Browsing Category

Children’s

Children's, News

Perspectives of COVID-19 from a Pediatric Psychologist

By Dan Marullo, Ph.D.

With COVID-19 being declared a pandemic, we are now tasked to change our personal and collective behavior. It is understandable that many will experience fear, anxiety and anger in the coming days and weeks. This is normal and certainly a typical reaction to a crisis. However, whether we respond with grace or with terror is in our individual and collective control.

It is normal to be afraid. It is OK to acknowledge that fear and to take steps to cope with anxiety. Please consider the following:

  1. Fear of the unknown is normal. We are each subject to feeling a host of emotions such as anxiety, worry, irritability and sadness. We can also experience poor sleep or appetite, trouble with concentration, a tendency to withdraw from other people and perhaps even feeling hopeless. These can be normal reactions to the situation and it helps to recognize this in ourselves and in others. For example, recognizing that your spouse or child is uncharacteristically moody or snappish may mean that they are feeling overwhelmed and need support. Certainly, anyone feeling suicidal may need immediate attention.
  • Seek reliable information. There is much that we still do not know about COVID-19 and that alone increases fear and anxiety. Gaining reliable information is key to addressing this uncertainty. Reputable websites for updates and information include the Centers for Disease Control and Prevention, the National Institutes of Health and the World Health Organization. Websites for good psychological information related to COVID-19 include the American Psychological Association and the American Psychiatric Association.
  • Practice self-care. Because we are all susceptible to emotional distress, it becomes more important to take care of ourselves physically and emotionally. This may be complicated by social distancing given that social activities are commonly used by people to cope. We may not be able to attend religious services, go to work or school, the gym, shopping and so on. However, we can adapt and remain connected. Many churches are hosting online services, you can exercise at home using YouTube classes, and so on. A few things to keep in mind:
    • Maintain a typical routine as much as possible. Try having your kids do schoolwork at home at the times they would at school. Do the same if you are working from home.
    • Take a media/social media break. Depending on what you read or watch, COVID-19 is either the world’s biggest hoax or the end of the world. Neither is true. Seek accurate information and take a break from all the chatter.
    • Social distance does not mean social isolation. We may not be able to go out, have play dates or travel, but we can maintain contact with family and friends via Facetime and other platforms. This is especially critical for our most vulnerable family and friends, those that must be on isolation because of health concerns such as the elderly and those with underlying medical conditions.
    • Consider volunteering in some way. The simple act of giving has been shown to reduce distress in the giver. It is gratifying to see people organizing food drives and other activities to support their communities.
    • Find ways to maintain your spirits. A good sense of humor goes a long way. Our Italian brothers and sisters are singing from their balconies in defiance of their isolation. People are amazing. Find your path.
  • Be a role model. Our children are watching how we react to this crisis. What do you want them to see? Children and teens rely on the adults in their lives to model and teach behavior. A child’s coping often relies on how adults cope. Now is the time to teach resilience, compassion, self-sacrifice and healthy coping. These are lessons children will remember for the rest of their lives. We adults should manage our emotions and fears, and be the leaders our children need us to be.
  • Support our children. Our children are responding to this crisis as well and need support during this time. How children cope and what they need varies by their age and level of development. For example, small children respond to the distress around them and need comforting and security. School aged children, tweens and teens need information that is tailored to their age (Younger children need the basic facts, older kids can deal with more detail and abstraction). Recognize that a change in behavior may be a sign of distress and an opportunity to engage and support. Please consider:
    • Maintaining a typical routine as much as possible. This includes schoolwork, bedtimes and mealtimes.
    • Giving age-appropriate information and answering questions honestly.
    • Monitoring use of TV and other media, particularly if your child is constantly looking at COVID-19-related content (Remember, bad information is scary).
    • Providing opportunities for kids to give and contribute. Help them organize a food drive or a video chat with nursing home patients. This promotes a sense of engagement and teaches resilience.
    • Managing your own emotions. Remember, our kids are watching. What do you want them to learn?
  • Acknowledge and recognize grief. Many of us are experiencing loss and uncertainty and it is OK to acknowledge that fact. As this process unfolds, we may lose people we love, jobs that we depend on, perhaps even that sense of safety that we once enjoyed. Coming to terms with loss is necessary and healthy. Now is the time for each of us to reach out as individuals and as a community to support one another, in small ways and in large.
  • Look for the lesson. I, like many of you, have experienced tragedy in my life. From that experience I have learned valuable lessons. I have learned much about myself and what I value and treasure. I do not know what lessons each of us may learn from this pandemic, but I do know there is something of value to learn if we leave ourselves open.

As I conclude this message, I feel a tremendous sense of community and hope. In some perverse way, this event has given all of us a “time out.” Perhaps this is our time to reflect, reconnect with others and remember what is truly of value in this life. I wish you all well.

Dan Marullo, Ph.D., is a pediatric psychologist and neuropsychologist at Children’s of Alabama and the University of Alabama at Birmingham.

Children's, Health and Safety

Preventing Cardiac Arrest in Young Athletes

Annual pre-participation physicals can help prevent cardiac arrest in young athletes.  Cardiac arrest occurs when the heart malfunctions and stops beating unexpectedly. With its pumping action disrupted, the heart cannot pump blood to the brain, lungs and other organs.  This can cause sudden cardiac death in a matter of minutes.

Signs of  Cardiac Arrest

  • sudden collapse
  • no pulse
  • no breathing
  • loss of consciousness

Cardiac arrest is possible to survive if the child receives immediate medical care via  cardiopulmonary resuscitation (CPR) or  an automated external defibrillator (AED), a device that delivers an electrical shock to help the heart re-establish an effective rhythm.

Medical Conditions That Can Lead to Cardiac Arrest

  • heart disease
  • heart attack
  • enlarged heart
  • electrical problems in the heart
  • electrical shock
  • an injury to the heart at the wrong moment in  the heart’s cycle

Other Risk Factors

  • health supplements
  • energy drinks
  • illegal drug use
  • not being truthful about medical conditions

Barbara Mostella, RN,  Pediatric Cardiology Clinic supervisor at  the University of Alabama at Birmingham (UAB) and Children’s of Alabama, said it is important for young athletes to have an annual medical exam by a physician  before playing sports. “Even though any young person can have a cardiac arrest, athletes are at a higher risk with competitive exercise if there is an underlying heart condition.”

Children’s  and UAB Pediatric Cardiology established Alabama LifeStart  to encourage schools  to have AEDs readily available and  establish an emergency action plan with trained personnel. “The preventive measures encouraged during this initiative provides the school staff with a means to help save a child’s life in the event of a cardiac arrest,” Mostella said.

A Preventive Checklist

  • Annual Medical Exams
    • In Alabama, the state requires high school athletes to have an annual medical exam/pre-participation physical by a physician. A physician who knows your child’s medical history is the best person to perform  the exam. If you choose to use a school sports physician, the medical report should be sent to your child’s regular pediatrician to review and keep on file with their medical records.
    • A screening or medical form questionnaire is also required and should be completed truthfully. The screening includes questions about your child’s medical and family history. 
  • Symptoms – if these occur during or after exercise, they should not be ignored and evaluated immediately by a medical professional
    • tiredness
    • unusual shortness of breath
    • dizziness
    • fainting
    • chest pain
    • rapid heartbeat
    • seizures
  • Treatment
  • If symptoms occur, special tests may be required (electrocardiogram or EKG, echocardiogram, stress test, etc.) to determine if there is a heart condition.
  • Follow-up and care as needed with a physician/cardiologist if abnormalities are found.
Children's

Vitamins

Should your child take vitamins to stay healthy? There are many multi-vitamins marketed for kids, including fruit flavored gummy vitamins, but are they necessary?

 

Jeana Jackson, Nutrition Director at Children’s of Alabama says because vitamins are stored in the body, eating a variety of different food groups is all that is necessary. “The good news is generally most of our patients will get all of the vitamins and minerals they need from a healthy and well-balanced diet.” Jackson says.

If your child is a picky eater and you have concerns about whether they are getting enough variety in their diet, Jackson recommends talking to your child’s pediatrician about their nutrition. In this case she says a multi-vitamin may do the trick.

There are other instances when vitamins are recommended. “Babies that are exclusively breast fed need vitamin supplementation from their first few days of life because breast milk is low in Vitamin D”, Jackson says.  She also says a child’s pediatrician may recommend supplementation in the instance of diseases like Crohn’s or Inflammatory Bowel Disease.

The American Academy of Pediatrics does not recommend a multi-vitamin for children. However, Jackson says if a parent chooses to give their child a multivitamin, they are generally safe. She recommends against a large dose of vitamins that may cause problems with nutrient absorption of other vitamins and minerals. An example of this would be a C vitamin that doses well beyond the Recommended Dietary Allowance.

Children's

Bronchiolitis

 

bronc pic

 

Bronchiolitis is a lung infection that can be common in young children and infants. It causes bronchioles (small airways in the lung) to get inflamed and congested. The sickness is usually caused by a virus, which infects the smallest airways in the lungs. The bronchioles become inflamed and produce mucus, which causes difficulty breathing.  It is most common during winter months. The symptoms begin like a cold and then progress to wheezing, coughing, and difficulty breathing. Symptoms can last a few weeks to a month. Normally, children can heal at home without requiring hospitalization.

Symptoms

  • Coughing
  • Runny nose
  • Stuffy nose
  • Low grade fever
  • Difficulty breathing
  • Whistling noise when the child breathes

 

Causes

Most cases of bronchiolitis are caused by the by Respiratory Syncytial Virus (RSV). RSV is very common and infects almost every child by the age of 2. Outbreaks of the virus occur every winter. The virus can be spread easily through droplets in the air when someone with RSV coughs, sneezes, or talks. It can also be spread by touching shared objects such as door handles, toys or utensils and then touching your eyes, nose, or mouth.

 

Risk Factors

Infants younger than the age of 3 are at the greatest risk of getting RSV because their immune systems are not fully developed.

Other factors include:

  • A depressed immune system
  • A child with a heart or lung condition
  • Exposure to tobacco smoke
  • Contact with multiple children
  • Siblings who attend school

 

 

When to see a doctor

Call the doctor if your child has the following symptoms:

  • Difficulty eating, swallowing, or drinking
  • Breathing becomes rapid and shallow
  • Vomiting
  • Skin turns pale
  • Sluggish appearance

Call 911 or take your child to the nearest emergency room if your child has the following symptoms:

  • Respiratory distress
  • Lethargic appearance
  • Skin turns blue

 

Prevention and Treatment

The best prevention for bronchiolitis is washing your hands frequently; especially before touching a child when you’ve had a respiratory illness. If your child has bronchiolitis, keep them home until they are well to prevent the spreading of the infection.

More prevention tips: Don’t allow children to share drinking glasses or utensils with others, teach children to cover their coughs and sneezes and Disinfect surfaces in your home.

Vaccines and Medication

There are no vaccines for the most common forms of RSV, but an annual flu shot is recommended for everyone over 6 months old.

Children's

PERTUSSIS-THE 100 DAY COUGH

Whoop image.jpg

Cold and flu are not the only illnesses that may be approaching this fall and winter. Outbreaks of Pertussis, better known as ‘whooping cough,’ also occur more often during cold and flu season. Pertussis is a highly contagious respiratory illness caused by the spread of a bacteria called Bordetella pertussis. Pertussis causes swelling of the airways, leading to a violent “whoop sounding” cough.   This cough has been known to last up to 10 weeks or more. Although pertussis can affect people of all ages, it can be life-threatening for infants. According to the Centers for Disease Control, children are at a greater risk of getting pertussis. About 50% of children under the age of 1 infected with pertussis require hospitalization. The best way to prevent Pertussis is to get the DTaP (Diphtheria, Tetanus, Pertussis) vaccine.

Signs and Symptoms

In the early stages, pertussis may appear to be a common cold. Symptoms may include:

  • Runny nose
  • Low-grade fever
  • Occasional cough
  • Pauses in breathing (in infants)

Symptoms after having Pertussis for 1-2 weeks may include:

  • Multiple rapid coughs followed by a high-pitched “whoop” sound. This cough often occurs at night.
  • Vomiting during or after coughing
  • Exhaustion after coughing

Prevention

  • Use tissues to cover the mouth and nose when sneezing or coughing.
  • Throw away tissues after use.
  • Cough and sneeze into your upper sleeve or bend of the elbow to help keep the hands clean.
  • Wash hands with soap and water for at least 20 seconds
  • Use hand sanitizer throughout the day
  • Vaccinate your child.  9 out of 10 children are fully protected from the virus after receiving the vaccine.
  • DTaP (Diphtheria, Tetanus, Pertussis) vaccine for babies and children
  • TDaP (Tetanus, Diphtheria, Pertussis) booster shot for preteens, teens, and adults
  • Pregnant women may receive the TDaP vaccine between 27-36 weeks of pregnancy.

For more information about vaccinations regarding pertussis and other diseases, please visit https://www.cdc.gov/pertussis/vaccines.html

To schedule your appointment for pertussis vaccination, please visit https://www.childrensal.org/HowtomakeAppointments

 

 

Children's

Psychiatric Intake Response Center (PIRC)

Navigating the mental health care system is challenging for patients, families and providers. A new resource based at Children’s of Alabama helps to bridge this gap for parents. The Psychiatric Intake Response Center (PIRC) is a collaboration between Children’s of Alabama and the Anne B. LaRussa Foundation for Hope.

 

PIRC Director Cindy Jones says “PIRC provides resources to any adult caller and we have more than 1,300 resources in the state of Alabama.”

 

The PIRC is only one of three of its kind in the country. When a parent has concerns about their child, they are able to call PIRC confidentially. Licensed mental health clinicians trained to assess a child or teen’s emotional and behavioral needs answer the calls. “If someone calls the PIRC, we are able to briefly assess the situation and point them in the direction of resources in the community,” Jones says. PIRC does not provide over the phone diagnoses.

 

Jones says parents should watch for signs of mental distress:

  • Isolating themselves
  • Changes in eating habits
  • Weight changes
  • Changes in sleeping habits
  • Mood swings

Children and teens shouldn’t suffer alone. There are hundreds of resources available in the state of Alabama to help families navigate through difficult situations and offer them support.

 

PIRC is open seven days a week from 8 a.m. to 11 p.m. Any adult with a mental health question or concern regarding their child is encouraged to call 205-638-7472. In the event of a crisis situation, call 911 or go to the nearest emergency room.

Children's

World Thrombosis Day

thrombosisThrombosis or blood clot does not occur often in children. However, a hospitalized child has a much higher chance of developing a blood clot, mainly due to the use of a small soft tube (central venous catheter) that is inserted into a vein to give medicines, nutrients, blood products, or fluids.

The Pediatric Thrombosis Program at Children’s provides comprehensive care to children who have blood clots. Our team includes physicians, pharmacists, nurse practitioners, nurses, school liaisons, social workers, child life specialists and other health care professionals committed to the care of infants, children and young adults affected by blood clots.

Q: What is a blood clot?

A: A blood clot forms when blood becomes solid rather than liquid. Blood clots happen mostly in veins or blood vessels that carry blood back to your heart from the rest of your body, but can happen in arteries too. Some common places for blood clots to form are arms, legs and lungs.

Q: What are symptoms of a blood clot?

A: Symptoms are different for each person and depend on where the blood clot is. If a blood clot is in your arm or legs (known as deep vein thrombosis or DVT), you may have pain at the site along with redness and/or swelling of affected area. If a blood clot forms in your lungs (known as pulmonary embolism or PE), you may have sudden chest pain that is worse when you take a deep breath. You may also feel short of breath and may cough up blood.

Q: What are causes of blood clots?

A: Anyone can get a blood clot.  Many things can make you more likely to have a clot. The most common risk factor in children is the use of a central venous catheter. Some other common risk factors include:

  • Increased estrogen (steroid hormones in the body)
    • Birth control (pills, patches, rings)
    • Pregnancy
    • Estrogen hormone therapy
  • Medical conditions
    • Cancer
    • Inflammatory conditions such as lupus, sickle cell disease and inflammatory bowel disease
  • Other
    • Obesity
    • Smoking
    • A family history of blood clots
  • Immobility
    • Hospitalization
    • Sitting too long (long car or plane rides)
  • Surgery/Trauma
    • Major surgery (hip, abdomen, knee)
    • Broken bone

Q: How are blood clots diagnosed?

A: When a blood clot is suspected, your doctor will start with a medical history and physical exam. Then imaging studies may be done to confirm there is a blood clot. The most commonly used imaging to diagnose DVT is a Doppler ultrasound. CT scan is the test of choice to diagnose a PE.

Q: How are blood clots treated?

A: The main treatment for blood clots is anticoagulant medication  or blood thinners. Blood thinners may be given as a pill by mouth, a shot into the skin or through a shot into a vein.  Your doctor will decide how long you need to be treated depending on why you developed a clot in the first place.

The goals of these medicines are:

  • To keep the clot from getting bigger
  • To stop the clot from breaking and going to other parts of your body (lungs/brain).
  • To stop a new clot from forming
  • To decrease long term effects of having a clot

 

For more information about our Pediatric Thrombosis Program, services we offer and conditions we treat, visit www.childrensal.org/thrombosis

Children's, Health and Safety

Poison Purse

There are many poison dangers that parents of small children need to be aware of, from the cleaning products found in the kitchen to medicine stored in a bathroom. But there’s a hidden danger you may not have considered. How many poisonous items can be found in your purse or the purses of any guests in your home? Ann Slattery is the Director of the Regional Poison Control Center at Children’s of Alabama. She says a woman’s purse can contain any number of poison dangers. “When people come into your home they may bring things that are harmful to your child in their pocketbook,” she says.

Some examples of dangerous items often kept in purses:

A non-childproof pill container: It could contain medications that are dangerous to a small child like heart medicine, an iron tablet, or a painkiller.

Toothpaste: May cause an upset stomach and possible fluoride poisoning.

Eye drops:  Especially the ones that remove redness could lower heart rate and blood pressure.

Hand sanitizer, hair spray, perfume: All contain alcohol and can cause intoxication, including the risk of respiratory arrest and death

Button batteries: Can get lodged and burn through the esophagus quickly

Hand lotion, nail polish, lipstick: All can be irritating to the stomach and potentially dangerous

Slattery says the dangers are especially present when small children five and under are the in home. She advises placing purses and bags, including your guests’ bags away. “For children five and under this would be something we would worry about, just keep it out of sight, out of reach,” she says. Likewise be mindful of the contents in your purse when you visit someone else’s home with small children.

If you suspect your child has ingested something poisonous, call the Regional Poison Control Center at 1-800-222-1222. The service is free and confidential, and health care providers are available to take calls 24 hours a day, seven days a week.

 

 

Children's, Health and Safety

Heat Illness

HeatExhaustion.jpgThe heat index in Alabama is expected to be very high at greater than 95 degrees over the next several days.  Dr. Hannah Gardner says, “kids are at risk for heat cramps, heat exhaustion and heat stroke if they play outside or have athletic practices in this hot, humid weather. It’s important for parents and coaches to be aware of the signs and symptoms of heat illness.”

Signs and Symptoms

Of heat exhaustion:

  • increased thirst
  • weakness and extreme tiredness
  • fainting
  • muscle cramps
  • nausea and vomiting
  • irritability
  • headache
  • increased sweating
  • cool, clammy skin
  • body temperature rises, but to less than 105°F (40.5°C)

Of heatstroke:

  • severe headache
  • weakness, dizziness
  • confusion
  • fast breathing and heartbeat
  • loss of consciousness (passing out)
  • seizures
  • little or no sweating
  • flushed, hot, dry skin
  • body temperature rises to 105°F (40.5°C) or higher

What to Do

If your child has symptoms of heatstroke, get emergency medical care immediately.

For cases of heat exhaustion or while awaiting help for a child with possible heatstroke:

  • Bring the child indoors or into the shade immediately.
  • Undress the child.
  • Have the child lie down; raise the feet slightly.
  • If the child is alert, place in a lukewarm bath or spray with lukewarm water.
  • If the child is alert and coherent, give frequent sips of cool, clear fluids.
  • If the child is vomiting, turn onto his or her side to prevent choking.

To help protect kids from heat illness

  • Teach kids to always drink plenty of liquids before and during activity in hot, sunny weather — even if they’re not thirsty.
  • Kids should wear light-colored, loose clothing on hot days and use sunscreen when outdoors.
  • On hot or humid days, limit outdoor activity during the hottest parts of the day.
  • Teach kids to come indoors, rest and hydrate right away whenever they feel overheated
Children's, Health and Safety

Preparing your child for Surgery

Has your child’s doctor said he or she will need to have surgery? This can be a scary time for the child and parent. But there are some things you can do to help ease your child’s anxiety and ensure a smoother experience.

Laura Lovell is a Child Life Specialist at Children’s of Alabama. She says the most important recommendation is to be honest with your child. “We encourage you to be honest with your child,”Lovell says. “We have a lot of families come in and the first thing they say is, ‘We didn’t tell them why we’re here.’This adds a lot of stress in addition to being in an unfamiliar environment.”Lovell says a lot of the anxiety can be lessened by talking with your child in advance about what they can expect.

Lovell recommends parents have honest conversations that are age appropriate for the child. For a younger child, she recommends looking for toys that are similar to what the child would see in the hospital. Most toy stores have doctor’s office toys that may include items like a stethoscope or a blood pressure cuff. Lovell encourages parents to engage younger children in role play, or encourage the child to play “doctor”with a stuffed animal.

Lovell also recommends a child bring a comfort item with them the day of surgery. “We do encourage them to bring something of comfort with them, whether that’s a blanket, or a stuffed animal or a toy, something they can have as they’re going back to the operating room and waking up in recovery,”she says.

Older children and teens can benefit from special attention as well. When preparing a teenager for surgery, Lovell says older kids can typically benefit from a little more detail. “We encourage the teens to ask questions,”she says. She adds that teens may want to bring an item of comfort too like a favorite blanket.

Children’s of Alabama and all pediatric facilities are especially geared to respond to the needs of children. “We cater to children, we have an amazing staff that will go through and explain everything to the child,”Lovell says. “We give them opportunities like choosing a flavor for their mask. There are choices they can make so they feel empowered to be part of their care.” If a child is especially anxious prior to surgery, parents can schedule a pre-surgery tour. Lovell recommends contacting the child’s pediatrician to request that tour through the Child Life Department.