Ashten Fleming, DNP, RN, NEA-BC, is the newest member of the all-female team at the helm of the Cook Children’s Physician Network (CCPN). In January 2023, she stepped into the role of Assistant Vice President of Primary Care and Specialty Services. She joined Vice President of Primary Care & Specialty Services Veronica Tolley, MHA, as well as fellow Assistant Vice Presidents Tara Allen, FACMPE and Teresa Baker, FACHE. Together, the four women work to support primary and specialty care practices and CCPN. The network began in 1995 and includes more than 700 primary care and pediatric sub-specialty physicians with offices in Tarrant, Denton, Parker, Johnson, Collin and Hood counties plus West Texas.

Ashten’s specific role focuses on operational development and implementation of business strategies support for Cook Children’s providers and departments. In one recent example, she helped onboard a new specialty practice of physicians and staff, connecting them with all the resources they need. Growth and team building is one aspect of the role, in addition to supporting quality patient care, managing market trends that might affect the teams, and working in collaboration with the system and providers to integrate technology to support sound financial and patient care outcomes.

Prior to coming to Cook Children's, Ashten worked at Medical City Healthcare for ten years, most recently in an assistant vice president role.

“What I love about coming to Cook Children’s is the special culture it takes to deal with pediatric patients,” she said. “There really is something different here - the kindness with which we interact with each other is really a big thing.”

Ashten had always wanted to be a nurse -- she enjoyed working with people directly and meeting people where they were. She attended Southwestern Adventist University for her BSN, the University of Texas at Arlington for her MSN and the University of South Alabama for her Doctorate of Nurse Practice Executive Administration. But she always found herself in leadership roles, either as the charge nurse, clinical supervisor or committee leader. At her first job, her bosses told her she belonged in the director development program.

“I didn’t want that. I went home and prayed and I said ‘I didn’t want this for my career, so if you want me to do that, you’re going to have to do all these things,’” she said. “That prayer was answered very specifically and I said okay, ‘I heard you.’ And six months later, I took on my first director role and it’s gone from there.”

Since stepping into a leadership position, Ashten discovered she can advocate for patients and her clinical team on a higher level. Even if it is a different path than she envisioned, she now finds genuine joy in her role and the impact she is able to have.

However, she is quick to point out she doesn’t do it alone.

Working together in a “hive brain manner"

Ashten and her three colleagues at the head of CCPN work together to tackle the many aspects of the program. In addition to supporting primary and specialty care practices, they oversee aspects of the regional clinics, telemedicine, physician recruitment, off-campus multi-specialty centers, UCCs and Neighborhood Centers.

They work together in almost a “hive brain” manner, Ashten said. When they receive a more specific request, it's likely at least one of them has the insight needed to tackle it.

Together, they work to encourage a culture of empowerment, self-awareness and communication among CCPN staff. They round with their departments and talk to leaders and staff, asking them for insights and feedback. Ashten works hard to be accessible to her departments and their needs; recently, she got feedback from one of her departments that she was “down-to-earth and approachable,” which was “really touching for me because that is my goal.”

In February, the team gave a presentation at a Cook Children’s director’s retreat in which they encouraged leaders to assess teams for working strengths and working frustrations and understanding the role each person plays on the team.

“We need all the different types of leaders and team members, and make sure we put them in the right roles,” Ashten said.

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By Carrie Pyle, D.O.

I had the opportunity to go on a medical mission trip to Migori, Kenya through an organization called Kenya Relief. The organization operates an orphanage, a school and a medical clinic.

Nearly every two weeks, a medical mission team travels to Migori to spend about four days working in the clinic. The teams are made up of outpatient providers, surgeons of different specialties, anesthesiologists, nurses and surgical techs. My team included a surgeon, two podiatrists, six certified registered nurse anesthetists (CRNAs), a family nurse practitioner, a radiologist, a sonographer, a social worker and myself.

I was able to go on the trip with my husband, Garrett Dupree, who is a CRNA. He provided anesthesia to surgical patients.

My whole experience was incredibly challenging and humbling. I saw kids ranging in age from a couple of months old to young adults. I saw patients with conditions I had only studied in textbooks but had never seen in real life. Because we did not have internet access to our usual online resources, I had to rely on my knowledge and advice from my team to care for these patients. We were able to work through this obstacle as a team and brainstorm ways to work together to provide better care.

Some days I saw some very heartbreaking cases. One of the first patients I saw was a young girl who has never been able to walk. Since she was an infant, she has experienced seizures intermittently and hadn’t received any treatment. We had a long conversation and answered some of the family’s long-term questions, even though the prognosis wasn't the answer they had hoped for.

I also saw another young girl who had developed a very serious bone infection called osteomyelitis, which caused swelling and drainage in her knee. She never received treatment to cure the infection. She needed to go to a children’s hospital immediately for antibiotics and possibly surgery to save her leg and prevent the potentially life-threatening infection from spreading.

Sending her to this hospital posed a significant financial burden to the family, but they were determined to get their child the care she needed. Together as a team, we helped the family cover the cost so that she could start treatment. By the time our team left, she was slowly improving.

Overall, my time in Migori was incredibly heartwarming and heartbreaking at the same time. Every patient we saw was so kind and grateful to be heard and to receive help. At the same time, I was really shocked by the degree of poverty and the significant barriers to medical care that are accepted as the norm for Kenyans. They’re faced with decisions to either have food on the table, send their children to school or receive medical care, and oftentimes, medical care is chosen last. I left Kenya feeling grateful for the high quality and comparably easier access to medical care that we have here in the States.

Osaretin Aimuyo, M.D., Cook Children's Pediatrics Arlington
“My mother has always told me, 'If you aim for the treetop, you'll never leave the ground. But if you aim for the sky, you will always reach the tree.' It was her way of telling me to always aim high and have strong aspirations.”

Diane Arnaout, M.D., Cook Children's Pediatrics Forest Park
“Even though I’m a pediatrician with 13 years of experience, I still go to my mom for advice about my kids. From burping my grumpy infant to helping my school-aged kid with school troubles, mom has always had reassuring words to help me realize that it’s all going to be okay.  Also she taught me that if my kid smells a lemon in the car, she won’t puke from motion sickness. Mind-blowing. Mom is the MVP.”

Sireesha Mutyala, M.D., Cook Children's Pediatrics Plano Legacy
"Always volunteer in your neighborhood, school and church or temple. Being involved gives you a voice and builds a better community!"

Alice Phillips, M.D., Cook Children's Pediatrics Cityview
“My mom always told me being a grandmother was the best but she still had good advice for me.  She pushed me to take care of myself.  ‘Take care of Ben and Annie’s Mom. She will be a better mom if you do.' Even though she is not with me anymore, I still feel her presence in the many lessons she shared with me. Once a mom. Always a mom.”

Rekha Sivadasan, M.D., Cook Children's Pediatrics Frisco
“One of the best pieces of advice my mother ever gave me was ‘Listen to your inner voice, do the best you can and leave the rest in God’s hands.' I have made this my mantra for life!”

Karen Evans, M.D., Cook Children's Pediatrics Parkwood
“Advice from mother: ‘Know that you are loved.  Strive to be and do better than the generation before you.  For this, live your life in honor to God and your path will be made clear.’”

Bianka Soria-Olmos, D.O., Cook Children's Pediatrics Haslet
“The most important advice from the two most important women in my life came in the form of day-to-day lifelong lessons. I was fortunate to have my abuelita (grandmother) live with my family when I was growing up. She was the matriarch of our family until her death a few years ago. She reminded me ‘Ser fuerte y trabajadora. Es mas que suficiente para lograr todo lo que tu quieras’ ('Be strong and hardworking. It is more than enough to achieve everything you want.') From my mom I have learned a lot about balancing motherhood and a career. I've always looked up to her and now enjoy seeing her love for my boys.”

The study, also published by the American Academy of Pediatrics, is the first of its kind to show how flu vaccinations significantly reduce a child’s risk of dying from influenza.

For four flu season, from 2010 to 2014, the CDC found that flu vaccines reduce the risk of flu-associated death by nearly two-thirds (65 percent) among healthy kids and by 51 percent among kids with underlying high-risk medical conditions such as asthma, chronic lung disease, heart disease and weakened immune systems.

“One of the questions we hear a lot from parents is does the flu vaccine really work,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cok Children's. “I hope this study helps parents see the real, life-saving value of the vaccinations. This report from the CDC shows us that the flu vaccine can play a major role in preventing more children dying from the flu.”

The study looked at 358 laboratory-confirmed, flu associated deaths. Of the reported pediatric deaths with known vaccination status (291), only one in four children (26 percent) had been vaccinated.

During the 2016‐2017 influenza season, 0 Tarrant County influenza‐associated pediatric deaths has been reported. As of week 12 for the 2016-2017 season, two influenza‐associated pediatric deaths have been reported in Texas, with a total of 55 reported nationwide.

To learn more:

• CDC Report
• AAP Report
• It's Only The Flu That Killed Her

About the Source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

"We try and try, but he won't burp."

Oh, the magical burp. It's that often elusive sound that would be offensive for you to let loose at the dinner table, but everyone celebrates when it comes from your newborn.

So, what's the point? Easy, to get some of the air that's trapped in the stomach below the milk … out. Some babies are easy to burp. They can suck down eight ounces of milk in five minutes and you barely get them upright before your hear a big, manly burp. There are other babies who, no matter what you do: pat, bounce, dance or turn them upside down … they are not going to burp.

I actually don't think it matters. I think the biggest benefit of the process of burping is simply that you aren't immediately laying them down flat right after they feed. Keeping them upright helps the milk settle lower in their stomach and provides some protection from spitting up, but actually obtaining the precious belch is probably not all that important.

Do you have more questions about newborns? Check out Dr. Smith’s program, Newborn University, including 20 posts about newborn care and classes or consultation at his office in Lewisville.

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.

"My mom used to say, 'When God closes a door, He always opens a window.' I have found that to be true many times in my life. My life as a pediatrician is a result of crawling through an open window when the door I thought I was supposed to walk through was closed to me."

Jason Terk, M.D., Keller, Keller Parkway

"Florinda Peak, the most amazing Mommy in the world, to 5 year old Dr Sandra Peak who did not want to practice reading… 'You have to learn how to read…because when you do the whole world opens up to you!'”

Sandra Peak, M.D., Lewisville

"The best advice my mother ever gave me was to give to others without expecting anything in return. (She also told me to never go outside with wet hair because I’d catch a cold, but medical school later disproved that. Sorry mom.)"

Diane Arnaout, M.D., Willow Park

"The best advice my mother ever gave me was, “never miss the chance to use a perfectly good bathroom” when you are out of the house."

Audrey Rogers, M.D., Fort Worth, Forest Park

Nicole Wineriter, M.D., Keller, HeritageTrace

"My mom told me to respect (be nice) to the nurses because they can either make or break your day."

Samuel Sheng, M.D., Arlington Neighborhood Clinic

"Encourage others. She always wrote notes to people for accomplishments, during sad times and just because."

Justin Smith, M.D., Lewisville

And finally, our favorite advice ...

"Marry Joan."

Tom Rogers, M.D., Forest Park. Dr. Rogers and his wife Joan have been married 59 years and today, she is a proud mother. "Joan worked to pay my way through medical school, gave me two great kids who are both pediatricians, and has allowed me to work without having to pay attention to small things like finances, maintenance of our house and yardwork. I couldn't be where I am today without her," Dr. Rogers said.

Happy Mother's Day from all of us at Cook Children's ...