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Children's, News

Viral Immunotherapy For Pediatric Brain Tumors Shows Promise

A modified herpes virus, alone and in combination with radiation, has been shown to be well tolerated with early signs of clinical effectiveness in pediatric patients with high-grade brain tumors, or gliomas, according to findings from researchers at the University of Alabama at Birmingham and Children’s of Alabama. The findings were presented at the virtual American Association for Cancer Research Annual Meeting 2021, held April 10-15 and published online in the New England Journal of Medicine on April 10.

Dr. Gregory Friedman
Dr. Gregory Friedman

Brain tumors are the most common solid tumor in children, and aggressive types like glioblastoma have an extremely low survival rate: as low as 10 percent five years after diagnosis. Even tumors successfully treated by surgery, radiation and/or chemotherapy have a high recurrence rate.

“This is the first study utilizing delivery of a viral immunotherapy directly into the tumor of children with brain tumors, and the results indicate the engineered herpes virus can be delivered safely into tumors located in all areas of the cerebrum in children,” said Gregory Friedman, M.D., professor in the Department of Pediatrics at UAB, research scientist at the UAB O’Neal Comprehensive Cancer Center, and director of developmental therapeutics for the Alabama Center for Childhood Cancer and Blood Disorders at UAB and Children’s of Alabama. “The key findings thus far are that the approach is safe and well tolerable, and the preliminary evidence of efficacy is promising.”

In the Phase 1 clinical trial of 12 patients between 7 and 18 years of age, the investigators employed a modified virus known as G207, derived from the herpes virus responsible for cold sores. The virus is genetically altered so that it infects only tumor cells. When injected into a malignant brain tumor via a catheter, the virus enters the tumor cells and replicates. This kills the cell and releases the virus’s progeny to hunt out other tumor cells. Additionally, the virus induces a strong immune response by the body’s immune system, which can attack the tumor. The trial tested G207 alone and then combined with a single low-dose of radiation designed to increase virus replication and spread throughout the tumor.

G207 is the product of more than 30 years of research. James Markert, M.D., MPH, chair of the UAB Department of Neurosurgery, was part of the team at Massachusetts General Hospital in the early 1990’s that first developed the concept of using oncolytic herpes viruses. He worked on the parent virus for G207 and conducted the first clinical study of G207 at UAB. Today the use of viral therapies is under investigation for nearly every type of cancer.

A second-generation virus, called M032, has been developed by Markert and collaborators Yancey Gillespie, Ph.D., professor of neurosurgery, and Richard Whitley, M.D., Distinguished Professor of pediatric infectious disease, and is in clinical trials at UAB in adults with glioblastoma. UAB investigator Renee Chambers, DVM, M.D., is using M032 in a study of brain tumors in dogs, which can develop tumors very similar to those in humans.

In the current trial, 11 of the 12 patients demonstrated a treatment response. The overall survival rate was more than double the typical survival rate for children with high-grade glioma. Some 36 percent of the patients thus far have survived longer than 18 months, surpassing the medial overall survival for newly diagnosed patients with high-grade glioma.

Friedman’s team reports that G207 alone or in combination with radiation therapy was well tolerated, with no serious adverse side effects attributed to the treatment.

“There are still more studies needed; but thus far, viral immunotherapy with several different viruses, including herpes virus, has shown promise in treating high-grade brain tumors in both adults and children,” Friedman said. “We also have an ongoing clinical trial to test the safety of G207 when delivered into the cerebellum, an area of the brain that has not been tested before in adults or children but is the most common location for pediatric tumors to arise.”

Friedman says the next steps are to determine the ideal timing to treat patients and what therapies can be used with viral immunotherapy to maximize the anti-tumor immune response. Based on the encouraging Phase 1 trial results, he and his team are working with the Pediatric Brain Tumor Consortium to develop a multi-institutional Phase 2 trial of G207 for progressive pediatric high-grade glioma, which they hope to initiate later this year.

The study was supported by the United States Food and Drug Administration Orphan Products Clinical Trials Grants Program, Cannonball Kids’ Cancer Foundation, the Rally Foundation for Childhood Cancer Research, Hyundai Hope on Wheels, St. Baldrick’s Foundation, and the Kaul Pediatric Research Institute. G207 was provided by Treovir, LLC.

Friedman is supported, in part, by contracts between UAB and Eli Lilly and Co. and Pfizer. Markert and Whitley have financial interests in Treovir, LLC, which provided G207 for the trial. 

Children's

Inclement Weather Updates

March 25, 2021 12:30 p.m.

Due to the potential for severe weather in the area, the following office locations will be closed for the remainder of the day.

  • Greenvale Pediatrics (Hoover, Alabaster, Brook Highland)
  • Vestavia Pediatrics
  • Mayfair Medical Group
  • Pediatrics West (Bessemer, McAdory)

Most locations will still have a physician on call for urgent medical needs. Please call your child’s pediatrician’s after hours number or answering service to be connected to a doctor.

If you have a medical emergency, please call 911. 

March 25, 2021 – 9:30 a.m.

We are monitoring today’s severe weather forecast. Any information about office closings will be posted here and to childrensal.org/weather throughout the day.

If you have a medical emergency, please call 911. 

Children's, Health and Safety

Poisonings: Prepare, Prevent, Protect

Your home should be a safe place for your family, but there are actually many hidden dangers. Our homes are filled with poisonous substances. Knowing the dangers and how to prevent them can keep kids safe.
Ann Slattery is the director of the Alabama Poison Information Center at Children’s of Alabama. She says parents and grandparents should do their part to “Prepare, Prevent, and Protect” kids against accidental poisoning.

PREPARE
Prepare now for the possible event of poisoning. Slattery recommends saving the toll free number for the Alabama Poison Information Center in your phone to keep it close at hand at all times. The number is 1-800-222-1222. Also, she recommends every home have a carbon monoxide detector, and that adults should prepare a list of all medications. “For adults we say have a list of your everyday medications available in case you have to call the poison center,” she said.

PREVENT
Act now to prevent the risk of poisoning. Store all cleaning products up and out of reach of children. Slattery also recommends storing prescription medicine in lock boxes. “Make sure you have child resistant closures on your medications,” she said. “Remember there is no such thing as child proof.” Slattery advises to remember this risk when visitors are in the home. You never know what guests may have in their bags, so store purses and suitcases out of reach or behind locked doors and away from children.

PROTECT
In the unfortunate event that an exposure does occur, call the Alabama Poison Information Center immediately at 1-800-222-1222. Slattery advises that if the individual is unconscious, having trouble breathing or experiencing a seizure to instead call 911 immediately.

By taking the proper precautions now, you can help keep children safe from the risk of poisoning. But if an accident does happen, be prepared to act quickly in the event of an emergency.

Children's, Development

Screen Time and Teens: The Hidden Pandemic

Screen Time and Teens

While the world has been focused on the COVID-19 pandemic, an underlying, hidden pandemic has been growing – screen time among teenagers. Some studies show that teens spend close to nine hours a day online, ranging from being on the phone, watching TV or playing video games. Approximately three-quarters of teens own a smartphone and half of them feel addicted to using their phones. Fortunately, there are proactive ways for parents to tackle this issue including establishing screen time limits for their teens.

Since many students have been doing online school, they have more time to scroll aimlessly through social media and spend hours on their phones. Some parents are working from home while others are working in the office, so their attention is not often geared toward their teens’ screen time. Free time among teenagers can often breed unhealthy habits if gone unchecked.

Neuropsychologist at Children’s of Alabama, Dr. Dan Marullo, offers insights on teens partaking in too much screen time. “Too much screen time in teens can lead to comparison to others and belief that their life is not as good as the people they follow,” Marullo said.

The false ideal of perfection on social media contributes to low self-esteem and eventually could develop into mental health disorders, including anxiety and depression, if not addressed.

Too much screen time in teens interferes with physical activity, homework, sleep, social activities with friends and time spent with family. It also can lead to attention problems, a higher incidence of depression, anxiety and exposure to unsafe content and contacts. Screen time can lead to obesity due to increased sedentary activity, mindless eating and interference with normal sleeping patterns. Lack of sleep contributes to problems with mood, attention and learning.

Some phone activities can be productive, including researching for a school project, engaging in creative outlets or interacting with friends on online platforms. However, many activities are unproductive or harmful for teens, including visiting unsafe websites, playing violent video games, watching inappropriate TV shows, sexting and engaging with strangers who pose a threat online. Cyberbullying, which is using the internet, cell phone or other technology to send texts or images intended to hurt or embarrass another person, can be an outcome of too much screen time as well.

Dr. Marullo suggests monitoring and limiting your teen’s screen time to no more than a couple hours per day outside of schoolwork. 

Parents should remember these tips when forming a healthy screen time habit for their teens:

  • Monitor social media sites, apps and browsing history.
  • Research video and computer games before letting your teen get them. Preview games with your teen to see what they are like.
  • Review or reset the phone location and privacy settings.
  • Follow or friend your teen on social media sites or get a trusted adult friend to do so.
  • Ensure your teen has a wide range of free-time activities (spending time with friends, playing sports, volunteer work, being involved in school clubs, etc.). Less free time can lead to less time spent on screens!
  • Turn off all screens during family meals and when your teen goes to bed. Keep devices with screens out of your teen’s room after bedtime.
  • Know your teen’s usernames and passwords.
  • Consider screen time a special privilege that teens need to earn, not a right to which they are entitled.
  • Stay up to date on the latest apps, social media platforms and digital slang.
  • Use screening tools for phones, TV, tablets and computers to limit access to certain content.
  • Teach your teen about internet and social media safety, ensuring they know the dangers of sharing private information online or sexting.
  • Teach positive, respectful digital behavior.
  • Keep the computer in a common area so you can monitor their online activity.
Children's

Inclement Weather Updates 3/17/2021

We are monitoring today’s severe weather forecast. Any information about office closings will be posted here and http://www.childrensal.org/weather throughout the day.

March 17, 2:30 p.m.

Due to the potential for severe weather in the area, the following office locations will be closed for the remainder of the day.

  • Pell City Pediatrics
  • Greenvale Pediatrics (Hoover, Alabaster, Brook Highland)
  • Vestavia Pediatrics
  • Over the Mountain Pediatrics

Most locations will still have a physician on call for urgent medical needs. Please call your child’s pediatrician’s after hours number or answering service to be connected to a doctor.

If you have a medical emergency, please call 911. 

March 17, 2021 – 2 p.m. 

Due to the potential for severe weather in the area, the following office locations will be closed for the remainder of the day.

  • Pediatrics West, both locations
  • Midtown Pediatrics (patient families can call the answering service at 205-930-4151 to speak to the physician on call)

Health and Safety

Protecting Your Teen from 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 potential warning signs in their teenage kids’ relationships to help prevent abuse.

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. Gaslighting is defined by the Centers for Disease Control and Prevention as “presenting false information to the victim with the intent of making them doubt their own memory and perception.” 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.

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

The victim in an abusive relationship is likely to experience adverse health issues during the relationship or develop health issues later on from the traumatic experience. If the relationship is physically violent, long-term injuries or even death could result. 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. 

In order to protect their children from teen dating violence, parents should know what to be aware of when their child is in a relationship.

Warning signs 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

Schneider wants parents to know how they can reduce the occurrence of TDV and protect their teens.

“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.”

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 child/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.

Resources you or your teen can call if they are in an abusive relationship:

  • National Dating Abuse Helpline – call 1-866-331-9474 or log on to interactive website loveisrespect.org to receive immediate, confidential assistance
  • Birmingham Crisis Center – call 205-323-7777
  • Birmingham Rape Response – call 205-323-7273
  • CHIPS Center (Children’s Hospital Intervention and Prevention Services) – call 205-638-2751
  • RAINN (Rape Abuse and Incest National Network) – call 1-800-656-4673
  • If your teen is in immediate danger, call 911
Children's

Fever

Parents can understandably be concerned when their child doesn’t feel well and has a fever. But how high is too high? When should a parent treat a fever at home and when should they seek medical help?

Dr. Mark Baker is an Associate Professor of Pediatrics at Children’s of Alabama and works in the Emergency Department. He says a fever is anything higher than 100.4 degrees Fahrenheit. “Fever is the body’s response to an infection,” he says. “Fevers are generally well tolerated in healthy children, especially if they are up to date with recommended childhood vaccines.” 

Dr. Baker says there are instances when a parent should take a fever seriously and seek medical attention. These include when a child has a temperature higher than 100.4 AND:

  • Is 3 months of age or younger
  • Has serious underlying medical problems
  • Experiences pain or other concerns

If any of these conditions exist, parents are encouraged to take their child to the Emergency Department. If a parent is unsure how serious the situation may be, their child’s pediatrician is available to help. Even after hours, a pediatrician’s office has a 24/7 on call line.

Dr. Baker says in an otherwise healthy child, a fever can usually be treated at home with either ibuprofen or acetaminophen, (Motrin or Tylenol). He says it is best to stick with one form of treatment and follow the dosage instructions. If the over the counter medicine isn’t helping, Dr. Baker advises parents to call their child’s pediatrician or go to the Emergency Department.

Parents can also make sure their child is more comfortable by dressing them in lightweight clothing and covering them with a light sheet or blanket. It’s very important that the child gets plenty of fluids to stay hydrated. A sponge bath or wet cloth may help lower their temperature and make them feel more comfortable. All kids get fevers, and in most cases recover completely within a few days. But if you ever have concerns about your child’s well-being, it’s best to contact their doctor for guidance.

Children's

Weather Updates

Tuesday, Feb. 16, 2021 – 9:50 a.m.

The following locations will be closed on Tuesday, Feb. 16. 

  • Greenvale Pediatrics (Alabaster, Brook Highland and Hoover) 
  • Pediatrics East
  • Pediatrics West
  • Pell City Pediatrics
  • North Alabama Children’s Specialists
  • Mayfair Medical Group
  • Midtown Pediatrics
  • Vestavia Pediatrics
    • If you have an urgent medical question that cannot wait until we open, please call our answering service at 205-930-4310 and a nurse will call you back. If you have a medical emergency, please call 911.

Tuesday, Feb. 16, 2021 – 8:25 a.m.

The following locations will open at noon on Tuesday, Feb. 16. Updates will be posted here if the offices modify their posted opening times plans due to changing weather conditions.

  • Over the Mountain Pediatrics
  • Midtown Pediatrics
  • Pediatrics West (Bessemer and McAdory)
  • Pell City Pediatrics
  • Mayfair Medical Group
    • If you have an urgent matter, please call Mayfair’s answering service at 205-930-4263 to speak with a nurse or doctor on call.

Monday, Feb. 15, 2021 – 3 p.m.

Due to possible inclement weather conditions on Tuesday morning, Feb. 16, outpatient clinics at Children’s of Alabama, Children’s on 3rd, Children’s on Lakeshore and Children’s South will open at 1:00 p.m.

Children’s South Surgery will be closed Tuesday, Feb. 16.

All surgical services at Children’s downtown Russell Campus will continue as scheduled.

As always Children’s Emergency Department remains open, and anyone experiencing an emergency should dial 911.

Outpatient clinics are attempting to reach appointments by telephone today and will try to work in all patients that arrive tomorrow. Please call 205-638-6200 to reschedule if you are unable to keep your appointment. 

Children's

Urgent Care or Emergency Department?

When your child needs quick medical care, in some cases, it’s hard to determine whether you should go to an urgent care center or to the emergency department  (ED). Before making that important decision, here are some things to consider.

Urgent Care Center Treatment
Urgent care centers can manage the same problems as your regular health care provider when your child is sick. These centers also can provide services like X-rays, stitches and splints. If you can’t get to your provider’s office or it’s after regular office hours, you can get medical care at an urgent care center.

In addition, urgent care centers can also treat:

•            simple bone injuries

•            minor burns

•            cuts

•            splinter removal

•            sprains and other sports injuries

•            minor animal bites

•            fever

•            belly pain

•            vomiting or diarrhea

Visiting the ED

The ED is equipped to handle more serious problems, like Children’s of Alabama Emergency Department, which is prepared for life-threatening illnesses and injuries at any time of the day or night..

You should go to the ED if your child experiences any of the following:

•            trouble breathing

•            unusual sleepiness or confusion or cannot awaken

•            a stiff neck with a fever

•            a continuous fast heartbeat

•            ingested a poison, drug or unknown substance

•            a head injury and is vomiting

•            an eye injury

•            a serious burn

•            a fever in a child less than six weeks old (although certain types of fevers in older children may be able to be seen elsewhere)

Some situations are so serious that you need the help of trained medical personnel on the way to the hospital and need to call 911 immediately.

Call 911 if your child:

•            isn’t breathing or is turning blue

•            is unconscious after a fall

•            is having a seizure

•            has a serious allergic reaction

•            has a broken bone that sticks out through the skin 

•            took an unknown amount of medicine and is now hard to rouse

•            is choking

•            has a large cut that won’t stop bleeding

So, what happens when you first arrive at the ED? “In the Emergency Department, children are seen first by a triage nurse who does a medical assessment as to the severity of illness,” said Kathy Monroe, M.D., MSQI, and attending physician in pediatric emergency medicine at Children’s of Alabama. “Children with severe illnesses are seen right away, while others may have a wait time according to the severity of their illness,” she said.

Additional Things to Consider

Whether you are going to an urgent care center or an ED, you should know the name and number of your child’s primary care provider, your child’s medical history and the details of your child’s current medical concern. And it’s good to know the name and number of the pharmacy where you usually get your prescriptions filled.

Here is what you should include in child’s medical history:

•            medicines your child is taking

•            allergies

•            history of previous hospitalizations

•            any previous surgeries

•            illnesses

•            relevant family history

•            immunization history

When giving the details of your child’s current medical concern, be sure to include:

•            when the problem began (the time of injury or how many days your child has been sick)

•            the symptoms of the current illness or injury

•            treatments and medicines you have already tried

•            when your child last had anything to eat or drink

Dr. Monroe said, “Parents should definitely check with their child’s pediatrician for guidance when making decisions about urgent care, emergency care or a doctor’s office. Planning ahead is important for any situation.”

The Children’s of Alabama ED is located at 1601 5th Avenue South in downtown Birmingham. Around-the-clock valet services are provided at no charge for patient families at the corner of 5th Avenue South and 16th Street.

Children's

Can Children and Teens Take the COVID-19 Vaccine?

So far, the COVID-19 vaccine is recommended only for people 16 and older. It’s not yet approved for children younger than that. That’s because the first safety trials didn’t include younger age groups. As safety trials continue, researchers will know more about whether the vaccine is safe and works well in younger age groups. You can find the latest vaccine information by checking the CDC’s website.

Doctors, nurses, and health workers are taking the vaccine already. Soon it will be available for the public. When it is, healthy people over age 16 can take it. Experts predict that will happen by spring 2021.

So what’s the best way to protect your family? Keep doing the things you’re already doing:

  • Wear a mask.
  • Stay at least 6 feet away from people you don’t live with.
  • Avoid crowds.
  • Wash your hands well and often with soap and water or use hand sanitizer.
  • Try not to touch your nose, mouth, or eyes unless you know your hands are clean.

For more on COVID-19, please visit our website.