Avoid nipple shields. These allow the baby to latch onto the shield, not the breast. This may decrease milk supply. Initially avoid supplementing with formula and pacifiers. These decrease nursing time. The baby’s nursing is the way your body knows to produce milk. Don’t worry that there is no milk at first. Colostrum is there and that is just what your baby needs for a good start. Expect your milk to come in within 36-72 hours after delivery. You will usually be aware the milk is there and you may be sore. This will pass with nursing, warm showers, and compresses. Remember, when the milk arrives, your baby’s nursing is what stimulates breast milk production. Interrupting nursing with supplements and pacifiers will delay breast milk production. Take care of yourself. Eat well, drink plenty of fluids, and stay rested. Open the baby’s mouth to ensure contact with the whole areola, not just the nipple. Ask for help from the staff, doctors, and your family. Feeding and preparation for feeding will occupy a lot of time with your baby over the first month. Once you have begun breastfeeding, it is helpful to establish a routine for getting ready to nurse. Prior to nursing, wash your hands, gather whatever you need during nursing (a beverage, burp cloth, reading material), and consider turning off your phone so you can nurse undisturbed.

Acne(https://www.healthychildren.org/English/health-issues/conditions/skin/Pages/What-Causes-Acne.aspx) Allergies(https://www.healthychildren.org/English/health-issues/conditions/allergies-asthma/Pages/Allergies.aspx) Asthma(https://www.healthychildren.org/English/health-issues/conditions/allergies-asthma/pages/Asthma-Triggers-and-What-to-do-About-Them.aspx) Chronic Conditions(https://www.healthychildren.org/English/health-issues/conditions/chronic/Pages/default.aspx) Diarrhea(https://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/Diarrhea.aspx) Ear Infections(https://www.healthychildren.org/English/health-issues/conditions/ear-nose-throat/Pages/Ear-Infection-Information.aspx) Eczema: How to Avoid the ItchFever(https://www.healthychildren.org/English/health-issues/conditions/skin/Pages/Eczema.aspx)

1. Select the "Message a Doctor" feature to request a form. 2. Click the "New Message" link 3. Choose "The Office (General Inquiries)" from the "Message To" dropdown menu 4. Choose "Other" in the Subject dropdown menu 5. In the body of the message, detail the form you wish to be completed, how you would like to receive the form (pick-up, mail, fax), and phone number where you can be reached for any questions. Please provide a mailing address to have the form mailed or a fax number if you would like the form to be faxed. Remember there may be a waiting period for all forms. You will receive a response in your portal account inbox when the form has been completed. 6. Click "Send Message" to submit your form request

Answer: Yes and No. The Privacy Rule generally allows a parent to have access to the medical records about his or her child, as his or her minor child’s personal representative when such access is not inconsistent with State or other law. There are three situations when the parent would not be the minor’s personal representative under the Privacy Rule. These exceptions are: 1. When the minor is the one who consents to care and the consent of the parent is not required under State or other applicable law; 2. When the minor obtains care at the direction of a court or a person appointed by the court; and 3. When, and to the extent that, the parent agrees that the minor and the health care provider may have a confidential relationship. Parental access would be denied when State or other law prohibits such access. Finally, as is the case with respect to all personal representatives under the Privacy Rule, a provider may choose not to treat a parent as a personal representative when the provider reasonably believes, in his or her professional judgment, that the child has been or may be subjected to domestic violence, abuse or neglect, or that treating the parent as the child’s personal representative could endanger the child. ​ Source: HHS.gov(https://www.hhs.gov/hipaa/for-professionals/faq/227/can-i-access-medical-record-if-i-have-power-of-attorney/index.html)

Visiting any physician can be an intimidating experience. Parents can lessen the stress and worry associated with their child’s doctor visit by taking steps to be sure that you have all the information needed for the appointment. Never feel embarrassed or shy about asking for clarification about something the provider says. If the provider asks questions that may seem embarrassing or overly personal to you or your child, remember that the information you provide allows your doctor to better establish a diagnosis or to determine what treatment is most appropriate. Be honest and don’t withhold information from the doctor. Utilize the office personnel, medical assistants, and nurses as they can be additional resources for information. Do not hesitate to ask them questions about your child’s healthcare or your concerns. Advanced preparation for your child’s doctor visit is a vital step towards becoming a partner in your child’s healthcare. Our physicians welcome your active participation in their care

1. Login to your portal account and click the Rx Refill box. 2. Scroll down to the medication you wish to refill, and select Refill. 3. Select your prescribing provider from the dropdown menu 4. Type a message to the provider, if applicable. 5. Find and select your preferred pharmacy. 6. Click the "Request Refill" button to submit your request.

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Answer: Over the past several decades, adolescents have gained many opportunities to receive confidential health care services, particularly for concerns related to sexual activity, pregnancy, HIV and other sexually transmitted diseases (STDs), substance abuse, and mental health. From both a clinical and a public policy perspective, protection of confidentiality for adolescents has been based on recognition that some minors would not seek needed health care if they could not receive it confidentially, and that their forgoing care would have negative health implications for them as well as society. Concerns about privacy prevent adolescents from seeking care. ​ Adolescents and the professionals who provide their health care have long expected that when an adolescent is allowed to give consent for health care, information pertaining to it will usually be considered confidential. ​ In the state of Alabama, minors of any age may consent to: • Contraceptive Services • STI Services • Prenatal Care • Adoption • Medical Care for Minor's Child In the state of Alabama, minors 14 and older can consent to any and all medical care for themselves. ​ Source: Guttmatcher(https://www.guttmacher.org/journals/psrh/2004/hipaa-privacy-rule-and-adolescents-legal-questions-and-clinical-challenges)

• Schedule an appointment by calling 256.891.0300. Patients are seen by appointment, Monday through Friday from 8a-12p and 1p-5p during regular business hours. • Arrive Early. We will update your information at each visit. This usually takes only a few minutes. • Patients who have arrived on time will be seen ahead of those who arrive late. • Call ahead if you are late or unable to make your appointment time. • If you arrive late, your wait may be longer or your child’s visit may have to be rescheduled. • We will do all we can to accommodate your child’s appointment and to minimize the need to reschedule. • Late arrivals will be offered the next available appointment. While we will do our best to accommodate requests, the first-available appointment may or may not be on the day the appointment was missed. • Whenever possible, please give 24 hours notice if you cannot make your appointment.

It is important that you alternate the position used for nursing so you drain all the milk sinuses regularly. Properly distribute pressure on the areola and nipple to avoid soreness. The following are three of the more common positions for breastfeeding: • The Madonna: Traditional sitting position. Sit with the baby’s body across your abdomen, supporting her with the same arm as your breast. https://static.wixstatic.com/media/undefined • Cross-Cradle: Holding your baby across your lap, using the opposite arm to the breast she is feeding from to support her. https://static.wixstatic.com/media/undefined • Football Hold: With pillows positioned along the side of your body, hold your baby under your arm; much in the same way a football player holds the football. https://static.wixstatic.com/media/undefined • Lying Down: Lie on your side with knees bent. Lay baby on his/her side facing you, bringing his/her face toward your breast. Use pillows for comfort or support, if needed. https://static.wixstatic.com/media/undefined • Laid-back: Semi-reclined, with your baby lying across your stomach or shoulder. https://static.wixstatic.com/media/undefined Improper positioning of the baby at the breast is a major cause of nipple soreness. The baby should be held closely enough so the tip of the nose touches the breast. The chin should press against the breast as well. The mouth should be opened widely and positioned slightly below the center of the breast. This will result in the lower lip covering more of the areola than the upper lip. The baby’s mouth should cover much of the areola, not just attach to the nipple.

During the first few weeks, it is important to provide some support for the breasts during feeding. The preferred method of supporting the breast is the C-hold. You cup your free hand to form the letter C with your thumb on top and your fingers curved below the breast. You can then gently guide the breast so that the nipple is centered in the baby’s mouth. This technique helps keep the breasts from obstructing the baby’s breathing, and is especially useful for large breasted women.

When an adolescent is allowed to give consent for health care, information pertaining to it will usually be considered confidential. The minor child will need to sign any and all releases of information pertaining to their medical record when: • The minor is 14 or older • The minor has requested confidential services • The minor is pregnant • The minor is seeking health services to determine or treat pregnancy, venereal disease, drug dependency, alcohol toxicity, or other diseases that must be reported to the state Board of Health • The medical care is court-ordered​ In any of the above situations, if a parent desires access to a child's medical records, the child must give signed consent. ​ Source: Guttmatcher(https://www.guttmacher.org/state-policy/explore/overview-minors-consent-law)

1. Select the "Message a Doctor" feature to begin your message 2. Click the "New Message" link 3. Choose your provider from the "Message To" dropdown menu 4. Choose a Subject from the dropdown menu 5. In the body of the message, please provide the patient's name, date of birth, a phone number where you can be reached for any questions, and a brief, detailed description of your question or comment. 6. Click "Send Message" to submit your form request 7. You will receive a response in your portal account inbox

Before the appointment, write down a list of things you need to tell the doctor. Note any concerns or questions you may have. Also write down the names and dosages of any medication your child may be taking, including over the counter medications. It is very important to take this list with you to your child’s appointment – don’t count on remembering everything. • If it is your first visit, request medical records from your previous doctor. We can assist you with this in our office, if needed. • Keep a health care diary and take it to the visit. For example; changes in health status, physical observations, specific complaints or concerns and abnormal side effects or symptoms since the last visit. • Prepare a list of your child’s medications (including over the counter), dosages, and drug allergies. It is very important to take this list with you to your child’s appointment – don’t count on remembering everything. • Check current medications to make sure refills are available or you should be prepared to ask the doctor for medication refills. • Prepare and maintain a list of immunizations your child has had in the past. We can assist you with this in our office, if needed. • Consider the clothing your child will wear to the appointment. For example, if your child is scheduled to have a check-up or a sports physical, have them wear clothing easily removed. • If the patient has medical insurance, be sure to bring your card(s) to your appointment.

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If the baby is allowed to determine the length of the feeding, his/her mouth will gently release the nipple when he/she is finished. If you wish to remove your baby from the nipple before this occurs, you will need to break the suction. Insert your finger gently into the corner of your infant’s mouth and press your finger against your breast near the corner of your baby’s mouth. The nipple should then slip easily out of the baby’s mouth.

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• Login to your patient portal account. • Select "Review Medical Record" • Choose "Immunizatons" from the lefthand side to review your child's immunization history

• Arrive a few minutes early and be prepared to update any necessary information. • Prepare for a short to moderate wait time in the reception room by bringing a book or a magazine. • Listen to the doctor’s questions and answer them as accurately and honestly as possible. • Maintain a healthcare folder that includes any educational materials, healthcare information, and appointment information given to you at your child’s visit. • Review your list of questions with your doctor and make sure each is answered to your satisfaction. • Ask questions that may arise during the visit. • Write down or ask for written instructions to help you understand your child’s care plan. • Ask how you can educate yourself about your child’s healthcare needs. • Listen to your child. If they feel something is wrong, share your concerns with your doctor.

In order for you to produce equal amounts of milk in each breast, you want to ensure that both breasts receive the same amount of stimulation. They must also be emptied regularly in order to avoid problems with plugged ducts, engorgement, or breast infections. Routinely offer both breasts at every nursing. Alternate the breast you begin with at each feeding. Encourage your baby to take the second breast. Burp him/her and stimulate him/her after he/she has finished nursing on the first side. He/she can then have unlimited nursing time on the second breast. If you end with the left breast at a nursing, you will begin the next nursing with the left breast.

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• Did the provider order new medications for your child, and, if so, did you understand how and when to take them? • Does your child have enough medication to last until the next visit? • Make sure you have a return visit scheduled, if needed. • Make certain you have the written prescriptions or confirm the pharmacy for electronic prescriptions before you leave. • Check out at the front desk before leaving. • With a little preparation, by asking the right questions and by following a few simple guidelines, you and your child will get the most from each visit to your doctor.

Your child may have reached 14 years of age and will need to consent to your access of their account. Please view our HIPAA section for more information. If this is not the case, and you cannot view your child's information, please contact our office for troubleshooting.

Please contact our office for assistance in linking proxy accounts.

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After nursing, let your nipples air-dry. Moisture can lead to tender and sore nipples. You can pat the nipples dry with a soft cloth or leave the bra flap down a few minutes. Air-drying is especially important if you plan to apply a lubricant, such as lanolin, to the nipples since this lubricant can trap moisture.

You should always feel free to call our office, even if it's for routine things like medicines, minor illnesses, injuries, behavior, or even parenting advice. Keep in mind, though, that your provider may not be able to answer your questions without seeing your child first.

The supply of breast milk is determined by the amount of nipple stimulation that you receive from your baby. When the baby nurses frequently, there is greater nipple stimulation and greater milk production. Nursing makes milk. To ensure that you have enough breast milk, nurse your baby frequently offering both breasts at each feeding. This will ensure that more milk will be produced.

1. Login to your patient portal account 2. Select "Account Settings" in the upper righthand corner 3. Update your email address 4. Choose "Save Account Settings"

In the first few days, nursing times are generally short, about 10 to 15 minutes. Your baby may nurse only on one breast each feeding and then drift off to sleep. The second breast should be offered each time. As the days pass and your baby becomes more alert, nursing times usually increase. In general, feeding length should be determined by your baby’s needs. When the flow of milk diminishes from your first breast and the rich hind milk has been extracted, the baby will release the nipple and it will slide out of his/her mouth. You can then offer the second breast and again permit sufficient nursing time for the baby to receive the hind milk. This hind milk is rich in fat and is important for your baby to receive. Unlimited suckling time, beginning directly after birth, improves breastfeeding. There is no reason to restrict feeding frequency or duration when you first begin breastfeeding. Unlimited nursing time has been shown to help decrease breast engorgement for moms and jaundice in babies. Some initial nipple discomfort is to be expected on about the third postpartum day. Prevention of sore nipples through use of proper positioning and correct feeding techniques is the most effective. Decreasing the time or frequency of feedings will only serve to delay nipple soreness by a day or two.

URGENT CARE Sometimes it's hard to tell how sick your child is. However, urgent care or a trip to the hospital is usually not needed for a simple cold or cough, mild diarrhea, constipation, temper tantrums, or sleep problems. However, if your child has any of the following, call to find out if he needs to be seen: • Vomiting and diarrhea that last for more than a few hours in a child of any age • Rash, especially if there is also a fever • Any cough or cold that does not get better in several days, or a cold that gets worse and is accompanied by a fever • Cuts that might need stitches • Limping or is not able to move an arm or leg • Ear pain with fever, is unable to sleep or drink, is vomiting, has diarrhea, or is acting ill • Drainage from an ear • Severe sore throat or problems swallowing • Sharp or persistent pains in the abdomen or stomach • Pain that gets worse or does not go away after several hours • A rectal temperature of 100.4°F (38°C) or higher in a baby younger than 2 months • Fever and repeated vomiting at the same time • Blood in the urine • Bloody diarrhea or diarrhea that will not go away • Not drinking for more than 12 hours EMERGENCY CARE Call 911 (or your emergency number) for any severely ill or injured child or if your infant or child has any of the following: • Bleeding that does not stop with direct pressure over the wound • Suspected poisoning (Call the Poison Help line at 1-800-222-1222.) • Seizures (rhythmic jerking and loss of consciousness) • Trouble breathing • Skin or lips that look blue, purple, or gray • Neck stiffness or rash with fever • Head injury with loss of consciousness, confusion, vomiting, or poor skin color • Sudden lack of energy or is not able to move • Unconsciousness or lack of response • Acting strangely or becoming more withdrawn and less alert • A cut or burn that is large, deep, or involves the head, chest, abdomen, hands, groin, or face

Yes! 1. Login to your patient portal 2. Select "Review Medical Record" 3. From this page you can print a Summary, a date range, download specific sections of your record, and even request an amendment.

Please contact our office, so we can reset your portal account.

We prefer that you call with general questions during office hours. Before you call, have a pen and paper ready to write down any instructions and questions. It's easy to forget things, especially if you are worried about your child. During the call make sure your child is near the phone, if possible, in case you need to answer any questions. Also, be prepared to provide information about your child's health. FEVER If you think your child has a fever, take your child's temperature before you call. If your child does have a fever, write down the temperature and time you took it. MEDICAL PROBLEMS Remind the doctor about past medical problems (such as asthma, seizures, or other conditions). He or she cares for many children each day and may not remember your child's health history. MEDICINES Be sure to mention if your child is taking any medicines, including prescription or nonprescription drugs, inhalers, supplements, vitamins, herbal products, or home remedies. PHARMACY Have the phone number of your pharmacy ready. If our office needs to return your call, make sure you are available for a callback. Turn off "Do Not Disturb," and keep phone lines open so that we can return your call in a timely manner. If you leave a cell phone number, be sure that you have your cell phone on and will be in an area where you can receive calls.

In the first few days, nursing times are generally short, about 10 to 15 minutes. Your baby may nurse only on one breast each feeding and then drift off to sleep. The second breast should be offered each time. As the days pass and your baby becomes more alert, nursing times usually increase. In general, feeding length should be determined by your baby’s needs. When the flow of milk diminishes from your first breast and the rich hind milk has been extracted, the baby will release the nipple and it will slide out of his/her mouth. You can then offer the second breast and again permit sufficient nursing time for the baby to receive the hind milk. This hind milk is rich in fat and is important for your baby to receive. Unlimited suckling time, beginning directly after birth, improves breastfeeding. There is no reason to restrict feeding frequency or duration when you first begin breastfeeding. Unlimited nursing time has been shown to help decrease breast engorgement for moms and jaundice in babies. Some initial nipple discomfort is to be expected on about the third postpartum day. Prevention of sore nipples through use of proper positioning and correct feeding techniques is the most effective. Decreasing the time or frequency of feedings will only serve to delay nipple soreness by a day or two.

Almost all medications taken by a breastfeeding mother are passed to the baby through the milk. Check with your physician before taking any medications. Avoid cigarette smoking. Nicotine is excreted in breast milk and has been found to decrease breast milk supply. Remember that breastfeeding is the best way to feed your baby. It works best if you remain relaxed and let nature take its course. Knowing what to do can help prevent problems. Please call our office or the hospital lactation consultant if you have any questions about breastfeeding.

To request a portal invitation or for assistance with an issue not listed above, please contact our office at (256) 891-0300.

Infant formulas are sold in three forms: ready-to-use, concentrated liquid, and powder. There are differences in cost and convenience between the different types of formula. The ready-to-use is most expensive. Powder is least expensive. Keep bottles and nipples clean. Wash in a dishwasher or scrub bottles. Wash nipples and caps with hot, soapy water and a bottle brush, squeezing water through holes in nipples. Rinse, dry, and place in a protected location until time for use. We do not recommend one brand of nipple or bottle over another. Nipple holes should be the correct size. Milk should drop at a rate of 1-2 drops per second. If holes are too large, discard the nipple. Formula may be mixed as you go or mixed in advance and stored for up to 48 hours in the refrigerator. Offer formula at room temperature. We do not recommend using a microwave to heat formula as the milk can get very hot in places and scald the baby’s mouth. Warming a bottle from the refrigerator can be done under warm running water or a bottle warmer. Seated comfortably and holding your baby with his/her head slightly elevated, hold the bottle so that the neck of the bottle and nipple are always filled with formula. Never prop the bottle.

Burping helps to remove swallowed air. Both breast and bottle-fed babies swallow air. Sit him/her in your lap with his/her head supported, hold him/her upright over your shoulder, or place him/her face down over your lap, and pat his/her back. Burp your baby frequently during the feeding as well as at the end.

Feed on demand – that is, whenever your baby seems hungry. This usually is between 2-4 hours. In general, the baby will have more knowledge as to his/her hunger than anyone else. Begin by placing 2-3 oz. of formula in the bottle. If this is not finished, discard remainder immediately. When your baby finishes the amount of milk offered, begin to increase the amount placed in the bottle by ½ to 1 oz. In general, have a little more milk in the bottle than is ordinarily taken. Remember, if the baby is sucking his/her fingers and smacking, and it has not been 2 hours since the last feeding, he/she may be suckling for comfort and a pacifier may be tried.

Sucking comforts babies. Even when not hungry, babies often suckle the fingers and thumb for comfort. You will learn the difference in your baby’s hungry behavior and “I need comfort” behavior in time. For formula-fed babies, a pacifier is fine. Breastfeeding moms may want to limit pacifiers until your milk supply is well established, as mentioned earlier. Allowing frequent nursing will meet your baby’s comfort needs.

At bedtime and naptime, prepare your baby by being sure he/she is warm, dry, and not hungry. It is fine to rock for comfort, and then place him/her in his/her bed to go to sleep. Babies should sleep on their backs with no pillows or soft bedding. Babies who are put in bed awake, sleepy and satisfied, and allowed to go to sleep on their own are better sleepers in the long run.

Items needed: 1. A warm room 2. Table or countertop of comfortable height 3. A soft washcloth 4. No-tears shampoo 5. Rubbing alcohol 6. Cotton balls and Q-tips 7. Full-sized towel Your baby may be washed in a dishpan or in the sink. Always check water temperature. He/she may not be placed in water before the cord is off. Daily baths are fine, but are not necessary. Wash his/her face and head first, and his/her diaper area last. After bathing, rinse and dry. If the skin is too dry, you may use baby lotion or hand cream. We don’t recommend baby oil/powder.

The umbilical cord should dry and fall off in 1-3 weeks. After bathing, clean the cord with alcohol using cotton balls or Q-tips. Lift up the cord so that the base of the cord can be cleaned and dried. When the cord drops off, clean the base with alcohol until this area completely heals. Position diaper below cord and leave cord uncovered. Some bleeding, green, or yellow discharge, or odor is common as the cord separates. If the skin around the cord is warm or red, call our office.

Gently wash the penis with a cotton ball and mild soap, rinse, and pat dry. Apply Vaseline until healed.

Don’t try to pull the foreskin back over the head of the penis. As your child grows, the foreskin will gradually loosen and they will be able to gradually retract it more and more.

Babies need very basic clothing for the first month of life. They should be dressed comfortably for their environment. A cotton gown and diaper will be sufficient for several weeks. A light blanket for sleeping will be needed. Do not overdress. Either cloth or disposable diapers may be used.

When taking a rectal temperature, first shake down the thermometer below the 96 degree mark. Lubricate the tip with Vaseline or other lubricant for easy insertion. Lay the baby on his/her stomach in your lap (with a diaper underneath for protection), holding the baby firmly. Spread the buttocks with one hand. Carefully insert the thermometer into the rectum ½ to ¾ of an inch. Do not let go of the baby or the thermometer. Hold the thermometer in place for 2-3 minutes. Remove the thermometer and read results where the mercury stops. Cleanse the bulb with soap and cool water. Rectal temperature records the baby’s internal temperature. A normal rectal temperature can be 97.0 to 100.0 degrees. If the temperature is above 100.5 degrees, do not give fever-reducing medication and please call your pediatrician.

If, during the first three months of life, the baby’s rectal temperature is over 100.5 degrees, he/she is extremely fussy or lethargic, has difficulty breathing, or has excessive vomiting or diarrhea, notify your physician. In this age group, we don’t recommend giving Tylenol without talking to a doctor. Your pediatrician will instruct you further with any special care or treatment.

Squeeze the bulb syringe. Insert into each nostril or the sides of his/her mouth. Release syringe compression and suction mucous out of the baby’s nose or mouth. Cleanse bulb often with soap and water.