Inside Pediatrics Spring/Summer 2026

PEDIATRICS

Spring/Summer 2026

PATHS TO BETTER PATIENT CARE FIVE STORIES THAT SHOW NEW ROUTES CHILDREN’S IS TAKING TO HELP PATIENTS

ALSO INSIDE: SPLIT-LIVER TRANSPLANT— A MILESTONE FOR CHILDREN’S AND UAB (PG. 20)

A t Children’s of Alabama, we take pride in providing our patients with the best possible care, whatever it may take. In some cases, this involves developing unique strategies or taking an extra step to address challenges. These Paths to Better Patient Care are the focus of this issue of Inside Pediatrics. In orthopedics, our team addressed a common problem by modifying an existing procedure. Now, patients with patellar instability are returning to sports and other activities faster and with fewer complications. Our neurosurgery and hematology teams each encountered the same challenge: the need for mental health support for patients with certain conditions. Both divisions took the unique approach of embedding psychologists within their teams to serve these patients. In gastroenterology, leaders turned to expansion. To improve patient care, they realized they needed more people. So in the last couple of years, they’ve added six faculty. As you’ll see in this issue, it’s already made a difference, and it’s setting the team up for more success going forward.

Tom Shufflebarger, President and CEO

For our urology team, technology provided an answer. When leaders in this division realized many families were making long drives here only to learn their child simply needed better bathroom habits, they began offering telehealth for patients with certain symptoms. It has made life easier for many patient families. Each of these stories showcases how our teams are finding the best paths to improving patient care. These are just some of the ways we are here for all the patients we serve.

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On The Cover: Along the journey of patient care, obstacles often abound for both patients and providers. It might involve a crowded waiting room, a challenging condition, or a long recovery. At Children’s of Alabama, we encounter many of these impediments. But we don’t let them derail us. When the road seems blocked, we find a way around it—a Pathway to Better Patient Care. In the five feature stories in this issue, you'll see how we’ve faced problems, developed solutions, and in some cases, blazed new trails.

Inside This Issue:

ADMINISTRATION Tom Shufflebarger, President and CEO Chandler Bibb, Chief Development Officer Garland Stansell, Chief Communications Officer

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Division Rounds Quick briefs and news from around the hospital

EDITORIAL Conan Gasque, Editor Amy Dabbs

Reconstruction Reimagined The modified procedure to help patients with patellar instability Paths To Better Patient Care FEATURE STORIES:

DESIGN Becca Hodges Scott LeBlanc Dana Stuckey

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ILLUSTRATION Raúl Arias

PSYCHOLOGICAL SUPPORT: PART 1 Helping Patients with Sickle Cell Disease

PHOTOGRAPY Maurice Adams Eric Gray Denise McGill CONTRIBUTORS Debra L. Gordon, MS Sarah Handzel, BSN, RN Julia Kasmirski Rhonda Lee Lother Angel Pine Maureen Salamon Heather Watts

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PSYCHOLOGICAL SUPPORT: PART 2 Addressing PTSD in Kids with Hydrocephalus

Creating a New Ecosystem How division expansion is transforming care in gastroenterology

When Nature Calls A telehealth solution for patients with bathroom issues

DIGITAL CONTENT Andre Green

MEDICAL LEADERSHIP Yung Lau, M.D. Katharine Reynolds Ireland Chair of Pediatrics Chair, UAB Department of Pediatrics Physician-in-Chief, Children’s of Alabama Mike Chen, M.D., MBA Joseph M. Farley Chair in Pediatric Surgery University of Alabama at Birmingham Chief of Pediatric Surgery & Surgeon-in-Chief Children’s of Alabama Sonya Pritchard, M.D. Professor Chief of Service, Child & Adolescent Psychiatry Children’s of Alabama

Recognitions News, honors, awards, and leadership

For questions or additional information or to share feedback, please contact us at InsidePediatrics@ChildrensAL.org . An online version of the magazine is available at ChildrensAL.org/InsidePediatrics.

DIVISION ROUNDS

For a closer look at these stories and more, visit InsidePeds.org.

ENDOCRINOLOGY

A Look at the Future of Type 1 Diabetes Management

A journal supplement co-edited by Ambika P. Ashraf, M.D., director of the Division of Pediatric Endocrinology and Diabetes, takes a look at different ways to approach the management of type 1 diabetes (T1D), some of which could slow, stop, or even prevent the disease.

The supplement, which appeared in Frontiers in

Endocrinology, was published as a collection of 14 peer-reviewed research articles on T1D. It brings together researchers from around the world and addresses immune modulation, beta-cell preservation, remission, screening, gene editing, stem cell therapies, and metabolic memory. Two articles are authored by researchers at Children’s of Alabama and the University of Alabama at Birmingham (UAB). The supplement focuses on three questions: Can we slow or stop the immune destruction of beta cells? Can we preserve insulin production? Can we delay or prevent the onset of symptomatic type 1 diabetes? Another theme in the supplement is screening for antibodies that predict type 1 diabetes risk before symptoms appear, which opens the door to interventions when they are most beneficial.

Several articles in the collection explore therapies that support beta cell health without suppressing the immune system but by strengthening the cells themselves. These include medications such as verapamil, experimental TXNIP targeting drugs, and high dose GABA, all of which aim to help insulin producing cells survive longer. Perhaps the most important message of the supplement is that there likely will not be a one-size-fits-all approach for people with T1D, but a mix of options based on the individual patient. As Ashraf and her co-editors wrote in an editorial in the issue: “The innovative concepts highlighted here will undoubtedly shape the future of diabetology and inspire further research into state- of-the-art, disease-modifying therapies for T1D.”

DIVISION ROUNDS is a brief roundup of the innovative work Children’s of Alabama’s medical experts are doing in various divisions around the hospital. It showcases how we’re improving patient care and influencing the world of medicine. For more details and to find similar stories, please visit InsidePeds.org .

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CARDIOLOGY

Building a Team Around Pulmonary Hypertension

To better manage care for patients with pulmonary hypertension (PH), Children’s of Alabama is using a coordinated approach that brings together multiple disciplines on one team. The team consists of pediatric cardiologist Frank Bennett Pearce, M.D.; pediatric cardiac critical care specialists Ahmad Khalil, M.D., and Matthew Clark, M.D.; pediatric cardiology fellow Kevin Wall, M.D.; and pediatric cardiology nurse specialist Jodie Kanaday, RN. Together, they round weekly on patients with PH to determine the best course of action for this rare but complex condition. “We wanted to improve communication by having us all together saying the same thing to the consultant teams and to the families,” Pearce said. That consistency matters, especially when care unfolds over weeks or months. From a cardiology standpoint, PH has always been part of the landscape, Pearce said. “A lot of the treatment and diagnostic procedures, such as catheterizations and echocardiograms, come through cardiology anyway,” he said. “So we end up being the treating doctors in lots of cases, or at least consultants.” At the same time, many of the sickest patients are in neonatal and pediatric intensive care units and managed by critical care specialists.

Bringing these disciplines together as one team allows for better decision-making. PH is typically treated with medications such as pulmonary vasodilators regardless of cause, but timing and diagnosis matter. That’s why it’s important to have a precise anatomic diagnosis before starting medication, Pearce said. In babies with bronchopulmonary dysplasia, for instance, PH may be driven by acquired pulmonary vein stenosis—a condition that requires catheter-based or surgical intervention before medication. Previously, decisions like these might have been made in parallel by different services. Now, they are made together. The team manages about a dozen inpatient pulmonary hypertension cases each month on inpatients at Children’s and the University of Alabama Birmingham (UAB) and also provides support once the patient has been discharged.

BEHAVIORAL HEALTH

Group Therapy Playing a Crucial Role in the Mental Health Crisis In a time when many adolescents are struggling, assistance from behavioral health providers is in

environment that is perceived as being more comfortable and more relatable than individual therapy.” For many participants, the experience can be surprising. “What we hear consistently is, ‘I thought I would hate it, but now I love it—it’s the best thing that ever happened,’” Patterson said. Parents can be equally impressed when they see their children using the skills they’ve learned in therapy. Group therapy also gives providers a chance to see their patients through a new lens. “It almost lets you be a fly on the wall or gives you more insight into their day-to-day interactions,” Patterson said.

high demand. Seeing all patients in a timely manner can be challenging. But for some providers, including the Children’s of Alabama behavioral health team, group therapy is showing promising results as an effective—and efficient—way to help the many patients who need their support. Group therapy is nothing new—Children’s has been offering it for years. For adolescents in particular, it has great potential. “Pediatric patients really tend to respond well to the social aspect of a group,” said Debra Patterson, Ph.D., director of Psychology and Associated Services at Children’s. “We do know, especially among early teens and adolescents, one of the things that makes them tick is to compare themselves to peers, as opposed to parents.” In group therapy, a young person can get this. Instead of sitting in a room with a parent and a therapist—as they would in individual therapy—they’re working with five to 10 of their peers and maybe only two adults. “So it creates, for a pediatric population, an

The group context is also more efficient than individual therapy. For example, Children’s offers a focused pain coping group. By offering this in a group setting, a therapist can see and help five patients at once instead of just one. “In other words, we increase that provider’s ability to provide services by 500%, which is enormous,” Patterson said. “And these kids leave that group doing well and having all the skills that they need, just as if they had sat one-on-one.” Group therapy is not for everyone, though, Patterson says. In some cases, a patient might need individual therapy first. In others, the type of group a patient needs might not be available. Age is also a consideration. But for those who go through it, group therapy can produce the same results as individual therapy. “What the research is telling us,” Patterson said, “is that group therapy is as effective and is equivalent to individual therapies for a really wide range of diagnoses.”

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Inside Pediatrics | Children’s of Alabama

DIVISION ROUNDS (cont.)

PULMONOLOGY

Patients with CF who now have access to this disease-modifying drug 90 %

New Study Explains ETI’s Effectiveness on Cystic Fibrosis A new study involving Children’s of Alabama pediatric pulmonologist Spencer Poore, M.D., and University of Alabama at Birmingham (UAB) pulmonologist George M. Solomon, M.D., answers a key question about a transformative drug for cystic fibrosis (CF)—how does it really work? The drug, a fixed-dose combination of elexacaftor, tezacaftor, and ivacaftor (ETI), is a cystic fibrosis transmembrane conductance regulator (CFTR) modulator. When it was approved in 2019, it gave nearly 90% of patients with CF access to a disease-modifying drug. In the pivotal clinical trial, ETI significantly improved lung function and reduced pulmonary exacerbations while improving patient quality of life. But it wasn’t clear what made the drug work. Now, the PROMISE study provides part of the answer, clearly demonstrating that some of ETI’s effects are due to its ability to tamp down inflammation. Inflammation is the background noise of CF: always present, always active, contributing to lung damage, infections, fatigue, weight loss, and poor outcomes. Even when symptoms improve, some degree of inflammation continues unchecked.

487

223

Total participants in the PROMISE study

Participants specifically tracked for inflammation markers

But as PROMISE showed, ETI dramatically reduces that inflammation. The PROMISE trial is a prospective, multicenter, observational study following 487 people ages 12 and older with CF. A group of 223 participants agreed to participate in the inflammation sub-study, in which their blood and sputum were collected prior to starting ETI and then five times over the next 30 months. Within one month of starting ETI, airway inflammation markers fell sharply and remained low throughout the 30 months. At the same time, markers of system inflammation also significantly declined. As the authors wrote, “These changes represent a disease modifying benefit of this transformative therapy.” More work remains to be done. “We have not seen complete resolution,” Poore said. But, he noted, the set point has shifted. And this represents a shift in the disease itself. “What I was taught versus what I see now,” he added, “is different.”

NEONATOLOGY

A Closer Look at Chorioamnionitis

Chorioamnionitis occurs in 1–5% of births in the U.S.

1-5 %

Much of Jain’s research has delved into chorio’s potential health implications for babies once they’re born—and the effects can be devastating. One

The vast majority of preterm births—especially “micro-preemies” born at 22 or 23 weeks’ gestation—stem from a single cause: chorioamnionitis, an inflammation of the placenta and membranes surrounding the fetus. But Children’s of Alabama neonatologist Viral Jain, M.D., is on a mission to determine why the condition occurs, the ways it affects babies’ health, and how to stop it. Occurring in an estimated 1% to 5% of births in the United

of his studies shows that the incidence of cerebral palsy is far higher in infants born when chorio progresses to such a severe extent it becomes funisitis, or inflammation of the umbilical cord. To help predict the cerebral palsy risk of these infants while they’re still in the neonatal intensive care unit (NICU)—when early intervention can more easily be planned—Jain’s research has also used MRI to look for specific markers in the brain suggesting a high risk of the disabling condition. Another of Jain’s studies suggests that infants born early due to chorio have chronic lung damage. Ultimately, Jain says, his research—which has been funded by the American Heart Association and National Institutes of Health—seeks to learn how chorio propagates so doctors can impede its damage. “The goal is to find out what treatment we can give so when it’s just mild, we can stop the progression and it won’t become full-blown chorio and we end up delivering the baby preterm,” he said. “If we can do that, we can prevent a lot of organ damage to the lungs or brain.”

States, chorioamnionitis—often shortened to chorio— can be hard to spot. It’s typically diagnosed using clinical signs of inflammation, such as fever or elevated heart rates in either the mother or the baby. But chorio often eludes clinical diagnosis, silently causing damage to the placenta and triggering preterm birth, Jain says. Some of the extensive research conducted on chorio has focused on its causes, which may include infection, environmental chemicals, smoking, and bleeding. But scientists still have a poor understanding of why it happens, Jain notes, as well as how to catch it early enough to stop premature delivery.

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Inside Pediatrics provides information, news, and the latest updates from departments and divisions at Children’s of Alabama. Articles and features cover the current developments and discoveries related to pediatric medical research, clinical trials, and treatments happening today. Inside Pediatrics helps keep you connected and up-to-date on the latest breakthroughs and medical advances at Children’s of Alabama.

NEPHROLOGY

NINJA: A Decade of Preventing Acute Kidney Injury Acute kidney injury (AKI) is a common but under-recognized and preventable complication in hospitalized children. That’s why, a decade ago, Children’s of Alabama became the second of now more than 20 pediatric hospitals that are part of the Nephrotoxic Injury Negated by Just-in-Time Action (NINJA) initiative, which aims to prevent AKI in children exposed to nephrotoxic medication. As the hospital marks the 10th anniversary of this initiative, leaders estimate that it has helped them prevent more than 1,000 AKI episodes, and the rate of events continues to drop more and more each year. AKI is hardly a benign condition; even a single episode of AKI can set a child on a trajectory toward hypertension and chronic kidney disease later in life. In non-ICU patients, the most common cause is nephrotoxic medications such as aminoglycosides, NSAIDs, and vancomycin. Historically, the care of these patients was reactive, beginning when severe AKI was found. NINJA was designed to flip the script by taking a preventive approach. Now, children exposed to a high nephrotoxic medication burden—defined as three or more in one day or prolonged aminoglycoside/vancomycin use—are identified, discussed, and screened for early signs of kidney injury. “The NINJA initiative works by helping providers recognize who is at risk for AKI and asking them to be judicious and vigilant,” Children’s pediatric nephrologist David Askenazi, M.D., MSPH, said. “The buy-in has been amazing and a true testament to the hospital’s dedication to a culture of safety. While physicians have an important role, our pharmacists and quality improvement personnel are the critical NINJAs.” Multicenter studies on NINJA published in 2020 show an overall AKI reduction of 62%. Now, the Division of Pediatric Nephrology is working with the hospital’s IT experts to integrate the NINJA system into the EPIC electronic medical record (EMR). “This will enhance the clinician’s ability to see what’s happening in real time and decrease the time burden for data collection” Askenazi said. “Patients who meet NINJA criteria will be flagged immediately, and their providers will have clinical-decision tools to help streamline and optimize care.”

CATEGORIES

BEHAVIORAL HEALTH

CARDIOLOGY

ENDOCRINOLOGY

GASTROENTEROLOGY

HEMATOLOGY & ONCOLOGY

NEONATOLOGY

NEPHROLOGY

NEUROLOGY & NEUROSURGERY

ORTHOPEDICS

PULMONOLOGY

UROLOGY

UPCOMING EVENTS

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ORTHOPEDICS

Reconstruction Reimagined

CHILDREN’S SURGEONS ARE TAKING A NEW APPROACH FOR TREATING PATELLAR INSTABILITY

F or Kevin Williams, M.D., and the Children’s of Alabama orthopedic team, patellar instability is a commonly seen problem. The condition—in which the kneecap repeatedly slips out of place—and all of its inherent challenges have been the subject of much discussion worldwide recently, Williams says. But he and his team have developed a solution—a modified procedure that combines existing, well-established methods and is already showing promise.

Kevin Williams, M.D.

The procedure is called medial patellofemoral ligament (MPFL) reconstruction. Williams and his team began developing a modified version of it about two years ago and refined

it in 2025. They’ve used it on approximately 15–25 patients, and the results have been encouraging. “Children and adolescents that are still growing and developing have been able to get back to doing activities they enjoy—like dancing and gymnastics—faster compared with our previous, more invasive procedures,” he said. “Complications have been scarce so far in the early stages of this modified procedure.” THE CHALLENGES OF PATELLAR INSTABILITY The procedure treats a problem that is challenging for several reasons, perhaps most notably the various ways patellar instability can present. In some cases, a child might have been born with a kneecap problem or developed it early in childhood, which means the body is used to the anomaly. When treating children,

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Inside Pediatrics | Children’s of Alabama

orthopedic surgeons also have to manage challenges such as small bones and growth plates, “which we don't want to impede or create any problems with, because it could be detrimental toward a kid’s growth,” Williams explained. Williams and his team developed the modified procedure to address all of these challenges. It allows them to use small implants that are stitch based or suture-based and don’t require a lot of drilling. It also allows surgeons to spare the growth plate and balance the soft tissues. limited fashion by surgeons in North America and abroad, Williams says. To perform the procedure, the surgery team creates holes in the bones to attach the kneecap to the inside of the femur bone via either an allograft or autograft tissue source. Williams and his team use smaller instrumentation and grafts for this procedure to spare the growth plate and account for the smaller anatomy. “The surgical procedure is designed to grow with the patient,” he said. HOW IT WORKS MPFL reconstruction in young adolescents is performed in a

Though the team’s procedure is different from others that are available, it’s not experimental, Williams says, because it’s a combination of techniques that are already standard practice. The implants used in this procedure are approved by the U.S. Food and Drug Administration.

RECOVERY One of the biggest benefits of the new technique is recovery time. “Compared with the bigger anatomy changing surgeries, it’s much improved,” Williams said. With modified MPFL reconstruction, the patient is typically on crutches for only a week or two before they’re able to walk around mostly normally. After that, they wear a brace for up to two months. In many cases, they’re back to playing sports within three or four months, although some may need six months, depending on factors such as age and underlying conditions.

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RISKS COMPARED TO ALTERNATIVES

LOOKING FORWARD Despite the success of the procedure, it’s not something the team pushes. Williams says they typically try conservative approaches first, such as braces—which don’t typically work well in these cases—or rehab. But he says it’s a good option if surgery is needed. Williams anticipates that they’ll learn more as they perform more of these procedures. With the hospital’s move to a new electronic health record system, the team is working on strategies to better track outcomes. “That’s one of the goals for this year—we’re planning on tracking patient-reported outcomes more effectively and becoming more involved in national registries to track procedural success and contribute to research more vastly in the U.S. and abroad,” he said. So far, the team and their patients have been pleased with the impact of the modified MPFL procedure. “We've been happy with the breadth of underlying conditions our modified procedure treats, with decreased complications, and with increasing capacity for returning to sports,” Williams said. ●

Another benefit is decreased risk. Though every surgery comes with risks, Williams says the modified MPFL procedure seems to carry fewer risks compared to conventional techniques, especially when it comes to issues with the growth plate. WIDE RANGE OF USES Part of what makes the procedure successful is its ability to treat patients whose kneecap issues stem from a variety of causes. For example, many children with Ehlers-Danlos syndrome, Down syndrome, Klinefelter syndrome, and other congenital conditions are often predisposed to having kneecap problems. Williams and his team have successfully treated them with the modified MPFL procedure. It also works for patients with nail-patella syndrome and genitopatellar syndrome. The Children’s orthopedic team sees many of these types of cases because they serve the entire state of Alabama.

Children’s of Alabama by the Numbers

97 Residents

75 Categorical Pediatrics

4 Combined Pediatrics/ Genetics 3 Combined Medicine/ Neurology

15 Combined Medicine/ Pediatrics

75 Fellows

20

Fellowship Programs

for 2025–2026 Academic Year

96 . 49 % Pass Rate on First Attempt

301 Faculty

474 Publications

Top 35 in Research Funding

American Board of Pediatrics, 2016–2025

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Inside Pediatrics | Children’s of Alabama

A Helping Hand

As doctors have begun to recognize the psychological toll of certain conditions on their patients, some teams at Children’s of Alabama have embedded psychologists to help. In this two-part story, we take a look at the difference this psychological support is making in hematology and neurosurgery.

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HEMATOLOGY & ONCOLOGY

Managing the Mental Health Challenges Related to Sickle Cell Disease

P ain is as much a part of sickle cell disease as white lights are a part of Christmas. It’s what lands kids in the emergency room and hospital; it severely affects their quality of life; and it leaves them constantly on guard, lest it return. Less visible—but just as real—are the emotional, cognitive, and psychological burdens that accumulate over years of living with the condition. Now, Children’s of Alabama has a new program designed to address the non-physical aspects of the disease. Funded by a generous donor and developed by pediatric psychologist Kathryn “Kate” King, Ph.D., the program’s aim is to help kids with mental health issues related not only to their disease but to the stress of growing up in today’s world.

“Our kids and teens with sickle cell experience a lot of different psychosocial issues,” King said. “But first and foremost, they’re kids and teens. There’s so much that comes up that’s not even related to their sickle cell. But then it ends up impacting their sickle cell.” Like their peers, they experience anxiety, depressed mood, stress, and the challenges of growing up. But layered on top is a disease marked by chronic pain, complex treatment regimens, frequent medical visits and, for some, cognitive effects related to the disease itself. WHEN PAIN BECOMES CHRONIC Sickle cell pain is often thought of as acute flares that are treated and subside. But for many children and adolescents, King said, the pain becomes chronic. “It starts to become more frequent, and the pain signaling becomes more like a faulty fire alarm,” she said, continuously going off even when there’s no smoke.

Kathryn King, Ph.D.

“There’s so much that comes up that’s not even related to their sickle cell. But then it ends up impacting their sickle cell.”

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Inside Pediatrics | Children’s of Alabama

At that point, medication alone is often not enough.

King teaches her patients to use alarms and visual reminders to improve adherence, and she works with parents to help them understand when to hand over responsibility to their child. Some parents struggle to let go, she said, while others step back too quickly. The goal is a gradual, scaffolded approach. “The parent can still function as the safety net, but the patient is progressively learning the needed skills to become their own safety net.” King tries to see patients in conjunction with their medical appointments. She also follows them when they’re hospitalized and offers telehealth visits. With nearly 1,000 patients in Children’s sickle cell program and just one dedicated psychologist, however, demand far exceeds capacity. Currently, she sees about 20 patients a week, with plans to grow gradually.

So an important focus is boosting patients’ ability to cope with pain. That includes evidence-based strategies such as diaphragmatic breathing and guided imagery to calm the autonomic nervous

system and reduce the intensity of pain signals.

“The parent can still function as the safety net, but the patient is progressively

And it works. Screening tools find patients’ pain scores dropping several points after using such strategies even before receiving pain medication, King said. Equally important is helping kids and their families reframe the pain. Understanding when

learning the needed skills

to become their own safety net.”

pain is severe enough to require escalation to the hospital and when it can be managed while continuing daily activities can reduce fear and help maintain normalcy. Another focus is helping adolescents transition to self-management. This period during adolescence is known for high rates of treatment lapses and worsening outcomes as kids try to become more independent with this complex disease. “They’re managing so many different treatments and medications, so adherence drops,” King said. “It could be forgetfulness, because they can experience cognitive issues related to sickle cell, but sometimes it’s more about not wanting to feel different.”

“My goal is to extend to as many of those as I can,” she said. “But there’s just one of me.”

She’s also focused on tracking data for the program, including barriers and facilitators for care as well as outcomes. She’d eventually like to publish on the program’s experience to help other hospitals start their own. ●

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NEUROLOGY & NEUROSURGERY

Addressing PTSD in Kids With Hydrocephalus

The young child was beyond terrified of the hospital. Born with hydrocephalus, he’d had numerous surgeries, and his anxiety was so high that just getting him to the car for doctors’ appointments was a struggle. It could take an hour to get from the parking garage to the hospital entrance, given his tantrums and refusal to walk. The behavior continued at home every time someone opened the front door. “The parents really couldn’t live their life because it was so intense,” said Elizabeth McRae, Ph.D., a pediatric clinical child psychologist at Children’s of Alabama.

Elizabeth McRae, Ph.D.

Here was a clear case of post-traumatic stress disorder (PTSD) related to the boy’s illness. Resolving it is exactly what McRae, who joined the neurosurgery team in January 2024, was hired to do.

For years, neurosurgeons and families caring for children with hydrocephalus understood the physical stakes: shunts that could fail without warning, repeated surgeries, emergency trips to the hospital. What was less visible—and often unaddressed—was the psychological toll of living in constant vigilance both for the patient and the family.

Earlier work at Children’s helped bring that reality into focus, documenting high rates of medical post-traumatic stress among families coping with hydrocephalus. But identifying the problem was only the beginning.

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“Based on the results of that previous survey, we brought Dr. McRae on board and embedded her in our neurosurgery practice to provide psychological support for PTSD from screening and diagnosis through interventions to getting people plugged in to community resources,” pediatric neurosurgeon Brandon Rocque, M.D., said. What’s emerged is an integrated, trauma-informed model of care that treats psychological health as part of standard neurosurgical practice. Families of children with hydrocephalus face a unique kind of uncertainty, McRae said. Even when a child is medically stable, the possibility of sudden deterioration and a need for a new shunt never disappears. That’s why resilience, which she defines as strengthening the ability of families and patients to view difficulties as challenges rather than barriers, is so important. Whether she’s meeting a family for the first time at diagnosis or after a child’s 10th surgery, she starts from the same place: helping them identify strengths they already have that can enable them to cope. McRae also emphasizes connection. “One of the key predictors of potential traumatic stress is feeling like we’ve lost power FROM MEASURING STRESS TO BUILDING RESILIENCE

“There’s also a big piece of how do we prevent the trauma?” she continued. One approach, she said, is “taking a trauma-informed approach to our service so we mitigate the risk on the front end.” That includes explaining what’s going to happen to children, giving them options and a sense of control whenever possible, creating a sense of structure and predictability in the hospital setting as much as possible, and relying on other services such as Child Life to help children cope and adjust through play. McRae works closely with the surgeons, nurses, and residents in both clinic and hospital settings, participating in the morning clinical discussions. Nurses refer families they see struggling, and surgeons seek her input about how to provide trauma-informed care in communication and interactions with patients. The clinical model emphasizes brief, targeted interventions—an intentional choice in a population already burdened by multiple appointments. “I’m doing them a disservice if I can’t do something fairly efficiently,” McRae said. These strategies were helpful with the aforementioned young child. McRae worked with him and his mother using developmentally appropriate coping strategies such as play-based breathing exercises, predictable reassurance, and gradual exposure. She had him pretend to be a snake and breathe in slowly and deeply like a snake to quell his anxiety. A scavenger hunt throughout the hospital helped provide distraction so he could become comfortable in the medical setting. And Rocque met with him dressed in his blue scrubs for a meet and greet, no medicine involved, since the child was usually so frightened by anyone in blue scrubs. McRae also involved the boy’s mother in the interventions, providing a greater sense of control over the situation.

“So, if right off the bat we can encourage a

and feeling isolated,” she said. “So, if right off the bat we can encourage a connection and empower them, to me, those are two of the best things we can do up front.”

connection and empower them… those are two of the best things we can do up front.”

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“This is the first time anybody has tried to integrate psychology into pediatric neurosurgery like this. There are so many questions that we need to answer.”

“This is the first time anybody has tried to integrate psychology into pediatric neurosurgery like this,” Rocque said. “There are so many questions that we need to answer.” That includes developing screening tools to identify which families need support most urgently and tracking service metrics to ensure the model can be replicated.

The result? The walk from the car to the hospital takes just a few minutes. The tantrums in the clinic are over. His parents have space to breathe. All this was achieved over the course of just six, one-hour sessions. Research is also a big part of the program, McRae said. To that end, she and the team are collecting data on how the model functions, including who benefits most, how referrals happen, what interventions are feasible, and whether the approach is sustainable.

“We really want to show that this works,” Rocque said.

Early signs suggest it is. The model has already been adopted in other specialty clinics, including tuberous sclerosis.

“Ideally,” Rocque said, “I would love for this to become the standard of care in pediatric neurosurgery.” ●

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PedsCast Podcast

The Children’s of Alabama PedsCast is a pediatric sub-specialist peer-to-peer podcast focused on research, innovative programs and advances in pediatric health care at Children’s of Alabama. Featured speakers include physicians, surgeons, clinical specialists, and other experts in the field of pediatrics.

Improving Early Detection of Kidney Disease in Cystic Fibrosis Patients Tom Harris, M.D.

Developing New Therapies For Children With Cancer And

GLP-1s in T1D: Improving Control Beyond Insulin Giovanna Beauchamp, M.D. Ortal Resnick, M.D.

Blood Disorders Jamie Aye, M.D.

To tune in, visit ChildrensAL.org/PedsCast or subscribe through your favorite podcast app.

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GASTROENTEROLOGY

Creating a New Ecosystem DIVISION EXPANSION IS LEADING TO TRANSFORMATIVE CHANGE IN GASTROENTEROLOGY W hen Sandeep Gupta, M.D., arrived at Children’s of Alabama and the University of Alabama at Birmingham (UAB) as chief of the Division of Pediatric Gastroenterology, Hepatology, and Nutrition in 2023, he immediately recognized the need for expansion. So, not long after his arrival, he embarked on a mission to grow his team. Within the last year-and-a-half, he has welcomed six new faculty, and they’re already making a difference in the way the division serves its patients.

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Inside Pediatrics | Children’s of Alabama

“So now we are able to better serve the people more intentionally, more mindfully.” —Sandeep Gupta, M.D.

For Gupta, that was the objective—providing better patient care. It’s a large undertaking considering Children’s massive catchment area—the entire state of Alabama along with surrounding states. “Every disease state we have is in the hundreds,” he said. “And the doctors we had in those areas were just one or two.” Intestinal rehabilitation, or “short gut,” is a good example. It’s a complex issue affecting more than 160 of the team’s patients. But previously, only one doctor was available to serve them. With inflammatory bowel disease (IBD), the team had two doctors for more than 400 patients. The math was similar for patients with liver issues. “There was such a need to bring [new hires] in to just serve what we have,” Gupta said. “We were simply trying to keep our heads above water.” To address these issues, Gupta began the process of expanding the division in September 2024, making all the new hires over the course of the next year. In the case of IBD, the expansion was transformative. That group now has two new clinicians, Rahmath

Althaf, D.O., and Maggie Vickers, M.D., and a basic scientist, Babajide Ojo, Ph.D. “Now, what we have

is basically a team that goes from bench to bedside,” Gupta said. “We are starting studies where we are collecting samples from patients in the clinic, and then [Ojo] is processing these in the lab to do the studies. And with the discoveries he will make, we can then bring the knowledge back to the bedside.” It’s an “ecosystem” that Gupta believes has not existed in gastroenterology at Children’s. The team has study coordinators and is part of national consortia. “So basically, we are creating a self dependent and interdependent team that can grow on its own,” he said. Gupta aspires to create the same setup for intestinal rehabilitation. In the meantime, care is already improving. With Sirine Belaid, M.D., joining the team, the division now has two doctors to treat these patients, allowing them to see inpatients twice each week instead of once. “So now we are able to better serve the people more intentionally, more mindfully,” Gupta said.

Gupta also added liver doctors David Willcutts, M.D., and Stephanie

Saaybi, M.D., who “will helps us grow the liver team further,” he said.

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Perhaps the most salient sign of the team’s success so far is this: Patients who once had no choice but to go hundreds of miles away for treatment are now able to stay in Alabama for their care. “They are now being sent back to us by the doctors, who are saying, ‘Hey, UAB has a great program—go back there, you don’t need to come see us anymore,’” Gupta said. “So it has

been very fulfilling that people are recognizing we are acing our game here.”

With changes of this magnitude, Gupta believes the division can start to move from excellence to eminence, which was another of his goals when he first arrived. ●

FACULTY HIRED SINCE SEPTEMBER 2024

RAHMATH ALTHAF, D.O., an assistant professor, earned her medical degree from the Touro College of Osteopathic Medicine. She completed her residency in general pediatrics at the Medical College of Georgia and her pediatric gastroenterology fellowship at UAB. Her research and clinical interests include IBD and intestinal ultrasound.

SIRINE BELAID, M.D., an assistant professor, earned her medical degree from the University of Pittsburgh. She completed her residency in general pediatrics at the University of Iowa Stead Family’s Children’s Hospital and her pediatric gastroenterology fellowship at the University of Pittsburgh Medical Center.

BABAJIDE OJO, PH.D., an assistant professor, earned his doctoral degree in nutritional sciences from Oklahoma State University. He completed his postdoctoral research at Stanford University School of Medicine. He received the NIH MOSAIC K99/R00 award in 2023. His research interests include using patient-derived intestinal organoids and murine models to determine how the environment (dietary components, therapies) shapes epithelial metabolism and differentiation in intestinal health and inflammatory bowel diseases.

STEPHANIE SAAYBI, M.D., an assistant professor, earned her medical degree from the American University of Beirut in Lebanon. She completed her residency in general pediatrics at MedStar Georgetown University Hospital and her pediatric gastroenterology fellowship at UAB. She completed an additional fellowship in pediatric advanced hepatology and liver transplant at Northwestern University.

MAGGIE VICKERS, M.D., an assistant professor, earned her medical degree from UAB. She completed her residency in general pediatrics and her pediatric gastroenterology fellowship at the Le Bonheur Children’s Hospital, St. Jude Children’s Research Hospital, and Regional One Health. Her clinical interests include general gastroenterology, nutrition, and inflammatory bowel disease.

DAVID WILLCUTTS, M.D., an assistant professor, earned his medical degree from the University of Texas Southwestern Medical Center, where he also completed his residency in pediatrics and his pediatric gastroenterology fellowship. He completed an additional fellowship in pediatric advanced hepatology and liver transplant at the University of Colorado.

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Inside Pediatrics | Children’s of Alabama

Children’s of Alabama Performs Rare Split-Liver Transplantation in Major Milestone for Pediatric Transplant Care

I n the fall of 2025, Children’s of Alabama, in collaboration with the University of Alabama at Birmingham (UAB) Division of Transplantation, successfully performed a rare split-liver transplantation, marking the first use of this lifesaving technique within the Children’s and UAB partnership in nearly a decade. Split-liver transplantation, a highly complex procedure, allows a single deceased-donor liver to be divided and transplanted into two recipients located at separate hospitals. This innovative approach expands access to lifesaving organs, particularly for pediatric patients who depend on Children’s nationally recognized liver transplant program.

The operation required a coordinated effort across both institutions, incorporating advanced machine perfusion technology to preserve the donor liver and extensive logistical planning for the out-of-state donor operation. “This achievement represents the culmination of extensive preparation, education, and protocol development across multiple teams,” said Pozo Jatem, surgical director of the Pediatric Liver Transplant Program at Children’s. “It involved close collaboration with the pediatric intensive care unit, hepatology, anesthesiology, pharmacy, nutrition, nephrology, and interventional radiology. It even resulted in the creation of a new intraoperative dialysis protocol to ensure this delicate procedure could be performed safely in critically ill patients.” “This successful split-liver transplantation is a significant milestone and an important step toward expanding access for many more patients on our waitlist,” said Sheikh, who also serves as surgical director of UAB’s Living Donor Liver Transplant Program. “It reflects the extraordinary dedication of our jointly staffed teams at both Children’s of Alabama and UAB.” ●

The transplant was led by UAB assistant professors of surgery Saulat Sheikh, MBBS, and Marcos Pozo Jatem, M.D., working alongside Children’s of Alabama’s

multidisciplinary transplant teams.

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Innovation and discovery happen here •

When people with extraordinary talent and passion are given the technology, the facilities, and the support, they

achieve great things. The research and breakthroughs happening today will help shape the future of treatments

and lead to cures. And it benefits not only the patients and families who come to Children’s of Alabama, but people

across the country and around the world for years to come.

Learn more at ChildrensAL.org

UROLOGY

F or families of children with bladder and bowel dysfunction, the journey to care at Children’s of Alabama can involve a long drive, a crowded waiting room, and the worry that the problem was serious—only to be told that what their child needs most is better bathroom habits. “We have a really wide catchment area,” said Children’s chief of pediatric urology Stacy Tanaka, M.D. “Sometimes we were seeing families coming in from the coast. They had driven three-and-a-half, four hours.” By the time they arrived, parked and waited, an entire day was lost and the advice they received was, well, less than earth-shattering. “They get here, and you tell them, ‘Hey, you just need to urinate and poop a little bit better,’” she said. “It doesn’t go over that well sometimes.” In fact, it could have been handled by a phone call.

Stacy Tanaka, M.D.

Today, that’s essentially how they handle it. Tanaka and nurse practitioner Kelsey Boswell Moore, CRNP, see more than 20 patients each week via telehealth.

Kelsey Boswell Moore, CRNP

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“They’re sitting in their living room… In that relaxed environment, it’s easier to talk about how often they’re going, when they’re going and what’s really happening,”

The program launched in early 2025, partly out of necessity. “We were transitioning and were a bit understaffed,” Tanaka said. “We started it just as a ‘let’s try to get as many patients seen as possible.’” What began as a staffing solution quickly became a new model of care. One reason it works so well is that most children with bladder and bowel dysfunction improve just from counseling and conservative management on better bladder habits and better bowel habits. They don’t even require prescription medication. If any red flags pop up, such

really go away. In that relaxed environment, it’s easier to talk about how often they’re going, when they’re going and what’s really happening,” she said. “Sometimes they say they’ve done everything,” she said. “But the child is still drinking fluids late at night or didn’t actually go to the bathroom before bed.” And for those who do need to be seen in person, the telehealth visit allows Moore and Tanaka to prepare for the appointment by ordering any necessary tests, which increases efficiency. If families still want to be seen in the office or have the child undergo imaging, “We can absolutely do that,” Tanaka said. “We can rule out the scary things, and then it becomes easier to continue with telehealth knowing everything looks OK.” “This only works if the patient and parent are engaged,” she said. “If they don’t feel right about the plan, it’s not going to work.” And it does work. For instance, consider the 8-year-old boy with enuresis. The problem became obvious after a brief telehealth visit. “When he woke up in the morning, he didn’t go to the restroom,” Tanaka said. “He would eat breakfast, get dressed, and the first time he went was at school.” The child had trained himself to ignore bladder signals. The solution? A schedule. Go first thing in the morning and use the restroom at planned times during the day. Also, alert the teacher. Four weeks later, the problem was resolved.

as a child who had back surgery or is having urinary tract infections with fever, the team brings them in for a face-to-face consultation. “Those are signals we need to see you sooner,” Tanaka said.

For most families, all it takes is talking and instructions.

“A lot of times they’ve never really paid attention to how often they’re going to the bathroom,” said Moore, who conducts most of the telehealth visits. “They’ll say they have urgency, or that they can’t hold it, but then you realize they’re waiting until the last minute every time.”

“That family never had to step foot in the hospital,” Tanaka said. Which, of course, is the goal. ●

Telehealth makes it easier to explore those details.

“They’re sitting in their living room,” Tanaka said. “It’s a more relaxed environment. All the other distractions

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Inside Pediatrics | Children’s of Alabama

Recognitions

News, Leadership, Honors, Awards

NEWS

LEADERSHIP

Chen Named President-Elect of the American Pediatric Surgical Association Mike Chen, M.D., MBA, director of the UAB Division of Pediatric Surgery, was named president-elect of the American Pediatric Surgical Association (APSA) for 2026 to 2027. He will then serve as president from 2027 to 2028. APSA is the largest professional organization in the country dedicated to the pediatric surgical specialty. It provides pediatric surgeons and associated professionals with training as well as educational and research opportunities. “Being named president elect of APSA is an immense honor,” Chen said. “I hope to have a continued impact by advancing education, discovery, and advocacy in our field to ensure all children can receive the highest quality of surgical care.” Gupta Reappointed Editor-in-Chief of Two International Journals Sandeep Gupta, M.D., chief of the Division of Pediatric Gastroenterology, Hepatology & Nutrition, was reappointed editor-in-chief of the Journal of Pediatric Gastroenterology and Nutrition (JPGN) and JPGN Reports, two leading journals in the field. Both journals are co-owned by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) and have a significant global footprint within pediatric medicine. Ilonze Named American Society of Hematology Ambassador Chibuzo Ilonze, M.D., MPH, assistant professor in the Division of Pediatric Hematology and Oncology, was selected to serve as an ambassador for the American Society of Hematology (ASH). ASH is the world’s largest professional society dedicated to the study and treatment of blood and bone marrow disorders.

Richard Whitely, M.D.

Richard Whitley: A Legacy of Care For more than five decades, Richard Whitley, M.D., distinguished professor in the Division of Pediatric Infectious Diseases, helped shape not only Children’s of Alabama and the University of Alabama at Birmingham (UAB) Department of Pediatrics, but the field of pediatric infectious diseases on a global scale. Whitley retired in December 2025. Over the course of his career, Whitley became one of the most widely recognized figures in the department and one of the most influential physician scientists at UAB. His work helped redefine how viral infections are treated and how rare diseases are studied, establishing research frameworks that continue to guide clinical practice around the world. In the early days of antiviral research, many believed viruses could not be treated safely without harming the patient. Whitley challenged that thinking, helping demonstrate that targeted antiviral therapies were not only possible but lifesaving. His vision led to a rapidly expanding research program that placed UAB on the national map for pediatric infectious disease discovery.

global presence. He became a sought after lecturer, collaborator, and advisor, traveling extensively to scientific meetings and research centers around the world. Throughout his career, Whitley received some of the highest honors in medicine. He was awarded the American Academy of Pediatrics Excellence in Pediatrics Research Award for his contributions to antiviral therapeutics. He also received the Alexander Fleming Award for Lifetime Achievement from the Infectious Diseases Society of America. He was consistently recognized among the best doctors in America, reflecting both his scientific impact and clinical excellence. Despite receiving multiple offers from major academic centers, Whitley chose to remain at UAB, a decision colleagues say played a pivotal role in the department’s long-term success. In addition to his research, Whitley held several leadership roles throughout his career, including vice chair for research, division chief for infectious diseases, and interim chair of the department. Though he was offered the permanent chair position, Whitley ultimately chose to focus on what he felt he did best, building research programs and mentoring others.

As Whitley’s reputation grew, so did his

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