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.” 

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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.

Any parent of a 0-12 month old infant may be concerned about SIDS, but suffocation is the leading cause of injury related death in infants and it can be prevented.

Co-sleeping

The AAP recommends babies sleep in the same room as the parents, but not in the same bed (room-sharing without bed-sharing). Watch the video below to learn more about the dangers of co-sleeping with real stories from our experts:

Related Links:

• Ver el vídeo en español
• Safe sleep: Young moms, are you listening?
• Tummy time troubles?

For more information:

Child maltreatment includes all forms of physical and emotional ill-treatment, sexual abuse, neglect, and exploitation that results in actual or potential harm to the child's health, development or dignity. The youngest children, age 0-3, are the most vulnerable.

We're working to make North Texas one of the safest places to raise a child. Click here for more information.

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.”

The school nurse has long offered an escape from the classroom… and as many Band-Aids as a kid could need. But the responsibilities of a school nurse stretch far beyond their tiny office walls. They are the keepers of care for hundreds, if not thousands, of students. Their duties range from administering CPR to managing insulin pumps and blood sugar levels. In between all of that, there is another heavy responsibility they are tasked with: recognizing and reporting suspected abuse and neglect.

“We want our nurses to have the updated knowledge, skills and resources they need to keep our kids safe and to do their job effectively,” said Cindy Parsons, Director of Health Services at Keller ISD. “The school nurse has an important role in education about child abuse. Teachers and other school staff members may not be as familiar with subtle signs of neglect, and the school nurse is often the person who helps to educate them.”

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.