rest and hydrate right away whenever they feel overheated
Health and Safety

Fireworks Displays Can Be Dangerous When Not Left To Professionals

Fireworks are synonymous with the 4th of July holiday.

The American Academy of Pediatrics (AAP) continues to urge families not to buy fireworks for their own or their children’s use, as thousands of people, most often children and teens, are injured each year while using consumer fireworks.

Sue Rowe, a charge nurse in the Burn Center at Children’s of Alabama, has advice for those who choose to use their own fireworks this 4th of July.

Her number one fireworks safety rule? “Never leave children unattended around fireworks.”

If you are using fireworks on your own, only use them with adult supervision. Keep children at a safe distance from lit fireworks. She also suggests keeping a bucket of water nearby. Store fireworks in a safe place, outside the main living area, such as in a garage or storage area, out of a child’s sight and reach.

And while sparklers may seem like a safe alternative to large, showy displays, they can be just as dangerous. “The tip of a sparkler produces a significant amount of intense heat,” Rowe said. The AAP reports that sparklers can reach above 1,800 degrees Fahrenheit – hot enough to melt some metals.

However, accidents do happen, and Rowe offers tips if your child is burned with a firework. “The first thing is to immediately apply cool water to the burn site.” She cautions against ice packs, though. For home care, “apply a topical antibiotic ointment to the affected area.” If the burn is significant, a trip to the closest emergency department is advised.

The Burn Center at Children’s of Alabama is the only designated pediatric burn center in the state and one of the largest in the southeast. A specially trained team of pediatric surgeons, registered nurses, physical and occupational therapists, social workers, child life therapists, teachers, pastoral care staff, nutritionists and burn technicians work together to form a cohesive team of professionals dedicated to treating children with burn injuries. The Children’s of Alabama Burn Center is a six-bed specialty unit designed to care for the needs of burn patients ages birth to teenagers. For more information, visit www.childrensal.org/BurnCenter.

Children's, Health and Safety

Lawn Mower Safety

As you begin assigning chores to your children this summer, there are few things to consider about yard work and lawn mower safety.

“We see quite a few patients in our emergency room during the summer because of lawn mower injuries,” said Lisa Maloney, pediatric emergency medicine. “Most typical are skin lacerations and injuries to extremities, such as their hands and feet. We also see some eye injuries when items like rocks or sticks are picked up and thrown by a lawn mower.”

In general, children should be at least:

  • 12 years old to safely operate a walk-behind power or hand lawn mower
  • 16 years old to safely operate a riding lawn mower

When you decide your child is ready to use a lawn mower, spend some time with them reviewing the equipment’s owner manual in advance and talking about how to do the job safely. The most important thing, said Maloney, is parental supervision.

“Lawn mower injuries can be severe. These types of injuries require many surgeries involving many specialists, especially when the goal involves saving a limb,” Maloney said.

Before mowing:

  • Inspect the area to be cut, and remove any items that could be picked up and thrown by the lawn mower.
  • Ensure your lawn equipment is in good working condition.

While mowing:

  • Use sunscreen, safety glasses or goggles, closed-toe shoes and hearing protection.
  • Small children should be a safe distance away while the lawn mower is in use.
  • Never allow children to ride as passengers on a riding lawn mower.
  • Avoid mowing in reverse.
  • Push or drive your mower up and down slopes, not across, to prevent mower rollover.

After mowing:

  • When you turn your mower off, make sure the blades are completely stopped.
  • Only refuel the mower once the engine has cooled.

A lawn mower is a very powerful tool. It can cause serious injuries, but many of these injuries are preventable. Keep your children safe around lawn mowers this summer. Following these guidelines can help prevent lawn mower injuries.

Children's, Health and Safety

Talking to Your Children About the News

Children hear about what’s going on in the world through social media, friends, or adults’ conversations. Sometimes the news is uplifting — like kids their age taking a stand on social or environmental issues. Other times, children may worry about current events like the recent school shooting in Texas and need an adult to help make sense of what’s happening.

Help your child understand the news and feel more in control by taking these steps: 

Find Out What Your Child Already Knows

  • Ask your kids questions to see if they know about a current event. For school-age kids and teens, you can ask what they have heard at school or on social media. 
  • Consider your child’s age and development. Younger kids may not grasp the difference between fact and fantasy. Most kids realize the news is real by the time they are 7 or 8 years old.
  • Follow your child’s lead. If your child doesn’t seem interested in an event or doesn’t want to talk about it at the moment, don’t push. 

Answer Questions Honestly and Briefly

  • Tell the truth, but share only as much as your child needs to know. Try to calm any fears and help kids feel safe. Don’t offer more details than your child is interested in.
  • Listen carefully. When kids hear about an upsetting event like a school shooting, they may worry, “Could I be next? Could that happen to me?” Older kids may have lots of questions. Focus on what your kids ask so you can help them cope with their fears. An adult’s willingness to listen sends a powerful message.
  • It’s OK to say you don’t know the answer. If your child asks a question that stumps you, say you’ll find out. Or use age-appropriate websites to spend time together looking for an answer.
  • Limit how much kids watch online, on TV, and social media about the events. The strong images may be upsetting for kids and teens. 

Help Kids Feel in Control

  • Encourage your child to talk. If your child is afraid about what’s going on, ask about it. Even when kids can’t control an event — like a school shooting or natural disaster — it can help them to share their fears with you.
  • Urge teens to look beyond a news story. Ask why they think an outlet featured a frightening or disturbing story. Was it to boost ratings and clicks or because the story was truly newsworthy? In this way, a scary story can be turned into a discussion about the role and mission of the news.
  • Teach your children to be prepared, not panicked. For example, if the news is about a school shooting, talk about the ways schools are keeping kids safe. If it’s about a natural disaster, make a family plan for what you might do. If an illness is spreading, talk about ways to protect yourself and others.
  • Talk about what you can do to help. After a tragic event, finding ways to help can give kids a sense of control. Look for news stories that highlight what other people are doing. Articles such as School Violence: What Students Can Do may be helpful for older kids and teens. 
  • Put news stories in context. Broaden the discussion from a specific news item about a difficult event to a larger conversation. Use it as a way to talk about helping, cooperation, and the ways that people cope with hardship.

Limit Exposure to the News

  • Decide what and how much news is appropriate for your child. Think about how old your kids are and how mature they are. Encourage them to take breaks from following the news, especially when the topics are difficult.
  • Keep tabs on the amount of difficult news your child hears. Notice how often you discuss the news in front of your kids. Turn off the TV so the news is not playing in the background all day.
  • Set limits. It’s OK to tell your kids that you don’t want them to have constant exposure and to set ground rules on device and social media use. 
  • Watch the news with your child and talk about it. Turn off a story if you think it’s not appropriate for your child. 

Keep the Conversation Going

  • Talk about current events with your child often. Help kids think through stories they hear – good and bad. Ask questions like: “What do you think about these events?” or “How do you think these things happen?” With these types of questions, you can encourage conversation about non-news topics.
  • Watch for stress. If your child shows changes in behavior (such as not sleeping or eating, not wanting to be around people, or worrying all the time), call your child’s doctor or a behavioral health care provider. They can help your child manage anxiety and feel better able to cope.

More Resources from Our Partners

Children's, Development, Health and Safety

Communication Begins at Birth: 12 – 24 Months

This year-long period is when language development truly takes off. Your child’s understanding of the world around them, especially for language and sounds, is much more developed than before. Most kids typically say their first words around their first birthday, but a toddler who is actively learning to walk will commonly postpone their speech development. By two years old, most toddlers will say 50-100 words or moreand be able to put together two-word phrases.

Listed below are some typical milestones, enhancement activities, and red flags for your baby’s hearing and speech development at this age. Note that every child is different, and some reach these milestones sooner or later than others. If your child is not developing in accordance with these guidelines, consider contacting your pediatrician or family health physician. 

Typical Development: 

  • Uses several words with a variety of speech sounds, slowly developing into 20-50 words
  • Enjoys simple songs and rhymes
  • Understands two step directions (ex: “Get your shoes and come here”)
  • Can make simple needs known through speech
  • Asks simple questions
  • Knows and points to body parts

Activities: 

  • Praise and encourage efforts in all areas: moving, playing, talking, singing
  • Avoid over-correcting your child’s efforts to speak
  • Always fully listen when your child speaks to you
  • Ask your child questions that stimulate thought and check understanding

Red Flags: 

  • Uses only vowel sounds to speak
  • Cannot follow simple commands
  • Does not respond to sounds or responds only to loud sounds
  • Points or grunts to make needs known

Your little one is listening to everything you say and storing it away at an incredible rate. Instead of using “baby” words, start using the correct names for people, places, and things. Speak slowly and clearly, and keep it simple. Your child’s vocabulary will grow quickly, but pronunciation isn’t likely to keep pace. By 2 years of age, most kids are understandable only about half the time, so emphasize the correct pronunciations in your responses.

Gestures are an important part of language development. Make the connection between the gestures your child makes and language by using a running commentary such as, “Do you want a drink?” (when your child points to the refrigerator), then wait for a response. Then say, “What do you want? Milk? OK, let’s get some milk.” Such behavior encourages kids to respond and participate in conversations

Children’s of Alabama Hearing and Speech Center: https://www.childrensal.org/hearing-and-speech 

Children's

Communication Begins at Birth: 9 – 12 Months

These months can be a cornerstone period for your baby’s communication development. During this period, your baby might say “mama” or “dada” for the first time, and will mostly communicate using body language, like pointing and shaking his or her head. Your baby will pay even more attention to words and gestures and will try to imitate you and various sounds from his or her environment.

Listed below are some typical milestones, enhancement activities, and red flags for your baby’s hearing and speech development at this age. Note that every child is different, and some reach these milestones sooner or later than others. If your child is not developing in accordance with these guidelines, consider contacting your pediatrician or family health physician. 

Typical Development:

  • Continues to point his/her finger to communicate desires
  • Uses jargon that sounds like speech
  • Can clearly say 1-2 words (ex: mama, dada, uh oh, bye)
  • Imitates sounds such as animals, cars, and trains
  • Looks at or points to familiar objects or pictures when they are named 
  • Responds to his/her own name, phone ringing or someone’s voice, even when not loud

Activities:

  • Point to pictures to identify people, objects and toys
  • Talk to your baby throughout the day. Mix in adult tones of speech, not just baby talk
  • Identify and imitate environmental sounds such as birds and planes

Red Flags:

  • Uses few or no speech sounds 
  • Does not use gestures to communicate: waving, high fives
  • Does not show understanding of any words

There are many activities that parents can do to ensure that their baby is getting the information he or she needs for proper development of speech and hearing. Though your baby may only be saying a few words, naming familiar objects will help your baby learn what they are called and store this information before they can use words.  Labeling objects during the course of the day reinforces the message that everything has its own name. Make learning a whole-body experience: Touch your baby’s toe when you say the word “toe.” Or point out your own ear and say, “Mommy’s ear.” Face your baby when you speak to let him or her see your facial expression and lip movements. Children’s of Alabama Hearing and Speech Center: https://www.childrensal.org/hearing-and-speech 

Children's, Development, Health and Safety

Communication Begins at Birth: 4 – 8 Months

During these months, your baby is learning to talk with lots of babbling and laughing. They are discovering a new range of sounds as well as imitating some of those sounds. They will also start to understand different tones of voice and respond accordingly.

Having a “conversation” with your baby is as important as ever during this time. Surprisingly, babies comprehend words long before they can say them, so use real words and cut back on the baby talk.

Listed below are some typical milestones, enhancement activities and red flags for your baby’s hearing and speech development at this age. Note that every child is different, and some reach these milestones sooner or later than others. If your child is not achieving these developmental milestones, consider contacting your pediatrician or family health physician.

Typical Development:

  • Turns head to locate sounds beyond what able to see
  • Notices toys make sounds
  • Shows interest and pleasure when spoken to
  • Responds to different tones and sounds but not upset
  • Calms by favorite sounds
  • Begins to repeat sounds (such as “ooh,” “ahh,” and “ba-ba”)
  • Responds to name when called
  • Makes sounds to get attention
  • Shouts to gain attention
  • Understands “no-no” and “bye-bye”

Red Flags:

  • Does not laugh or smile
  • Makes little noise
  • Does not respond to sound or responds only to loud sounds
  • Does not interact vocally by making sounds or makes sounds only in monotones

Activities:

  • Call baby by name
  • Play vocal and simple games like peek-a-boo
  • Talk about activities during play
  • Make play sounds and wait for response: taking turns
  • Name body parts while playing and dressing
  • Read to your baby

By the end of eight months, you can expect a lot of progression in your baby’s ability to listen and talk. They will respond to their names, respond to sounds by making their own, babble repetitive consonants, imitate sounds and even associate words with familiar objects. Reinforce this progress by introducing your baby to simple words that apply to everyday life. They understand more that you think!