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Posts from the ‘Children’s’ Category

AAP Provides New Guidelines for Fruit Juice Portions

Recently, the American Academy of Pediatrics (AAP) released their new recommendations for children’s fruit juice consumption. The AAP warns that fruit juice can become a problem because it is easily over-consumed by young children who enjoy the taste, and parents usually do not set limits because juice is often viewed as nutritious. Rainie Carter, a clinical nutritionist at Children’s of Alabama, says, “For years, families viewed juice as a healthy way to provide their child with more vitamins and minerals. The reality is that, when the fiber is stripped from the fruit to create juice, we are left with a product that similar to a sugary soda. The body’s blood sugar response mimics that of a soda, and there can be consequences if the product is consumed too often.” Recent research associates excessive juice consumption with intestinal gas, tooth decay, and unhealthy weight gain. “In clinical practice, I have seen both ends of the spectrum — excessive weight gain and inadequate weight gain. When children over consume juice, they gain from the unneeded calories or they have very little appetite for solid, nutritious foods,” Carter states.

The first update since 2001, these guidelines encourage parents to limit the juice servings for children over 1 year of age and to avoid giving juice to infants under 1 year of age.

Infants (under 1 year of age) 

The new guidelines indicate that fruit juice should not be given to children under 1 year of age (unless recommended by the child’s pediatrician) as “no additional nutrients are needed” to supplement human milk or prepared infant formula. The AAP advises against giving juice before introducing solid foods to the child’s diet to ensure that the child receives all necessary nutrients from milk or formula that cannot be replaced by juice.

Children (over 1 year of age)

The AAP also advises parents to reduce amount of 100% fruit juice given to older children. The portion sizes should be restricted to 4 ounces for children ages 1-3 years, 4-6 ounces for children ages 4-6 years and 8 ounces for those 7 and older. It is also important to avoid giving juice in a bottle or portable covered cup, opting instead for an open cup to reduce the amount of time teeth are exposed to the carbohydrate in juice products, which can lead to dental decay.

The importance of providing fresh, whole fruit to children is also emphasized, reminding parents that it is recommended to provide 2 to 2 ½ cups of fruit servings per day. Of this, no more than 1 cup should be replaced by 100% fruit juice. The AAP also warns that replacing the recommended fruit intake with juice does not promote the establishment of healthy eating behaviors. “Establishing healthier eating behaviors early on in life means healthier eating later in life as well. If children are given a variety of foods on a consistent basis, they will typically become less prone to picky eating,” Carter adds.

Infants can consume mashed or pureed fruit such as applesauce or fruit-based baby foods. Older children need the protein and fiber contained in whole fruits to maintain good colon health. Parents should encourage children to consume whole fruit and depend on water as the primary source of hydration. “Fiber helps to slow digestion and keep a person feeling fuller longer so whole fruit is a better choice than juice in many ways. Updating the consumption guidelines to include more fiber-rich fruits and less juice will help consumers make more well-informed decisions about their health,” Carter notes.


Hearing and Speech Milestones

From the moment a baby is born, he or she is learning. That’s why it’s important for parents to be aware of and watch for important developmental milestones from birth the age 3. Jill Smith is the director of the Hearing and Speech Center at Children’s of Alabama. She said engaging in simple activities like talking to your baby while changing a diaper actually helps them learn to communicate. Smith said even the routine task of feeding your baby lays a foundation for speech.


“Those same muscles they are using to suck on the bottle are the same muscles they will use when learning to talk,” Smith said.
Crying is a form of communication for several months of a baby’s development. Babies cry to let parents know when they need something or when they are overwhelmed or tired. They can also engage in two-way “conversations,” exchanging smiles and cooing with mom or dad.
During this important developmental stage, Smith recommends parents consistently talk to their child. This may include reading to them, engaging in “conversations” with them and pointing out objects or animals when at the park or around the home.
“You can be saying, ‘Oh! There’s a bird,’ or ‘Look at our friend, the dog,’ and even though they may just be laying back in their stroller, they’re taking it all in, listening and learning,” Smith said.
Babies should begin reaching basic speech and hearing milestones as they grow:

3 Months Old

  • Smiling (responding to parent)
  • Cooing, babbling with parent

6 Months Old

  • Should understand “No”
  • Recognizes his or her name
  • Recognizes when a parent is in the room

1 Year Old

  • Should be speaking basic words like “No,” “Dada” and “Mama”

18 Months Old

  • Should be able to speak 30-50 words

2 Years Old

  • Should be able to string words together like “I don’t want,” “My ball,” and “Go outside”
  • Should have a vocabulary of 200-300 words

Children communicate at different rates just as they mature physically at different rates, but Smith said if a child is not using any words by 18 months old, parents should consult a pediatrician and request a speech evaluation.

Early speech and language skills are associated with success in reading, writing and social skills later in life. By engaging in “baby talk” with your baby, you help build a foundation for his or her future.

Protecting Children from Sexual Abuse

It’s estimated that 1 million children are abused every year. Many abuse victims suffer from sexual abuse. Deb Schneider is the executive director of the Children’s Hospital Intervention and Prevention Services (CHIPS) Center at Children’s of Alabama. She says even though it’s a difficult subject, it’s important parents teach children that their bodies are “private property.”

“Parents should be having an ongoing conversation with their kids. This is not a one-time thing,” Schneider says. “It’s good to look for teachable moments, like when you see a private property sign, or during bath time, or when you see an Amber Alert.”
Schneider says often when people try to entice children, they trick them with what she calls bait. “They use things like toys, candy or money,” she says. “They also will try to keep them from telling about the abuse. They may threaten to harm them or someone they love if they tell.”

She advises parents to educate children to understand what “bait” may look like and how to seek help if they find themselves in an uncomfortable situation.
Children should understand the “I Can Plan.”
Teach Children the “I Can Plan:”
  • Try to say NO
  • Try to Get Away
  • Tell Someone
  • It’s Not Your Fault
If a child reports a suspected incident of sexual abuse, Schneider advises parents to stay calm, thank the child for telling, assure the child you will get help and contact the authorities, whether it’s the local police or Department of Human Resources.
Schneider says hard as it may seem to stay calm, it’s very important to not frighten the child and not ask too many questions so the child will continue to share when asked by authorities. Authorities are trained to conduct interviews with children to help prosecute an abuser.
The CHIPS Center has abuse prevention resources available. For more information, 205- 638-2751 or go to

Seasonal Flu

This flu season has caused a major influx of patients at medical facilities across the state of Alabama. Birmingham-area hospitals are reaching or already over capacity in response to the recent outbreak of the illness.

Jefferson County Health Department Officer Dr. Mark Wilson addressed the increase in local flu cases during a press conference on Jan. 10.  Wilson said that while the outbreak is not severe enough to be considered a pandemic, it is a significant “seasonal flu situation.”

Delphene Hobby-Noland,  Manager of Infection Prevention and Control at Children’s of Alabama, said that the answer to avoiding the flu is as simple as taking basic precautionary steps.

“The two biggest preventative measures you can take are to get your annual flu immunization and to wash your hands,” Hobby-Noland said. “Our hands are the primary way that we transmit germs.”

Hobby-Noland said that those most susceptible to the flu are children and the elderly because their immune systems tend to be weaker. Children under the age of  5, especially those younger than  2 years old, are particularly more likely to suffer from flu-related complications. These complications include pneumonia, dehydration, worsening of long-term medical problems like heart disease or asthma, swelling in the brain, sinus problems and ear infections. Children younger than  6 months cannot receive the flu shot, meaning that it is important for everyone who is of age to be immunized, especially caregivers and parents of young children. There is still time to get the flu shot. While the shot does not cover all strains of the flu, it can shorten or cause the case to be less severe even if someone does get the illness.

Other preventative measures involve disinfecting commonly used surfaces, as well as encouraging children to cover their mouths with a tissue when coughing or sneezing and to avoid touching their faces.

The Jefferson County Health Department encourages people experiencing milder flu-like symptoms to stay at home or call their personal doctor instead of going to the hospital. This helps to prevent further overcrowding, risking exposure to more serious illnesses and spreading the flu.

Common symptoms of the flu include:

  • Fever or feeling feverish with chills, though not all people with the flu will have a fever
  • Cough
  • Sore throat
  • Runny or stuffy nose
  • Muscle or body aches
  • Headaches
  • Fatigue
  • Vomiting and diarrhea, which are more common in children

For more information, visit

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 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.