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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!

Children's, Development, Health and Safety

Communication Begins at Birth 1 – 3 Months

May is Better Speech and Hearing Month.

Once a child is born, he or she starts gaining crucial skills for proper development. The basic building blocks for typical and healthy child development includes the development of speech and hearing communication. It is important for parents to be aware of developmental milestones because communication begins at birth.

Through a four-part series of blog posts, we will be highlighting important communication milestones for babies between the ages of one to 24 months. This series will help parents know what to expect as their baby develops. 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.

One to three months is an exciting time for parents because babies make a lot of progress in communicating. Your baby’s personality will start to show through as you have two-way “conversations,” exchanging smiles and oohs and aahs.

Listed below are some typical milestones, enhancement activities and red flags for your baby’s hearing and speech development at this age.

Typical Development:

  • Pays attention to faces and surroundings
  • Smiles at the sound of a parent or caregiver’s voice
  • Calms to caregiver’s voice
  • Smiles with social contact
  • Coos and makes sounds when talked to
  • Imitates some sounds and facial expressions

Activities

  • Smile at baby
  • Talk, babble, coo to baby
  • Sing to baby

Red Flags:

  • Does not respond to a sound
  • Does not look at face

Babies main form of communication at this age is crying. They may cry to let their parents know that they need something, or because they are overwhelmed by all of the sights and sounds of the world. Sometimes they cry for no clear reason, so as long as your baby is not sick or hurt, try not to be upset if your baby is crying and you can’t console him or her right away.

For more, visit the Children’s of Alabama Hearing and Speech Center website: https://www.childrensal.org/hearing-and-speech 

Health and Safety

Bicycle Safety

Biking is a beneficial summer activity for children because it provides an opportunity to exercise, get outside, play and interact with other children. However, parents should consider these tips as their child engages in bike riding this summer. Children should be efficient in their bike-riding skills and proficient in the rules of the road before embarking on their own biking adventures. Parents should ride alongside their child until they are confident that they can ride on their own.

When riding a bike, always remember to do the following:

  • Wear a securely-fitted helmet and fasten the chin strap
  • Follow traffic signs and signals
  • Ride in the same direction as traffic
  • Stay in the bike lane whenever possible
  • Look left, right and left again before entering street or crossing intersection
  • Use the sidewalk appropriately and be alert of other pedestrians
  • Never use electronics while riding
  • Use hand signals when changing directions
  • Make sure you ride in a straight line and do not swerve around cars – be predictable as you ride
  • Use lights on your bike and wear bright-colored clothing

Director Think First Alabama, Julie Farmer, said, “Parents should model good behavior and always wear a helmet when riding a bike.” Parents should teach their child how to ride a bike in a safe area, such as an unused parking lot or empty athletic track. Children need to be taught the rules of the road and safety hand signals. A good resource to teach hand signals  is provided by the National Highway Traffic Safety Administration at  www.nhtsa.gov/sites/nhtsa.gov/files/8009-handsignals.pdf

According to the Consumer Product Safety Commission (CPSC), “A majority of the 80,000 cycling-related head injuries treated in emergency rooms each year are brain injuries.”

According to Safe Kids, “Properly-fitted helmets can reduce the risk of head injuries by at least 45% – yet less than half of children 14 and under usually wear a bike helmet.” The Alabama law for bike helmets states that children under the age of 16 must wear a helmet when riding a bicycle. In cases of violation, the child’s parent or guardian may receive up to a $50 citation.

Parents should always make sure their child has the right size helmet. Your child’s helmet should align with the U.S. Consumer Product Safety Commission’s standards and have a certification stamp on the side – either Ansi or Snell. The fit and certification of a helmet is more important than the cost of the helmet itself. In addition, parents should make sure their child knows how to correctly put on the helmet to ensure their head is protected.

“A helmet should sit on top of the head in a level position, and should not rock forward, backward or side to side. The helmet straps must always be buckled, but not too tightly,” said Farmer.

In addition to helmet fit, proper bike fit is extremely important to ensure a safe ride. If possible, parents should bring their child along with them to the store when shopping for a bike. Be sure your child’s feet can touch the ground when they sit on the bike.

Before your child leaves on a bike ride, make sure:

  • The reflectors are stable
  • Brakes work efficiently
  • Gears shift easily
  • Tires are properly secured and inflated
  • Helmet is secured
  • Your child is not wearing long, loose clothing, flip-flops or sandals

Children should be at least 10 years old before riding a bike without a parent present. There are many factors that contribute to the decision, such as traffic, sidewalks available or where someone lives, but 10 years old is a good choice. At this age, children have the cognitive ability to determine how close the sound or sight of cars are in relation to their current location. To learn more about this or other safety topics, visit our website at childrensal.org.

Children's, Health and Safety

CHILDREN’S OF ALABAMA DOCTORS INVESTIGATING CASES OF HEPATITIS

Hepatologists and infectious disease doctors at Children’s of Alabama and the University of Alabama at Birmingham are investigating several cases of hepatitis found in the state since last fall, and they want to make the public aware of how to stay safe.

The Centers For Disease Control and Prevention (CDC) released the latest data on these cases Friday.

Children’s of Alabama doctors treated nine patients – all children under 10 years old – for hepatitis between October 2021 and February 2022. They say all nine cases were caused by adenovirus – a common virus that often leads to vomiting and diarrhea. Two of the patients needed liver transplants.

Doctors say what’s unique about this situation is that adenovirus typically does not lead to hepatitis in healthy patients. When it does lead to hepatitis, it’s usually in patients who are immunocompromised. When doctors at Children’s and UAB discovered the initial cases in the fall, they alerted the Alabama Department of Public Health (ADPH) and the CDC.

Doctors say the cases initially presented as vomiting and diarrhea. Within a few days, the patients showed signs of jaundice and yellowing of the eyes, which are indications of possible liver failure.

To protect yourself from adenovirus, doctors offer the following recommendations:

  • Washing hands with soap and water for at least 20 seconds or use alcohol based hand sanitizer
  • Avoid touching eyes, nose or mouth with unclean hands
  • Use disinfectants to wipe down surfaces
  • Avoid close contact with infected individuals
Children's, Health and Safety

What is Hemophilia?

Hemophilia is an inherited bleeding disorder where the blood fails to clot. Hemophilia is a lifelong bleeding disorder that currently does not have a cure.

  • There are low levels of clotting proteins in the blood.
  • It is seen mostly in boys (rarely in girls).
  • Very few people have it.
  • There are about 400 babies with hemophilia born in the U.S. each year.
  • About one in every 20,000 men in the U.S. have hemophilia.
  • About 80% of those with hemophilia have hemophilia A (factor 8 deficiency) and 20% have hemophilia B (factor 9 deficiency).
  • Hemophilia occurs in all races and social groups.
  • Women may carry the gene that is passed on to her children.
  • People with hemophilia are born with the disorder.

How can medications help?

  • They can help prevent or stop bleeding.
  • By using medicine and visiting a hematologist regularly, a person with hemophilia can expect to live a long and healthy life.

What happens when someone with hemophilia has an injury?

  • The injured blood vessel gets smaller (vasoconstricts) to let less blood through.
  • Platelets rush to the site and stick together to form a platelet plug.
  • Clotting factor proteins in the blood work together to make threads of fibrin (a protein produced by the body). The fibrin weaves itself into a clot over the platelet plug. This makes a strong seal.

How are injuries different when someone has hemophilia?

  • People with hemophilia can’t make a fibrin clot.
  • A person with hemophilia has problems when a fibrin clot is needed to stop the bleeding. People with hemophilia don’t have enough of certain clotting factors.
  • The fibrin clot is not made or is so thin that the bleeding continues.
  • Someone with hemophilia does not bleed faster than someone without hemophilia. However, the person with hemophilia will bleed longer.

Why is this a problem?

  • Bleeding inside the body is more of a problem for people with hemophilia than bleeding on the outside from a cut or scrape.
  • Inside the body, the blood can go into spaces in joints, muscles, and organs.
  • Over time, this can cause great damage, especially if the bleeding is not treated or happens often.

For educational purposes only. For specific medical advice, diagnosis and treatment, consult your doctor.

For more information, visit Hemophilia and Bleeding Disorders Birmingham, Alabama (AL) – Children’s of Alabama (childrensal.org).

Children's, Health and Safety

Spotting Signs of Teen Dating Violence

One in 10 teenagers will experience some sort of abuse by a dating partner, according to the Children’s Safety Network. Negative short-term or long-term health issues can result from abusive relationships. Parents should be cognizant of warning signs in their teenagers’ relationships.

Dating violence manifests in many different forms, including emotional, physical and sexual abuse. Emotional abuse can be hard to recognize because it typically progresses gradually throughout the relationship. Emotional abuse can include intimidation, manipulation, intense jealousy, threats, controlling behavior, verbal assault and gaslighting. Physical abuse is any means of physical harm, including hitting, kicking or punching. Sexual abuse involves forcing a partner to engage in any type of sexual experience without consent.

“If the perpetrator is more interested in controlling you, then that is a big red flag,” said Debra Schneider, director of the Children’s Hospital Intervention and Prevention Services (CHIPS Center) at Children’s of Alabama.

Teens in an abusive relationship have an increased risk of depression, anxiety, post-traumatic stress disorder, substance abuse, antisocial behaviors, eating disorders, negative body image, sexually transmitted diseases, trust issues, emotional triggers, lying, stealing, cheating and lack of discernment when picking appropriate partners in adulthood.

“Open dialogue about physical and emotional boundaries in relationships should begin when children are young,” Schneider said. “Boundaries and respect are vital to pave the way toward healthy relationships in their teenage years. If parents are modeling a healthy relationship, that’s going to be what teens are used to and what they expect in their own relationships.”

Parents should be mindful of:
• Secrecy or withdrawal from friends and family
• Onset of anxiety and/or depression
• Physical findings (bruises, cuts, headaches, back pain)
• Only spending time with partner
• Feeling excessive guilt or shame
• Avoidance of school or social events with excuses that don’t seem to make any sense

If you observe any warning signs of an unhealthy or abusive relationship in your teen, talk to them about it. It is important to start a conversation with your teen and listen to them. Try to understand and validate their feelings in this situation. Your show of support will increase their trust and your teen will be more comfortable sharing information with you. This open conversation will be crucial in educating your teen about what should be expected in a healthy and safe relationship. A teen who is being abused needs someone to hear and believe them and be reminded that abuse is never deserved.

The CHIPS Center has abuse prevention resources available. For more information, call 205-638-2751 or visit childrensal.org/CHIPS.

Other resources for you or your teen:

• National Dating Abuse Helpline – 1-866-331-9474 or loveisrespect.org to receive immediate, confidential assistance
• Birmingham Crisis Center – 205-323-7777
• Birmingham Rape Response – 205-323-7273
• RAINN (Rape Abuse and Incest National Network) – 1-800-656-4673
• If your teen is in immediate danger, call 911.

Children's, Health and Safety, News

April is Child Abuse Prevention Month

More than 11,600 children in Alabama were victims of abuse in 2020, according to the National Child Abuse and Neglect Data System. However, the actual number may be higher because many instances of abuse go unreported. The support systems on which many families rely, such as extended family, childcare, schools, religious groups and other community organizations, were limited because of the COVID-19 pandemic.

As families continue to face health and economic strains connected to the pandemic, stressed guardians may be more likely to respond to their child’s behavior in an aggressive way. “Increased stress levels among parents is often a major predictor of physical abuse and neglect of children,” said Debra Schneider, director of the Children’s Hospital Intervention and Prevention Services (CHIPS) Center at Children’s of Alabama.

April is Child Abuse Prevention Month, but CHIPS staff works year-round to facilitate healing from physical, mental and emotional abuse and to provide prevention education.

Parents and caregivers should look for signs of abusive situations. The child who has endured abuse the longest typically has the longest healing process. The quicker an abusive situation is reported, the faster a child can be provided with medical care, therapy and counseling to heal. “Abuse is not the child’s whole story,” Schneider said. “There is hope when intervention occurs.”

Children who are being abused might:

• Have new onset fears
• Have a vocabulary too advanced regarding sexual activity
• Be withdrawn from friends and family
• Have nightmares
• Experience a drop in their grades
• Change in appearance (wearing clothes that don’t align with the weather)
• Not want to go home
• Start using drugs
• Bully others
• Be sad or depressed
• Have stories to explain injuries that don’t make sense or keep changing
• Not want to be with the abuser
• Act out at school

There are also signs to watch out for in abusers themselves. They usually walk the victim through a grooming process. Schneider said it is important to remember that the child is usually not abused 24/7. The relationship often consists of a more positive bond. The abuser knows what the child likes, is curious about and afraid of, and they use it to their advantage. Some sort of ‘relationship’ is formed, and a trust is established between them. That way, when harm enters the picture, the child is less likely to question their character and actions. Other signs include spending more time with the child than is appropriate, giving extraordinary gifts to the child more than what’s normal, using excuses to be alone with the child and implementing gaslighting techniques.

Most children think abuse comes from a stranger, but abusers are usually someone a child knows. Schneider suggests teaching about “stranger danger;” however, build off that concept to make them aware that abusers can be someone they know. Schneider states most children are taught about stranger danger, but children need to be taught that most sexual abuse happens with someone a child knows.

Children in an abusive situation need a trusted adult to confide in – parents, grandparents, a teacher, friend’s parent/caregiver or guidance counselor. School prevention education programs encourage a child to tell three adults: two inside and one outside their family. That trusted adult can clearly communicate to the child, “I am here for you if anything is going on. I am not here to judge.”

Adults who suspect abuse should approach the child gently. If the adult asks too many questions, the child may feel in trouble. Adults should never make promises to not tell anyone, since that is a key action to be taken when stopping abusive situations. Remind the child that abuse is NEVER their fault.

Since conversations about abuse can be very difficult to bring up, Schneider suggests bringing up an incident from the news as a segue into a conversation about the abusive situation. In addition, having these conversations in the car creates a more relaxed, noninvasive environment.

If you suspect an abusive situation, report it immediately. Anyone can provide a report of suspected abuse to report to the local department of human resources or a child protective services agency. All it takes is a suspicion of abuse; the caller doesn’t have to have specific evidence. You can also contact the Childhelp National Child Abuse Hotline at 1-800-4-A-CHILD (1-800-422-4453). You don’t have to give your name. If the child is in immediate danger, call 911.

CHIPS staff is a team of specially trained counselors, doctors, social workers and pediatric sexual assault nurse examiners (PSANE). The staff works with law enforcement, the Department of Human Resources and child advocacy center representatives to provide the best possible care for children and families affected by child maltreatment. Services provided include forensic medical evaluations, social work assessments, play therapy, counseling, care coordination, prevention education, court support, expert court testimony and specialized support for victims of human trafficking. For more information, call 205-638-2751 or visit childrensal.org/CHIPS.

Nutrition

Tips for Picky Eaters

By: Rainie Robinson, MS, RD, LD, CDE

Looking for a simple way to make sure your child’s plate is balanced? Try filling half of their plate with non-starchy vegetables like cucumbers, broccoli and green beans. Use your child’s fist to help measure a starch like mashed potatoes or pasta. Their fist is also a good measure for protein portion size. Protein can be a tricky addition, especially for younger kids who tend to be a little pickier. Some outside of the box protein ideas are  frozen Greek yogurt, trail mix with almonds or peanuts, string cheese or cubed cheese, or even use hummus for dip. Consider plating your child’s meal on a colorful plate with dividers, or cutting vegetables into interesting shapes to make meal time more fun.

A great way to encourage children to make healthier choices is to incorporate a family dinner time. Studies have shown that kids who eat with their parents tend to make better grades, have a lower risk for becoming overweight, usually make healthier food choices, and typically engage in fewer risky behaviors as they grow older. If you’re feeling crunched for time, try starting with one family meal per week.

Children’s of Alabama has 24 registered dietitians ready to help your child thrive. March is National Nutrition Month and a great time to learn more about how dietitians can help your family. We are here to help guide your child as they continue to grow and develop. From the NICU through adulthood, each specialty service has its own dietitian that has become an expert in what your child needs. Our goal is to provide you with the nutrition education and tools you need to help your family live well.

For more information on National Nutrition Month, healthy eating tips, and resources, visit https://www.childrensal.org/clinical-nutrition.

Children's

Children’s of Alabama Celebrates The Women of the Executive Team

March is Women’s History Month. At Children’s of Alabama, 86 percent of our workforce is female. And you’ll see that reflected in hospital leadership as well.

This group of women has nearly 250 combined years of service at Children’s. Their leadership stretches from patient care, nursing and operations to customer service, finance, risk management and government relations.

Pictured here, left to right, are Heather Hargis, vice president, Operations; Lori Moler, vice president, Customer Service; Jamie Dabal, vice president, Operations; Suzanne Respess, vice president, Government Relations; Delicia Mason, vice president, Nursing Operations; Heather Baty, vice president, Ambulatory Operations; Stacy White, senior executive leader, Behavioral Health; and Sandy Thurmond, vice president, Primary Care Services. Not pictured, Vickie Atkins, vice president, Risk Management, and Dawn Walton, chief financial officer