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Children's, Health and Safety

Parenting During a Pandemic

“During a pandemic, risk factors for child abuse and neglect like parental stress due to finances and instability increase,” said Deb Schneider, director of Children’s Hospital Intervention and Prevention Services (CHIPS) Center at Children’s of Alabama. Now that schools and childcare centers are closed due to the COVID-19 pandemic, it’s important to make plans to keep kids busy at home. Advance planning and working together can help reduce stress in the household.

Parenting During a Pandemic

  • Establish a routine to help children cope with anxiety
  • Limit children’s access to news and social media related to the pandemic.
  • Never discipline a child when you are angry.
  • If you, the parent/caregiver, are experiencing stress and anxiety, take a break. Call a friend or family member.
  • Family activities like walking, playing card games and working puzzles help ease stress.
  • Give children access to art supplies and music as alternatives to screen time

Being away from friends, extended family and social activities can be hard on teens and kids. To help them stay connected,  set up FaceTime or Skype playdates or visits.

Recognizing and Reporting Abuse

While kids are currently out of school due to the COVID-19 pandemic,  experts at Children’s of Alabama want to remind you of the importance of recognizing and reporting abuse of any kind.

“By learning common types of abuse and what you can do, you can make a huge difference in a child’s life,” Schneider said. “The earlier abused children get help, the greater chance they have to heal from their abuse and not perpetuate the cycle.”

The four types of child abuse are:
• Physical Abuse
• Sexual Abuse
• Emotional Abuse
• Neglect

The signs of child abuse vary depending on the type of abuse, but there are some common indicators.

Warning signs of emotional abuse in children:
• Excessively withdrawn, fearful or anxious about doing something wrong
•  Extremes in behavior (extremely compliant or extremely demanding; extremely passive or extremely aggressive)
• Doesn’t seem to be attached to the parent or caregiver
• Acts either inappropriately adult (taking care of other children) or inappropriately infantile (rocking, thumb sucking, tantrums)

Warning signs of physical abuse in children:
• Frequent injuries or unexplained bruises, welts or cuts
• Is always watchful and “on alert,” as if waiting for something bad to happen
• Injuries appear to have a pattern such as marks from a hand or belt
• Shies away from touch, flinches at sudden movements or seems afraid to go home
• Wears inappropriate clothing to cover up injuries,i.e.  long-sleeved shirts on hot days

Warning signs of neglect in children:
• Clothes are ill-fitting, filthy or inappropriate for the weather
• Hygiene is consistently bad (unbathed, matted and unwashed hair, noticeable body odor)
• Untreated illnesses and physical injuries
• Is frequently unsupervised or left alone or allowed to play in unsafe situations and environments
• Is frequently late or missing from school

Warning signs of sexual abuse in children:
• Trouble walking or sitting
• Displays knowledge or interest in sexual acts inappropriate to his or her age, or even seductive behavior
• Makes strong efforts to avoid a specific person without an obvious reason
• Doesn’t want to change clothes in front of others or participate in physical activities

Supervision is important. Know where your children are. Make sure children know sexual abuse is never their fault and that they won’t be in any trouble if they tell.

Help for Alabama’s abused children is available at the CHIPS Center. The CHIPS Center provides forensic medical evaluations, psychosocial assessments, play therapy, counseling for non-offending caregivers and other support services. All counseling and preventive services are free. If you suspect a child has been or is being abused,   please contact your county Department of Human Resources or  call the CHIPS Center at Children’s by dialing 205-638-2751. For more information,  visit childrensal.org/CHIPS.

Children's, Health and Safety

HAND SANITIZER: KEEPING LITTLE HANDS CLEAN AND SAFE

Hand Sanitizer

Door knobs. Stair rails. Elevator buttons. Just the thought of touching any of those during cold and flu season and now coronavirus may send you running for the nearest bottle of hand sanitizer. Hand sanitizer is a convenient way to keep your hands clean and germ-free, but parents should be aware of the potential harm it can cause.

“There are times when you don’t have access to good old-fashioned soap and water to wash your hands,” said Ann Slattery, director of the Alabama Poison Information Center at Children’s of Alabama. “Using hand sanitizer is an easy way to stay healthy when you’re on the go, but it’s not without its own inherent danger because it contains alcohol.”

In order to be most effective against germs and viruses a hand sanitizer must contain  60 to 95 percent alcohol, and many formulas contain a stronger alcohol concentration than most hard liquors. Just 1 ounce of hand sanitizer – most are greater than 60 percent – has the same alcohol content as a 12 ounce can of beer. Therefore, accidental ingestion or intentional misuse of hand sanitizer is cause for concern.

“From a young child’s perspective, hand sanitizer may smell good, and it’s usually in brightly colored, glittery bottles,” Slattery said. “With older children, there are reports of them daring others to drink it.”

“The number of reported cases of hand sanitizer exposure in Alabama has grown since 2011. That year, there were 159 exposure calls to the Alabama Poison Information Center involving hand sanitizer. In 2019 the APIC documented almost 300 hand sanitizer poison exposures in Alabama,” Slattery said. Nationally, there were nearly 20,000 reported hand sanitizer exposure cases in 2018.

To prevent potentially harmful exposure to hand sanitizer:

  • Keep hand sanitizer well out of reach of children at all times.
  • Children should use hand sanitizer only with adult supervision.
  • Apply a dime-sized amount of sanitizer to dry hands and rub together until completely dry.

If you suspect your child may have ingested any amount of hand sanitizer, Slattery encourages parents to call Alabama Poison Information Center at 1-800-222-1222 immediately. The signs won’t always be as obvious as an empty bottle lying around. “When in doubt, check it out,” she said.

Some potential symptoms of harmful exposure to hand sanitizer include:

  • Drowsiness
  • Stumbling
  • Falling

Some delayed symptoms could include a drop in blood sugar and a drop in body temperature.

The Alabama Poison Information Center’s hotline is available 24 hours a day, 7 days a week always free and confidentially. Established in 1958, The Alabama Poison Information Center at Children’s of Alabama receives more than 50,000 poison calls annually, plus makes more than 60,000 follow-up calls. For more information, visit https://www.childrensal.org/apic

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.
Health and Safety

FAQS: 2019-2020 FLU SEASON

Q: What is influenza or flu?

A: Influenza (also known as the flu) is an infection of the respiratory tract. It is caused by a virus that spreads easily from person to person.  It spreads when people cough or sneeze out droplets that are infected with the virus and other people breathe them in. The droplets also can land on things like doorknobs or shopping carts, infecting people who touch these things.

Q: Is flu contagious?

A: The flu is very contagious. People can spread it from a day before they feel sick until their symptoms are gone. This is about one week for adults, but it can be longer for young children.

Q: How will I know if my child has flu and not just a cold?

A: The fall and winter months are cold and flu season. Both the cold and the flu can present similar symptoms, including cough, congestion and runny nose. In general, the flu hits a lot harder and quicker than a cold. When people have the flu, they usually feel worse than they do with a cold. Most people start to feel sick about two days after they come in contact with the flu virus.

Flu symptoms include:

  • fever
  • chills
  • headache
  • muscle or body aches
  • dizziness
  • loss of appetite
  • tiredness or fatigue
  • cough
  • sore throat
  • runny or stuffy nose
  • nausea or vomiting
  • weakness
  • ear pain
  • diarrhea or vomiting, ( more common in children than adults)

Q: Is it too late for my child to get this season’s flu vaccine?

A: There’s still time to get a flu vaccine this season. Flu season in the United States is from October to May. Vaccines are provided at most pediatricians’ offices. The American Academy of Pediatrics (AAP) recommends the flu shot for everyone over 6 months old.

Q: What is the treatment for flu?

A: Most children with flu get better at home. In the event a child does get sick, you can help mitigate symptoms. Make sure your child is drinking plenty of fluids. You can give appropriate doses of acetaminophen or ibuprofen to relieve fever and aches, and make sure they are getting plenty of rest.

Q: When should I seek medical treatment for my child if I suspect flu?

A: Bring your child to the doctor if you’re concerned about severe symptoms. Most of the time parents can care for their children with plenty of rest, fluids and extra comfort. Some children are more likely to have problems when they get the flu, including:

  • children up to the age of 5, especially babies
  • children and teens whose immune system is weakened from medicines or illnesses
  • children and teens with chronic (long-term) medical conditions, such as asthma or diabetes

Q: In addition to the flu vaccine, how else can we stay healthy during cold and flu season?

A:  The American Academy of Pediatrics (AAP) recommends the flu shot for everyone over 6 months old. Here are some other tips for staying healthy during cold and flu season:

  • Cover your cough and sneeze
  • Wash your hands
  • Clean living and working areas
  • Avoid crowds
  • Stay home from work or school if you are sick
  • Avoid touching your eyes, nose, and mouth

Q: How can we prevent the spread of germs in our house if my child is sick?

A: The flu virus spreads when people cough or sneeze out droplets that are infected with the virus and other people breathe them in. The droplets also can land on things like doorknobs or shopping carts, infecting people who touch these things.

Teaching children the importance of hand washing is the best way to stop germs from causing sickness. It’s especially important after coughing or nose blowing, after using the bathroom and before preparing or eating food.

There’s a right way to wash hands, too. Use warm water and plenty of soap, then rub your hands together vigorously for at least 15 seconds (away from the water). Children can sing a short song — try “Happy Birthday” — during the process to make sure they spend enough time washing. Rinse your hands and finish by drying them well on a clean towel. Hand sanitizer can be a good way for children to kill germs on their hands when soap and water aren’t available.

Cleaning household surfaces well is also important. Wipe down frequently handled objects around the house, such as toys, doorknobs, light switches, sink fixtures, and flushing handles on the toilets.

Soap and water are perfectly fine for cleaning. If you want something stronger, you can try an antibacterial cleanser. It may not kill all the germs that can lead to sickness, but it can reduce the amount of bacteria on an object.

It’s generally safe to use any cleaning agent that’s sold in stores but try to avoid using multiple cleaning agents or chemical sprays on a single object because the mix of chemicals can irritate skin and eyes.

Q: If my child has had flu, when can he return to school, child care, etc.?

A: Children with the flu should stay home from school and childcare until they feel better. They should only go back when they have been fever-free for at least 24 hours without using a fever-reducing medicine. Some children need to stay home longer. Ask the doctor what’s best for your child.

Find more information and resources at https://www.childrensal.org/cold-and-flu-updates-and-resources.

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.

Children's, Health and Safety

Safe Sleep

SIDS or Sudden Infant Death Syndrome is the number one cause of death in babies under 12 months. SIDS is the sudden and unexplained death of a baby and often occurs during sleep.

SIDS is very frightening for new parents, but there are things you can do to keep your baby safe and help prevent SIDS. Dr. Candice Dye is an Associate Professor of Pediatrics at Children’s of Alabama and UAB. She says parents and caregivers of babies should remember the ABCs of Sleep. “Alone, on their back, in a crib. It’s that simple,” she says.

ABCs of Sleep
•Alone
•On their Back
•In a Crib

Dr. Dye explains each point:

ALONE- “Items in the crib pose a huge suffocation risk,” she says. “No bumper pads, no stuffed animals, no loose blankets. Nothing else in the crib. A boring crib equals a healthy baby.”

On their BACK- “This is different from when our grandparents or parents were doing this, but babies should be laid down on their back,” Dr. Dye says. “This ensures that the baby can breathe and they are not getting trapped face down unable to breathe.”
In their CRIB- “It’s really easy for parents to be tired and want to keep the baby in their bed with them, but an adult mattress is not the same as an infant crib mattress and there is the risk of the adult rolling onto the baby while sleeping,” she says.
Who is at risk?

All babies are at risk for SIDS. There is no single cause. However, SIDS is more common in black and Native American infants than in Caucasian infants. More boys than girls fall victim to SIDS.
Other risk factors include:
•Smoking, drinking or drug use during pregnancy and after birth
•Poor prenatal care
•Prematurity or low birth weight
•Family history of SIDS
•Mothers younger than 20
•Exposure to secondhand smoke
•Overheating

Dr. Dye strongly recommends that parents make grandparents and caregivers aware about the risk of SIDS and that they follow the ABCs of sleep when caring for the baby. She also cautions parents not to rely on store-bought devices or gadgets that may claim to help prevent SIDS.
Once babies consistently roll over from back to front on their own, they are less at risk of developing SIDS and can sleep in the position they choose. Until then, a parent can greatly reduce the risk of their child dying by SIDS by following the ABCs of sleep.

Children's, Health and Safety

Antibiotic Resistance

Your child has a cold and feels miserable. You take him or her to the pediatrician expecting an antibiotic as treatment. Unfortunately, this mindset has lead to more and more children becoming dangerously resistant to antibiotics.

 

Dr. Shannon Ross is with Infectious Diseases at Children’s of Alabama. She says antibiotic overuse is leading to children becoming very sick and harder to treat. “We see children every day who five to 10 years ago, we could have treated with an oral antibiotic. But because there are not many options, we are having to admit them and give them an IV antibiotic,” she says.

Most illnesses are caused by a virus. However, antibiotics don’t treat viruses. They treat bacterial infections. “A bacterial infection would be something like pneumonia or an ear infection,” Dr. Ross says. “And antibiotics are necessary to treat those infections.” Antibiotics can even be life-saving when used to treat a bacterial infection. But if a child receives antibiotics when it’s not needed, this overuse can lead to the child being resistant over time. “We are seeing, over the past decade or so, increasing resistance,” Dr. Ross says. “Common infections, pneumonias, bladder infections we used to treat easily are now resistant to common antibiotics.”

Antibiotic resistance is a widespread problem. The Centers for Disease Control and Prevention (CDC) calls it “one of the world’s most pressing public health problems.” Dr. Ross says parents can play an essential role in preventing antibiotic resistance. “When taking your child to the pediatrician, talk to your pediatrician about the diagnosis.If he or she prescribes an antibiotic, it’s OK to ask what the antibiotic is for and if it’s necessary.” She also advises that parents don’t pressure pediatricians to prescribe medicine their child doesn’t need.

If the pediatrician does prescribe an antibiotic. Remember these safety tips:

  • Take antibiotic exactly as prescribed
  • Don’t skip a dose
  • Finish the course of treatment
  • Never share antibiotics with anyone else

Parents can also help fight antibiotic resistance by encouraging their children to take simple steps to prevent the spread of infections. Encourage hand-washing and make sure your child is up to date on their immunizations. Also, remember if your child has a cold the best thing to do is “ride it out.” Help keep them hydrated and make sure they get plenty of rest. This will help their immune system to fight off the virus on its own.

Children's, Health and Safety

When to Visit the Emergency Department

Your child doesn’t feel well, but should you take them to the emergency department? Sometimes it can be hard to tell when a child requires urgent medical treatment or if the concern can wait.

Dr. Sam Strachan is a pediatric emergency fellow.  He says the emergency department at Children’s of Alabama alone receives approximately 80,000 visits each year.  That’s an average of 219 patients each day!

Dr. Strachan says the emergency department will never turn anyone away, but a child may be better served and have a shorter wait time by seeing their pediatrician instead.  “Every child should have a pediatrician,” he says.  “If a child isn’t feeling well, even in the middle of the night, you can always call your pediatrician’s on-call number for advice.”

You should always take your child to the emergency department in a true emergency.  These signs include:

Go to Emergency Department

  • serious injury
  • trouble breathing
  • not drinking enough, not urinating enough
  • unusual sleepiness or confusion
  • a head injury and is vomiting
  • an eye injury
  • a serious burn

Call 911 if your child

  • isn’t breathing or is turning blue
  • is unconscious after a fall
  • is having a seizure
  • has a serious allergic reaction
  • has broken a bone that sticks out through the skin
  • is choking
  • has a large cut that is bleeding uncontrollably

A high fever can be scary for a parent to see, however, Dr. Strachan says it’s the body’s natural defense mechanism against infection.  “A lot of parents are concerned with a fever of 104 or 105 in their child,” he says.  “However children can deal with high fevers better than adults can.”  Babies are the exception.  “Any baby under two months old should be seen right away for any fever greater than or equal to 100.4,” he says.

Dr. Strachan offers these tips to help decide if a child needs to go to the emergency department in the event of a fever:

  • If feverish, try Motrin or Tylenol, depending on the age of the child
  • If the child feels well between fever, wait to see pediatrician until the next day

If it’s not a true emergency, it’s always best to wait to see your child’s pediatrician. “On the front end you’re taking away resources from children who really need it,” Dr. Strachan says. There’s another benefit to seeing the pediatrician.

“They know your child, they know your child’s history,” Dr. Strachan says.

Through an established relationship with a pediatrician, a child can receive better long term care.