For the second year in a row, Cook Children’s Emergency Department and Urgent Care Centers are seeing a big influx of parents bringing in children who have been exposed to COVID-19 but show no symptoms. This is causing long wait times at all locations and putting unnecessary strain on the health care system.

On Monday, Aug. 29, our Emergency Department (ED) staff saw 614 patients, which is equivalent to a patient checking in every 2 minutes for 24 hours straight. That’s nearly double the number of patients we typically see in the ED. Our seven Urgent Care Centers (UCC) saw 873 patients, which is also much more than usual.

“We are seeing patient volumes equivalent to our worst winters, and it’s taking a toll on our staff,” said Kara Starnes, D.O., medical director of Cook Children’s Urgent Care. “We need everyone’s help by staying home if you only need a COVID test or if your child has mild symptoms.”

Currently, 23% of COVID tests at Cook Children’s UCCs are coming back positive. In addition to COVID, Dr. Starnes says they are seeing a lot of colds.

“If your child tests positive for COVID at home, you can trust the test. You don’t need to have a health care provider confirm the results,” Dr. Starnes said. “If a COVID test comes back negative, it’s safe to monitor minor symptoms at home and re-test in 48 hours.”

Parents and caregivers are encouraged to reach out to their primary care physicians if their child is not feeling well.

Cook Children’s experienced a very similar situation in August 2021, likely triggered by kids going back to school.

Please avoid the emergency room and UCCS for COVID-19 testing. If your child has been exposed to COVID-19, please use an at-home test or schedule an appointment with a testing location such as a pharmacy.

“If your child needs emergency care treatment, our Emergency Department is here for you. That’s why we’re here,” said Natalie Carpenter, director of Emergency Services at Cook Children's. “But please don’t come to the emergency department for a simple COVID test.”

The ED should only be used for COVID-19 symptoms such as:

• Trouble breathing
• Persistent pain or pressure in the chest
• New confusion
• Inability to wake or stay awake
• Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone

If you are going to the ED, please limit the number of people you bring with you (if possible).

Where do you go when your child needs to be seen by a doctor?

Here’s a guide:

• Go to the emergency room if your child has trouble breathing, unusual sleepiness or confusion, poison ingestion, head injury with vomiting, serious burn or another life-threatening condition. 
   
• Call your health care provider if your child has ear pain, sore throat, diarrhea or vomiting, rash, cough or other non-urgent health concerns. The pediatrician’s office can help you decide what steps to take. 
   
• If you can’t get to your provider’s office or it’s after hours, go to an urgent care center. Urgent care centers manage the same problems as your regular health care provider plus services such as X-rays, stitches and splints.

Free COVID Tests Still Available to be Delivered to Your Home

Every home in the U.S. is eligible to order three rounds of at-home COVID-19 test kits from the government. You can easily sign up at covid.gov/tests and have the tests delivered to your home. The last day to order tests is Friday, Sept. 2.

For detailed information about what to do if your child tests positive or negative, download the PDFs attached to this article. 

That new approach, beginning in October 2001, pulled in the expertise of a plastic surgeon who trained a small team of paramedics as wound management technicians in the Cook Children’s ED. The techs became specialists for stitching up the gashes and bandaging the abrasions in pediatric patients.

One of those techs, Richard Berry, estimates that he has made almost 20,000 wound repairs over the past two decades. Berry was one of the original paramedics trained to cleanse and suture wounds. Between him and his four co-workers on the team currently, there’s always at least one technician available in the Cook Children’s ED from 10:30 a.m. to 2 a.m.

When is a wound serious enough to warrant a trip to the hospital? If severe bleeding doesn’t stop after 15 minutes of direct pressure. Or if the edges of a gaping wound don’t close. The best outcome of a stitched-up cut is the restoration of tissue function with minimal scarring.

“We see everything from fairly superficial little chin lacerations from falling in the bathtubs, and forehead lacerations that are fairly straightforward, to fingertip amputations or partial amputations,” Berry said.

The program’s launch at Cook Children’s 20 years ago brought about multiple upsides: Shorter wait time to get stitches. Lacerations closed quicker. Reduced risk for infection. And technicians who have experience and a touch of finesse backed by know-how and supervised practice.

Larry Reaves, M.D., a plastic ​and reconstructive surgeon for Cook Children's, oversees the training for the paramedics who move into the wound management specialty. Dr. Reaves described the program as a reliable tool for efficient delivery of quality care.

“Once we started it, everybody loved it. The patients loved it. The doctors in the ER loved it. It was an experiment that worked out very, very well,” he said.

The 20th anniversary marks a milestone. We at Cook Children’s are looking back at why the program was implemented, how it evolved, and what impact it makes.

In the Beginning

Back in 2001, on-call plastic surgeons were requested in the ED almost every night to stitch up various wounds, Dr. Reaves said. “This is not sustainable,” he remembers. So the idea was proposed to teach a few paramedics on staff to suture the simpler lacerations (a one-centimeter chin cut, for instance). Plastic surgeons would get called in only for the more complex wounds (anything involving the eyelid, for example, or a wound with irregular edges).

Dr. Reaves began a course that includes instruction in topics such as anatomy, anesthetics, proper examination techniques and patient/family interaction. Some of the paramedics in the first group had prior suturing experience that Dr. Reaves helped refine. It takes about a year now for new techs to complete the classroom portion and hands-on practice.

“We talk about proper preparation of the wound before you sew it up, recognizing other injuries in the wound, rinsing it well,’ he said. “Preparation of the wound is as important as the sewing of the wound.”

Berry started working at Cook Children’s as an ED paramedic almost 25 years ago, back when the skin adhesive Dermabond was the go-to fix for simple lacerations. After he learned to suture as a wound management technician, Berry took on some of the training duties for the newer team members. He enjoys the challenge of restoring a split lip, a severed fingertip or other injury.

“I love putting kids back together as close to how God made them to begin with. It’s a passion that I have for repairing. You take something that is way torn up and you’re able to put it back together where it looks like it’s supposed to.”

Growth and Expansion

Early on in the program, wound techs worked in the ED from noon to midnight. But as the number of patients increased over the years, the demand for suturing services grew. So now the techs cover 16 hours per day, from 10:30 a.m. until 2 a.m. – ideally, two techs on duty. Berry said the team typically sees eight to 12 patients each shift.

The process starts in triage, where a nurse or physician’s assistant assesses the injury and decides if that case would be best handled by wound techs. Topical numbing medication typically starts in triage, too. Parents sometimes request the on-call plastic surgeon. But as they proved their ability, the techs advanced to the more complex wounds, Berry said. Their presence in the ED reduces the frequency of calling in plastic surgeons.

“Our scope increased more than what the original plan was, but we also demonstrated that we could do it,” he said.

Child life specialists work with the techs to comfort and calm the patients while the stitches go in. Berry listed the program’s other big benefits:

• Streamlined workflow in the department. Suturing procedures usually take 15-30 minutes, and when a wound tech does the job, it frees up the physicians to see more severely ill or injured patients instead.
• Less time spent in the waiting room. If the wound isn’t complex, Berry said, there’s no need to wait hours for a tied-up doctor or plastic surgeon.
• Reduced risk of infection. “The sooner you get them washed out, cleaned up and repaired, the less bacteria load there is in a wound. Just the normal bacteria that’s on the skin can migrate into the open wound,” Berry said.
• Expertise for the best possible cosmetic result. Wounds are the techs’ #1 focus and priority. “This is what we do every day. We get very good at it,” he said. “Suturing is a technical skill. The more you do it, the better you get at it, the faster you get.”

Before discharge, the techs provide aftercare instructions regarding sun exposure and other precautions. Berry emphasizes that it can take a year for a wound to fully heal. He likes for his patients to come back to the ED so that he can remove the stitches himself and check the progress. If there’s a concern about a slow or difficult recovery, referral can be made to Dr. Reaves and the Cook Children’s Wound Care office.

Berry and Dr. Reaves describe the program as a unique collaboration with major advantages. Wound management techs in the ED cut the wait time without compromising the quality of treatment, Dr. Reaves said. “The patient wins in that situation,” he said. “We think it’s very good care.”

All patients with exposure to COVID-19, regardless of symptoms, will need to quarantine for 14 days. This is required, regardless of test results, because COVID-19 can develop between two and 14 days after an exposure.

At Cook Children’s Urgent Care, a patient may be required to have two negative COVID-19 tests before their doctor or nurse practitioner will sign a form allowing the child to return to school. This will likely be the case if the child's symptoms are high risk for the virus. 

If a child tests positive for COVID-19, they will need to stay home for 10 days after the onset of their own symptoms. This could mean a quarantine longer than 14 days. 

Cook Children's Health Care System follows guidelines from the Centers for Disease Control and Prevention (CDC).

We also follow the Infectious Disease Society of America which has issued the following COVID-19 guidelines: 

• Intermediate to high clinical suspicion of COVID-19: A COVID-19 test should be repeated in 24 to 48 hours (different samples if indicated)
• Low clinical suspicion: No re-testing

All patients with high-risk symptoms should be tested for COVID-19 before returning to school based on physician or nurse practitioner discretion.

These symptoms include:

• Fever
• Cough
• Shortness of breath
• Body aches
• Loss of taste/smell
• Headache
• Sore throat
• Sustained vomiting or diarrhea (and usually a combination of the these symptoms)

“Our goal is to make sure we limit the spread of COVID-19 as much as we possibly can to keep everyone healthy,” said Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “If the first test gives a false negative result, we could potentially be sending a contagious child back into the classroom. That is why a second test is needed in cases of high suspicion.” 

All patients with low-risk symptoms and NO known exposure to COVID-19 can be tested before returning to school based on physician discretion. Low-risk symptoms include congestion or runny nose, rash or a single episodes of vomiting or diarrhea.

Click here to read more about COVID-19 testing.

In 2018, she and her family joined the often overlooked but growing homeless population in Fort Worth. When Dana and her husband became unemployed and could no longer afford to put a roof over their heads, they turned to the Union Gospel Mission shelter for help. It was there that they were introduced to a program called the Homeless Initiative, which aims to provide a medical home for children experiencing homelessness in Tarrant County, a population of roughly 15,000.

“The Homeless Initiative program provides medical care, actually any service that Cook Children’s can offer, to the children who reside in the three shelters in Tarrant County: Presbyterian Night Shelter, Union Gospel Mission and Arlington Life Shelter,” said Pat Ballard, an RN at Cook Children’s and one of the two case managers for the Homeless Initiative. “We do well checks, sick visits, TB testing, we have a flu clinic, we get them up-to-date on vaccines, any specialty doctors that they need, dentists, dental care, dental surgery, we schedule it all.”

The Homeless Initiative began in 2008 as a collaboration between Cook Children’s and former Fort Worth Mayor Mike Moncrief. The goal was to provide a path to medical care for this vulnerable population of children who, too often, were only seen by emergency room physicians.

“Back in 2008, about 98% of homeless children in Tarrant County were using ERs for primary care issues,” said Ballard. “That’s a huge burden for any ER and it puts stress on the whole system.”

The initial goal of the program was to make sure children had a primary care physician through Cook Children’s Neighborhood Clinics. These doctors would provide appointments for things like well checks, ear infections and upper respiratory conditions. It didn’t take long, however, for organizers to realize the need for mental health services and trauma-informed care, which takes a person’s traumatic experiences into account and promotes environments of healing.

“I don’t think we fully understood the problem in the beginning,” explained Denise Coover, LCSW, trauma informed care specialist at Cook Children’s. “Many of these kids have been through a lot of trauma. The more questions we asked, the more we learned.”

Coover joined the program in 2013 and provides on-site behavioral health assessments of children in the three shelters where the Homeless Initiative operates. Many of the questions in her assessment gauge what children have witnessed or endured such as physical and emotional abuse. She adds that being able to talk to the children themselves is key because often, parents don’t know the extent of what their children have been through, especially if they’ve been separated due to time in jail or foster care.

“A lot of our children have witnessed domestic violence. We have a lot of children who make disclosures of sexual assault, physical abuse, neglect and sex trafficking,” Coover said. “When we think about trauma, we have to remember the true definition is an event, or the threat of an event, that overwhelms someone’s ability to cope. If you can think of something that would overwhelm your ability to cope, our children are dealing with that.”

According to the National Center on Family Homelessness, children experiencing homelessness get sick twice as often as other children. They also suffer from more mental health issues such as anxiety, depression and withdrawal.

“We know while these children are in the shelter, this is our opportunity to intervene with them and provide them help,” Coover said. “They can’t wait six weeks, 12 weeks on a waiting list. They need intervention and they need it now.”

To make sure children experiencing homelessness in Tarrant County get the care they need quickly, Cook Children’s provides free transportation to the program’s families.

“We have a 16 passenger shuttle with a full-time, dedicated driver that delivers our kids to every appointment that we make,” Ballard explained. “That means picking up the parent at the shelter, going to school and getting the child, bringing them back to the clinic, whatever we have to do to get that child to an appointment we do.”

And if an appointment interferes with a family’s ability to eat lunch, the driver will make a special stop to make sure parents and children don’t miss a meal.

Another major goal for the Homeless Initiative is to make sure families transitioning out of homelessness have everything they need to succeed. Cynthia Thomas, LMSW, another case manager for the program, spearheads this mission. She says her job is to support and empower families experiencing homelessness.

“I provide strollers, car seats, anything a parent would need. They may need assistance in the education system, or school supplies. My role is to find out what non-health resources are necessary for them to be successful,” expressed Thomas, who works for The Women’s Center of Tarrant County.

While such supplies are necessary for success, Thomas’ main goal is to cultivate life skills families can take with them when they leave the shelters. To foster these skills, she organizes parenting classes several times a week at all three shelters. Thomas works with community volunteers and organizations across Tarrant County to create educational presentations meant to equip parents for raising children and teens.

“When they leave the shelter, we want them to feel empowered and we also want them to be able to speak for themselves,” said Thomas.

Some families need a little extra help with this, especially those who have children with special needs. Thomas often acts as a mentor and spokesperson for these parents who may have trouble navigating the special education system.

“A lot of times, the parent doesn’t understand the verbiage of the special education program, so I will go through it with them so they understand it better,” said Thomas. “One of the most rewarding parts of my job is seeing parents gain confidence and feel empowered. One mother was too afraid to say anything during meetings we had with the school. I was able to watch her learn how the system works, become comfortable and lose that fear.”

It’s been 11 years since the Homeless Initiative began and the impact is visible. As of December 2018, nearly 16,000 children and their families had been transported to medical appointments through the effort. Forty-five percent of those children returned to a neighborhood clinic after leaving the shelters, meaning they were no longer using emergency rooms as their medical home.

“I can go in the clinic two, three years later and I’ll see a mom sitting in the clinic with her kids,” said Ballard. “That’s really nice to see that you’ve made a difference in their medical care.”

The program isn’t intended to be just an appointment at a doctor’s office. Cook Children’s hopes it will be a support system when families need it most.

“It’s a chaotic world right now, but this is one of the things we don’t have to stress about,” said Brown-Bonner. “When I forget something, I get a reminder. They go above and beyond to make sure you’re comfortable and that things are taken care of. I’m very grateful and I know that there are other parents that are as well.”

For the Homeless Initiative team, the work seems never ending, but they know their efforts have a higher purpose.

“We know the outcomes for these children are not good if there’s no intervention medically and emotionally,” said Coover. “But the thing about resilience, that is the ability to bounce back from difficult life experiences, is it just takes one person believing in a child to build the resiliency they will need to succeed.”

"There are a lot of patients who need specialized care or even higher levels of care and it’s really important that in this rapidly growing community that we have that available to these families," said Dr. Hogan, pediatricitian at Cook Children's Pediatrics Prosper Trail.

Dr. Hogan is one of 24 Cook Children's pediatricians currently treating patients in this region of North Texas. She says patients like hers need a place to access specialized and emergency pediatric care without having to drive 30 minutes to an hour away from home.

"A lot families have hardships and are not able to drive that far, or take off work all the time to go to these visits, and having this inpatient hospital and specialized care right her will make it easier for all the families," Dr. Hogan explained.

Construction of Cook Children's Medical Center North is in the initial phases with plans to have a full service hospital completed in 2022. The new hospital will be located on a 23-acre site in Prosper at Windsong Parkway and Highway 380. Having started in October of last year, phase one is already underway with plans to open a primary and urgent care clinic in the fall. An outpatient surgery center and specialty clinic with imaging and lab services will open in 2020.

"I'm really excited about the hospital opening up and being able to refer my patients to specialists, right here in Prosper, and being able to send my patients to get the specialized care that they need, having higher levels of care right across town," said Dr. Hogan. "I think that is going to be really wonderful for the families here."

Currently, Cook Children’s operates eight primary care offices in and around the Town of Prosper. The expansion near Windsong Ranch marks the first time in Cook Children's 101 year history that a full-service hospital has been built outside of Fort Worth.

"Just like the Town of Prosper is family, a close knit community, so is Cook Children’s," said Dr. Hogan. "We are all here wanting your children to be healthy and do better in life and be able to get the care they need to grow up to be happy and healthy adults."

They just didn’t know exactly how or for how long.

Inside the hospital, nurses and security guards were on high alert. The 2-month-old boy the Shiras were on their way to pick up was under a security watch. He had a broken femur and doctors were certain his injury was no accident. The longest and strongest bone in his body had been snapped in half. On top of that, he was suffering withdrawals from methamphetamine. Child Protective Services (CPS) acted quickly by taking the baby into their custody and beginning the search for a foster family.

“We got a call saying they were ready to discharge this baby and we decided to drive to Fort Worth to pick him up. We didn’t know much, but were told to find a specific nurse and give her a code,” said Katie Shira. “When we first arrived, the staff was very guarded. They weren’t going to let us see him until they figured out we were the foster parents. I was really impressed because they were doing everything to protect him.”

The baby, now known as Jett, was in a Pavlik harness. The full-body contraption kept both of his legs from moving. Katie and Chas listened as nurses explained how they should care for Jett. They had to handle him with extreme caution as the slightest adjustment could cause the baby pain.

When they left the hospital that night, the Shiras had no idea what life had in store. While they both wanted to provide love and support to a child in need, they never imagined the child would be in such a severe state.

“Sometimes I didn’t know if he was crying because his leg was broken or if he was withdrawing from meth,” said Katie. “It was so hard. He would shake and have tremors. His jaw would quiver. It was scary to watch and very sad.”

It took about six months for Jett’s addiction to subside. Slowly, his withdraws faded away and at the same time his leg was healing fast. He was soon able to ditch the harness and begin walking on his own. In many ways, things were looking up, but there was still a tough road ahead.

Jett’s biological family was fighting to get him back. They denied allegations of abusing the little boy and wanted full custody.

After 18 months of Jett living in the Shira’s home, the case finally went to trial. Katie describes the months leading up to that point as some of the most difficult she’s experienced.

“It’s a very odd feeling to have your life in the hands of 12 strangers,” she said. “I was struggling emotionally for two to three months before trial. I couldn’t sleep. I couldn’t eat. The anticipation of what was about to happen was so daunting.”

Katie and Chas both feared that Jett would be taken away from them. Even worse, they were scared he would be placed back into the care of the people who hurt him.

“When the trial began, the attorneys for the biological parents were arguing that his broken leg was an accident,” said Katie. “It got pretty ugly. Dr. Jamye Coffman was on the stand for 3 or 4 hours. She testified that there was no way this was an accident and his injury could have only been the result of abuse.”

Jamye Coffman, M.D. is a child abuse pediatrician and the medical director of the Child Advocacy Resources and Evaluation (CARE) team at Cook Children’s. She saw Jett soon after he arrived at Cook Children’s and followed his journey back to health and into a new home. It would be great to say that Jett’s case was one of the few Dr. Coffman became involved in that year, but the truth is her office saw 1,520 child abuse visits in 2015.

For the Shira family, having Dr. Coffman and the CARE team on their side was a game-changer. After seven days in court and two hours of deliberation, the jury came back with a decision. The Shiras were granted full custody of Jett.

“It’s funny because I feel like she has no idea what she has done for us. She changed the entire dynamic of the trial,” said Katie with audible emotion in her voice. “I get teary thinking about her because I believe she is an angel walking among us.”

For Dr. Coffman, knowing the outcome of cases like Jett’s help her stay motivated.

“Sometimes we don’t know if what we’re doing is really making a difference in a particular child’s life,” Dr. Coffman said. “Knowing that we helped a child is what keeps us going.”

Jett is now 2 years old and was officially adopted by the Shiras in January. Katie says there are days when she still can’t believe he’s theirs.

“It’s still kind of surreal that we don’t have to worry about his safety and well-being. He can just live with us forever,” she said.

In addition to becoming an official Shira, Jett is about to take on a new role. Katie and Chas are expecting their first child in May meaning Jett is about to become a big brother.

“We always wanted to have our own children, but we really wanted to adopt first,” Katie said. “We realized there are kids out there who don’t have the convenience of waiting until we have our perfect family. There are kids at the CPS office right now who just need someone to say yes.”

Adopting Jett Video

About the CARE Team

Led by pediatricians who are board-certified in child abuse medicine, the Cook Children's Child Advocacy Resources and Evaluation (CARE) team provides medical evaluations, psychosocial assessments and preventive education. Most CARE team examinations are conducted following a referral from Child Protective Services, a law enforcement agency or a medical provider.

The team provides medical evaluations for:

• Sexual abuse
• Physical abuse
• Other forms of child maltreatment
• Neglect
• Drug exposure
• Medical child abuse

Find more information by clicking here.

Never in a million years did she dream that he would not be able to leave the hospital with her after he was born.

As an adult oncologist in Abilene, Dr. Amechi is accustomed to the ups and downs that go along with medicine. But she wasn’t prepared at her twentieth week of pregnancy when she learned that the amniotic fluid that was supposed to be surrounding her unborn son was missing.

“You never really expect to be in that situation,” said Dr. Amechi. “I just thought I was pregnant, I arranged my maternity leave and I was ready to have my baby.”

When Dr. Amechi’s son, Samuel, was born, he immediately began suffering from respiratory issues and needed to be intubated. On top of that, his kidneys were not able to fully develop due to the lack of amniotic fluid, leaving him in need of dialysis. He was admitted to the Neonatal Intensive Care Unit (NICU) at the hospital where Dr. Amechi gave birth. For two months, Dr. Amechi spent day after day by Samuel’s side. The hospital was three hours away from their home in West Texas, and with a steady round of complications, the Amechi family had little hope of Samuel being discharged anytime soon.

“When I realized we weren’t going to get out of the NICU before September, I started bawling,” said Dr. Amechi. “That’s when my nurse said that’s it, let’s look for other options.”

After talking with the medical staff at the hospital, Dr. Amechi and her family decided to transfer Samuel to the NICU at Cook Children’s Medical Center. While it wasn’t home, it was a little closer to home. The Amechi family now only had to drive two hours to Fort Worth instead of the three hours they’d grown accustom to. And for the first time, they could spend the night next to Samuel. Unlike many other NICUs in the U.S., Cook Children’s NICU has private rooms with couches that pull out into a bed. This means families don’t have to leave their child’s side if they don’t want to.

“Cook Children’s has a way of arranging things to make life a little easier for families, even small things like parking. It was nice to be able park and not worry about finding a spot or having to pay for the garage,” said Dr. Amechi.

She says there was also a common goal among the NICU staff at Cook Children’s to get her son home, something she didn’t necessarily feel was the case before the transfer.

“We have a diverse and caring group of specialized people who are taking care of these very sick infants,” said Jonathan Nedrelow, M.D., medical director of the NICU at Cook Children’s. “From our nursing staff, to pharmacy, respiratory therapists, physicians and advanced practice nurses, we are all focused on doing what is best for the patient and their family.”

After three months at Cook Children’s, Samuel was finally deemed healthy enough to go home for the very first time. He was discharged in early September and is enjoying life with his two big sisters.

“Being able to leave the hospital with my son was a blessing,” said Dr. Amechi. “I remember when I was first told that I couldn’t take him home and I felt like the floor was going to fall from under me. So even though I was scared, I couldn’t wait to take him home.”

Stories like Dr. Amechi’s are not uncommon. In fact, Cook Children’s sees more than 1,000 babies admitted to the NICU each year. But often, when parents learn their newborn is in need of specialized care, they don’t realize they have a choice as to where that care is facilitated.

“Parents should know that they have a say when it comes to the care of their child,” said Dr. Nedrelow. “They should also know that there are different levels of care available.”

The NICU at Cook Children’s has been designated as a Level IV NICU by the state of Texas, meaning it provides the highest standard of neonatal care. Dr. Nedrelow says parents interested in transferring to Cook Children’s should contact their insurance company first. Because every company is different, having written approval from your insurance company before the transfer is the best way to ensure the care will be covered by your policy.

“If you’re considering transferring your baby to another hospital, be sure to talk to your physician,” said Dr. Nedrelow. “Ultimately, it’s your decision on where your newborn is treated, but your physician makes the referral and remains part of the treatment process so it’s important to discuss the process with him or her.”

About Cook Children's Neonatal Intensive Care Unit

If you would like to schedule an appointment for a NICU tour, refer a patient or speak to our staff, please call our offices at 855-687-6428. You can also find more information on our website. 

In the absence of state-led standards, DSHS was tasked with developing criteria for designating levels of neonatal and maternal care. This includes specifying the minimum requirements for each level, one through four. Any NICU in Texas that receives Medicaid reimbursements must undergo this designation process by September 2018 in order to continue collecting Medicaid funds. Cook Children’s NICU was one of the first NICUs in the state to be reviewed.

“While all NICUs help babies who need extra care, Level IV NICUs care for the most critical and vulnerable infants,” said Jonathan Nedrelow, M.D., neonatologist and medical director of the NICU at Cook Children’s Medical Center. “This designation reinforces the fact that Cook Children’s is among the best care centers in Texas for medically-fragile babies.”

• Comprehensive care for infants born at all gestational ages and birth weights with critical illnesses.
• Surgical repair for complex congenital or acquired conditions.
• A full range of pediatric subspecialties and surgical specialists.
• Access to high-risk infant follow-up care through the NEST program once babies are discharged.
• Ability to transport critically-ill babies via aircraft.
• Outreach education to lower-level facilities.
• Single rooms so parents can comfortably stay with their babies.

“Cook Children’s NICU is the only Level IV NICU in Tarrant County,” said Sheralyn Hartline, director of the NICU at Cook Children’s Medical Center. “This recognition is significant because it means families of critically ill babies don’t have to travel far from home to receive the best care available. The physicians and nurses at Cook Children’s NICU provide exceptional care for the some of the sickest babies in Texas and across the United States.”

Find the requirements for a Neonatal Designation Level IV, according to Texas Administrative Code, here. For more information on House Bill 15, please visit the Texas Health and Human Services website.

Learn More About Cook Children's NICU
No one ever wants to think about their newborn being critically ill. But it's good to be as prepared as possible, so if you do have to make such choices, we'll help you be well-informed. Start by asking your doctor about what type of treatment your baby may need. Then ask which NICU has the best equipment and staff to provide that care. You may want to research and learn about the differences between each one. For example, only Cook Children's NICU offers all single rooms, specially designed so that babies can receive the highest level of care and parents can comfortably stay with their babies as much as they like. Your OB/GYN or pediatrician may also be good sources of NICU information. 

Irving Police said the boy admitted to choking to death his ex-girlfriend, but his unsolicited confession came before he had his rights read to him.

Although the story is sad and shocking to us, it’s all too common.

When it comes to relationships, teens are the most common age group to experience dating violence, and dating inexperience is often to blame.

“Many teens in danger don’t realize their relationships are unhealthy or that certain behaviors are inappropriate,” said Jamye Coffman, M.D., medical director of the Cook Children’s CARE (Child Advocacy Resource and Evaluation) team. “Abuse doesn’t always involve physical assault, and many inexperienced teens and young adults view threats jealousy and controlling behaviors as signs of love.”

An estimated one in three teenagers is in an abusive relationship.

Because abuse is common in teenage relationships, it’s important for parents to talk with their children about the signs of abuse and the components of a healthy relationship before teens start dating. Parents should also model respectful behaviors in their own relationships.

“Explain that partners should respect and support one another and maintain safe boundaries,” Coffman said. “If you are worried, you can say, ‘I’m concerned about our current relationship, and I want to make sure this is a healthy one for you.’ By maintaining a healthy, respectful relationship with your teenager, you can keep communication open.”

Unfortunately, many of these relationships by teens are carried over into adulthood.

If teenagers are in an abusive relationship and want to break up, support from family and friend is essential. According to Dr. Coffman, teenagers should always carry a cell phone so they can call for help if necessary. They should also never end an abusive relationship when they are alone.

If teens attend school with their significant other, the school needs to be aware of the situation to prevent retaliation from occurring during the school day.

“The break-up period is the most dangerous time for abuse to occur or escalate,” Dr. Coffman said. “Parents need to help their children develop a plan, which should include ways to maintain safety. It’s also important for parents to recognize that girls are not the only ones at risk for abuse, and abuse doesn’t only happen in heterosexual relationships.”

Identifying Abuse

The following signs indicate teenagers may be in unhealthy relationships:

• Checking their significant other’s email, text messages or voicemail without permission.
• Jealousy.
• Mood swings.
• Offhand comments intended to degrade or put down, which are often written off as joking or teasing.
• Withdrawal from friends, family and favorite activities.
• Unexplained bruises or physical injuries.

The best thing a friend can do is help a woman suffering from domestic violence to connect with people who can get her out of her situation so she can develop a safe plan to reclaim her life. If you are in the Fort Worth area, contact One Safe Place to learn more about domestic violence, support victims, or to receive help. Nationally, call the National Domestic Violence hotline at 1-800-SAFE (7233).

A recent announcement of a new smartphone app by Eli Lilly for glucagon use instructions reminded me specifically of the growing number of smartphone apps in diabetes care. A recent survey showed that the average smartphone user has 41 apps loaded on his or her smartphone. Apps powered by Internet connectivity affords users many options ranging from productivity to entertainment. I use my smartphone multiple times per day for various tasks ranging from checking email, reading medical news briefs, or entertaining my daughter with Angry Birds.

Health related applications loaded on smartphones along with other devices such as tablet computers represent a growing new trend of mobile health (Mhealth). Mhealth is a term used for the practice of medicine and public health supported by mobile devices. Mhealth currently provides a number of useful services including access to health information, real-time patient monitoring, and communication with the health care team. Many health care organizations, now have apps providing families with useful health information. A growing number of diabetes care apps are appearing to meet the needs of children and families dealing with this chronic condition.

Caring for type 1 diabetes involves a great deal of daily work: recording essential information such as blood sugars, insulin doses, carbohydrates eaten at meals, exercise, and illness. The diabetes education received by children and their families in the Cook Children’s pediatric diabetes program stresses two key skills of organization and interpretation of the daily flood of information. An organized system for capture of information is vitally important to give children and families maximal control over type 1 diabetes. The “old school method” for organization is a paper logbook carried everywhere with all information recorded. This system remains the best overall method helping both families and the pediatric diabetes care team to make important medical treatment decisions.

I know that many children and families struggle with maintaining a high level of organization. Diabetes smartphone applications present the potential to meet the needs of a mobile, tech-savvy population seeking a step beyond paper logbooks. I think this population is already comfortable with downloading and using apps from either iTunes or Android Market (Google play) and is willing to experiment with new methods of managing diabetes information.

Diabetes apps lend themselves to the necessary skills of management which include:

· Recording blood sugar readings

· Recording carbohydrates eaten at meals and snacks

· Looking up food carbohydrate content

· Calculating insulin doses

· Recording other information such as exercise or illness

· Communication with the diabetes care team

The growing number of diabetes apps (free and pay) makes it hard at times to determine which app is best for diabetes care. There is technology, such as IBGstar, that was designed to specifically integrate with Apple devices such as the iPhone or iPad. Other applications, such as Wavesense and Glucose Buddy, work with both Apple and Android devices. Newer apps also include allowing the user to link his or her social media accounts such as Facebook or Twitter with the app. A recent entry into diabetes apps designed by a pediatric endocrinologist, Endogoddess, offers another twist by rewarding care efforts with points.

I believe that technology advances such as diabetes apps and glucose sensors are part of the continuing forward progress in diabetes care. As with all new technology, I strive with families to make the best use of the tools available to improve diabetes care.

So much has happened in this first month. We’ve been through what the nurses and doctors call the “honeymoon phase” when things are going well and are relatively drama free. And then, the “roller coaster ride,” as everyone refers to it, began. There will be a few good days in a row that really get your spirits up and then you’ll come back the next day and, like a slap in the face, you are met with unsettling news and faced with setbacks. All that progress your child has made is erased and you feel like you’re starting over in some cases.

In this first month, we’ve been through things that no new parent wants to experience. We’ve learned that Avery has a congenital heart defect called a patent ductus arterius (PDA) and she could possibly need surgery. We’ve witnessed her being “bagged” or resuscitated more times than I care to count. I’ve watched her get a catheter because they thought she might have a urinary tract infection. She’s had multiple blood transfusions. Poor baby has fought off pneumonia and continues to get help breathing with the support of a ventilator.

In addition to those scary things, we’ve also hit some key milestones. She is now over 2 pounds! She has grown an inch and a half. She has been cleared of brain bleeds. She is tolerating her feeds and is producing dirty diapers regularly. Poop is something that is highly celebrated around here! I never knew I would be so excited to see my daughter poop, but it’s a great sign that her digestive system is working properly.

It’s hard to actually feel like a parent in a situation like this when you have a team of doctors and nurses doing most of the work for your child. Right now, I cherish the simple things like taking her temperature and changing her diaper because those are actually things I can do for her by myself. I got to help give her a bath the other day and it was the most I’ve been able to touch her since she’s been born. It was the best day I’ve had in weeks.

And even though we have very limited interaction with her right now, we are getting to know our daughter. Things we’ve learned so far: She is a feisty little thing. She doesn’t hesitate to push the nurses away when they are doing something she doesn’t like. She doesn’t like to sleep very much. She is not very good at being still. It often looks like she’s having her own little dance party in her incubator, especially when she lies on her tummy and shakes her little booty.

The more I learn, the more I am intrigued by her and I can’t wait to learn more.

You can read part one of Avery's Journey here.