Children's, Health and Safety

Heart Transplants in Children: Providing Kids Their Best Quality of Life

Heart transplantation surgery has advanced significantly since the first successful transplant in 1967. However, it is still considered a “last resort” when treating heart conditions.

“Our goal is to keep patients alive and healthy with their own heart, with the use of medications, or other assist devices. Transplantation really is the last option. And, transplantation is not a perfect treatment. A transplanted organ does not last forever,” states Dr. Wally Carlo, Associate Professor at the University of Alabama at Birmingham and Medical Director of the Pediatric Advanced Heart Failure and Transplant Program at Children’s of Alabama.

Instances where transplantation is appropriate include:

  • Patients who are born with congenital heart conditions and have undergone multiple operations, but their heart is giving out and there is no further surgery available to them.
  • Patients who have previously been healthy children and teenagers and suddenly present with the first symptoms of a weakened heart or cardiomyopathy they may have had for years—but had not demonstrated any symptoms until that time.
  • Patients who have acquired a new infection of the heart.
  • Babies born with very rare conditions that are not amenable to surgery or conditions wherein the heart muscle is very weak.

Surprisingly, infants tend to have a very forgiving immune system. “An infant transplanted successfully in the current era should be expected to have at least a 25-year graft survival, meaning we would expect them to be benefitting from that transplanted organ for two or three decades. Then, at that point, 25 years from now, we may have new options to treat them,” explains Dr. Carlo.

Risks of Post-Transplantation

Post-transplant is a precarious time for heart recipients. Transplant patients require immunosuppressive medications to help the body not reject the organ. Unfortunately, at the same time, those medications set patients up to potentially develop infections their body cannot fight off, cancers, or other complications.

It’s important for patients and family members to understand the potential risks. Dr. Carlo assures this information is presented in a way that does not put extra strain on the family—it’s all about education.

“We really want families to enter transplantation being fully informed of the risks that come along with this treatment strategy. It’s a really involved process that requires a thorough evaluation of the patient and the family. We get to know them; they get to know us. And they get to really learn all about transplantation and what it entails, because it is a life changing therapy.”

Heart Transplant Innovations

The transplant team at Children’s is currently studying different immune system therapies done at the time of transplantation to try to better understand patient outcomes in the first year after transplant. Additional research takes a look back at transplant outcomes to learn who is benefitting the most from various immunosuppressive strategies after transplantation.

Children’s is also participating in a multicenter trial involving a group of approximately 10 institutions. The trial is studying muscle injections of stem cells into the right ventricle. The goal is that the stem cells will stimulate the right ventricle to become stronger, or to remain stronger, for a longer period of time in patients who suffer from hypoplastic left heart syndrome (HLHS).

“Hypoplastic left heart syndrome patients make up an important number of our transplant candidates, and we would love to have a way to reduce the number of those patients coming to us throughout their life. If we could help keep the function of their right ventricle better for a longer period of time, those patients will have a better quality of life and duration of life,” notes Dr. Carlo.

To learn more about the stem cell study, individuals can email hlhs@mayo.edu. And, to learn more about the transplant program at Children’s, visit http://www.childrensal.org/heart.

“We have a fantastic team. We average about nine to ten transplants per year. We would love for children to be healthy and not need any transplants. But, we are there for them and their families, and I think we provide a really tremendous service,” shares Dr. Carlo. “We also have events throughout the year where we support organ donation and try to get the word out about the importance of increasing the organ pool, so that our patients have a better chance at getting the therapy they need.”

To listen to an interview on this topic with Dr. Wally Carlo, Associate Professor at the University of Alabama at Birmingham and Medical Director of the Pediatric Advanced Heart Failure and Transplant Program at Children’s of Alabama, follow this link: https://radiomd.com/childrensalabama/item/41779

Children's, Health and Safety

Pharmacist Shares Her Tips for Giving Oral Medication to Children

Giving a child prescribed or over the counter oral medications can be a stressful experience for both the child and the parent or caregiver. Emily Kirby, a pharmacist from Children’s of Alabama, shares her tried and true tips for improving this necessary, but sometimes challenging, task.

  • Use the “chocolate syrup sandwich” method. Coat the tongue with chocolate syrup (or peanut butter), then give the medication, then give chocolate syrup (or peanut butter) again.
  • Have the child suck on ice or a popsicle prior to giving the medication.
  • Allow the child to drink the medication through a straw, or aim an oral syringe toward the cheek, away from the tongue to avoid taste buds.
  • Confirm with your pharmacist or physician that the tablet is safe to crush. If it is safe, crush the tablet and mix medication with applesauce, pudding or other room temperature soft food. Only mix with one to two bites of food (not an entire serving) to make sure that all the medication is taken.
  • Request a flavoring for the medication. Many pharmacies can add flavoring agents to liquid medications to improve palatability.
  • Liquid medications should only be measured with a syringe, dosing cup or medication spoon. Spoons used for eating and serving food are not accurate for measuring medication doses.

It’s important to take all doses of your child’s medication(s), so keep these tips in mind for your child’s next dose.

If your child accidentally takes more than the prescribed amount of oral medication, call the Alabama Poison Information Center for assistance at 1-800-222-1222. The poison specialist can determine if further treatment is needed.

Children's, Health and Safety

Kids and Hot Cars: Preventing Heatstroke Deaths

Heatstroke is the leading cause of non-crash vehicle related death in the United States. Since 1998, when data first began to be tracked, at least 849 children have died of heatstroke in cars —all preventable.

Marie Crew, director of Safe Kids Alabama at Children’s of Alabama, has tips for parents and caregivers to help prevent any additional tragic deaths related to heatstroke and cars.

Key Facts:

  • The average annual death toll had been 37, but in 2018 and 2019 the death tolls were the highest, 53 and 52 respectively.
  • It doesn’t need be an extreme heat day for heatstroke to happen. The inside of a car can heat up to 109 degrees in just 20 minutes on an 80 degree day.
  • A child’s body temperature increases three to five times faster than that of an adult.
  • When a child’s core body temperature hits 107 degrees, his internal organs begin to shut down.
  • More than half — 54 percent — of child heatstroke deaths occur because a caregiver has forgotten the child in the car.

Help protect kids from heatstroke by remembering to ACT:

  • AVOID heatstroke.
    • CREATE reminders.
    • TAKE action. Call 911, if you see a child in a vehicle alone.

During COVID-19, be especially careful to avoid stress-related tragedies. We know these are challenging times. That’s why it’s more important than ever to remember the proven solutions that prevent injuries and save lives.

“Leave something in the backseat you need at your destination so you’ll remember to check that backseat before you leave your vehicle. It could be your cell phone, wallet, purse or briefcase,” Crew said. 

Never leave your child alone in a car, not even during a quick trip to the store. While leaving your child in the car alone might seem like a good idea during these challenging times, it is not worth the risk. Cars can heat up to dangerous levels in just a short amount of time, even on mild, sunny days – and cracking a window doesn’t help. It’s easy to get distracted or delayed in the store, one of the scenarios that has led to too many unintentional tragedies. This is a time to consider all your options and to find other ways to get your shopping done. Many stores are delivering or offering curbside pickup, neighbors are helping each other by combining trips and leaving the kids home with a sitter may be the best choice.

Keep car doors and trunks locked and keep key fobs out of reach. With many families home and dealing with a new environment and responsibilities, supervision can be more difficult. Kids as young as 1 or 2 years old are known to climb into unlocked cars and trunks to play, but they can’t always get out. Locking your car doors and reminding your neighbors (even those without kids) to do the same provides an important level of protection. It is one less thing to worry about. If, for some reason, you cannot find a child you thought was just outside playing, check cars, trunks and pools first.

Children's, Health and Safety

Children’s of Alabama Burn Center: Fireworks Displays Can Be Dangerous When Not Left to Professionals

Fireworks are synonymous with the 4th of July holiday. With some communities across the country canceling their professional displays this year because of social distancing concerns, there could be an increase in the personal use of fireworks, along with a potential for increased injuries.

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.

Each year, more than 300 children are admitted to the Burn Center at Children’s of Alabama, 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. On an outpatient basis, the Burn Clinic treats more than 900 patients every year. For more information, visit www.childrensal.org/BurnCenter.

Children's, Nutrition

Eating Healthy During a Pandemic

By: Rainie Robinson, pediatric nutritionist MyPlateInfographic

Having the entire family home all day during the COVID-19 pandemic can present many challenges. One of those challenges is maintaining a healthy diet. Eating fruits and vegetables is crucial to ensure our bodies are getting needed vitamins, minerals and fiber.

In some cases, fresh fruits and vegetables may be a little more difficult to find in stores. When they are available, remember to use those items first before they spoil. You can also freeze most fresh fruits and vegetables in an airtight container for approximately three months. In addition to fresh produce, frozen and canned vegetables can also provide the nutrition that we need.

If fresh produce is not available, frozen is a great option because items are frozen at peak freshness. When buying frozen produce, be sure to check the ingredients list below the nutrition facts label. Choose items that only list the fruit or vegetable to avoid added sugars and salt.

Canned items like meat or vegetables can also be good options. Just remember to look for no added salt or reduced sodium versions. Draining and rinsing canned food items can remove up to 40%  of sodium. When choosing canned meat, try to use fresher varieties like chicken or tuna and avoid potted meat types like Vienna sausages as they are higher in preservatives.

Additionally, try to avoid junk foods like chips and snack cakes. These items can be appealing because of their long shelf life but are devoid of nutrition and have large amounts of salt, sugar and preservatives that can make you feel sluggish.

In the end, remember that there are no good or bad foods. Sometimes creating a balanced meal means relying on what your family has available. Give yourself grace during trying times and know that you are doing what you can to feed your family well!

Children's, Health and Safety

Maintaining Your Child’s Heath During Social Distancing

youngblood_gigiMaintaining your child’s regular medical care is still important while sheltering in place. Dr. Gigi Youngblood of Pediatrics East offers tips for parents and caregivers.

Well Child Check Ups

“If your child is due for immunizations, and everyone in your home is well, plan to keep your well check up unless otherwise instructed by your pediatrician. Most offices have changed the flow of the office to minimize risk of exposure to you and your child,” Youngblood said.

Only one caregiver (no other family members, including siblings) should bring your child in to see the pediatrician. The nurses and doctors will be wearing masks, and possibly goggles and gowns, as we come to see you. The youngest patients, particularly those in need of immunizations and well visits, will typically be scheduled during the morning hours and will be seen in rooms that have been designated for well visits only.

But, when in doubt, contact your pediatrician to discuss details specific for your situation. “While there are risks of leaving home for a check up, there are also significant risks if large numbers of children get behind on vaccinations,” Youngblood said.

Chronic Health Conditions 

 If your child is not due for immunizations but has chronic health conditions such as asthma, allergies, ADHD or eczema, a telehealth visit may be a good option. “A telehealth visit might be a great way to check in and ensure your child is getting good symptom control and optimal management,” Youngblood said.

Insurance coverage for telehealth visits varies, although many insurance providers are currently covering telehealth visits at little or no cost to the patient, Youngblood said.

What if my child is sick?

 Telehealth is also an excellent way to touch base with your doctor if your child is sick. Your doctor will decide if a telehealth visit is appropriate for your child in any particular situation, but this is a great way for your doctor to assess the situation and determine the next best step.

What about an injury?

If the injury is something you would typically have seen your pediatrician for, Youngblood said, call as soon as possible to see if this is something that could be safely assessed at the office.  Some minor injuries might be safely assessed via telehealth or a video conference with your doctor.

COVID-19 Resources

For more information about your child’s health and resources related to COVID-19, please visit www.childrensal.org/coronavirus.

Children's, Health and Safety, News

Preventing Injury

SD-InjuryPrevention-1Although cases of children and infants sick with COVID-19 are not showing up in the numbers seen in adults, they are affected in other ways. Amid quarantines and school closings, some parents are forced to watch their children and work from home while others deal with the frustration of providing for their families without a steady income. This leaves children in a vulnerable position and at increased risk of injury – the No. 1 killer and cause of hospitalization among youth.

Doctors working with the Injury Free Coalition for Kids of Birmingham are on the frontlines treating injuries resulting from ATV accidents to dog bites. Children’s of Alabama Emergency Department Medical Director and University of Alabama at Birmingham (UAB) Professor Kathy Monroe, M.D., and Children’s Pediatric Emergency Medicine Physician and UAB Professor Michele Nichols, M.D., are doing all they can to raise awareness and address a likely increase in childhood injuries amid the COVID-19 pandemic. Injury prevention professionals emphasize the safety and well-being of children so that they remain injury-free.

“We must remain mindful and vigilant,” said Barbara Barlow, M.D., founder and executive director of the Injury Free Coalition for Kids. “Our sites across the country are working to find ways to help families address motor vehicle safety, home safety and the need for safe play spaces during the virus outbreak.”

“The Centers for Disease Control and Prevention (CDC) is encouraging families to help children to stay active and play outdoors, go on bike rides, and walks, but obviously while practicing social distancing,” said Injury Free Board President Lois Lee, M.D. “The CDC also says it’s important to take regular indoor activity breaks to stretch and dance as well as keep children socially connected by helping them reach out to friends and family via phone, video chats, and writing letters or cards when it is not possible to visit due to stay at home orders.”

For more information about how to keep kids safe and engaged, visit childrensal.org/coronavirus and click on the “COVID-19 KidsHealth and Resources” tab.

In addition to keeping children injury-free, the CDC offers the following tips to help families stay healthy and virus-free:

• Cleaning hands often using soap and water or alcohol-based hand sanitizer
• Avoid people who are sick (coughing and sneezing)
• Clean and disinfect high-touch surfaces daily in household common areas (e.g. tables, hard-backed chairs, doorknobs, light switches, remotes, handles, desks, toilets, sinks)
• Launder items including washable plush toys as appropriate in accordance with the manufacturer’s instructions. If possible, launder items using the warmest appropriate water setting for the items and dry items completely. Dirty laundry from an ill person can be washed with other people’s items.

Cold-like symptoms such as fever, runny nose, cough, shortness of breath, vomiting and diarrhea have been associated with COVID-19 in children and are reasons for contacting primary care providers.

About Injury Free Coalition for Kids
The Injury Free Coalition for Kids is among the country’s most effective injury prevention programs. It is a national program developed with funding from the Robert Wood Johnson Foundation comprised of hospital-based, community-oriented programs whose efforts are anchored in research, education and advocacy. Currently, the Coalition includes more than 30 sites located in just as many cities, each housed in the trauma center of their participating institution. It is run under the guidance of a board comprised of Coalition members and approved by the organization, operated by a set of bylaws established by the governing board.

Children's, Health and Safety

Parenting During a Pandemic

“During a pandemic, risk factors for child abuse and neglect like parental stress due to finances and instability increase,” said Deb Schneider, director of Children’s Hospital Intervention and Prevention Services (CHIPS) Center at Children’s of Alabama. Now that schools and childcare centers are closed due to the COVID-19 pandemic, it’s important to make plans to keep kids busy at home. Advance planning and working together can help reduce stress in the household.

Parenting During a Pandemic

  • Establish a routine to help children cope with anxiety
  • Limit children’s access to news and social media related to the pandemic.
  • Never discipline a child when you are angry.
  • If you, the parent/caregiver, are experiencing stress and anxiety, take a break. Call a friend or family member.
  • Family activities like walking, playing card games and working puzzles help ease stress.
  • Give children access to art supplies and music as alternatives to screen time

Being away from friends, extended family and social activities can be hard on teens and kids. To help them stay connected,  set up FaceTime or Skype playdates or visits.

Recognizing and Reporting Abuse

While kids are currently out of school due to the COVID-19 pandemic,  experts at Children’s of Alabama want to remind you of the importance of recognizing and reporting abuse of any kind.

“By learning common types of abuse and what you can do, you can make a huge difference in a child’s life,” Schneider said. “The earlier abused children get help, the greater chance they have to heal from their abuse and not perpetuate the cycle.”

The four types of child abuse are:
• Physical Abuse
• Sexual Abuse
• Emotional Abuse
• Neglect

The signs of child abuse vary depending on the type of abuse, but there are some common indicators.

Warning signs of emotional abuse in children:
• Excessively withdrawn, fearful or anxious about doing something wrong
•  Extremes in behavior (extremely compliant or extremely demanding; extremely passive or extremely aggressive)
• Doesn’t seem to be attached to the parent or caregiver
• Acts either inappropriately adult (taking care of other children) or inappropriately infantile (rocking, thumb sucking, tantrums)

Warning signs of physical abuse in children:
• Frequent injuries or unexplained bruises, welts or cuts
• Is always watchful and “on alert,” as if waiting for something bad to happen
• Injuries appear to have a pattern such as marks from a hand or belt
• Shies away from touch, flinches at sudden movements or seems afraid to go home
• Wears inappropriate clothing to cover up injuries,i.e.  long-sleeved shirts on hot days

Warning signs of neglect in children:
• Clothes are ill-fitting, filthy or inappropriate for the weather
• Hygiene is consistently bad (unbathed, matted and unwashed hair, noticeable body odor)
• Untreated illnesses and physical injuries
• Is frequently unsupervised or left alone or allowed to play in unsafe situations and environments
• Is frequently late or missing from school

Warning signs of sexual abuse in children:
• Trouble walking or sitting
• Displays knowledge or interest in sexual acts inappropriate to his or her age, or even seductive behavior
• Makes strong efforts to avoid a specific person without an obvious reason
• Doesn’t want to change clothes in front of others or participate in physical activities

Supervision is important. Know where your children are. Make sure children know sexual abuse is never their fault and that they won’t be in any trouble if they tell.

Help for Alabama’s abused children is available at the CHIPS Center. The CHIPS Center provides forensic medical evaluations, psychosocial assessments, play therapy, counseling for non-offending caregivers and other support services. All counseling and preventive services are free. If you suspect a child has been or is being abused,   please contact your county Department of Human Resources or  call the CHIPS Center at Children’s by dialing 205-638-2751. For more information,  visit childrensal.org/CHIPS.

Children's, Health and Safety

HAND SANITIZER: KEEPING LITTLE HANDS CLEAN AND SAFE

Hand Sanitizer

Door knobs. Stair rails. Elevator buttons. Just the thought of touching any of those during cold and flu season and now coronavirus may send you running for the nearest bottle of hand sanitizer. Hand sanitizer is a convenient way to keep your hands clean and germ-free, but parents should be aware of the potential harm it can cause.

“There are times when you don’t have access to good old-fashioned soap and water to wash your hands,” said Ann Slattery, director of the Alabama Poison Information Center at Children’s of Alabama. “Using hand sanitizer is an easy way to stay healthy when you’re on the go, but it’s not without its own inherent danger because it contains alcohol.”

In order to be most effective against germs and viruses a hand sanitizer must contain  60 to 95 percent alcohol, and many formulas contain a stronger alcohol concentration than most hard liquors. Just 1 ounce of hand sanitizer – most are greater than 60 percent – has the same alcohol content as a 12 ounce can of beer. Therefore, accidental ingestion or intentional misuse of hand sanitizer is cause for concern.

“From a young child’s perspective, hand sanitizer may smell good, and it’s usually in brightly colored, glittery bottles,” Slattery said. “With older children, there are reports of them daring others to drink it.”

“The number of reported cases of hand sanitizer exposure in Alabama has grown since 2011. That year, there were 159 exposure calls to the Alabama Poison Information Center involving hand sanitizer. In 2019 the APIC documented almost 300 hand sanitizer poison exposures in Alabama,” Slattery said. Nationally, there were nearly 20,000 reported hand sanitizer exposure cases in 2018.

To prevent potentially harmful exposure to hand sanitizer:

  • Keep hand sanitizer well out of reach of children at all times.
  • Children should use hand sanitizer only with adult supervision.
  • Apply a dime-sized amount of sanitizer to dry hands and rub together until completely dry.

If you suspect your child may have ingested any amount of hand sanitizer, Slattery encourages parents to call Alabama Poison Information Center at 1-800-222-1222 immediately. The signs won’t always be as obvious as an empty bottle lying around. “When in doubt, check it out,” she said.

Some potential symptoms of harmful exposure to hand sanitizer include:

  • Drowsiness
  • Stumbling
  • Falling

Some delayed symptoms could include a drop in blood sugar and a drop in body temperature.

The Alabama Poison Information Center’s hotline is available 24 hours a day, 7 days a week always free and confidentially. Established in 1958, The Alabama Poison Information Center at Children’s of Alabama receives more than 50,000 poison calls annually, plus makes more than 60,000 follow-up calls. For more information, visit https://www.childrensal.org/apic

Children's, News

Perspectives of COVID-19 from a Pediatric Psychologist

By Dan Marullo, Ph.D.

With COVID-19 being declared a pandemic, we are now tasked to change our personal and collective behavior. It is understandable that many will experience fear, anxiety and anger in the coming days and weeks. This is normal and certainly a typical reaction to a crisis. However, whether we respond with grace or with terror is in our individual and collective control.

It is normal to be afraid. It is OK to acknowledge that fear and to take steps to cope with anxiety. Please consider the following:

  1. Fear of the unknown is normal. We are each subject to feeling a host of emotions such as anxiety, worry, irritability and sadness. We can also experience poor sleep or appetite, trouble with concentration, a tendency to withdraw from other people and perhaps even feeling hopeless. These can be normal reactions to the situation and it helps to recognize this in ourselves and in others. For example, recognizing that your spouse or child is uncharacteristically moody or snappish may mean that they are feeling overwhelmed and need support. Certainly, anyone feeling suicidal may need immediate attention.
  • Seek reliable information. There is much that we still do not know about COVID-19 and that alone increases fear and anxiety. Gaining reliable information is key to addressing this uncertainty. Reputable websites for updates and information include the Centers for Disease Control and Prevention, the National Institutes of Health and the World Health Organization. Websites for good psychological information related to COVID-19 include the American Psychological Association and the American Psychiatric Association.
  • Practice self-care. Because we are all susceptible to emotional distress, it becomes more important to take care of ourselves physically and emotionally. This may be complicated by social distancing given that social activities are commonly used by people to cope. We may not be able to attend religious services, go to work or school, the gym, shopping and so on. However, we can adapt and remain connected. Many churches are hosting online services, you can exercise at home using YouTube classes, and so on. A few things to keep in mind:
    • Maintain a typical routine as much as possible. Try having your kids do schoolwork at home at the times they would at school. Do the same if you are working from home.
    • Take a media/social media break. Depending on what you read or watch, COVID-19 is either the world’s biggest hoax or the end of the world. Neither is true. Seek accurate information and take a break from all the chatter.
    • Social distance does not mean social isolation. We may not be able to go out, have play dates or travel, but we can maintain contact with family and friends via Facetime and other platforms. This is especially critical for our most vulnerable family and friends, those that must be on isolation because of health concerns such as the elderly and those with underlying medical conditions.
    • Consider volunteering in some way. The simple act of giving has been shown to reduce distress in the giver. It is gratifying to see people organizing food drives and other activities to support their communities.
    • Find ways to maintain your spirits. A good sense of humor goes a long way. Our Italian brothers and sisters are singing from their balconies in defiance of their isolation. People are amazing. Find your path.
  • Be a role model. Our children are watching how we react to this crisis. What do you want them to see? Children and teens rely on the adults in their lives to model and teach behavior. A child’s coping often relies on how adults cope. Now is the time to teach resilience, compassion, self-sacrifice and healthy coping. These are lessons children will remember for the rest of their lives. We adults should manage our emotions and fears, and be the leaders our children need us to be.
  • Support our children. Our children are responding to this crisis as well and need support during this time. How children cope and what they need varies by their age and level of development. For example, small children respond to the distress around them and need comforting and security. School aged children, tweens and teens need information that is tailored to their age (Younger children need the basic facts, older kids can deal with more detail and abstraction). Recognize that a change in behavior may be a sign of distress and an opportunity to engage and support. Please consider:
    • Maintaining a typical routine as much as possible. This includes schoolwork, bedtimes and mealtimes.
    • Giving age-appropriate information and answering questions honestly.
    • Monitoring use of TV and other media, particularly if your child is constantly looking at COVID-19-related content (Remember, bad information is scary).
    • Providing opportunities for kids to give and contribute. Help them organize a food drive or a video chat with nursing home patients. This promotes a sense of engagement and teaches resilience.
    • Managing your own emotions. Remember, our kids are watching. What do you want them to learn?
  • Acknowledge and recognize grief. Many of us are experiencing loss and uncertainty and it is OK to acknowledge that fact. As this process unfolds, we may lose people we love, jobs that we depend on, perhaps even that sense of safety that we once enjoyed. Coming to terms with loss is necessary and healthy. Now is the time for each of us to reach out as individuals and as a community to support one another, in small ways and in large.
  • Look for the lesson. I, like many of you, have experienced tragedy in my life. From that experience I have learned valuable lessons. I have learned much about myself and what I value and treasure. I do not know what lessons each of us may learn from this pandemic, but I do know there is something of value to learn if we leave ourselves open.

As I conclude this message, I feel a tremendous sense of community and hope. In some perverse way, this event has given all of us a “time out.” Perhaps this is our time to reflect, reconnect with others and remember what is truly of value in this life. I wish you all well.

Dan Marullo, Ph.D., is a pediatric psychologist and neuropsychologist at Children’s of Alabama and the University of Alabama at Birmingham.