The Safe Baby Sleep Council, led by Cook Children’s, takes a partnership approach to educating families and providing resources across much of North Texas.

In various locations from hospitals to health fairs to caregiver classes – even at Mayfest – the coalition’s 41 member organizations deliver the same reliable message. When parents of newborns request a birth certificate in Tarrant County, for instance, they receive a brochure about safe sleep, courtesy of the council. 

“Our hope is that families hear why safe sleep is important at their birthing hospital, and then when they receive their birth certificate, they are hearing the same message again,” said Samantha St. John, program coordinator for safe sleep at the Cook Children’s Center for Community Health (C4CH). “Consistency is key.”

Every year in the United States, about 3,500 babies die unexpectedly during sleep. Sometimes the cause can be determined, such as accidental suffocation or strangulation. But if the baby had no apparent medical problems, and their sleep space contained nothing potentially hazardous, the death is considered Sudden Infant Death Syndrome (SIDS). SIDS accounts for about one-third of all sleep deaths in infants younger than 1 year old.  

October is SIDS Awareness Month, a time to highlight the work of the Safe Baby Sleep Council in our region. St. John said council members are passionate about helping families create the safest sleep environment possible to reduce the chance of SIDS.

They want parents to know the safest way for babies to sleep is on their back, on a firm surface with a tight fitted sheet in a crib or bassinet or pack ‘n play, and with no pillows or blankets or toys. Co-sleeping with parents or siblings – in an adult bed, couch or recliner, for example -- isn’t safe for infants.

“There is a misconception that SIDS is a diagnosis, but you can't take your baby to the physician to be tested for SIDS. SIDS is simply the lack of a reason the infant should have passed away,” she said.

According to the National Institutes of Health, the risk for SIDS increases if three factors intersect: first, the infant has a condition that affects their heartrate or breathing; second, if they’re undergoing a spurt of rapid growth or development; third, if something external creates stress, such as exposure to secondhand smoke or being placed to sleep on their stomachs.

Spreading the Word

Safe Sleep is one of five injury prevention campaigns at C4CH along with gun safety, poison control, drowning prevention and car seats. The Initiative started in 2014 within Cook Children's Medical Center and then branched out to area hospitals. It grew over the years to include Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), Tarrant County Public Health and other organizations that serve families. 

St. John coordinates the coalition partners and supplies the materials they hand out at their offices and community events. Sometimes bundled together, the main resources are:

• Sleep sacks
• Educational slim cards in English and Spanish
• “Sleep Baby Safe and Snug” children’s books, purchased through Charlie's Kids foundation and available in English and Spanish

Between October 2022 and mid-September 2023, the council distributed 3,540 sleep sacks and 28,404 books and brochures, funded by Cook Children’s.

“We're able to provide all the education and resources to our partners so they do not have to worry about budgeting for these materials or recreating resources that are already available,” St. John said.

The children’s book is popular because it is written in a rhythmic pattern that babies enjoy. An added bonus -- reading promotes bonding.

“Oftentimes we hear that parents share a bed because they want to bond with their baby. But bonding really happens much more when we're awake,” St. John said. “A great interaction with our babies is to read books.”

When caregivers learn the facts, they’re motivated to tell others. Jennifer Gadnai, MBA, BSN, RN serves as the council’s co-chair. She said the word is getting out through Safe Baby Sleep courses and other venues. And in a partnership with the City of Fort Worth, the safe sleep message gets additional exposure as a public service announcement on the banners of city buses and benches.

“This is getting the life-saving education to the people who need it the most,” Gadnai said.

Gadnai’s passion for safe sleep stems from her work in the Emergency Department (ED) at Cook Children’s. “Over my 17 years here I have seen too many sleep-related deaths in our ED,” she said. “It’s a horrible event and devastating for all involved.”

Out in the Community

Coalition members interact with families at community events, where information tables and pack ‘n play displays draw the attention of people passing by. Table attendants will ask: What’s unsafe in the pack ‘n play demonstration?

“Parents will point out the obvious like the blankets, but they'll often miss things like the wedge pillow or the hat on the doll's head or that there's a pacifier tethered to the doll's clothing,” St. John said. It’s an opportunity, then, to teach some the lesser-known points of safe sleep, like the importance of a tight fitted sheet. 

Another type of community outreach occurs in visits to area high schools. Daniel Guzman, M.D., Cook Children’s emergency medicine physician and medical director of C4CH, speaks to home economics classes about various injury prevention topics. In those conversations, students frequently tell Dr. Guzman that infant brothers and sisters sleep on their tummies or under a blanket. He wants teens to know they can and should make a difference at home.

“If they see their sibling on their tummy, turn them over and place them on their backs. It's as easy as that. That might save a life right there,” Dr. Guzman said. “Or remove any stuffed animals or blankets from the crib.”

Hearing the facts from a trusted source helps the safe sleep message resonate. “It's always about if you can change one life,” Dr. Guzman said. “If it's one person who responds, that change goes a long way. It saves lives.”  

Related stories:

• 30 Infant Deaths Lined to Unsafe Sleep Prompt Call for Awareness
• Safe Sleep Starts with Babies in Their Own Separate Sleep Area

They shared how Cook Children’s is currently being impacted by a surge in COVID-19 cases and hospitalizations.

Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases, Corwin Warmink, M.D., medical director of Emergency Services, Kara Starnes, D.O., medical director of Urgent Care Services, and Bianka Soria-Olmos, D.O., pediatrician at Cook Children’s Pediatrics Haslet have all worked tirelessly to ensure our patients and families are receiving the best care throughout the pandemic.

During the news conference, the experts addressed what they are seeing in our urgent care locations, emergency department, and Cook Children’s system as a whole.

“We need compassion from the community and this is an illness affecting our children,” Dr. Starnes said. “We are hitting crisis mode and we can’t do it without your help.”

Cook Children's Urgent Care facilities are being stretched thin. Over the weekend, Cook Children’s was forced to close its Hurst location due to a lack of staff members and high demand for services.

"This is the first time we’ve had to take such measures. We closed in an effort to consolidate staff and safely take care of our patients,” Dr. Starnes explained.

On Monday, the six remaining urgent care locations saw 1,400 children. This is twice the number of patients the urgent care centers typically see.

Dr. Starnes stressed that if you believe your child has been exposed to COVID-19, it is best to find a local testing site in the community or use an at-home testing kit. You can find a list of local COVID-19 testing locations here. 

Cook Children’s Emergency Department (ED) is experiencing patient volumes not seen since the H1N1 pandemic in 2009. On Monday, the ED saw 601 patients with patients arriving every 2.5 minutes.

“We are breaking records we don’t like to break,” Dr. Warmink said. “I have been at Cook Children’s for 18 years and this is the worst it’s ever been.”

We encourage all families to come to the emergency room for emergencies but ask that they do not come for a simple COVID-19 test. This pulls resources away from critically ill and injured patients and takes up already limited bed space. Along with COVID-19, we are still seeing RSV cases but thankfully, they appear to be on a downswing.

“The adults in the room need to step up and do the right thing,” Dr. Warmink said. “If you send your kid to school without a mask, it’s not if they are going to get sick, it’s when.”

Dr. Warmink advises all parents, “Ask yourself if this can wait” before bringing their child into the emergency department.

Most children have mild illness with COVID-19, but that is not the case for everyone. Throughout the course of the pandemic, Cook Children's has hospitalized 1,129 children with COVID-19, with 241 of those admitted to the Intensive Care Unit (ICU). Throughout the pandemic, seven children with COVID-19 have died. Two died this past week. They were a 4 year old and a 15 year old. 

"We are seeing more severe illness than we have seen at any point during the pandemic. The January surge was nothing compared to what we’re seeing now,” Dr. Whitworth said.

As a result, on Monday, Cook Children’s opened up a third COVID-19 unit for the first time since the start of the pandemic. This unit has nine beds – and within the first 24 hours of being open, was completely full.

With Labor Day weekend ahead of us, Dr. Whitworth encourages everyone to be safe, mask up, and socially distance, as we cannot handle another influx at this time.

“Every child that has the virus inside of them has the potential to spread it to someone else, and they don’t mean to,” Dr. Whitworth said. “Much of what we are seeing is 100% preventable, children have to wear a mask.”

Cook Children's also set a record for COVID-19 hospitalizations on Wednesday with 35 patients. This is the highest number of COVID-19 patients hospitalized at the medical center at any point in the pandemic. The COVID-19 ICU was also filled. 

What can the community do to help?

All four experts we heard from on Wednesday have a few simple pleas:

1. Get vaccinated and get your child vaccinated as soon as possible.
2. Please have your children wear a mask to school.
3. Wash your hands frequently.
4. Re-think gatherings – if you gather, wear masks, stay socially distant and gather outdoors if possible.

Across the board, Cook Children's is seeing record numbers of families each day who are wanting rapid COVID-19 tests for their children.

"We understand this is a scary time, but want to remind families not to panic if your child was exposed to COVID-19," Dr. Starnes said. "We understand schools have requirements, but we need you to understand we do not want you to panic or rush in to be seen immediately after an exposure. Rushing to our urgent care locations puts a strain on our resources.”

The best thing you can do if your child was exposed is find a local testing-only site in the community or use an at an at-home testing kit.

Cough, fever, runny nose, sore throat, body aches, headache, vomiting and diarrhea are all common symptoms of COVID.

For children over the age of 3 months, these symptoms can typically be managed at home with symptomatic care. Medications such as acetaminophen or ibuprofen can help with fever and pain. You should encourage your child to drink plenty of fluids and it is ok if they do not have much of an appetite.

Parents should seek care for their child over 3 months of age if they have had 5 days or more of fever, difficulty breathing, inability to keep fluids down or stay hydrated (no tears or no urination for 8 hours or longer) or if their child is having pain or fever that is not helped by an appropriate dose of fever reducer/pain reliever.

Patients under 3 months of age who are sick should be seen in person and evaluated.

Also, if there is at least one known positive case at home and others are sick, it can be assumed that all have COVID and everyone needs to isolate at home for 10 days from the start of symptoms.

“We cannot magically create hospital beds at the drop of a hat,” Dr. Whitworth said. “Wear a mask no matter if you’re vaccinated or not, wearing a mask is not an option.”

Medical Director of Infectious Diseases, Suzanne Whitworth, M.D., hosted a Q&A with reporters today about this latest update.  

What’s the capacity like at your hospital?

We have devoted 10 beds to COVID-19-infected intensive care patients. So those 10 beds are available. We have two or three of them occupied right now. I believe the most we've had occupied in the ICU with COVID-19 at one time is five. We have plenty of room to expand and we are okay. The volume of children in the hospital with COVID-19 is much less than the volume of adults. We are almost at capacity for our floor COVID-19 unit. We have 20 beds there and 17 patients in those beds, but we are already looking at which other unit we can add so that we should have plenty of room for our patients. We're not worried about running out of beds.

Just hearing the amount of children that are in the hospital is gut-wrenching enough, but I'm wondering what those children are like right now. What are their symptoms? How are they feeling?

I think our children are like most of the children hospitalized nationally. We have some children in the hospital who are not very ill. They need oxygen for a day or two, and then they go home and they're fine. We have some children who are really more ill with COVID-19 pneumonia. Those children we've been treating with remdesivir, and dexamethazone, we have some that wind up in the ICU with COVID-19 infection. We have some children who have the multi-system inflammatory syndrome, that MIS-C that you've read about. We've reported about 21 to 24 of those to the health department so far since the beginning of the pandemic. And I believe we have a couple of those kids in the hospital currently, too. Some of those children are even sicker and require ventilation in the ICU also. So it's really a full spectrum.

Did you expect this exponential growth in cases and is this something you’re anticipating going forward?

We have been very hopeful that this would not happen like all the rest of the world, but it has. And we do think that the number of children that will require hospitalization over the next few weeks or months will very likely go up. We think this will increase.

Are you planning on adding additional beds?

I think we will have to change a little bit of what we're doing. I am not fearful that we will not have enough beds, period. I think we will have plenty of beds in the hospital, but we want to maintain areas that are devoted completely to COVID-19. We have one area completely devoted to COVID-19 on the floor and one in the ICU. We're probably going to need to add another floor unit to take care of COVID-19 patients over the next few days or the next week. So we look at which units we can do that with based on air flow and staffing and those kinds of issues.

What are your feelings moving forward into the holiday as we're dealing with this and what are your fears?

It's hard for me to imagine a way that this is going to get better before January or February at the earliest. My fear is that at this moment, we have so much more community disease. When people gather at Thanksgiving and Christmas, I'm worried that our more vulnerable populations will get sick. Right now, the people that are ramping up the numbers of COVID-19 infections are younger, and many of those do not require hospitalization. So at the moment, our hospitals are getting full, especially the adult facilities. I'm worried about those adult facilities and their capacity, but we're okay in pediatrics.

The problem I see could get worse if over Thanksgiving, there are family gatherings where elderly people become exposed and more of those require hospitalization. My fear about the holidays is that we will increase disease and then increase hospitalization at a time when many of the adult facilities are already maxed out. My sincere hope is that there will be minimal family gatherings and minimal disease transmission over the holidays. We haven't had holidays during a pandemic, so we really don't know how it's going to go. But I'm hopeful that everyone will continue to do their social distancing and masking and staying six feet apart and hand-washing and all of those kinds of things that we've been talking about since the beginning, so that things won't get worse during the holidays.

A lot of parents are wondering if children are getting infected at school or if they're actually getting infected at extra-curricular activities. What are your thoughts?

The numbers of kids that are believed to have gotten infected at school really has not been bad. We had been concerned about how kids in schools would do. I know there have been outbreaks with football and volleyball and some other team sports. And I think the classroom has gone probably better than what we expected. The problem that you run into is that kids are together all day at school, wearing a mask, six-feet apart and often behind Plexiglas shields. And after that, the parents feel like it's normal to say, they're at school together all day anyway, let's have the birthday party. What they don't realize is the birthday party is unmasked because people are eating, several parents show up at birthday parties who would not normally be in the same space, and I worry that it is more, the extracurricular events than it is actually in the classroom.

I think a lot of people were under the impression that kids don't get COVID-19. Not true?

We are living proof that that is not the case. We know that we're really lucky that children do not get as sick in high volumes as adults do. But certainly kids get sick and certainly kids get intensive care unit sick with this disease. Absolutely they can. We are very fortunate we have not had any deaths here. It is my understanding that there have been a couple of deaths in the Texas Panhandle. Certainly there are isolated cases with pediatric deaths in the country.

Biggest takeaway that you would hope people would take from hearing these statistics today that you guys have the most patients at one time?

Overall, things are worse. And when you look at the population of America, we have so many people that remain at risk. It isn't just the elderly. It's thought that 150 million American citizens have a pre-existing condition that puts them at risk for severe COVID-19 disease. That's almost half of our population. So even though it's the holidays and even though we're tired of staying home and wearing masks every time we leave the house, we just can't stop it. You just have to keep wearing your mask because you never know if you're carrying this virus asymptomatically, you could be putting other people at risk. When you're out in public, begin to think about standing six feet away from whoever you're talking to. Many people already have, but make it your habit to stay feet away from other people, and wear your mask. I think we just have to be more aggressive and do that more thoughtfully and not stop over the next few months.

Have you seen children without underlying conditions become hospitalized with COVID-19?

Yes, we have seen perfectly healthy children come into the hospital who have COVID-19, who wind up on a ventilator and life support. That does happen. It's not a high number, but you can't say that children are not at risk. That has happened here and it does happen.