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Posts from the ‘Children’s’ Category

Severe Weather Preparedness

In Alabama, we are no stranger to severe weather, so it is a good idea to have a plan for your family to stay safe. Severe weather can happen any time in any part of the country, so it’s a good idea to be prepared ahead of time. Once a storm is approaching, it’s often too late to work on a preparedness plan.

Debbie Coshatt is the Nurse Educator in the Patient Health and Safety Information Department at Children’s of Alabama. She recommends families discuss their severe weather plan in advance, including where they will go for safety. “You want to make sure to go to an area without windows. If the house has a basement that would be ideal. Go to the lowest level of the home, an interior room without windows. A bathroom or a closet are good options,” she says. She also suggests that families practice going to their “safe place” to become more comfortable with the process.

Safe Place

  • Without windows
  • Lowest level of the home
  • Interior room

Coshatt recommends that families prepare a severe weather bag for each member of the family. The bags should always be stored in their “safe place.” This bag should contain essentials such as:

Severe Weather Bag

  • Helmet
  • Flashlight
  • Shoes
  • Name Band (filled out by parents)

She also recommends keeping a weather radio with an extra set of batteries in the safe place.

Other Safe Place Essentials

  • Weather radio
  • Extra batteries

The Patient Health and Safety Information Department at Children’s of Alabama has more information about this and other health and safety related topics. The department also has Storm Bags available for purchase for $5. They are located off the Russell Lobby in the Benjamin Russell Building at Children’s of Alabama.

Poison Look-a-Likes

Parents who take great care to child-proof their home may be overlooking every day household items that pose a risk of poisoning. Ann Slattery is the director of the Regional Poison Control Center at Children’s of Alabama. She says parents need to watch out for what she calls “look-a-like” products.

For instance, a child may think a bottle of pine cleaner looks like a bottle of apple juice or a bottle of all-purpose cleaner looks like a sports drink. There has also been an increase in poisonings due to detergent pods. The bright colors can cause a child to mistake it for a piece of candy. Experts say it’s best to use traditional detergent if you have a child under 6 years old in the home.

Slattery says the Regional Poison Control Center at Children’s of Alabama received more than 42,000 calls in 2016. Many of those calls were associated with household look-a-like items. She encourages parents to look around their home for items that may be mistaken for food or drink. And remember, just because an item has child-resistant packaging doesn’t always mean its child-proof.

Slattery says the risk doesn’t only apply to children. “Adults may unintentionally get into these products, not realizing what they are,” she says. “In some cases, it could be dark and they reach for the wrong bottle.” Accidental poisoning may also occur when an individual suffers from dementia. “All household cleaning products should be kept out of sight and out of reach. Ideally, these products should be in a cabinet with a child-resistant closure,” Slattery advises.

The Regional Poison Control Center at Children’s of Alabama is available 24/7/365 for poison advice for all ages. The number is 1-800-222-1222. Slattery recommends parents store the number in their cell phones for easy access.

Teen Driving

Automobile crashes are the number one killer of teenagers and the number one cause of disabling injuries for teens.  Sadly many of these accidents are preventable.

Leslie Brown is the coordinator of Alabama Safe Kids at Children’s of Alabama.

She says parents play an important role in encouraging their children to be safe as a driver and a passenger.

“Parents can start by talking to their child when in elementary school about being a safe passenger,” she says.  “Things like modeling safe behavior, wearing a seatbelt every time and putting the cell phone down. They’re going to do what we do,” she says.

In Alabama, the Graduated Driver License Law is a mandatory restriction in place for inexperienced drivers. One of the requirements is that a new driver may not have more than one non-family passenger in the vehicle with them other than the parent, guardian or a supervising licensed driver at least 21 years of age.

Brown says parents should become familiar with the Graduated Driver License Law and download a Teen Driving Agreement for their new driver to sign. This helps to establish important ground rules to keep the new driver safe.  And Brown says, if the teen violates any of these rules there should be consequences. “Take away their keys when they don’t follow the rules,” she says. “You can also offer rewards when they do make good choices.”

Brown says it’s important that teens and adults do these three things:

-Obey the law

-Wear a seatbelt

-Put down the cell phone

Brown has teenagers of her own so talking about safe driving isn’t just part of her job description, it’s personal.

“I always say to my teenagers, ‘Are you a great friend or a good friend?’” she says. I tell them, ‘Encourage your friends to wear their seatbelts.  Ask, ‘Can I send that text for you?’  instead of allowing them to text and drive.”

Getting a new driver’s license is an exciting time for a teenager.  By helping them to know the law and apply safe driving practices, parents can play an important role in keeping their teens alive.

Children’s of Alabama offers links to the Graduated Driver License Law, the Teen Driving Agreement, and more resources for parents and teens. Visit childrensal.org/Safe-Teen-Driving-Toolkit to download these resources.

Multidisciplinary liver clinics coming to Children’s of Alabama

By Dr. Reed Dimmitt, Director, Division of Pediatric Gastroenterology
David E. Dixon Endowed Chair in Pediatric Gastroenterology

With the addition of two more physicians in the coming months, Children’s of Alabama will soon be able to expand the care we provide to pediatric patients with liver disease.

Gillian Noel, M.D., is finishing her fellowship at Emory and will join us soon. Within a few months, we will welcome Mike Leonis, M.D., from Cincinnati, Ohio, as the director of our new pediatric liver center. Both are board certified in pediatric hepatology and will be the first two such certified physicians in the state.

These staff additions are the realization of a longtime goal to establish a liver center benefitting children across Alabama. We will be able to increase the number of liver transplants performed on children around the state, allowing physicians to refer more patients to Children’s instead of Vanderbilt and Emory. We will also expand specialized clinics for other conditions such as liver disease associated with cystic fibrosis, pediatric fatty liver disease and metabolic diseases.

These clinics will be multidisciplinary, including nutrition, genetics, pulmonary, psychology and child life. When patients come in from around the state, they will be able to see everyone at one time without making multiple appointments. Even local patients will find the process to be more efficient, requiring less time off school and work to get the care they need.

In addition to helping simplify the process for patients and their parents, these multidisciplinary clinics have proven to improve outcomes. The collaborative nature of the clinics will enable us to discuss cases from our own specialty while developing a transdisciplinary approach to the care of patients. We are able to care for the total patient, not only addressing their physical needs but also how their condition affects them emotionally and developmentally in a programmatic manner.

In conjunction with the liver clinics, we are planning an expanded pediatric obesity program so we can have interventions with these children as well.  The clinics will partner as needed to provide the full scope of care for all our patients.

With the addition of these doctors Leonis and Noel, we’ll have three physicians dedicated to liver disease and 13 faculty members in our group. We are pleased to welcome them in our efforts to continually improve care through the Division of Pediatric Gastroenterology at Children’s.

Medication Safety

Parents play an important role in protecting their children from various illnesses and injuries, including poisoning. Dr. Megan Brennard is a physician in the emergency department at Children’s of Alabama. She says poisoning and ingestions are common reasons why children visit the emergency department. “The most common poisoning we see in a child is medication poisoning,”she says.

It’s important for parents to keep all medicines up high and out of reach of children. But sometimes the danger may be brought in by someone else. “Sometimes the most dangerous medicine in your house was brought in by a grandparent,” Brennard says. “They may keep their purse on the floor and not even realize it’s a risk for the child.”

Often adults store medicine in pill boxes or organizers, but parents need to remember these are not child-proof. And to a child, medicine may look like candy. It’s important to talk with guests of your home to ensure any medicine they have is kept out of reach of children.

Along the lines of “candy,” Brennard recommends parents never call medicine “candy.” “Sometimes parents do that to encourage their child to take medicine, but it’s never a good idea to confuse the two,” she says.

All teaspoons and tablespoons are not equal

It’s also important that all medicine be given with the appropriate measuring device as provided by the pharmacist, whether it’s a syringe or measuring cup. Brennard says eating utensils come in various sizes. One teaspoon could range from a half teaspoon to one-and-a-half teaspoons when measured. She also adds that bottle tops for medicine are “child resistant” not “child-proof.” Some children are still able to open them. “It’s a good idea to get a lockbox to store medicine, anything with a code to get in. This adds another layer of protection,” Brennard says.

The Regional Poison Control Center at Children’s of Alabama is always available to answer questions or concerns. The number is 1-800-222-1222. Brennard recommends that parents store this number in their cell phone for easy access. Of course, always call 911 in the event of an emergency.

How Much Caffeine is Too Much?

The consumption of caffeine has become prevalent in adults, teens and children across the country. It is found in soda, coffee, tea, chocolate, energy drinks and several other products we consume every day. Caffeine is defined as a drug because it acts as a stimulant for the central nervous system.

The American Academy of Pediatrics recommends that children should not consume caffeine. If adolescents do drink caffeine, it is recommended that they intake no more than 100 milligrams (mg) per day. Higher doses can cause adverse reactions.

  • 12 oz can of Coca-Cola® = 46 mg
  • 5 oz cup of coffee = 60-180 mg
  • 12 oz glass of iced tea = 67-76 mg

In adults, low doses of caffeine can be used to enhance one’s ability to focus, but any amount over 100 mg actually creates the opposite effect.

Some adverse reactions to caffeine are:

  • Jitters
  • Anxiety
  • Nausea
  • Increased urination (over 500 mg of caffeine)
  • Headaches
  • Insomnia
  • Increased heart rate
  • Tremors
  • Seizures (over 1 gram of caffeine)

“In 2015-2016, the Regional Poison Control Center (RPCC) at Children’s of Alabama received an average of 110 calls per year regarding adverse reactions to caffeine,” said Becky Rozier, MSN, RN, CSPI, RPCC educator. “The highest number of caffeine calls came from parents of 1- to 2-year-olds who had unintentionally consumed caffeine. The second highest came from 13- to 19-year-olds and the third highest came from 6- to 12-year-olds. Both of these groups had intentionally consumed the caffeine.”

Food and Drug Administration regulation:

  • Limits sodas to 71 mg per 12 oz
  • Limits caffeine tablets to 200 mg per tablet
  • Does not regulate energy drinks

“There are true dangers to caffeine,” said Ann Slattery, DrPH, RN, RPh, CSPI, DABAT, RPCC managing director. “Educate your children and teens to closely look at the amount of caffeine listed on the labeling. For example, some energy drinks include herbals that contain caffeine (guarana, kola nut and yerba mate), but are not included in the amount of caffeine listed.”

If your child is experiencing adverse reactions to caffeine or you have a question about toxicity, call the RPCC at 1-800-222-1222. A specialist will calculate the amount of caffeine ingested versus the body weight of the individual. The RPCC is available for all ages, 24/7/365.

Nutrition Tips for Kids with Diabetes

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

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

Type 1

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

Type 2

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

Meals

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

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

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

Snacks

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

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

Grocery Shopping

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

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

E-Cigarettes and Vaping

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


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

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

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

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

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

Croup

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


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


Symptoms of Croup

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

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


Treating Croup at Home

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

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

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

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

Advances in genetic testing result in more effective diagnoses

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

Dr. Bruce Korf

Dr. Bruce Korf

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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