Each of the 1,528 pinwheels represents a visit with Cook Children’s Child Advocacy Resource and Evaluation (C.A.R.E) team due to suspected child abuse in 2025. In Prosper, 1,287 pinwheels illustrate the victims of child abuse in Denton County in 2025.

April is National Child Abuse Prevention Month. The pinwheels help draw attention to the issue and remind caregivers, families and parents they are not alone. Each pinwheel isn’t just a case or a number, it represents a child.

“We see kids who are referred to us from other medical providers, law enforcement, or CPS,” explained Erica Bohmer, M.D., a physician with the C.A.R.E. Team. “Anytime there's a concern for any kind of abuse or neglect they are referred to us.”

Dr. Bohmer clarifies that a referral to the C.A.R.E team does not automatically mean abuse is confirmed. In 2024, less than half of the children referred were substantiated.

Protecting the Child, Supporting the Caregiver

The C.A.R.E. Team consists of social workers, nurses, nurse practitioners, doctors and medical assistants who focus not only on the physical well-being of the child but also the family’s holistic care.

“We know that kids are most at risk (for child abuse) when their caregivers are going through really stressful or traumatic times in their own life, and they have a lower threshold of tolerance for being frustrated or they just don't have the right resources,” said Dr. Bohmer. “By providing help to caregivers we can have the biggest impact in preventing child abuse and neglect.”

Dr. Bohmer says abuse is usually identified during physical exams. The C.A.R.E. team most commonly receives outpatient referrals due to sexual abuse and most evaluations from inpatient referrals is due to physical abuse. Across the health care system and nationwide child neglect is often the biggest form of child abuse. The C.A.R.E team also performs neglect evaluations when there are concerns for illicit drug exposure.

A majority of referrals to the C.A.R.E team for suspected child abuse are due maltreatment and concerns for drug exposure.

Child abuse is preventable with the right tools and resources. The C.A.R.E. team understands the stresses of everyday life can take a toll, but it’s important for caregivers to know there is help available.

“We try to help identify resources that we can help families with, whether it's connecting them with food banks or if they need help filling out applications for a WIC or touching base with local, advocacy centers or even clothing, transportation, just anything that we can do to help the families, even down to working with electricity and water companies,” said Carla Davis, RN, nurse manager for the C.A.R.E. team

 In Texas any person who suspects child abuse or neglect must report it to law enforcement or the Texas Department of Family and Protective Services Abuse Hotline. Health care professionals are mandated reporters who must report suspicions of abuse within 24 hours. 

“We care about protecting the children and the entire family,” said Davis, “We want to try to support and help as best we can so that it can be a successful situation where the families can stay together.” 

Related Stories

• Cook Children's Center for Community Health Collaborates with Community Partners to Raise Awareness about Child Abuse Prevention

• Empowering Families through Mental Health Conversations

Each of the 1,540 pinwheels in Fort Worth represents a visit to the Cook Children's Child Advocacy Resources and Evaluation (CARE) Team where a child was evaluated for concerns of abuse or neglect in 2024. A referral to the CARE team for suspected child abuse does not automatically mean that abuse is confirmed. For example, about half of the children referred to the CARE team for physical abuse are substantiated.

The 1,148 wheels in Prosper represent the number of child abuse cases in Denton County in 2024. 

The purpose of the pinwheels is to show the scale and impact that child abuse and neglect has on our community, while also exemplifying the resources available to victims.

“It is tragically beautiful,” said CARE Team Nurse Manager Stacey Henley.

Henley says the CARE Team uses the time spent planting the pinwheels on each campus “to reflect and pray for each child who they have seen over the past year, which can be very therapeutic for the staff.”

The pinwheels are only one part of Cook Children’s efforts to raise awareness, prevent and care for those affected by child abuse and neglect. Across North Texas, Cook Children’s is part of a vast support network for families to not only help children when abuse happens, but also to step in beforehand and prevent it.

Across eight counties, Cook Children’s Center for Community Health (C4CH) partners with community groups to determine on a grass-roots level what different areas need to prevent child abuse and neglect. 

“During the month of April, we observe National Child Abuse Prevention Month to emphasize the importance of communities and organizations working together to support families and prevent child maltreatment,” said Frances Wampler, program coordinator with C4CH.

“Together, we can make a difference,” Wampler said. “By supporting families, recognizing signs of abuse, and reporting concerns, we help ensure every child has the opportunity to thrive.”

Go to saynotoabuse.org for additional prevention and support resources.

RELATED STORIES
Cook Children's Center for Community Health Collaborates with Community Partners to Raise Awareness about Child Abuse Prevention

This April, during Child Abuse Prevention Month, the Cook Children’s C.A.R.E (Child Advocacy Resource and Evaluation) Team celebrates its 30-year anniversary. For the last three decades, this department has played an invaluable role in helping child abuse victims and their families heal while providing preventative education to the community at large. 

About the C.A.R.E. Team

Led by pediatricians who are board-certified in child abuse medicine, the Cook Children's C.A.R.E. Team provides medical and forensic evaluations for victims of physical and sexual abuse, neglect, and drug exposure. All C.A.R.E. Team patients are referred from Child Protective Services (CPS), law enforcement agencies, or another medical provider.

“Our job is to make sure the child is okay, and if they’re not, to provide the necessary medical treatment and help them heal,” said Nurse Manager and forensic nurse examiner, Stacey Henley, MSN, RN. 

The C.A.R.E. Team does the critical work of providing a medical diagnosis—whether it’s found to be child abuse, an accident, or another underlying medical condition—and facilitating a treatment plan for the patient.

“Everything we do, we do because we care about these kids,” said C.A.R.E. Team Medical Director, Jamye Coffman, M.D. 

Helping Children Heal

The C.A.R.E. Team helps victims of all types of child abuse and neglect begin to heal physically, mentally, and emotionally. 

The team is trained to recognize the dynamics of trauma and fight-or-flight, which means they have an evidence-based understanding of why children don’t always report abuse.

“A lot of people think abuse looks like what happens in the movies, where someone gets attacked by a stranger in a dark alley,” Henley explains. “They don’t understand that over 95% of the time, a child's abuser is a family member, a close family friend, or someone else the child knows.”

The C.A.R.E. Team provides comprehensive psychosocial assessments of each patient’s physical, mental and emotional health to ensure they receive the care they need. They also work with numerous advocacy centers in the community—listed on their website under Prevention, help and support resources—that are dedicated to helping child abuse victims and their families find hope, healing, and justice. 

“Our job is to protect these kids,” Henley said. “We make sure their body is okay first, and then we help them start their healing journey.”

A Collaborative Approach

The C.A.R.E. Team collaborates with multiple different specialties, including hematology, orthopedics, pediatric radiology and more, to provide multidimensional care for patients. 

“I think it’s our superpower that we have such a great group of specialty services that are willing to work together to make a diagnosis of potential abuse,” Dr. Coffman said. “We need a lot of different perspectives because a medical diagnosis holds great ramifications for the child and the family.”

Beyond Cook Children’s, the C.A.R.E. Team is part of a larger multidisciplinary network involved in child abuse cases—including law enforcement, CPS, advocacy centers, and the District Attorney’s office. The C.A.R.E. Team ensures all other parties involved in a child’s case understand their medical diagnosis and its consequences.

Community Education and Partnerships

“We try to provide education to pretty much anybody who asks us because we want to make sure everyone has the appropriate medical information about abuse,” Henley said. 

Throughout the year, the C.A.R.E. Team hosts workshops and conferences with attendance from hundreds of other medical providers throughout the country. The team also provides community education for its advocacy center partners, school districts, daycares, churches, law enforcement, CPS, and more—ensuring all organizations are familiar with the medical symptoms of abuse and know when and how to report.

Several of the C.A.R.E. Team’s initiatives are also aimed at preventing and thwarting specific types of abuse. They commonly host workshops on The Period of PURPLE Crying, teaching parents how to navigate the frustration that can lead to severe and potentially life-threatening abuse. The team also participates in case reviews during which juvenile offenders or those with problematic sexual behaviors can be referred to counseling programs. 

“If they meet the qualifications, offenders can go into a program that helps them learn about why their behavior is inappropriate,” Henley said. “These are kids in our community and we need to help them, too.”

For more information on the signs of child abuse and prevention, visit saynotoabuse.org. To report abuse, neglect, or exploitation, contact the Texas Department of Family and Protective Services at 1-800-252-5400. If the child is in immediate danger, call 911.

National Child Abuse Prevention Month brings awareness to recognizing and reporting child abuse. It also recognizes the importance of families and communities working together to strengthen families to prevent child abuse and neglect. Texas consistently has some of the highest child abuse and neglect rates.

Child abuse and neglect include all forms of physical and emotional harm, sexual abuse, neglect, and exploitation that result in actual or potential harm to the child's health, development or dignity. Within this broad definition, five subtypes can be distinguished – physical abuse; sexual abuse; neglect and negligent treatment; emotional abuse; and exploitation.

Each of the 1,675 pinwheels displayed at Cook Children's reflects a child abuse visit. Neglect is the No. 1 type of child maltreatment. One in seven children has experienced child maltreatment in the past year. Texas is the No. 1 state for child abuse fatalities.

Led by a pediatrician who is board certified in child abuse medicine, the Cook Children's CARE Team provides medical and forensic evaluations for victims of physical abuse, neglect and drug exposure, sexual abuse screening examinations and preventative education for victims of child maltreatment.

Resources:

• The Cook Children’s Child Abuse and Neglect Prevention website and a phone number to text for local resources.
• Text ‘FIND’ to 67629 for local resources and support.
• Call 1-800-252-5400 to report abuse. Visit txabuseonline.org to report abuse online.
• Child Abuse and Neglect Prevention (cookchildrens.org)
• Go to saynotoabuse.org for additional prevention and support resources.

In 2021, there were 1,570 visits at Cook Children’s Medical Center in Fort Worth, Texas. Jamye Coffman, M.D., is the medical director of the Child Advocacy Resources and Evaluation (C.A.R.E.) Team at Cook Children’s.

On this episode of Raising Joy, she talks to us about her work as a pediatrician dedicated to treating victims of physical and sexual abuse, neglect and drug exposure. Dr. Coffman also shares about the increase in patients being targeted by predators online and how parents can help protect their children.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple, Spotify and Google Podcasts.

National Child Abuse Prevention Month brings awareness to recognizing and reporting child abuse. It also recognizes the importance of families and communities working together to strengthen families to prevent child abuse and neglect. Texas consistently has some of the highest child abuse and neglect rates. The pandemic has increased family stress and mental health challenges, both of which increase the risk for child abuse.

The campaign messages, placed inside the buses and on bus benches, will share healthy parenting habits, such as “Discipline fairly and with love. Never use violence or put-downs.”

The team at Cook Children’s aimed for this year’s campaign to help parents and caregivers by sharing everyday actions that can make a difference in their child’s life.

“We are all being inundated with negative media messaging right now. Kids are struggling and caregivers are stretched thin,” said Program Manager Breanna Anderson, The Center for Children’s Health. “It is crucial that Cook Children’s and other service organizations bring attention to the heartbreaking reality of child abuse and the need to report concerns to the appropriate authorities. However, this year in particular, we also wanted to layer in positive reminders to help bolster resiliency and healthy family interactions.”

The campaign will also share two resources: the Cook Children’s Child Abuse and Neglect Prevention website and a phone number to text for local resources.

The campaign signs say:

“It takes repetition to form a new habit. Do these things often:
Give your child praise and hugs. Say “I love you” often.
Set simple rules and consequences. Always follow through.
Discipline fairly and with love. Never use violence or put-downs.
Always show respect for your child’s thoughts and feelings.
Keep your sense of humor and manage stress in healthy ways.
If you feel overwhelmed, arrange for outside help.
For more tips, go to saynotoabuse.org

Text ‘FIND’ to 67629 for local resources and support.”

Call 1-800-252-5400 to report abuse. Visit txabuseonline.org to report abuse online.

Child Abuse and Neglect Prevention (cookchildrens.org)

Each of 1,570 pinwheels at Cook Children's reflect a child abuse visit

Each year for Child Abuse Prevention Month, Cook Children's displays pinwheels to represent a child abuse visit with the CARE Team. From January to December 2021, there were 1,570 child abuse visits to the CARE Team.  Neglect is the No. 1 type of child maltreatment. One in seven children has experienced child maltreatment in the past year. Texas is the No. 1 state for child abuse fatalities.

Led by a pediatrician who is board certified in child abuse medicine, the Cook Children's Child Advocacy Resources and Evaluation (CARE) Team provides medical and forensic evaluations for victims of physical abuse, neglect and drug exposure, sexual abuse screening examinations and preventative education for victims of child maltreatment.

Go to saynotoabuse.org for additional prevention and support resources.

Doctors at Cook Children’s believe the stresses from the COVID-19 pandemic are linked to nine cases of severe child abuse seen at the hospital since March 17, 2020. Three of those children have died. Typically, Cook Children’s sees this many such cases over the course of a month

All of the children admitted were 4 years old and under.

"We usually only average six deaths from abuse a year at Cook Children's and now we've had two children die on the same day," said Jamye Coffman, medical director of the Cook Children’s Center for Prevention and Child Abuse and Neglect and the CARE team​. "This is an issue related to stress. We are seeing it from all over from urban area to more rural counties."

For the providers who take care of these children, the news of this abuse didn’t come as a total surprise. During the recession in 2008/2009, Cook Children’s saw the leading cause of death from trauma change from motor vehicle crashes to abusive head trauma.

“We knew an increase in abuse was going to occur, but this happened faster than we ever imagined,” said Christi Thornhill, director of the Trauma Program, the CARE team and Fostering Health at Cook Children’s. “I mean this happened in a week and these are really bad abuse cases.”

Dr. Coffman believes these unprecedented times have simply become too much for some parents.

“People have so much increased stress right now,” Dr. Coffman said. “They’ve got financial stress. Some people lost their job or worried about keeping their current job. They lost their income. You’ve got stress from being overcrowded. Everyone’s cooped up together. They feel like they can’t get away from each other. These stressors can lead to abuse.”

Dr. Coffman said another factor is that people can’t get away from COVID-19 news. It’s on TV and social media constantly.

It’s more difficult to take your child to a grandparent or neighbor’s house right now. Kids aren’t going to school to give their parents some away time.

So what do you do now?

“Most of us know family members or neighbors we can reach out to when we know that maybe this is high stress situation,” Dr. Coffman said. “I think just maintaining some human connection is extremely important so people don’t feel isolated or people don’t feel as alone, which may reduce some of the anxiety and frustration. It may even be a phone call to somebody to say, ‘I’m having a hard time’ or even ‘my kids are driving me nuts.’”

Dr. Coffman emphasizes it’s normal to feel more frustrated because of the unknown and uncertain times, but when you feel frustrated, it’s Ok to ask for help or reach out and ask for advice.

"Stress is not an excuse for abusing your child, but rather we hope that caregivers can recognize their stress and ask for help rather than accelerate dangerous behaviors, and that others can recognize and intervene as well," Dr. Coffman added. 

Childhelp.org offers a resource for both parents and children alike during this time. For this article, we called this organization. We were told they are currently available to help and welcome any phone calls. The National Child Abuse Hotline is 1-800-4-A-Child or 1-800-422-4453.

Thornhill encourages people to get involved during this difficult time. The number one reporter of child abuse continues to be teachers, but kids aren’t seeing them right now.

“We worry about who will see abuse and report it right now,” Thornhill said. “That’s where we need neighbors and other family members to pay attention. If you hear the child next door screaming, call for help. All of us need to be involved. As much as most of us don’t want to, we all must make it our business.”

If you suspect a child is being abused or neglected, please contact the Texas Department of Family and Protective Services (TDFPS) toll free at 1-800-252-5400, 24 hours a day, 7 days a week. You may also file a report using the secure TDFPS website. Reports made through this website take up to 24 hours to process. The Texas Abuse Hotline is 1-800-252-5400.

For more resources:

• The Center for Prevention of Child Abuse and Neglect
• About The Center for Prevention of Child Abuse and Neglect
• Early Detection of Child Abuse and Neglect Training
• Predicting Child Abuse and Neglect
• childhelp.org
• Childhelp National Child Abuse Hotline

“It’s heartbreaking. We’ve seen a substantial increase in serious child abuse cases at Cook Children’s recently,” said Jamye Coffman, M.D., medical director of the Cook Children’s Center for Prevention of Child Abuse and Neglect and the CARE team​. “We can’t say for certain if the effects of COVID-19 are driving this increase. All we can do right now is sound the alarm about what we are seeing.

Since March 17, nine children, all 4 years old or younger, have been admitted to Cook Children’s Medical Center for injuries related to child abuse. Three of those children died.

So far in 2020, a total of four children have died as a result of injuries related to child abuse, with three of those deaths occurring within four weeks of each other.

To help put that number in perspective, Cook Children’s  saw a total of 4 deaths as a result of child abuse in all of 2017, 6 in 2018 and 6 in 2019. 

“It’s concerning to see this spike coincide with the pandemic, especially without knowing when it will come to an end or the ultimate toll it will take on our communities,” said Anu Partap, M.D. director for the Center for Prevention of Child Abuse and Neglect at Cook Children's. “With stay-at-home orders in effect, coupled with the loss of jobs, support systems and routines, the results can be disastrous.”

Cook Children’s isn’t the only hospital reporting an increase in severe child abuse. Healthcare workers at the Arnold Palmer Children’s Hospital in Orlando, Florida saw eight children with severe injuries in the past few weeks.

"These are children with, I'm talking multiple fractures, head injures that go to the operating room, severe burns. These are critical," Dr. Donald Plumley, medical director for pediatric trauma at Arnold Palmer hospital told News 6 Orlando.

In observance of Child Abuse Prevention Month in April, Cook Children’s staff planted 2,055 pinwheels outside of the medical center to represent each child abuse visit in 2019. With isolation and stresses mounting due to COVID-19, we could see even more pinwheels planted at the hospital next year.

“We know that families are under more stress, whether related to income or children being out of school. There’s a lot of pressure on parents and caregivers right now,” said Dr. Coffman. “What’s most concerning for us is that we saw a similar rise in child abuse during the recession. We don’t want to see that again”

Dr. Coffman says that in 2008, prior to the recession, the most common cause of death due to traumatic injuries in children was car accidents. During the recession, that changed to abusive head trauma.

“As North Texas heads into the peak of COVID-19, we have to take steps to support one another and rally, as we would during any natural disaster,” said Dr. Partap. “We can offer help, a listening ear or even just empathy for a parent who is struggling.”

Dr. Partap suggests reaching out to friends and family with children, either virtually or by phone, just to check in and offer support. If you are a parent who is struggling, know the best thing you can do is ask for help.

“In Tarrant County, 211 is a great resource for parents,” said Dr. Partap. “The Texas COVID-19 mental health hotline, the national Child Help Hotline, Texas youth crisis hotline and domestic violence hotlines are on stand-by with 24/7 staff.”

"Stress is not an excuse for abusing your child, but rather we hope that caregivers can recognize their stress and ask for help rather than accelerate dangerous behaviors, and that others can recognize and intervene as well," Dr. Coffman added.

Social distancing doesn’t mean you’re alone.

• Stay in regular contact with family, friends and neighbors by phone, social media or other technology. Even a few minutes of conversation a day is important.

• Take part in healthy activities that relieve stress. Go outside, take a walk, read or tell stories. Find ways to find joy and make connections.

Reduce the pressures of parenting

• You may feel like you have a lot more on your to-do list, especially with kids at home.
• Feel good about what is going well and celebrate the small things! Pat yourself on the back for a decent meal, a funny joke or just quiet moments.
• Build a new routine at home. Remember to include breaks for everyone to take care of themselves with downtime, playtime and exercise.
• Speak up when you need help and offer support to others when you can.

Reach out for help

Sometimes the pressure can be too much. Reaching out for help is important for you and your family. Following are 24-hour, free help lines for different needs.

• For confidential support when you need help with the stresses of parenting, contact Child Help: - Call or text 1-800-4-A-Child (1-800-422-4453) or live chat at childhelp.org
• For help with teen-specific concerns: - Call Texas Youth Helpline: 800-989-6884 or text 512-872-5777
• For help with parenting tips, local resources and to learn about family fun: - Visit helpandhope.org
• For mental health support and crisis care, contact iCARE: - Call or text iCARE at 817-335-3022
• For access to services through a social service hotline: - Dial 2-1-1 or 877-541-7905 or visit 211texas.org

(A printable flyer is available for download at the top right-hand corner of this page.)

About the Center for Prevention of Child Abuse and Neglect

Jamye Coffman, M.D., medical director of the Child Advocacy Resource and Evaluation (CARE) Team at Cook Children’s, says if we don’t talk about the issue, change won’t ever occur.

“Children are dependent on adults so it’s up to us to make sure they are protected and taken care of, regardless if they are our children or not,” Dr. Coffman said.

Today, we discussed abuse and neglect with Dr. Coffman to learn more about the types of abuse our children face and what we can do about it.

What are the types of services the CARE team provides?

The CARE team is made up of board-certified pediatricians and advanced practice nurses trained in the treatment of child abuse. Our team is involved in providing assessments, education and medical evaluations of the child.

What are the different types of abuse seen at Cook Children’s?

I think when people hear  the word "abuse" they think of sexual or physical abuse. But we also see kids for neglect.

Would you mind explaining neglect a little more to us?

The most common form of child maltreatment is neglect. We see different types of neglect, which is defined as a failure to provide adequate food, clothing and shelter. Children who are neglected are often underweight and/or unkempt. They may beg for food or eat out of a trashcan at school, or they may be dirty, have dirty clothes and have a bad odor. For infants, underweight or malnourished, unbathed and dirty or severe diaper rash can all be signs of neglect.

What is the impact that neglect can have on a child?

Neglect, especially in children under the age of 3, can cause the same long-term chronic health problems as being physically or sexually abused.

Primarily for younger children, babies, we see a lot of failure to thrive cases. Usually, these are kids under 2 or 3 years of age, who can’t get food for themselves. It may be because the parents are impaired with substances and are not paying attention to the needs of a child most of us take for granted like feeding the child or changing his or her diapers.

When the child gets older, we see school-aged kids who appear to be malnourished. The only meals they are getting are at school and they get breakfast and lunch. But during the weekends or summer when school is out, these kids are looking in the trash outside for food.

Another form of neglect is parents simply not watching their kids. That’s where we see bathtub drownings or a child left alone in a car.

Sometimes it’s about knowledge and awareness. It doesn’t always mean a criminal act. Sometimes the parents need to be educated and learn they can’t leave their child alone in the tub or in a car for even a short period of time.

What can the public watch for when it comes to child abuse and neglect?

For neglect, people should watch for a child who is extremely underweight or malnourished. They may beg for food or always have dirty clothes or a bad odor.

Any bruise on an infant is concerning because they are not mobile enough to bruise themselves, so if a bruise occurs it’s more than likely that someone else had to have had a part in it. Any unexplained injury of a young child. Infants under 6 months of age should not have bruises.

For older children, the concerning bruises are ear bruises, bruises on the padded parts of the body or the cheeks, and anything from the hips to the shoulders, on any side of the body (excluding the hip bone). If the child has bruises on the bony prominences such as forearms, shins, elbows, knees, forehead, nose or chin, those could all come from normal play that the child engages in and are not as concerning.

Other things to be looking for are pattern bruises anywhere on the body, which means anything that looks like an object such as a belt, switch or spoon. Similar to this are burns. If there is an emersion type burn on a child as if they had put a whole body part into hot water, that is also concerning. This is different from an accidental burn. Those types of burns, such as pulling a pot of hot water off the stove, would have a splash pattern from all the places the water went, whereas an emersion burn has a distinct pattern that usually looks like a glove or sock pattern. This means that their body was placed into hot water and was forced to stay there long enough for severe burns to form.

Sexual abuse can be difficult to detect because it doesn’t have many specific symptoms or behaviors. Some physical signs of sexual abuse, however, could include trauma or damage to the genital or anal areas, sexually transmitted diseases, or pregnancy.

Children may act out with sexual or inappropriate behavior that is beyond their expected developmental knowledge. This may indicate the child has witnessed or experienced the sexual behavior.

If someone does suspect a child is abused or neglected, how should they go about reporting the situation?

You should call the Texas Department of Family and Protective Services at 1-800-252-5400. If the child is in immediate danger, call 911.

I know it’s difficult to be involved. But these children are at increased risk of long-term poor health and early death. It’s our moral responsibility to act now and put our children first and get involved.

It’s also important to do what you can before things escalate. We have to watch out for one another. If you know someone, whether it’s a family member or close friend, offer to be a resource for them.

Step in and offer to babysit if you see a parent is struggling.

That doesn’t mean you don’t call if you see abuse though.

We all have to work together to do better and care enough to work together to improve the future of our children.

Cook Children’s has brought in visiting dogs for decades as a way to help patients and their families cope with their situations, but it was one of the first hospitals nationwide to realize the value in having dogs as badge-yielding staff members.

“People wouldn’t have pets the way they do and treat them like family members if there wasn’t something to that,” said Facility Dog Program Coordinator Kizzy Marco.

Just over three years ago, Ralph and Chanel became the first dogs to join Sit...Stay....PLAY, the facility dog program at Cook Children's.

“We are pioneering something really new,” said Marco. “The majority of hospitals in the country have animal-assisted therapy or dogs that visit routinely and that’s wonderful, but having them here as residents and as employees makes such a difference.”

As facility dog program coordinator, a large portion of Marco’s job involves handling Ralph, answering referrals and working one-on-one with patients and their families.

“I feel like people moved mountains to make these dogs available for our patients and families,” said Marco. “I’ve always loved working at Cook Children’s, but that was the moment I realized how much this place cares, probably beyond words, about the emotional well-being of its patients. Of course health care exists to take care of people physically, but we also have a responsibility to take care of people emotionally and these dogs are doing that.”

When Ralph comes in contact with a patient, the atmosphere changes immediately.

“I’ve seen kids at their very sickest,” said Marco. “I’ve seen kids at the end of their lives light up to see Ralph.”

Stephanie Myers witnessed the power of dog therapy first-hand when her 4-year-old daughter Baylee was introduced to Ralph after being diagnosed with stage 4 neuroblastoma.

“She hadn’t walked or gotten out of bed in about a week,” said Myers. “Kizzy brought Ralph in and I saw a light in Baylee’s eyes I hadn’t seen in a while. She instantly wanted to sit up and then stand so she could pet him.”

Ralph brought normalcy and softness to the situation with Baylee, as he does with so many others.

“Anytime Baylee has needed a little push, Ralph has been there to guide her through it,” said Myers. “He is such an amazing therapy dog and has given our daughter strength and a smile when we thought she might be out.”

“What our dogs do for patients is deep. A patient once vulnerably told me that he loved Ralph because he knew Ralph would never judge him. That says it all right there,” said Marco.

Because of the large number of both inpatient and outpatient cases, therapy dogs are not able to sit on every child’s bed or walk the halls with them or get ready for surgery with them.

However, many patients, families and staff members get the experience of seeing one of the dogs in passing walking down the hallway or in the cafeteria, which Marco considers a therapeutic encounter.

“You don’t know what people are carrying emotionally when they’re walking through the hallways,” said Marco, “so adding this goofy, smiling, prancing, fluffy, handsome Golden Retriever to the environment is so important. If you never knew a single patient story, if you never knew how much of an impact these dogs make, just knowing that is huge.”

When Ralph does have the opportunity to work one-on-one with a patient, they form a bond so strong that every child thinks Ralph is their best friend. When they see him and start calling his name, his tail starts to wag, he squints his eyes and starts shaking around with excitement.

“It’s almost like he remembers every kid he’s ever met,” said Marco.

While the dogs are a friendly face for children at the medical center, they really do serve an important role in the physical and emotional well-being of these patients.

Whether giving a dog a syringe of water mixed with juice to get a child to take medicine or taking him for a walk to get kids up and moving, these animals are trained to relate to the patients and their difficult experiences in a way that normalizes their environment and gives them something else to focus on.

Using dogs as a means of reducing anxiety in patients is especially true for Child Advocacy Resources and Evaluation (CARE) Team, which assesses cases of child abuse.

“When you’re talking about abuse and really difficult subjects with these kids, having a dog there can really ease their anxiety and help them voice what happened to them,” said Jamye Coffman, M.D., a child abuse pediatrician at Cook Children’s. “When you reduce the anxiety in a child, it reduces all the stress hormones so you don’t have any of the effects of stress on the child that can contribute to illness.”

Dr. Coffman has handled Kitty since she came to Cook Children’s nearly a year and a-half ago. Kitty stays with the CARE Team and is trained to jump up on the couch with patients when they are being interviewed to help relax them and their parents, making the environment feel less like a doctor’s office and more like a home.

But there is also an art to the things that dogs can do innately, the things that cannot be taught.

Not long after Marco and Ralph began working as a team, they were asked to visit a patient with a severe developmental delay. Marco was admittedly nervous because this patient was unpredictable in her movements and she was not sure how Ralph would react.

Without hesitation, Ralph walked up to the patient, looked her in the eyes and put his head on her lap while he sat there and let her do whatever she wanted.

“That’s the true gift of our dogs is that they don’t see any differences,” said Marco. “We know patients whose illness or treatments make them look or behave in a certain way. We know the ones that have especially great challenges, and hopefully it doesn’t alter how we interact with them, but Ralph doesn’t even know those things.”

For that child and her family, interacting with Ralph was a completely normal experience and there was nothing atypical about the situation.

“That’s an innate art that is something that we as a health system found a way to provide. It had never been provided to our patients and their families before,” said Marco. “It is very humbling to know that our dogs can make moments like that happen for families.”

It's important to remember that Ralph is only one dog out of five at Cook Children’s, making up only one-fifth of the program. Our most recent addition is a 2 year old Golden named Lulu who started working in inpatient psychiatry and partial hospitalization program just about a month ago.

Every day these dogs have encounters like this one, and every day they are doing something to make the hospital a better place for patients and their families.

The impact that these dogs have made and the moments they have shared with people in the time they have been at Cook Children’s is remarkable.

“It is profound that they know and have the ability to mourn with people who are mourning, to celebrate with people who are celebrating and to play with people who are playing,” said Marco. “I think there is a bond or intuition that connects them to people exactly where they are, and to watch that is amazing."

How to Help

The generosity of donors helps make it possible for Cook Children's to bring programs like Sit ... Stay ... PLAY to our patients. To support our dog therapy program and other programs like it, please call 682-885-4105 or donate online by clicking here. Learn more about Sit ... Stay ... PLAY by clicking here.

Unfortunately, stories of mothers harming their children have become far too prevalent in recent years. But there are often times hints a mom may abuse her child.

Joy Crabtree, Psy.D, a licensed psychologist for the Urgent Care and Pediatric Specialties Clinic in Southlake, said there are sometimes warning signs that a mom’s mental health is unstable or depression may be a concern including increased irritability, loss of patience, quick mood changes, excessive energy or extreme fatigue, and a sense of feeling hopeless or overwhelmed.

More serious warning signs, possibly of psychosis, include trouble distinguishing what is and isn’t real, a sense of extreme suspicion or paranoia, and even hearing voices or seeing things other people don’t see.

At times when psychosis or even an extreme depression is present, a woman can have irrational ideas about her baby — such as that the baby is possessed or that she has to hurt herself or her child. This condition can be extremely serious and disabling, and new mothers who are experiencing these symptoms need medical attention right away.

Women who have other psychiatric illnesses, such as bipolar disorder, major depression or schizoaffective disorder, may be at greater risk of developing postpartum mood symptoms. Any significant changes in behavior or bizarre beliefs require immediate medical attention and, often, a brief hospitalization. If you or someone you know is experiencing symptoms, don’t delay getting medical attention.

“The person who is in the midst of some type of mental health issue likely doesn’t know what is or isn’t reasonable,” Crabtree said. “Family members, friends, teachers, or other professionals in contact with parents need to step in if they feel a person needs help. A child should not be left alone with a parent in crisis. The care of the child then depends on other adults.”

Jamye Coffman, M.D., a child abuse pediatrician and medical director for Cook Children’s Advocacy Resource and Evaluation (CARE) Team, advises parents to monitor their nanny or babysitter at all times.

“I would set up cameras in my home,” Dr. Coffman said “We’ve had nanny cam videos brought to us and we’ve seen what can happen when the nanny or babysitter gets frustrated. They many not leave physical injuries or bruises, but we’ve seen some awful and abusive behavior that would not have been discovered without the cameras.”

The nanny, who has pleaded not guilty, is charged with trying to smother a baby boy in her care. Police say they have video from a hidden nanny cam of Moriah Gonzales, 20 years old, pressing her hands against the 3 month old untl he went limp. She has been charged with felony child abuse likely to cause great bodily harm.

So how do you avoid this kind of thing happening to you? Dr. Coffman says parents should start with research.

The Texas Department of Family and Protective Services provides a list of licensed child care centers and licensed or registered child care homes.Learn more about reporting abuse by clicking here. The Texas Abuse Hotline number is 1-800-252-5400.

Once you’ve selected the child care for you, Dr. Coffman says go visit it yourself. Also, make sure two adults are in the room with the children at all times. Ask about the visitation policy. If parents are discouraged to check in, find another place for your child’s care.

And most importantly, Dr. Coffman says to trust your gut.

“Even if you do all the research sometimes an incident hasn’t been reported and may have occurred,” Dr. Coffman said. “If you think something is off about where your child is being cared for, you don’t want to risk sending him or her back until something does happen. If you have that gut instinct, look for another day care.”

If you take your child to an in-home day care provider or you have a nanny at your home, similar rules apply. Dr. Coffman says she always prefers two sets of adult eyes on the child, but if that’s not possible, make frequent drop in visits. Any day care operator should welcome the opportunity for you to check in on your own child.

Click the following link for more information: Did you know only 7 percent of licensed child programs in Tarrant County considered quality? Click to read more.

But it doesn’t make her any less infuriated by the actions of an adult taking away the innocence of a child. Dr. Coffman said parents need to take certain steps to teach their children how to protect themselves:

1. Educate your children. Most importantly, educate your children about the dangers of predators. “The main thing is to educate your child and let them know what is not appropriate. What’s not OK,” Coffman said. “For children, young adults reading this, it’s not OK to be touched inappropriately. I don’t care who it is. Mom. Dad. Grandma. Grandpa. A family friend. A pastor. A police. A coach. It doesn’t matter who the authority figure is. If you are being abused, tell a trusted adult. If they don’t believe you or do something about it, keep telling an adult until someone does something.”
2. Start at a young age, making children aware of what is and what isn’t inappropriate touching. Dr. Coffman said at around 2 or 3 years old parents can use certain teaching moments to inform children on inappropriate touching. “When you are bathing your child that’s a good opportunity,” she said. “Make sure to name their body parts. I don’t care what you call it, just make sure your children know what their privates are called. During a bath or while they are using the potty, use that opportunity to teach them the difference between caregivers performing necessary child care during bathing or toileting and inappropriate touches. Let children know if someone else makes them feel funny or uncomfortable by touching them, to let you know.”
3. Let your children know it’s OK to talk to you. Generally speaking, Dr. Coffman said pedophiles don’t usually start out being extremely aggressive. They usually start with more generic touching and gaining the child’s trust. Dr. Coffman said that’s why it is extremely important to let your children know that they need to be able to come to you, as a parent, and let you know of anything that’s inappropriate. They also need to be assured that they will not get in trouble if they tell you they are uncomfortable about anything.
4. Communicate and report abuse. Let your child know to tell someone. Just letting someone know and reporting the crime can prevent a whole lot of tragedy.