Event leaders will be collecting unused and expired medications in a drive-thru in the building’s parking lot, and distributing free medication lockboxes.

Stacey Vanvliet, M.D., an inpatient pediatric hospitalist at Cook Children’s, stresses the importance of locking medications up, even if they seem harmless. She said suicide attempts “have become part of my daily practice” and most are overdoses on a substance that’s “convenient for the children and teens to grab.” While most patients are in their teens, children as young as 8 or 9 are routinely admitted to Cook Children’s for attempting suicide with medication.

“Commonly, we see Tylenol, Motrin, aspirin, Benadryl—things that people just stock in their cabinets to have on hand,” she said. “We see teenagers take huge handfuls of them.”

Each year, Cook Children’s treats hundreds of children and teens for medication poisonings and overdoses. Sadly, the number of these patients continues to reach record levels year after year.

"It is a huge problem right now. We’re seeing more kids in the hospital for opioid overdoses than ever before," said Artee Gandhi, M.D., medical director of Pain Management at Cook Children’s. 

Dr. Gandhi also points out that a recent letter published in the American Medical Association reported a 20% increase in drug overdose deaths among 14 to 18 year olds from 2020. The 1,150 deaths is double the number reported in 2019.

“While teen drug use has remained relatively stable, the biggest problem is kids trying to get their hands on prescription opioids such as oxycodone or other medications such as Xanax and Adderall,” Dr. Gandhi said. “So often, counterfeit versions of these drugs are laced with deadly amounts of fentanyl. Therefore, it is paramount that parents, educators and health care providers argue against medication misuse or drug experimentation at all.”

**Dr. Artee Gandhi and DEA agents will be available for interviews at this event.

Our kids are back to school!

The beginning of a new school year has a ton of opportunity, some excitement and some nerves. And this year there’s probably a little extra floating around.

And while we’re all thinking about COVID-19 and watching for those symptoms (fever, cough, congestion, sore throat and stomach issues), let’s not sleep on the other illnesses that we are seeing as kids roll back into school.

Here are four common childhood illnesses that seem to increase when we go back to school:

1. Strep throat - Fever and sore throat without a cold or cold symptoms is often a sign your child could have strep throat. Add in a rash or swollen lymph nodes in the neck and it’s even more likely. Kids with strep throat symptoms will likely need to be screened for strep throat and COVID-19. The good news about a positive strep test is that it allows your child to feel better and get back to school quickly.
2. Common colds - Not every upper respiratory illness is COVID-19 but trying to determine the difference between the two can be tricky. I expect as we get further into the school year, we’ll be doing more and more testing to help determine between the two in an effort to get kids back to school whenever possible.
3. Pink eye - Red, painful and itchy eyes are a common back-to-school problem. Many pink eye infections are viral but there are bacterial causes. Drops can be called in if a bacteria is suspected and, don’t forget, that allergies can cause these symptoms as well.
4. Head lice - If your child starts to itch their scalp, be on the lookout for head lice or nits that could be the cause. Other parents in the class will be notified if a child develops lice so they can be on the lookout. Prompt and aggressive treatment can keep it from re-circulating through the class.

Don’t forget about these common childhood illnesses and others as we get back to school.

Stay in close contact with your pediatrician when symptoms develop so we can help you keep your child and their classmates safe and healthy!

The American Academy of Pediatrics is recommending that all children over age 2 wear masks in school this fall. The internet rejoiced, everyone agreed it was a great plan, scientists and politicians shook hands, and no one had anything to say about it.

Ha. Kidding. I promptly picked up some curly fries and wine when I heard about it and laid face-down on my office floor. Not the most sanitary place to do some deep breathing, but whatever.

I hate to joke about serious things like this, but if I don’t, I may cry. The idea of a uniform and agreed-upon plan for halting the spread of a disease that could prevent the deaths of many seems like a pipe dream at this point.

Let’s walk through this and see if I can help you with your decisions this fall.

What did the American Academy of Pediatrics recommend?

• “Everything possible must be done to keep school in-person.” This is because the rates of academic struggle, obesity, and mental health crisis all rose tremendously this past year. Kids need to be in school. We all agree on that.
• They recommend all eligible kids receive the COVID vaccine (12 and up currently)
• Universal masking for anyone in school over age 2 (all students and all staff)
• Flexibility in policy – COVID is an ever-changing scenario and if something isn’t working well, schools need to recognize it and change it
• Attendance of students should be closely watched, and mental health resources for both students and staff should be available
• There should be ongoing federal, state, and local funding to schools to help them with all this.

Why is the AAP recommending all kids wear masks this Fall?

• The AAP is asking all students to wear masks in order to not only protect those that cannot be vaccinated yet, but also the families of these children, and the community as a whole.
• The AAP advocates for children. ALL children. Not just your kid. The wealthy ones. The poor ones. The sick ones. The healthy ones. The physically and mentally challenged. The kid who is being raised by his elderly grandmother and doesn’t have the means or transportation to get that vaccine yet. The kid who doesn’t have enough food at home but gets 2 good meals at school. The child who doesn’t have access to the fancy laptop or functioning internet. The AAP gives us advice based on what will help our community better support and protect our kids.
• Guess what? Last year, we masked in schools. We washed hands more. We asked sick kids to stay home. And schools were then found to not contribute significantly to the spread of COVID-19. (Click here for more information)
• We also noticed a pleasant, NONEXISTENT flu and RSV season as an added side-bonus.
• What happened this summer? We took our masks off, had playdates, saw friends, had parties. And now have plunged into a winter-sized scourge of viral illness. My office has been booked days in advance. The hospital is full. In July. These school strategies work not only in regards to COVID, but all viral illness– both focused studies and my own practice numbers have proven this.

What is the “Delta variant”?

• The COVID virus is mutating (as we expected), and this is the newest and most common version of it in the U.S. right now
• It is crazy, freaking contagious. More so than the original bad boy.
• Verdict’s out on whether it makes you sicker. I suspect it will put a larger burden on hospitals just given the number of unvaccinated people who may be infected.
• Vaccines seem to be working well against it.
• A recent study from the United Kingdom showed that children and adults under 50 were 2.5 times more likely to become infected with Delta.

Why should my vaccinated kid wear a mask?

• Because keeping track of who is vaccinated and who isn’t is a huge burden on schools. And trust me, they have already suffered enough burden.
• Because many kids cannot have the vaccine yet, or haven’t had access to it.
• Because we don’t yet know how well the vaccines work against the new COVID variants and until we are more comfortable with seeing how effective it will be, this is the most low-risk and safe thing we can do.

Will masking harm my kid? Why are all these people saying these awful things about masks?

• Putting a piece of thin cloth on your child’s face does not harm your child.
• I have written one mask exemption this entire year. One. It was for a child with a very rare lung disease. The child’s lungs are anatomically and physiologically very different than a normal child’s and keeping oxygen levels up even without a mask was a struggle for this kiddo.
• The worst I’ve seen is a mild face rash here and there. Otherwise, don’t believe the hype. Masks are not causing TMJ problems, lost social development, increased CO2 levels, increased illness, etc etc. It’s a lot of weak arguments with no evidence and as a pediatrician who saw and examined thousands of children this past year: the kids are fine.

Does masking protect other people? Or me?

• Both.
• Even if your child is the only child wearing a mask in the class, it will protect him. (Click here for more information)
• This all works better if everyone masks.
• If an unmasked sneeze happens nearby, a mask prevents your child from inhaling AS MUCH virus into his airway – and there is brewing evidence that the MORE virus particles you inhale into your body, the more severe the subsequent illness may be.
• I also think it really keeps kids from touching their face, picking their nose, putting fingers in mouth, etc. Our absolute lack of flu and RSV last winter can attest to this.

What if only some kids are wearing masks? Will my kids get bullied?

• I don’t know. I doubt it. We did a whole year where everyone masked and school-aged and young kids were generally pretty cool and flexible about it. Most don’t seem to care either way. The bullies in this scenario often seem to be the adults.

When are the vaccines for the younger kids going to be ready?

• Pfizer’s clinical trial data for children age 5 to 11 is likely coming in September. If approved, shots for kids this age will be available within 1-2 weeks after that.
• Ages 2 to under 5 coming soon after that, in October.
• 6 months to 2 years soon after that.

What about my child under 2 who can’t wear a mask?

• It’s okay. Send them to daycare. Send them to mother’s day out. Do the swim lesson. Get the speech therapy. You need it to work, thrive, survive. COVID seems to be milder in young kids. And while I can never guarantee anything in life 100%, I think the benefits outweigh the risks for kids in this age group.

What if the daycare doesn’t require their staff to be masked? Vaccinated?

• I’m hopeful that daycare centers will strongly encourage their staffs to vaccinate and mask up, but I know that not all will. I think you should ask the questions and expect answers from childcare centers. You can certainly make that a part of your decision-making process when choosing where to place your child.

Do kids really get severely sick with COVID?

• COVID in children is mostly mild. No one debates that. But kids (especially the older kids) contribute to the spread in the community.
• Let’s not forget the times it’s not mild. I’ve seen kids with post-COVID chronic fatigue, long-term smell and taste change or loss, multisystem inflammatory problems, psychosis, and cardiac issues that have kept them out of sports for the year.
• We are still learning about the long-term consequences of COVID infection. There is thought that up to 30% of people who have had COVID will develop long-term medical problems.
• I talked to one of the Cook Children’s Pediatric ICU doctors the other day, Dr. Linda Thompson. I wanted her input about kids with more severe illness as she has seen much more of it than I. She said she’s seen more severe illness in older children compared to the younger ages. She also mentioned “please let everyone know I vaccinated my 14-year-old as soon as I could.”

What do you recommend, Dr. Diane? What will you be doing with your kids?

My kids (6 and 7 years old) will be going to school in-person this fall. They will be wearing masks regardless of what the other children are doing. They can take them off when outside. We will talk about it a lot before it happens, and expectations will be clear.

We will practice wearing them while we watch our screen time to get used to them again on our faces. We will pick the favorite fabrics. If our community numbers drop and my children are able to safely get vaccinated this winter, I can’t wait to tell them to take ‘em off.

But until enough of us get vaccinated, COVID is not going away. And it will likely surge again this winter.

As long as the numbers keep climbing in the community, we have to protect not only the kids, but all of us. Remember those hospital numbers in January? Remember the goal of not over-straining our medical resources? Remember Uncle Pete who had a heart attack and there wasn’t a single hospital bed available for him last winter?

I’ve said it before and I’ll say it again: we are building this boat as we float in it. We don’t know what the future holds for us and we are making the best decisions we can in a situation that no one has yet conquered. Having patience as we gather the data and learn from our successes and mistakes is the beautiful and necessary process of science.

According to the study published this month in the journal Pediatrics, just half of mothers surveyed said they always put their babies to sleep on their backs.

The findings are alarming for physicians who say back-sleeping is a key way to reduce the risk of sudden infant death syndrome (SIDS).

“We see it all the time, and it is tragic,” said Corwin Warmink, M.D., medical director of the Emergency Department at Cook Children’s Medical Center. “SIDS is responsible for more infant deaths in the United States than anything else during the first year of life.”

While experts don’t know exactly why back-sleeping is best for preventing SIDS, it is believed that babies who sleep on their stomach get less oxygen and retain more carbon dioxide because they are “rebreathing” air. It is also possible that tummy-sleeping can lead to upper airway obstruction and choking.

“Infants should always sleep on their backs in a crib with a firm surface and a tight fitting sheet. No bumpers, pillows or soft bedding should be used,” mentioned Dr. Warmink.

Another big reason infants arrive in Cook Children’s Emergency Department is co-sleeping. While many parents find comfort in sharing a room with their baby, bed-sharing is never recommended.

“New parents are understandably exhausted, but even a quick nap with a newborn can turn deadly,” said Dr. Warmink. “It’s horrible to see a parent lose a child because they were accidently smothered in their sleep. Sharing a bedroom with an infant makes sense, but never on the same sleep surface.”

Dr. Warmink also insists infants should never sleep on a couch, sofa or cushioned chair, even when alone, and especially not with another person.

About Safe Sleep

Tarrant County has one of the highest infant mortality rates among Texas counties–exceeding the national average. The Center for Prevention of Child Maltreatment is guiding a safe infant sleep awareness campaign in collaboration with Baylor All Saints, JPS and Texas Health Harris Methodist. Learn more here.

What is the core?

“Core” is the word we use to describe the muscles in the middle part of your body. It includes muscles in your stomach, back, hips, and around your shoulder blades. They are not your “six-pack” that you might be able to see from the outside. They are deeper in your body. Even though you can’t see them from the outside the same way you might see big biceps, they are just as important, if not more so.

What does the core do?

All of these muscle groups work together to help keep your body stable. They create a good base for your arms and legs to work on. They help you have good posture, which distributes forces evenly throughout your body. They also work to transfer forces to and from your legs and your arms, like when you kick or throw a ball.

Why is it important?

Having a weak core is a lot like having a chain where the middle link is broken. Your body just can’t work very well without it? Or something like that. When your core doesn’t do its job, other muscles, bones, or ligaments have to do the work. The problem is that they were not designed for that job, so they aren’t very good at it. Without your core muscles working to keep your spine stable, you may be more likely to have injuries like back pain. Having a weak core has also been linked to other injuries, such as anterior cruciate ligament (ACL) tears, shoulder injuries and ankle injuries to name just a few.

What if my child doesn’t play any sports? Is the core still important?

It is still very important to have strong core muscles. We use these muscles even when we are resting. They work hard to keep us strong while sitting in school, riding in the car, and playing outside with friends. The core muscles are so important that they should activate before any movement of your arms or your legs in order to keep your spine stable, even if it is just reaching into a cabinet to get a cup.

So what can I do?

• Make sure to talk to your child’s doctor before starting any exercise programs.
• Encourage your children to sit with good posture using their core to align their body. This means their shoulder blades should be pulled down and toward each other. Their heads should be in a line over their shoulders. They should be drawing their belly button in toward their spine, and they should not have a big curve in their lower back.
• Sitting on Swiss/Therapy balls while sitting at a table or while playing video games so it can activate the core muscles while doing homework or having play time.
• Have plank competitions as a family to engage everyone’s core. 
• Get moving … taking family walks, riding bikes, swimming, getting involved in physical activities such as Karate, dance, gymnastics to name just a few.
• Pilates and yoga classes are both good ways to work on core strength once your child has learned the basics.

Hopefully this article helped to explain a little bit more about the core. If you child is having pain, or is having a difficult time with the ideas above, consider talking with your doctor about a referral for physical therapy.

About the author

Jacky Arrow, PT, DPT, SCS, is a physical therapist for the SPORTS program at Cook Children's. Our physicians, therapists, nurses and technologists work exclusively with kids and understand the unique needs of a growing athlete's bones, muscles, body and mind.