Children’s

All kids get a fever from time to time. A fever itself usually causes no harm and can actually be a good thing — it’s often a sign that the body is fighting an infection.

But when your child wakes in the middle of the night flushed, hot, and sweaty, it’s easy to be unsure of what to do next. Should you get out the thermometer? Call the doctor?

Here’s more about fevers, including advice from Children’s of Alabama pediatrician, Dr. Peily Soong.

What Is a Fever?

Fever happens when the body’s internal “thermostat” raises the body temperature above its normal level. This thermostat is found in a part of the brain called the hypothalamus. The hypothalamus knows what temperature your body should be (usually around 98.6°F/37°C) and will send messages to your body to keep it that way.

Most people’s body temperatures change a little bit during the course of the day: It’s usually a little lower in the morning and a little higher in the evening and can vary as kids run around, play, and exercise.

Sometimes, though, the hypothalamus will “reset” the body to a higher temperature in response to an infection, illness, or some other cause. Why? Researchers believe that turning up the heat is a way for the body to fight the germs that cause infections, making it a less comfortable place for them.

What Causes Fevers?

It’s important to remember that fever by itself is not an illness — it’s usually a sign or symptom of another problem.

Fevers can be caused by a few things, including:

Infection: Most fevers are caused by infection or other illness. A fever helps the body fight infections by stimulating natural defense mechanisms.

Overdressing: Infants, especially newborns, may get fevers if they’re over bundled or in a hot environment because they don’t regulate their body temperature as well as older kids. But because fevers in newborns can indicate a serious infection, even infants who are overdressed must be checked by a doctor if they have a fever.

Immunizations: Babies and kids sometimes get a low-grade fever after getting vaccinated.

Although teething may cause a slight rise in body temperature, it’s probably not the cause if a child’s temperature is higher than 100°F (37.8°C).

Is it a Fever?

A gentle kiss on the forehead or a hand placed lightly on the skin is often enough to give you a hint that your child has a fever. However, this method of taking a temperature (called tactile temperature) won’t give an accurate measurement.

Use a reliable digital thermometer to confirm a fever. It’s a fever when a child’s temperature is at or above one of these levels:

• measured orally (in the mouth): 100°F (37.8°C)
• measured rectally (in the bottom): 100.4°F (38°C)
• measured in an axillary position (under the arm): 99°F (37.2°C)

But how high a fever is doesn’t tell you much about how sick your child is. A simple cold or other viral infection can sometimes cause a rather high fever (in the 102°–104°F/38.9°–40°C range), but this doesn’t usually mean there’s a serious problem. In fact, a serious infection, especially in infants, might cause no fever or even a low body temperature (below 97°F or 36.1°C).

Because fevers can rise and fall, a child might have chills as the body’s temperature begins to rise. The child may sweat to release extra heat as the temperature starts to drop.

Sometimes kids with a fever breathe faster than usual and may have a faster heart rate. Call the doctor if your child has trouble breathing, is breathing faster than normal, or is still breathing fast after the fever comes down.

Q&A with Dr. Soong, Pediatrician at Children’s of Alabama

Q: What advice do you have for parents when their child is dealing with a fever?

A: “Fevers are a natural way your body reacts when fighting off infections. For the most part, parents should not panic about a fever and can treat their child’s fever with over-the-counter fever reducers if their child is feeling bad from the fever. With normal cold infections such as the common cold or flu, fevers can commonly reach temperatures of 105F. Parents should not stress on how high a fever is, but stress on how their child is feeling or acting.”

Q: When should a parent call the doctor?

A: “Parents should contact their doctor immediately if their child is less than 2 months of age and has a temperature greater than or equal to 100.4F. Parents with older children with fever should seek immediate care if their child is lethargic, having trouble breathing, or not drinking. If at all concerned about your child having fever, go ahead and have your child seen by a doctor. Children with fevers persisting for several days should be evaluated by their doctor.”

We’re celebrating Hispanic Heritage Month, a time to honor the histories, cultures and contributions of our employees from Central and South America, Mexico and Spain. At Children’s of Alabama, we are united in our mission and dedication in providing the finest pediatric healthcare to all children. Each of the employees featured here contribute to our core values of trust, teamwork, compassion, innovation and commitment. We thank them for sharing their stories of inspiration and impact.

Itala Milan
Language Services Manager

What led you to a career in healthcare?
I was the child who always wanted to help others. The medical field has allowed me to explore different career paths over the years. I eventually landed within an area about which I am passionate.

Who are some Latinos or Latinas that have inspired you?
I will have to say my father was a great inspiration, he was kind and made an impact on everyone who knew him. He taught me that education and knowledge of languages were two vital tools I would need in my life (He was right!).

On the famous side, Ellen Ochoa, who was the first Latina to go to space and the second female to be the director of the Johnson Space Center. She broke through many barriers and used her drive to accomplish so much. I always find inspiration from one of her quotes: ““Don’t be afraid to reach for the stars. I believe a good education can take you anywhere on Earth and beyond.”

What kind of impact do you hope to have? How do you hope to inspire others?
I hope I can have an impact on increasing awareness of the value of communication access, the use of technology available and communication going beyond the spoken word. If this eventually leads to our families at COA – to have a more positive patient experience – I will feel accomplished. I hope to inspire others by my actions: to motivate them to work hard and help build them up to have integrity, practice gratitude and stay true to who they are.

Evelyn Inestroza, RN
Emergency Department and CV Periop Nurse

What led you to a career in healthcare?
I chose to pursue healthcare/a career in nursing because of my mother and my sister. My mother is a nurse and growing up, I heard about her time as a nurse during the War in Nicaragua. I also watched how she cared for those in need in our community back in Honduras and then again when we moved to Alabama. The way she nurtured those in need with love and compassion are some of the qualities I knew came from her calling as a nurse.
I knew growing up I wanted to be in healthcare, but didn’t quite know what role I wanted to pursue. I remember choosing nursing as a career after my sister was given the devastating news that she could no longer pursue nursing due to her health issues. I chose to become a nurse to honor my sister’s dream.

Who are some Latinos or Latinas that have inspired you?
I consider my family to be my inspiration. My grandparents came from very little, yet they worked hard to give my parents an opportunity for a better life. My parents are my constant inspiration to want to do more; they are examples of hard work, loyalty, courage, determination, dedication and selflessness. Together they have managed to provide education not only for my siblings and I, but also for many others in Honduras and Nicaragua. My parents overcame many obstacles in their lives in order to provide for us and those in need, and I can say without a doubt that their efforts have paid off.

What kind of impact do you hope to have? How do you hope to inspire others?
I hope to impact the lives of those I encounter in or outside the hospital by setting an example of hard work, determination, compassion and show the endless possibilities you can accomplish as a nurse in someone’s life, including your own. I hope to remind parents that the hard work they are putting in now for the future of their children will one day also pay off as it did for me and my parents.

My hope is to inspire the younger generation to go after their dreams, to reach high and work hard, to take advantage of the opportunities they are given and use them for good. I hope to encourage our generation to use their talents, such as being bilingual to communicate effectively with those/and for those who struggle due to language barriers and help meet their health needs.

Amado Santos
Director of Patient Relations and Language services

What led you to a career in healthcare?
I chose healthcare because it gave me the opportunity to serve others. Since my early childhood in the west mountains of Honduras, I saw my mom and dad always being eager to serve others unconditionally. When I moved to the United States in 1989, my adoptive family in Alabama displayed the exact same spirit of servitude toward others. I always thought that I had to return to Honduras to be able to make a difference in my community; however, my career at Children’s has given me the opportunity to honor my parents (in both countries) by serving others as they did.

Who are some Latinos or Latinas that have inspired you?

Without a doubt my parents in Honduras. Regardless of the enormous challenges they faced due to lack of resources, they always found a way to keep food on the table for all of us (11 kids). To be humble, honest and work hard were expectations they had from me and my siblings. Most importantly they taught me to always treat others with kindness, dignity and respect.

What kind of impact do you hope to have? How do you hope to inspire others?

I hope to have a positive impact for those around me by staying truthful to my personal and professional core values and principles. I seek to inspire others by being a more genuine, kind, honest and compassionate human being.

Cristina Cruz, RN
Sexual Assault Nurse Examiner

What led you to a career in healthcare?
Coming from a border town and noticing the health disparities in underserved populations led me to want to help people in their most vulnerable times.

Who are some Latinos or Latinas that have inspired you?
I don’t have one or two Hispanic individuals that inspire me, I have thousands. I’m inspired by every single immigrant family out there that despite the stigma, having to learn another language and working long and odd hours to keep their family going, they wake up every morning and give it their all. Who could be more inspiring than them?

What kind of impact do you hope to have? How do you hope to inspire others?

I hope that as a nurse I can help educate the Hispanic people living in the South. It would be a dream to close the gap in health disparities in this underserved population. The fact that English is not your first language shouldn’t hinder you from being able to get the healthcare you need.

Representation is important. I hope by being on the front line, I can inspire the next generation of Hispanic healthcare workers! We need more of us that can relate to and educate our people.

Jeannette Elizondo
Certified Medical Interpreter

What led you to a career in healthcare?
I have always loved the healthcare field because you are constantly learning and will always have an opportunity to help someone in need.

Who are some Latinos or Latinas that have inspired you?
Honestly, the people that inspire me the most are my parents. They have always taught me to strive for the best, never give up, stay humble and always be kind because you never know what people are going through. They both have worked so hard for our family and I would never want to do anything to disappoint them. Both of my parents have had businesses of their own and didn’t let anyone or anything stop them. They have showed me to go for what you want and never give up.

What kind of impact do you hope to have? How do you hope to inspire others?
I hope to provide the best interpretation services to all children and parents that walk through this hospital. The best way I plan to make the most significant impact is to think of Children’s of Alabama mission, and that is to ensure I provide the finest and most accurate interpretation to all of our families. I hope to inspire others to always advocate for every child or patient that comes through our doors by making them feel welcomed, safe and educated. I love Children’s of Alabama and I think we do a great job at showing everyone that we love being here!

Carolina Chacon, RN
7 Dearth MedSurg Nurse

What led you to a career in healthcare?
I was always drawn to the healthcare field. After a few clinical rotations in high school, I decided nursing was the career for me. Nursing is a very rewarding field, you learn something new every shift. In this field, one is responsible for advocating and delivering the proper care to patients of all ethnic backgrounds and cultures.

Who are some Latinos or Latinas that have inspired you?
My parents are my biggest inspiration. They left their home country, came to the U.S., learned a different language and worked in laborious jobs just to provide their children opportunities they never had. That to me is a huge sacrifice and the most inspiring thing anyone can do.

What kind of impact do you hope to have? How do you hope to inspire others?

I hope to impact other Latinos who are seeking careers in healthcare. Representation matters. I remember growing up thinking none of these people looked like me. Latinos are everywhere, being a minority is not a barrier. We can be anything we want to be and we can achieve all the things we put our minds to. Whether it’s being a nurse at Children’s of Alabama or being an astronaut at NASA. We are all capable of doing great things.

CHILDREN’S OF ALABAMA
LANGUAGE SERVICES

Children’s of Alabama believes in the importance of effective communication in order to deliver the best possible family-centered pediatric care to all our patients and families. Language Services’ goal and commitment are to ensure that all language needs within our hospital are met in a timely and effective manner.

Our staff Spanish interpreters are trained medical interpreters who are cognizant of the importance of culturally-competent care. These services are provided free of charge to all our families and patients who need them.

Above are some of our Language Services team who bridge the communication gap for patients and families every day. Pictured left to right: Dahlia Smith, Irsia Quevedo, Jeanette Elizondo, Amado Sandos, Veronica Ramirez, Itala Milan, Areli Torres.

August is National Immunization Awareness Month. This annual observance highlights the importance of vaccination for people of all ages. With the back-to-school season in full swing, it’s important to understand the importance of vaccines for children and check your child’s immunization chart.

Q: What Do Vaccines Do?

A: Vaccines work by preparing the body to fight illness. Each vaccine contains either a dead or a weakened germ (or parts of it) that causes a particular disease.

The body practices fighting the disease by making antibodies that recognize specific parts of that germ. This permanent or long-lasting response means that if someone is exposed to the actual disease, the antibodies are in place and the body knows how to fight the disease, so the person doesn’t get sick. This is called immunity. The process by which vaccines create immunity is known as immunization.

Q: Will the Immune System Be Weaker by Relying on a Vaccine?

A: No, the immune system makes antibodies against a germ, like the chickenpox virus, whether it encounters it naturally or through a vaccine. Being vaccinated against one disease does not weaken the immune response to another disease.

Q: Can a Vaccine Give Someone the Disease It’s Supposed to Prevent?

A: It’s impossible to get the disease from any vaccine made with dead (killed) bacteria or viruses or just part of the bacteria or virus.

Only those vaccines made from weakened (also called attenuated) live viruses — like the chickenpox (varicella) and measles-mumps-rubella (MMR) vaccines — could possibly make a child develop a mild form of the disease. But it’s almost always much less severe than if a child became infected with the disease-causing virus itself. However, for kids with weak immune systems, such as those being treated for cancer, these vaccines may cause problems.

Q: Can Getting So Many Vaccines at One Time Harm My Baby?

A: Babies have stronger immune systems than you might think, and they can handle far more germs than what they receive from vaccines. In fact, the number of germs in vaccines is just a small percentage of the germs babies’ immune systems deal with every day.

A lot of consideration and research went into creating the immunization schedule most doctors use, and it has been proven safe time and time again. Still, some parents choose to use alternative schedules (spreading or “spacing out” vaccines) because they’re concerned about the number of shots their babies get at each checkup. This is actually more likely to make a baby sick. Studies show that many babies on alternative immunization schedules never get all the vaccines they need.

Q: Why Should My Child Get a Painful Shot if Vaccines Aren’t 100% Effective?

A: Few things in medicine work 100% of the time. But vaccines are one of the most effective weapons we have against disease — they work in 85% to 99% of cases. They greatly reduce your child’s risk of serious illness (particularly when more and more people are vaccinated) and give diseases fewer chances to take hold in a population.

Q: Why Do Healthy Kids Need to Be Immunized?

A: Vaccinations are intended to help keep healthy kids healthy. Because vaccines work by protecting the body before disease strikes, if you wait until your child gets sick, it will be too late for the vaccine to work. The best time to immunize kids is when they’re healthy.

Q: Can Vaccines Cause a Bad Reaction in My Child?

A: The most common reactions to vaccines are minor and include:

• Redness and swelling where the shot was given
• Fever
• Soreness at the site where the shot was given

In rare cases, vaccines can trigger more serious problems, such as seizures or severe allergic reactions. If your child has a history of allergies to food or medicine, or has had a problem with a vaccine before, let the doctor know before any vaccines are given. Every year, millions of kids are safely vaccinated and very few experience serious side effects.

Q: Should Children Get a COVID-19 Vaccine?

A: Yes, safe and effective COVID-19 vaccines are recommended for adults and all children ages 6 months and older. Booster shots are recommended for everyone ages 5 and older. Everyone who is eligible should get the COVID-19 vaccine and booster shot as soon as possible.

Participating Pediatric Practices are now offering the COVID-19 vaccine to patients 6 months and older. The vaccine is:

• Available for patients 6 months to less than 5 years in a 2 or 3-dose series
• Available for patients ages 5-11 years as a 2-dose series with a booster after 5 months
• Available for children ages 12 and older as a 2-dose series with a booster after 5 months

To find a practice near you, visit ChildrensAL.org.

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You may be thinking, “My child hates shots and pitches a fit even at the word.” There are techniques to make shots easier, such as encouraging your child to take calming breaths or even coughing as the needle goes in. Regardless of the fear, remind them that the shot itself lasts only for a second, but the protection lasts a long, long time after that.

Get your child up-to-date with their vaccines today. Click here to read the recommended immunization schedule.

Marilyn Prier, MPH, BSN, RN graduated from the University of Alabama Birmingham School of Nursing in 1986.  She immediately began her career at Children’s of Alabama where she worked for 37 years.  Marilyn’s life has been committed to ensuring that children have a healthy and happy life, whether at her job as a registered nurse at Children’s of Alabama or at home raising her four sons and enjoying her fifteen grandchildren. 

Upon graduation, Marilyn’s first position as a registered nurse was in the Pediatric Intensive Care Unit where she worked for two years.  She left Children’s for two years to work in home healthcare.  After receiving a call from a friend, she returned to Children’s and became the discharge planner for the inpatient units.  The CNO, Supora Thomas, had a vision for two big initiatives and she charged Marilyn with this task.  There were families whose children were discharged with a risk to suddenly stop breathing.  Marilyn put together a program to ensure that staff on the inpatient units could conduct CPR teaching for these families so they could intervene in these crucial moments.  She worked with a team reaching out to community partners and donors to supply CPR teaching kits over the years and this program remains in place today.

Another very important initiative was child passenger safety.  It was often discovered that parents did not have a car seat to safely get their child home upon discharge from the hospital.  Marilyn and her colleagues developed a program to identify these families and provide them with an appropriate child passenger safety seat.  Over the years Marilyn and her teammates became certified Child Passenger Safety Technicians, installing car seats and ensuring that families knew how to safety install their own seat.  The program has grown over many years and at the present time Children’s has a donor who supplies seats free of charge for families who are discharged from the hospital and in need of a car seat.  Another group of patients in need of car seats were patients with spica (body) casts or other physical or structural limitations.  These patients required a specialized car seat and again Marilyn and her team worked to ensure that a safe seat was acquired.  Since specialty car seats are very expensive and not needed for much longer than a few months, a loaner program was developed so that families could transport their child safely without the worry of additional expenses.

After a few years in the discharge planner role, Marilyn’s commitment to patient education prompted her transfer to the CHECK Center (Comprehensive Health Education Center for Kids) where she worked on developing printed patient health and education material for the hospital.   In partnership with BlueCross and BlueShield of Alabama, Marilyn was instrumental in creating the curriculum and design for an interactive mobile unit called Body Trek. Thousands of school age children have been given the opportunity to visit Body Trek. In the unit they learned how the human body works and important safety practices such as always wearing a seat belt and always wearing a helmet while riding a bicycle. Marilyn partnered with local schools of nursing to provide nursing students the opportunity to serve as volunteers with Body Trek while teaching the them the importance of teaching safety in the community.

In 2002, Marilyn returned to school and obtained a Master of Public Health degree.  This enabled Marilyn to grow and develop as a leader at Children’s of Alabama.  In 2006 Marilyn accepted the position as the Department Director for the CHECK Center.  The center later changed names to Patient Health and Safety Information.  She continued working on many initiatives including developing a strong liaison program between Children’s of Alabama and the Alabama Association of School Nurses and the Alabama State Department of Education’s School Nurse Administrator.  Children’s began providing annual educational sessions during the summer months so school nurses could obtain continuing education credits and stay on top of the many changing trends and treatment with school aged children. 

Marilyn is a strong advocate for child health and safety.  She was instrumental in developing partnerships that helped bring many programs into the schools and communities.   She also facilitated many new programs supporting staff inside the hospital.  Some of the programs she worked with are:

• Kids on the Block – a national program which used puppets to educate students about peers with different abilities, disabilities and diseases. The focus was on tolerance and diversity amongst their groups.
• Smoke House – a mobile unit funded by the Junior League of Birmingham that taught students about fire safety and how to escape from a burning house
• Scoliosis Screening – this program was a national mandate to assess adolescents for scoliosis. Marilyn and her team worked with local schools of nursing to provide scoliosis screenings in the middle schools around Birmingham
• Safe Sitter Inc. – this national program prepares school age children how to be safe at home alone or while babysitting.  Marilyn and her department staff taught this program at the hospital campus.
• Hand in Hand for Fitness – a program whereby Marilyn and her team worked with donors to provide fitness equipment to elementary schools
• Community CPR classes
• Get Well Network – an interactive program available on smart TVs throughout the new inpatient bed tower. This program has information for families on way finding, new diagnosis teaching and videos, as well as movies for the patients to watch.
• Daisy – this program is a recognition program specifically for nurses
• Safety store – opened in the patient health and safety department where child and home safety items were sold. 

Marilyn retired in April of 2021 from a lifetime career of advocating for child safety. She has been an instrumental force in nursing leadership at Children’s of Alabama.

Back to school season is stressful for children and parents alike, and parents are concerned about ensuring that their child eats a nourishing lunch to power through the school day. The situation can prove to be frustrating when the lunches come back home uneaten. Rainie Carter, director of Clinical Nutrition at Children’s of Alabama, offers tips for packing a lunch that will please both kids and parents.

Cover the Nutritional Bases

• Include protein to help keep them full through the afternoon with items like string cheese, yogurt, meat, or nuts (if the school guidelines allow them). Carter’s favorite tips are to use a whole wheat tortilla to make pinwheels with lunch meat or freezing yogurt the night before for a creamy treat.
• Fruits and vegetables are important for your child’s fiber intake. “Kids love to dip and scoop so you can pack a little bit of ranch dressing or hummus with vegetables,” Carter advises. For produce that turns brown when cut, like apples, Carter suggests squeezing a little bit of lemon juice over the chunks to placate picky kids.
• Stick with whole grain for items like bread or crackers, and stay away from concentrated sweets like candy or gummy snacks as these can lead to an energy crash later in the day. “Also, avoid sugary drinks like soda or juice. Make sure that they have plenty of water, and a frozen water bottle will work as an ice pack too.”

Involve Them in the Process

• Plan as a family for the week’s lunches. “Spend a little time pre-chopping veggies and fruit, and let your child put portions into bags or containers. If they’re old enough, let them do the cutting too. They are more likely to eat something if they remember helping with it,” Carter said.
• Giving your child options can be a great way to gain their interest. “Let them pick within your constraints,” Carter suggests. “For instance, show them two choices for a fruit and say, ‘Do you want apples or grapes today?” Parents can also do this in the store to make sure they buy what the child wants to eat. She says to stick to the outskirts of the store for fresh produce and whole grains, avoiding the packaged foods in the aisles.

Have a Little Fun

• Pack a variety of snacks to keep them interested and sneak in more nutrient-rich foods. “Lunch does not have to be a sandwich and a piece of fruit. Kids enjoy finger foods so bento boxes are popular to portion out a few snacks instead of one big lunch item,” Carter said.
• Get creative if your child tires of the same lunch items. “Some parents will use a cookie cutter to remove the sandwich crust and make a fun shape. If the school allows it, try putting things on sticks like a fruit kabob. Kids love colorful lunches too, so find ways to incorporate that,” Carter recommends.
• Try making trail mix with your child, letting them fill their own bags. Carter’s suggested ingredients are dried fruit, granola, nuts or chocolate chips.